A 4-year-old boy with snoring and confirmed adenotonsillar hypertrophy is posted for adenoidectomy. Preoperative examination notes a bifid uvula, and palpation reveals a notch in the posterior hard palate with a translucent zona pellucida in the midline soft palate. Why should adenoidectomy be deferred or modified in this child?
- A Risk of severe postoperative hemorrhage from aberrant vasculature
- B Risk of velopharyngeal insufficiency causing hypernasal speech and nasal regurgitation ✓
- C Risk of atlantoaxial instability during positioning
- D Risk of malignant transformation of residual adenoid tissue
Correct answer: B. Risk of velopharyngeal insufficiency causing hypernasal speech and nasal regurgitation
Explanation
Bifid uvula with a palatal notch and zona pellucida indicates submucous cleft palate. In these children the adenoid pad contributes to velopharyngeal closure during speech and swallowing, so routine adenoidectomy can precipitate velopharyngeal insufficiency with hypernasality and nasal regurgitation. If adenoidectomy is essential, a superior or partial adenoidectomy preserving the inferior portion is performed. Hemorrhage risk and malignancy risk are not specific to submucous cleft.
Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.