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Velopharyngeal insufficiency following palatine tonsillectomy

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Abstract

Although adenotonsillectomy is usually considered a minor operation, numerous uncommon but severe complications have been described. Even tonsillectomy alone can cause velopharyngeal insufficiency (VPI). We describe two cases in which severe VPI was noted after palatine tonsillectomy was performed because of recurrent peritonsillar abscesses. The patients underwent clinical examination, nasalance measurements, videonasopharyngoscopy and videofluoroscopy. Findings in both patients were consistent with lesions of branches of the vagus and glossopharyngeal nerves through lingual rami, while one of the patients probably also had a lesion of the hypoglossal nerve. Endoscopic and videofluoroscopic examinations demonstrated essential differences in the patients' preoperative state of velopharyngeal anatomy. Findings demonstrate the value of careful postoperative endoscopic and videofluoroscopic examination in cases with VPI after tonsillectomy to identify factors affecting subsequent VPI and to design possible treatment.

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References

  1. Barr LL, Hayden CK, Hill LC, Swischuk LE (1989) Radiographic evaluation of velopharyngeal incompetence in child-hood. AJR 153:811–814

    Google Scholar 

  2. Beck CN (1979) Glossopharyngeus und Tonsillektomie. Laryngorhinootologie 58:463–465

    Google Scholar 

  3. Cassell MD, Moon JB, Elkadi H (1990) Anatomy and physiology of the velopharynx.In: Bardach J, Morris HL (eds) Multi-disciplinary management of cleft lip and palate, chapter 47. Saunders, Philadelphia, pp 366–377

    Google Scholar 

  4. Chaco J, Yulers RB (1969) Velopharryngeal incompetence post tonsillo-adenoidectomy. An electromyographic study. Acta Otolaryngol (Stockh) 68:276–278

    Google Scholar 

  5. Chusid JG (1973) Correlative neuroanatomy and functional neurology, 15th edn. Lange, Los Altos, Calif., p 97

    Google Scholar 

  6. Croft CB, Shprintzen RJ, Ruben RJ (1981) Hypernasal speech following adenotonsillectomy. Otolaryngol Head Heck Surg 89:179–188

    Google Scholar 

  7. Donati F, Pfammatter JP, Mauderli M, Vassella F (1991) Neurologische Komplikationen nach Tonsillektomie. Schweiz Med Wochenschr 121:1612–1617

    Google Scholar 

  8. Fletcher SG, Adams LE, McCutcheon MJ (1989) Cleft palate speech assessment through oral-nasal acoustic measures: In: Bzoch KR (ed) Communicative disorders related to cleft lip and palate, 3rd edn. College Hill Publication, Little Brown, Boston, pp 246–257

    Google Scholar 

  9. Froeschels E (1951) Postoperative hyperrhinophonia (Rhinolalia aperta). Arch Otolaryngol 54:140–144

    Google Scholar 

  10. Gibb AG (1969) Unusual complications of tonsil and adenoid removal. J Laryngol Otol 83:1159–1174

    Google Scholar 

  11. Golding-Kushner KJ, Argamaso RV, Cotton RT, et al (1990) Standardization for the reporting of nasopharyngoscopy and multiview videofluoroscopy: report from an international working group. Cleft Palate 127:337–348

    Google Scholar 

  12. Haapanen M-L (1992) A simple clinical method of evaluating perceived hypernasality. Folia Phoniatr 43:122–132

    Google Scholar 

  13. Haapanen M-L (1992) Nasalance scores in normal Finnish speech. Folia Phoniatr 43:197–203

    Google Scholar 

  14. Hartenau W (1955) Seltene Komplikationen nach Tonsillektomie. Monatsschr Ohrenheilkd 89:117–118

    Google Scholar 

  15. Jackson IT (1985) Sphincter pharyngoplasty. Clin Plast Surg 12:711–717

    Google Scholar 

  16. Kriens O (1990) Anatomy of the cleft palate. In: Bardach J, Morris HL (eds) Multidisciplinary management of cleft lip and palate, chapter 35. Saunders, Philadelphia, pp 287–302

    Google Scholar 

  17. Michel O, Brusis T (1990) Hypoglassusparese nach Tonsillektomie. Laryngol Rhinol Otol 69:267–270

    Google Scholar 

  18. Obiako M N (1988) Speech defects as an unusual complication of adenoidectomy. Ear Nose Throat J 67:752–754

    Google Scholar 

  19. Pigott RW, Benson JF, White FD (1969) Nasendoscopy in the diagnosis of velopharyngeal incompetence. Plast Reconstr Surg 43:141–147

    Google Scholar 

  20. Shprintzen RJ (1990) Commentary [to Isberg AM, Henningsson GE (1990) Intraindividual change in the occurrence of Passavant's ridge due to change in velopharyngeal sphincter function: videofluoroscopic study. Cleft Palate Craniofac J 27:253–255] Cleft Palate Craniofac J 27:255–257

    Google Scholar 

  21. Siegel-Sadewitz VL, Shprintzen RJ (1986) Changes in velopharyngeal valving with age. Int J Pediatr Otorhinolaryngol 11:171–182

    Google Scholar 

  22. Sieluzycki C (1967) Complications following tonsillectomy. Otolaryngol Pol 21:281–287. Cited in Donati F, Pfammatter JP, Mauderli M, Vassella F (1991) Neurologische Komplikationen nach Tonsillektomie. Schweiz Med Wochenschr 121: 1612–1617

    Google Scholar 

  23. Skolnick ML (1969) Video velopharyngography in patients with nasal speech, with emphasis on lateral pharyngeal motion in velopharyngeal closure. Radiology 93:747–755

    Google Scholar 

  24. Skolnick ML (1970) Videofluoroscopic examination of velopharyngeal portal during phonation in lateral and base projection — a new technique for studying the mechanism of closure. Cleft Palate J 7:803–816

    Google Scholar 

  25. Wallner LJ (1968) Voice changes following adenotonsillectomy. Laryngoscope 78:1410–1418

    Google Scholar 

  26. Williams RG, Preece M, Rhys R, Eccless R (1992) The effect of adenoid and tonsil surgery on nasalance. Clin Otolaryngol 17:136–140

    Google Scholar 

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Authors and Affiliations

  1. Cleft Center, Department of Plastic Surgery, Helsinki University Central Hospital, Helsinki, Finland

    M. -L. Haapanen

  2. Department of Clinical Genetics, Helsinki University Central Hospital, Helsinki, Finland

    J. Ignatius

  3. Department of Otolaryngology, Helsinki University Central Hospital, Helsinki, Finland

    H. Rihkanen & L. Ertama

Authors
  1. M. -L. Haapanen
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  2. J. Ignatius
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  3. H. Rihkanen
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  4. L. Ertama
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Haapanen, M.L., Ignatius, J., Rihkanen, H. et al. Velopharyngeal insufficiency following palatine tonsillectomy. Eur Arch Otorhinolaryngol 251, 186–189 (1994). https://doi.org/10.1007/BF00181834

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  • DOI: https://doi.org/10.1007/BF00181834

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