Velopharyngeal insufficiency after adenotonsillectomy in children

Abstract

Objective: To evaluate preoperative risk factors of velopharyngeal insufficiency (VPI) after adenotonsillectomy in children. Settings: Tertiary cares medical centres. Design: Retrospective study using patient’s charts review. The aim of this study is to look at the associated risk factors that may explain the presentation of VPI in children following adenotonsillectomy. Methods and Material: Retrospective chart review of 32 children presented with VPI following adenotosillectomy between January 1, 2008 and December 30, 2014 at Asser Central Hospital (ACH) and Abha Private Hospital (APH). The data collected included the total number of adenotonsillectomy cases, patient age at surgery, gender, date of surgery, indications and outpatient postoperative notes. Exclusion criteria included; patients older than 12 years, children diagnosed having velocardiofacial syndrome, submucous clefts and those who had follow up less than 6 months. Results: Total numbers of ten thousand and eighty adenotonsillectomy cases were done in 7 years period. Thirty-two patients (0.3%) presented with postoperative hypernasality and nasal regurgitation. The mean age was 6 years. Females were more predominant than males (21 F, 11 M). The most common indication for surgery was mouth breathing and snoring in 19 (59.38%) patients. Short soft palate was the main cause of VPI in 20 (62.50%) patients. Conclusions: Velopharyngeal Insufficiency, although uncommon, is a well-known complication of adenotosillectomy. Patients presenting with obstructive symptoms and signs of adenotonsillectomy in presence of short soft plate or deep pharyngeal wall should be counseled for possible development of postoperative VPI. Most of symptoms of postoperative VPI resolve spontaneously.