Experience of Adult-Onset Velopharyngeal Insufficiency after Tuberculosis of the Soft Palate

89 Velopharyngeal insufficiency (VPI) is a condition in which the velopharyngeal structures fail to close the nasal cavity while the patient is speaking. VPI usually presents in association with cleft palate, submucous cleft palate, palatal fistulae, adenoidectomy, and neuromuscular disorders; after cleft palate surgery; or after the removal of tumors. Adult onset VPI is uncommon, and relatively few cases of this condition have been reported. Approximately 2% of patients with active pulmonary tuberculosis show evidence of upper respiratory tract involvement [1]. Although the most common site is the larynx, other structures, such as the tongue, palate, tonsils, pharynx, and buccal mucosa, may be involved. Primary tuberculosis of the upper respiratory tract in the absence of active pulmonary tuberculosis is exceptional. Here, we present a rare case of oronasal fistula, which occurred after tuberculosis of the soft palate in an adult. A 41-year-old woman presented at our institution’s Ear, Nose, and Throat Department with an ulcerative mass and an oronasal fistula of the soft palate. She had complained of hypernasality, nasal air emission, and nasal regurgitation for five days. The result of a mass biopsy of the ulcerative lesion on the soft palate (Fig. 1) revealed chronic granulomatous inflammation with caseous necrosis. There was no evidence of any primary focus in the body. Therefore, the patient was diagnosed as having oropharyngeal tuberculosis, and antituberculosis treatment based on isoniazid (300 mg), pyrazinamide (1,500 mg), ethambutol (800 mg), rifampicin (600 mg), and pyridoxine (50 mg) was started. One month later, the patient was referred to plastic surgery for the management of an oronasal fistula. She presented with a 10 × 10 mm oronasal fistula of the soft palate, presumed to be due to ulceration and contracture (Fig. 2). The remainder of the oral cavity was grossly normal. To assess nasality and velopharyngeal closure, a nasometer was utilized. A single speech therapist reviewed phonation results and scored speech acuity and intelligibility by using Experience of Adult-Onset Velopharyngeal Insufficiency after Tuberculosis of the Soft Palate