Furlow Palatoplasty and Tonsillectomy for Treating Patients With Submucous Cleft Palate and Tonsillar Hypertrophy: A One-Stage Procedure

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Permissions BRIEF CLINICAL STUDIES Furlow Palatoplasty and Tonsillectomy for Treating Patients With Submucous Cleft Palate and Tonsillar Hypertrophy: A One-Stage Procedure Abdel-Aziz, Mosaad MD*; Abdel-Fattah, Gamal MD†; Abdel-Aziz, Nada M. BDS‡; Sabry, Omar MD*; Elsherbeeny, Motaz MD* Author Information *Department of Otolaryngology, Kasr Alainy Faculty of Medicine, Cairo University

†Department of Otolaryngology, Misr University for Science and Technology (MUST), Cairo

‡Faculty of Dentistry, October University of Modern Science and Arts, Giza, Egypt

Address correspondence and reprint requests to Mosaad Abdel-Aziz, MD, 2 el-salam st., King Faisal, above el-baraka bank, Giza, Cairo, Egypt; E-mail: mosabeez@hotmail.com, mosabeez@cu.edu.eg, mosabeez@kasralainy.edu.eg

The study protocol was approved by the research ethics committee of our institute.

The authors report no conflicts of interest.

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.jcraniofacialsurgery.com.

The Journal of Craniofacial Surgery: July 26, 2022 - Volume - Issue - 10.1097/SCS.0000000000008732 doi: 10.1097/SCS.0000000000008732 BUY SDC PAP Metrics Abstract Background: Children with cleft palate are more liable to have obstructive sleep apnea than children with normal palate due to narrow airways. Tonsillar hypertrophy is a common cause of pediatric obstructive sleep apnea; hence, it is not surprising to be encountered during cleft palate repair. The aim of this study was to evaluate the feasibility of tonsillectomy and Furlow palatoplasty performed as a 1-stage operation in patients presenting with submucous cleft palate (SMCP) and tonsillar hypertrophy.

Materials and Methods: Eleven pediatric patients with SMCP and hypertrophied tonsils were included in this case series study. Furlow palatoplasty and tonsillectomy were performed for the patients in 1 sitting. The evaluation of velopharyngeal function was done preoperatively and postoperatively via auditory-perceptual-assessment, nasometry, and flexible nasopharyngoscopy. In addition, the Epworth sleepiness scale for children/adolescents was administered to the parents to assess daytime sleepiness of their children.

Results: The speech improved postoperatively. Auditory-perceptual-assessment showed significant reductions in hypernasal speech, nasal air escape, and weak pressure consonants. In addition, nasometry revealed significantly decreased nasalance scores for nasal and oral sentences. A postoperative increased velar movement was observed with a significant improvement in velopharyngeal closure. The preoperative Epworth sleepiness scale for children/adolescents assessment revealed excessive daytime sleepiness in 8 patients, with significant improvement of scores postoperatively.

Conclusions: Removal of hypertrophied tonsils during the repair of SMCP with Furlow palatoplasty did not negatively affect speech outcome or velar movement postoperatively. It is logical to perform both procedures simultaneously in 1 sitting to avoid postoperative sleep-related breathing disorder, which may necessitate a second stage operation.