Effect of Adenotonsillectomy on Velopharyngeal Valve Mechanism

April 7, 2023 updated by: Fatma Mohamed Abdallah, Assiut University
  1. To assess safety of tonsillectomy, adenoidectomy or adenotonsillectomy result toVelopharyngeal Valve Mechanism.
  2. To predict and prevent post adenotonsillectomy velopharyngeal dysfunction.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

INTRODUCTION The velopharyngeal mechanism consists of a muscular valve that extends from the posterior surface of the hard palate to the posterior pharyngeal wall and includes the velum, lateral pharyngeal walls and the posterior pharyngeal wall .The function of the velopharyngeal mechanism is to create a tight seal between the velum and pharyngeal walls to separate the oral and nasal cavities for various purposes, including speech. Velopharyngeal closure is accomplished through the contraction of several velopharyngeal muscles including the levator veli palatini, musculus uvulae, superior pharyngeal constrictor, palatopharyngeus, palatoglossus, and salpingopharyngeus. The tensor veli palatini is thought to be responsible for eustachian tube function.(1) Velopharyngeal closure patterns may be classified as follows: coronal, where there is predominant soft palate movement toward the posterior pharyngeal wall; sagittal, where there is predominant movement of the lateral pharyngeal walls toward the pharynx midline, circular, where balanced movements of lateral pharyngeal walls and soft palate are observed; circular with Passavant's ridge, where the circular closure is associated with the development of a mucosal fold named Passavant's ridge on the posterior pharyngeal wall.

Velopharyngeal dysfunction (VPD) is a condition where the velopharyngeal valve does not close consistently and completely during the production of oral sounds. Velopharyngeal dysfunction can be caused by abnormal anatomy (velopharyngeal insufficiency), abnormal neurophysiology (velopharyngeal incompetence),or particular articulation errors (velopharyngeal mislearning)(2). Velopharyngeal dysfunction (VPD) is a generic term which describes a set of disorders resulting in the 3 leakage of air into the nasal passages during speech production. As a result, speech samples can demonstrate hypernasality, nasal emissions, and poor intelligibility.(3) Aetiologies of velopharyngeal insufficiency:( Occult submucous cleft palate, Neuromuscular disorder, Residual adenoid tissue, Classical submucous cleft palate, Poor palatal mobility, Behavioural disorder, Normal palate, 22q11 deletion, Postoperative nasopharyngitis, Scarring from tonsillectomy ).(4) Hypertrophic tonsils can be so large that they push against the posterior faucial pillars and intrude into the pharynx. This can easily be seen through nasopharyngoscopy. When this occurs, it can cause both a functional and mechanical interference with lateral pharyngeal wall movement. In rare cases, a tonsil (or both) is so large that it extends up to the area between the velum and posterior pharyngeal wall, thus interfering with velopharyngeal closure. When hypertrophic tonsils interfere with velopharyngeal function (and also affect the airway(5), this can be corrected with a tonsillectomy. Most children actually have veloadenoidal closure because the adenoids are in the place of normal velar contact. Adenoid tissue is most prominent in very young children but begins to slowly atrophy around the age of 6. With the onset of puberty, there can be significant, and sometimes sudden, atrophy of the adenoid tissue, causing an increase in the distance between the velum and posterior pharyngeal wall. If the velum is normal, it stretches to accommodate the difference in the depth of the pharynx; thus, normal velopharyngeal closure is maintained(6). 15 non-cleft palate children who developed velopharyngeal incompetence (VPI) after adenotonsillectomy. Eight boys and 7 girls with a mean age of 6.2 years (range 4.3-11 years) were treated between 1970 and 1993. After 2 years conservative management to allow for spontaneous resolution, only (7 children) 47% achieved normal resonance. Speech therapy was employed mainly for those 4 patients with unrelated articulation errors. Fifty-three percent (8 children) required surgery for persistent hypernasality and in 6 a pharyngoplasty was performed and in one child a posterior pharyngeal cartilage graft was inserted. One case is still to have surgical intervention. Half of the non-cleft children who develop VPI after adenotonsillectomy will respond to conservative management.(7) Retrospective data collection was performed for patients seen in the Great Ormond Street Hospital for Children multidisciplinary VPI clinic from the 1st of January 2015 until 30th of April 2020. Paediatric patients with previous adenotonsillar surgery and no evidence of cleft palate or speech and language disorder were included in the study.29patients met the inclusion criteria, with 16 having previous adenotonsillectomy and 13 isolated adenoidectomy.Severe hypernasality was noted in 3 patients, while in 20 cases moderate or mild hypernasality was found. There were no patients with normal speech. Ten patients were treated with speech therapy alone, whereas surgical intervention was required in seventeen cases. In the population who received treatment and had adequately recorded follow-up, improvement in speech was noted in 86.9%, with 30.4% having oral resonance on last review. Of the patients with severe hypernasality, all improved but had some persistent hyper nasality on last clinic review(8).

Study Type

Interventional

Enrollment (Anticipated)

200

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Egypt
      • Assiut, Egypt
        • Recruiting
        • ENT department

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

Children patients (aged from 4yrs to 12yrs) who will be undergone adenoidectomy or tonsillectomy or adenotonsillectomy

Exclusion Criteria:

  • Clinical diagnosis of cleft palate.
  • Clinical diagnosis of submucous cleft palate
  • Neuromuscular disorders.
  • Patients with craniofacial syndromes.
  • Patient with mental retardation

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Non-Randomized
  • Interventional Model: Sequential Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Other: Effect of Adenotonsillectomy in velopharyngeal valve mechanism
We do adenotonsillectomy and show its effect in velopharyngeal valve
Procedure: adenotonsillectomy
removal of adenoid,tonsil in one session
Procedure: adenoidectomy
removal of adenoid
Procedure: tonsillectomy
removal of tonsil
Other: Effect of Adenoidectomy in velopharyngeal valve mechanism
We do adenoidectomy and show its effect in velopharyngeal valve
Procedure: adenoidectomy
removal of adenoid
Other: Effect of tonsillectomy in velopharyngeal valve mechanism
We do tonsillectomy and show its effect in velopharyngeal valve
Procedure: tonsillectomy
removal of tonsil

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Assessment of post adenotonsillectomy velopharyngeal dysfunction.
Time Frame: one year
Velopharyngeal dysfunction will be assessed by doing Fiberooptic endoscopic evaluation preoperative and postoperative.
one year

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Assiut University

Investigators

  • Principal Investigator: Mohamed Azzam Abdel-Razek, Professor, Assiut University ENT Department
  • Study Director: Mahmoud Aly Ragae, Lecturer, Assiut University ENT Department
  • Study Director: Hanan Abd El Rashed Mohamed, Lecturer, Assiut University ENT Department

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 14, 2023

Primary Completion (Anticipated)

December 1, 2023

Study Completion (Anticipated)

January 1, 2024

Study Registration Dates

First Submitted

March 20, 2023

First Submitted That Met QC Criteria

April 7, 2023

First Posted (Actual)

April 19, 2023

Study Record Updates

Last Update Posted (Actual)

April 19, 2023

Last Update Submitted That Met QC Criteria

April 7, 2023

Last Verified

April 1, 2023

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Effect of AT on VPV

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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