The impact of adenoid size on rate of revision sphincter pharyngoplasty. (2nd May 2014)

• Record Type: Journal Article
• Authors: O'Connell, Brendan P.; Dobbie, Allison M.; Oyer, Samuel L.; Montiel, Melissa; Hufnagle, Kathryn; Patel, Krishna G.; Discolo, Christopher M.; Nguyen, Shaun A.; White, David R.
• Is Part Of: Laryngoscope. Volume 124:Number 9(2014:Sep.)
• Page Start: 2170
• Page End: 2175
• Publication Date: 2014-05-02
• Subjects: Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.24683
• Languages: English
• ISSNs: 0023-852X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="lary24683-sec-0001" sec-type="section"> <title>Objectives/Hypothesis</title> <p>Determine the impact of adenoid size and prior adenoidectomy on outcomes of sphincter pharyngoplasty.</p> </sec> <sec id="lary24683-sec-0002" sec-type="section"> <title>Study Design</title> <p>Retrospective review.</p> </sec> <sec id="lary24683-sec-0003" sec-type="section"> <title>Methods</title> <p>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.</p> </sec> <sec id="lary24683-sec-0004" sec-type="section"> <title>Results</title> <p>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%, <italic>P</italic> = .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 (<italic>P</italic> = .014 and .018, respectively). Adenoid size did not impact revision rates in patients with repaired cleft palates or those with 22q11 microdeletions.</p> </sec> <sec id="lary24683-sec-0005" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> <sec id="lary24683-sec-0006" sec-type="section"> <title>Level of Evidence</title> <p>4. <italic>Laryngoscope</italic>, 124:2170–2175, 2014</p> </sec> </abstract>