Abstract
Encountering a nasopharyngeal polyp in a patient with submucous cleft palate (SMCP) is a difficult problem, as the lesion could support the weak palate. Removal of this lesion may unmask the SMCP with consequent worsening of speech nasality. Nasal septal polyp protruding to the nasopharynx in a patient with SMCP has not been reported before in the literature. This report describes a septal polyp arising from the posterior border of the nasal septum and protruding in the nasopharynx in a 16-year-old girl with submucous cleft palate. The polyp appeared to support the weak palate, and they acted as a ball and socket during speech articulation. Removal of this polyp may result in velopharyngeal insufficiency. Trans-nasal endoscopic removal of the polyp with obturation of the velopharyngeal port with a superiorly-based pharyngeal flap was performed in the same sitting. Pre- and postoperative speech evaluation using auditory perceptual assessment and nasometry revealed no worsening of nasality, also the patient reported improvement of her nasal breathing. We concluded that, the presence of a nasopharyngeal polyp in a patient with SMCP may compensate the speech problem. Removal of the polyp and treatment of SMCP by a pharyngeal flap in one-sitting is an effective procedure without adverse effect on patient’s speech.
Highlights
A submucous cleft palate (SMCP) is characterized by lateral diversion of palatal musculature insertion leaving the central midline part of the soft palate deficient of muscles [1]. It is usually diagnosed by three criteria which are bifid uvula, bluish mucosa of the midline of the soft palate, and notched posterior part of the hard palate that can be felt by palpation [2,3]
Hypertrophied adenoid as a space occupying nasopharyngeal tissue may support the weak palatal musculature, this supportive effect may be diminished with adenoid involution resulting in speech hypernasality [4]
Children with SMCP may complain of speech hypernasality especially after adenoid involution [4]
Summary
A submucous cleft palate (SMCP) is characterized by lateral diversion of palatal musculature insertion leaving the central midline part of the soft palate deficient of muscles [1]. Preoperative flexible nasopharyngoscopic views showing the nasopharyngeal polyp (P) and the arrow pointing to a notched soft palate during breathing (A), and during speech articulation (B). Computed tomography (CT) showed a large nasopharyngeal mass originating from the posterior border of the nasal septum with deficient midline palatal muscles (Figure 2). A superiorly-based midline pharyngeal flap was elevated from the posterior pharyngeal wall, and it was inserted in the soft palate midway between the posterior border of the hard palate and the posterior border of the soft palate through a transverse palatal split [1] This technique was performed to obliterate a potential defect that may occur postoperatively. Postoperative flexible nasopharyngoscopic views show the velopharyngeal port and the arrow points to the pharyngeal flap in the mid-line during breathing (A) and during speech articulation (B). The patient was advised to receive speech therapy as a routine method after surgical treatment of velopharyngeal insufficiency
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