A study of borderline cases of velopharyngeal insufficiency using cephalometry and nasofibroscopy

Abstract

Identification of borderline cases of velopharyngeal insufficiency (VPI) due to palatopharyngeal disproportion in the form of short palate or deep posterior pharyngeal wall is necessary particularly in preoperative assessment of adenotonsillectomy to prevent post-adenotonsillectomy velopharyngeal insufficiency and hypernasality. To evaluate the role of fiberoptic nasopharyngoscopy and cephalometry for assessment of clinically suspected cases of palatopharyngeal disproportion (borderline VPI) cases to identify the craniofacial morphometric measurements of such cases that may be helpful as a prognostic indicator in predicting and preventing post-adenotonsillectomy velopharyngeal dysfunction. This is an observational cross-sectional study of 38 patients with suspected palatopharyngeal disproportion (24 male and 14 female) with ages ranging from 3 to 7 years who were referred to the phoniatrics unit at Assiut University Hospital for the assessment of the velopharyngeal valve before adenotonsillectomy operation. The control group consisted of 25 normal individuals. They were subjected to (1) auditory perceptual assessment (APA) of the patients’ speech, (2) fiberoptic nasopharyngoscopy, and (3) lateral cephalometry. Auditory perceptual assessment showed no statistically significant difference between both groups. Fiberoptic nasopharyngoscopic examination revealed a highly significant statistical difference between both groups as regards lateral pharyngeal wall mobility (p = 0.000). Lateral cephalometric assessment showed significant statistical differences for maxillary protrusion (P = 0.04) which was slightly wider in the study group than in the control group and bony pharyngeal depth (Ptm-Ba) (P = 0.03) which was deeper in the study group than in the control group. Auditory perceptual assessment of speech, nasopharyngoscopy, and cephalometry are important tools that could be used for pre-adenotonsillectomy assessment of cases with palatopharyngeal disproportion to prevent the post-adenotonsillectomy velopharyngeal insufficiency and its consequences.