title: Hypertrophied tonsils impair velopharyngeal function after palatoplasty.
abstract: OBJECTIVE
  When tonsillar hypertrophy obstructing the airway is encountered in a child with a repaired cleft palate and velopharyngeal insufficiency, the surgeon may opt for tonsillectomy to relieve the airway obstruction, with possible effects on velopharyngeal closure. The aim of this study was to assess the impact of hypertrophied tonsils on velopharyngeal function in children with repaired cleft palate and to measure the effect of tonsillectomy on velopharyngeal closure and speech resonance.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Twelve children with repaired cleft palate and tonsillar hypertrophy underwent tonsillectomy to relieve airway obstruction. Preoperative and postoperative evaluation of velopharyngeal function was performed. Auditory perceptual assessment of speech and nasalance scores were measured, and velopharyngeal closure was evaluated by flexible nasopharyngoscopy.
  
  
  RESULTS
  Preoperative impairment of velopharyngeal function was detected. However, significant postoperative improvement of speech parameters (hypernasality, nasal emission of air, and weak pressure consonants measured with auditory perceptual assessment) was achieved, and the overall postoperative nasalance score was improved significantly for nasal and oral sentences. Reduction of velopharyngeal gap size was detected after removal of hypertrophied tonsils. Although the improvement of velopharyngeal closure was not significant, three cases demonstrated complete postoperative closure with no gap.
  
  
  CONCLUSIONS
  Hypertrophied tonsils may impair velopharyngeal function in children with repaired cleft palate, and tonsillectomy is beneficial for such patients as it can improve the velopharyngeal closure and speech resonance. Secondary corrective surgery may be avoided in some cases after tonsillectomy.
authors.affiliation: Department of Otolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt. mosabeez@yahoo.com
authors.forename: Mosaad
authors.initials: M
authors.lastname: Abdel-Aziz
mesh_terms: D001307:Auditory Perception / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006984:Hypertrophy / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D007828:Laryngoscopy; D008297:Male; D010159:Palate / Q000601:surgery*; D014066:Palatine Tonsil / Q000473:pathology* / Q000601:surgery; D010614:Pharynx / Q000503:physiopathology*; D011183:Postoperative Complications; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D013060:Speech / Q000502:physiology*; D014068:Tonsillectomy; D014681:Velopharyngeal Insufficiency / Q000209:etiology* / Q000503:physiopathology