title: The effectiveness of tonsillectomy and partial adenoidectomy on obstructive sleep apnea in cleft palate patients.
abstract: OBJECTIVE
  The most common cause of pediatric obstructive sleep apnea (OSA) is adenotonsillar hypertrophy (ATH). In cleft palate patients, however, the obstructive effects of ATH are more severe due to narrow airways. The aim of this study was to assess the effectiveness of tonsillectomy and/or partial adenoidectomy on OSA in cleft palate patients.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Tonsillectomy and/or partial adenoidectomy was performed in 17 repaired cleft palate patients with tonsillar and/or adenoid hypertrophy and OSA. Apnea/hypopnea (A/H) index and minimum O(2) saturation were measured before and after surgery. In addition, because these patients are vulnerable to speech impairment after pharyngeal surgery, auditory perceptual assessment (APA) and nasometric assessment of speech were performed.
  
  
  RESULTS
  The mean preoperative A/H index was 17.6 ± 3.9, and the mean preoperative minimum O(2) saturation was 88.7 ± 1.5%. Both parameters improved postoperatively, to 1.9 ± 2.3 and 93.7 ± 1.5% respectively, and the changes were significant (P < 0.001). In 12 cases (70.6%), A/H indexes were normalized following surgery. Associated comorbidities such as retrognathia and narrow pharyngeal airways may underlie incomplete recovery in some cases. There were no significant postoperative changes in APA and nasalance scores.
  
  
  CONCLUSIONS
  In most cases, tonsillectomy and/or partial adenoidectomy is an effective method for treatment of OSA in repaired cleft palate patients presenting with tonsillar and/or adenoid hypertrophy. However, some cases may need further procedures to relieve airway obstruction due to associated comorbidities.
authors.affiliation: Department of Otolaryngology, Faculty of Medicine, Cairo University, Egypt. mosabeez@yahoo.com
authors.forename: Mosaad
authors.initials: M
authors.lastname: Abdel-Aziz
mesh_terms: D000233:Adenoidectomy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000601:surgery*; D014068:Tonsillectomy / Q000379:methods*; D016896:Treatment Outcome