Adenoid involvement in velopharyngeal closure in children with cleft palate.

OBJECTIVE To assess the role of the adenoid pad in velopharyngeal (VP) closure. DESIGN A retrospective review of patients with cleft palate (CP) who underwent nasendoscopy and multiview videofluoroscopy during evaluation for VP insufficiency (VPI) from January 2006 to March 2008. PATIENTS Thirty-two consecutive patients were identified. None of the patients were lost to follow-up. Five patients were excluded: two for advanced age, two due to mental disabilities and one with a submucous cleft. INTERVENTION Video nasendoscopy and multiview videofluoroscopy were performed for evaluation of VPI. OUTCOME MEASURES Adenoid size based on nasendoscopy studies, and adenoid involvement in VP closure based on videofluoroscopy were recorded. RESULTS The average patient age was 6.6 years (range three to 13 years). Seventy-eight per cent of patients had small adenoid volumes (less than 50% obstruction of the choanae), and six patients (two unilateral cleft lip and palate patients, one bilateral cleft lip and palate patient, two isolated CP patients and one cleft of secondary palate patient) had large adenoid volumes (50% or greater obstruction of the choanae); the adenoid pads of these patients were almost always (five of six patients) involved in their VP closure patterns. Videofluoroscopy showed that 26% (95% CI 9% to 40%) of patients did not significantly use their adenoid pad in VP closure. Forty-three per cent of those not using their adenoids attempted contact with a Passavant's ridge. CONCLUSIONS In general, the adenoid pad should be maintained in CP patients. However, not all CP patients in the present study used their adenoid pad in attempted VP closure. If adenoidectomy is medically indicated, a percentage of these patents might be considered to be at lower risk for the development of postadenoidectomy VPI.