Role of x-ray lateral view nasopharynx in the diagnosis of subtle velopharyngeal incompetence

Abstract

Introduction: Velopharyngeal dysfunction following adenoidectomy is not uncommon. Incidence range from 1 per 1,500 to 1 per 10,000 patients. Children at risk can be identified including cleft palate, sub mucous cleft, and palatal hypotonia, but if it occurred in the absence of structural abnormalities, increased pharyngeal width or short soft palate has been proposed. Methods: The study included 227 children, 71 females and 156 males. Plain x-ray lateral view nasopharynx was done during pronouncing the vowel Eeee aiming to assess the degree of closure and the point of contact between the contracted soft palate and the adenoid pad. Children with cleft palate, bifid uvula , mythsenia gravis and congenital abnormality of the hard palate were excluded from the study Results: Thirteen patients out of 227 were included with a median age of 5.8 years having short functional length of the soft palate. Only 4 (1.7 %) among the studied patients developed velopharyngeal incompetence. All patients with short functional length of the soft palate demonstrate attachment to the adenoid anterior surface rather to others show posterior pharyngeal wall attachment. Results showed that there was an increased incidence of velopharyngeal incompetence with patients having short functional length of the soft palate. Conclusion: Plain x-ray lateral view nasopharynx during phonation of the vowel Eeee could be cheap and sensitive method in predicting velopharyngeal incompetence in children undergoing adenoidectomy.