Incidence and Risk Factors of Velopharyngeal Insufficiency Postadenotonsillectomy

Khami, Maria; Tan, Susan; Glicksman, Jordan T.; Husein, Murad

doi:10.1177/0194599815596494

Cited by 29 publications

(20 citation statements)

References 13 publications

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“…It often manifests as hypernasality, poor speech output, and nasal regurgitation. Unlike VPI due to anatomical abnormalities such as cleft palate, VPI following adenoidectomy is usually transient and resolves without further surgical intervention [53]. Cephalometry may be a useful way of providing information on VPI, as it can help indicate which children have VPI, and postoperatively which children will have prolonged postoperative VPI [54,55].…”

Section: Adenoidectomy Complicationsmentioning

confidence: 99%

Adenoidectomy in Children: What Is the Evidence and What Is its Role?

Schüpper

Nation

Pransky

2018

Curr Otorhinolaryngol Rep

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Purpose of Review Review the current state of the adenoidectomy procedure in the pediatric population with up-to-date indications for surgery, operative techniques, adverse events, non-surgical management of adenoid hypertrophy, and future directions. Recent Findings Adenoidectomy is indicated in children for the treatment of sleep-disordered breathing, nasal airway obstruction, recurrent acute otitis media, and chronic rhinosinusitis. A new recommendation was released in 2016, not supporting adenoidectomy for a primary indication of otitis media in children under 4 years old, including those with prior tympanostomy tubes, unless a distinct indication exists such as nasal obstruction or chronic adenoiditis. Although adenotonsillectomy is the mainstay of treatment for obstructive sleep apnea (OSA), recent studies have identified that non-obese patients with moderate OSA and small tonsils have comparable benefits with adenoidectomy alone with less complications. While conventional approaches such as indirect mirror-assisted curette and suction coagulation are still utilized, direct transnasal endoscopeassisted removal of the adenoids has proven to be a safe technique, with good short-and long-term outcomes. Novel nonsurgical therapies including immunotherapy have been evaluated. Summary Adenoidectomy is a safe procedure in the pediatric population and leads to excellent outcomes. Adverse events are rare, and hospitalization is uncommon. Children with sleep disturbance from nasal airway obstruction, ear disease, or chronic rhinosinusitis are the best operative candidates for this procedure.

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Section: Adenoidectomy Complicationsmentioning

confidence: 99%

Adenoidectomy in Children: What Is the Evidence and What Is its Role?

Schüpper

Nation

Pransky

2018

Curr Otorhinolaryngol Rep

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“…10,11 Velopharyngeal insufficiency (VPI) has been reported to occur in up to 13.6% of patients after T&A at a 3-week postoperative visit. 12 Most resolve with time and/or speech therapy at 5 months; however, approximately half of those with early VPI after T&A will have persistent VPI requiring surgical intervention. [11][12][13] Because of the hypotonia associated with both PW and T21, these children may be at higher risk of having postoperative VPI.…”

Section: Introductionmentioning

confidence: 99%

“…12 Most resolve with time and/or speech therapy at 5 months; however, approximately half of those with early VPI after T&A will have persistent VPI requiring surgical intervention. [11][12][13] Because of the hypotonia associated with both PW and T21, these children may be at higher risk of having postoperative VPI. One study has assessed VPI after T&A in PW patients and found that 2 of their 11 patients required surgical intervention for their postoperative VPI.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Adenotonsillectomy and Risk of Velopharyngeal Insufficiency in Children With Prader-Willi Syndrome

Padia

Muntz

Pfeffer

2017

Ann Otol Rhinol Laryngol

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This study demonstrated a higher rate of VPI after T&A in PW children as compared to another at-risk cohort, T21 patients. While the OAHI decreased after T&A in both groups, a significant number of children with PW or T21 had persistent OSA. Further investigation into the optimal management of OSA, while preventing treatment complications such as VPI, is needed for children with these high-risk conditions.

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“…In addition, all patients underwent adenoidectomy along with tonsillectomy. Velopharyngeal insufficiency may also be encountered after tonsillectomy alone, but it is more common in the pediatric population because tonsillectomy is generally performed along with adenoidectomy in children [ 14 ]. Consistently, no patient experienced a velopharyngeal insufficiency in our adult population.…”

Section: Discussionmentioning

confidence: 99%

A Novel Proposal for Classifying Pediatric Tonsillectomy Complications: Modified Clavien Classification

Hızlı

Kayabaşı

Cengiz³

et al. 2020

Cureus

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Introduction Tonsillectomy is one of the most common operations performed in the otolaryngology practice and there does not exist a systematic classification for tonsillectomy complications in the prior literature. In this study, we aimed at presenting a novel classification system to the current literature and analyzing complications of pediatric tonsillectomy based on this novel classification system. Methods A novel classification system based on modified Clavien classification was constituted for pediatric tonsillectomy complications. Medical records of 534 patients underwent tonsillectomy were retrospectively investigated and complication rates of tonsillectomy between children and adults were compared using this classification Results In total, 454 pediatric patients (258 males and 196 females, age range = 3-17 years) who underwent cold-knife tonsillectomy were eligible for the study. To compare the complication rates of the pediatric patients with adults, 80 adults with tonsillectomy (50 males and 30 females, age range 18-46) were also included. In children, the most common complication was dehydration, seen in 13 (2.86%) patients. The most serious complication was tooth aspiration (Grade 4a), seen in only one (0.22%) patient. Fifteen (3.3%) pediatric patients experienced more than one complication. Overall complication rate of pediatric tonsillectomy was 10.13% (46 patients). In adults, the most common complication was postoperative bleeding, seen in 11 (13.75%) adult patients. The most serious complication was Grade 3a postoperative bleeding, seen in four (5%) patients. Overall complication rate of adult tonsillectomy was 21.25% (17 patients). Overall complication rate of pediatric tonsillectomy was significantly lower compared with the complication rate of adult tonsillectomy (10.13% vs. 21.25%, p = 0.004, X 2 = 8.07). Conclusion Modified Clavien classification is a novel and simple tool to analyze and categorize complications of pediatric tonsillectomy.

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Incidence and Risk Factors of Velopharyngeal Insufficiency Postadenotonsillectomy

Cited by 29 publications

References 13 publications

Adenoidectomy in Children: What Is the Evidence and What Is its Role?

Adenoidectomy in Children: What Is the Evidence and What Is its Role?

Effectiveness of Adenotonsillectomy and Risk of Velopharyngeal Insufficiency in Children With Prader-Willi Syndrome

A Novel Proposal for Classifying Pediatric Tonsillectomy Complications: Modified Clavien Classification

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