title: The impact of adenoid size on rate of revision sphincter pharyngoplasty.
abstract: OBJECTIVE
  Determine the impact of adenoid size and prior adenoidectomy on outcomes of sphincter pharyngoplasty.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Retrospective review of patients 18 years of age or younger, who underwent sphincter pharyngoplasty for velopharyngeal insufficiency (VPI) from 2007 to 2012. Nasal endoscopy and nasometry testing were administered pre- and postoperatively. Preoperative adenoid size was scored by two blinded otolaryngologists. Primary outcome measures were sphincter pharyngoplasty revision rate, achievement of normal resonance, and degree of improvement in nasometry scores.
  
  
  RESULTS
  Eighty-six patients were included in this study. The overall rate of revision sphincter pharyngoplasty was 28%. Patients with mild adenoid hypertrophy underwent less revision surgery (14%) than patients with moderate to severe adenoid hypertrophy (38%, P = .046). Subgroup analysis was performed based on prior repair of cleft or submucous cleft palate and history of 22q11 microdeletion. Smaller adenoids were associated with lower surgical revision rates in patients who did not have a history of cleft palate or 22q11 microdeletion (P = .014 and .018, respectively). Adenoid size did not impact revision rates in patients with repaired cleft palates or those with 22q11 microdeletions.
  
  
  CONCLUSIONS
  Smaller or absent adenoids are associated with lower rates of revision surgery after sphincter pharyngoplasty in children with VPI. Patients with VPI and bulky adenoids, who do not have a history of cleft palate or 22q11 microdeletion, should be considered for adenoidectomy prior to sphincter pharyngoplasty.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Brendan P
authors.initials: BP
authors.lastname: O'Connell
authors.forename: Allison M
authors.initials: AM
authors.lastname: Dobbie
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Oyer
authors.forename: Melissa
authors.initials: M
authors.lastname: Montiel
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hufnagle
authors.forename: Krishna G
authors.initials: KG
authors.lastname: Patel
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Discolo
authors.forename: Shaun A
authors.initials: SA
authors.lastname: Nguyen
authors.forename: David R
authors.initials: DR
authors.lastname: White
mesh_terms: D000233:Adenoidectomy; D000234:Adenoids / Q000473:pathology*; D002648:Child; D005260:Female; D006801:Humans; D006984:Hypertrophy; D008297:Male; D009929:Organ Size; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014681:Velopharyngeal Insufficiency / Q000601:surgery*; D055158:Velopharyngeal Sphincter / Q000601:surgery*
keywords: Velopharyngeal insufficiency; adenoidectomy; cleft palate; speech surgery; sphincter pharyngoplasty; submucous cleft palate