title: Trans-oral endoscopic partial adenoidectomy does not worsen the speech after cleft palate repair.
abstract: BACKGROUND
  Adenoid hypertrophy may play a role in velopharyngeal closure especially in patients with palatal abnormality; adenoidectomy may lead to velopharyngeal insufficiency and hyper nasal speech. Patients with cleft palate even after repair should not undergo adenoidectomy unless absolutely needed, and in such situations, conservative or partial adenoidectomy is performed to avoid the occurrence of velopharyngeal insufficiency. Trans-oral endoscopic adenoidectomy enables the surgeon to inspect the velopharyngeal valve during the procedure.
  
  
  OBJECTIVE
  The aim of this study was to assess the effect of transoral endoscopic partial adenoidectomy on the speech of children with repaired cleft palate.
  
  
  METHODS
  Twenty children with repaired cleft palate underwent transoral endoscopic partial adenoidectomy to relieve their airway obstruction. The procedure was completely visualized with the use of a 70° 4mm nasal endoscope; the upper part of the adenoid was removed using adenoid curette and St. Claire Thompson forceps, while the lower part was retained to maintain the velopharyngeal competence. Preoperative and postoperative evaluation of speech was performed, subjectively by auditory perceptual assessment, and objectively by nasometric assessment.
  
  
  RESULTS
  Speech was not adversely affected after surgery. The difference between preoperative and postoperative auditory perceptual assessment and nasalance scores for nasal and oral sentences was insignificant (p=0.231, 0.442, 0.118 respectively).
  
  
  CONCLUSIONS
  Transoral endoscopic partial adenoidectomy is a safe method; it does not worsen the speech of repaired cleft palate patients. It enables the surgeon to strictly inspect the velopharyngeal valve during the procedure with better determination of the adenoidal part that may contribute in velopharyngeal closure.
authors.affiliation: Department of Otolaryngology, Cairo University, Cairo, Egypt. Electronic address: mosabeez@yahoo.com.
authors.forename: Mosaad
authors.initials: M
authors.lastname: Abdel-Aziz
authors.affiliation: Department of Otolaryngology, Cairo University, Cairo, Egypt.
authors.forename: Badawy
authors.initials: B
authors.lastname: Khalifa
authors.affiliation: Department of Otolaryngology, Cairo University, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Shawky
authors.affiliation: Department of Otolaryngology, Beni Suef University, Beni Suef, Egypt.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Rashed
authors.affiliation: Department of Otolaryngology, Beni Suef University, Beni Suef, Egypt.
authors.forename: Nader
authors.initials: N
authors.lastname: Naguib
authors.affiliation: Department of Otolaryngology (Phoniatric Unit), Cairo University, Cairo, Egypt.
authors.forename: Asmaa
authors.initials: A
authors.lastname: Abdel-Hameed
mesh_terms: D000233:Adenoidectomy / Q000379:methods*; D000234:Adenoids / Q000473:pathology; D000402:Airway Obstruction / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery*; D000075202:Contraindications; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000601:surgery; D008297:Male; D016896:Treatment Outcome; D014833:Voice Quality
keywords: Adenoid hypertrophy; Adenoidectomia endoscópica; Cleft palate; Endoscopic adenoidectomy; Fenda palatina; Hipertrofia da adenoide; Insuficiência velofaríngea; Velopharyngeal insufficiency