Velopharyngeal Insufficiency Accompanied with Hypertrophic Tonsils: A Case Report.

Kim, Eun Key; Koh, Kyung Suck; Park, Mi Kyong

Case Report

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2005;32(5):660-662.
Published online September 1, 2005.

Velopharyngeal Insufficiency Accompanied with Hypertrophic Tonsils: A Case Report.

Eun Key Kim, Kyung Suck Koh, Mi Kyong Park

¹Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine. kskoh@amc.seoul.kr
²Smile for Children.

Abstract

It is well documented that adenoidectomy is attributed to hypernasality in certain cases, but not clear that the enlarged tonsils affect the quality of speech. Hypertrophied tonsils may cause and complicate the problem of velopharyngeal incompetency. The huge tonsils prevent lateral pharyngeal walls from a medial movement and interfere velar elevation, being hypernasality. Hyponasality developes as the tonsils encroach in nasopharyngeal space. Voluminous tonsils also interfere airflow in the oropharyneal passage and produce the phenomenon of cul-de-sac resonance or muffled sound. The authors and et al. present a case of velopharyngeal insufficiency accompanied with hypertrophic tonsils. Improving the lateral constricting pharyngeal wall and velar elevation after tonsillectomy minimized the velopharyngeal gap. Accordingly, the procedures of sphincter pharyngoplasty and palatal lengthening resolved the problem of hypernasality instead of pharyngeal flap. Tonsillectomy prior to pharyngeal flap surgery tends to reduce the postoperative airway problems. Sometimes, however, only tonsillectomy does without pharyngeal flap. Surgical approach by stages and intermittent evaluation are recommended at intervals of at least six weeks.

Keywords: Velopharyngeal insufficiency; Tonsillar hypertrophy; Tonsillectomy; Hypernasality