Laryngoscope. 2012 Sep 5. doi: 10.1002/lary.23507. [Epub ahead of print]
The effectiveness of tonsillectomy and partial adenoidectomy on obstructive sleep apnea in cleft palate patients.
Abdel-Aziz M.
Source
Department of Otolaryngology, Faculty of Medicine, Cairo University, Egypt. mosabeez@yahoo.com.
Abstract
OBJECTIVES/HYPOTHESIS:
The most common cause of pediatric obstructive sleep apnea (OSA) is adenotonsillar hypertrophy (ATH). In cleft palate patients, however, the obstructive effects of ATH are more severe due to narrow airways. The aim of this study was to assess the effectiveness of tonsillectomy and/or partial adenoidectomy on OSA in cleft palate patients.
STUDY DESIGN:
Case series.
METHODS:
Tonsillectomy and/or partial adenoidectomy was performed in 17 repaired cleft palate patients with tonsillar and/or adenoid hypertrophy and OSA. Apnea/hypopnea (A/H) index and minimum O(2) saturation were measured before and after surgery. In addition, because these patients are vulnerable to speech impairment after pharyngeal surgery, auditory perceptual assessment (APA) and nasometric assessment of speech were performed.
RESULTS:
The mean preoperative A/H index was 17.6 ± 3.9, and the mean preoperative minimum O(2) saturation was 88.7 ± 1.5%. Both parameters improved postoperatively, to 1.9 ± 2.3 and 93.7 ± 1.5% respectively, and the changes were significant (P < 0.001). In 12 cases (70.6%), A/H indexes were normalized following surgery. Associated comorbidities such as retrognathia and narrow pharyngeal airways may underlie incomplete recovery in some cases. There were no significant postoperative changes in APA and nasalance scores.
CONCLUSIONS:
In most cases, tonsillectomy and/or partial adenoidectomy is an effective method for treatment of OSA in repaired cleft palate patients presenting with tonsillar and/or adenoid hypertrophy. However, some cases may need further procedures to relieve airway obstruction due to associated comorbidities.
Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
PMID: 22952113
[PubMed – as supplied by publisher]


BMC Ear Nose Throat Disord. 2012 Jun 25;12:6.
Congenital cholesteatoma of the infratemporal fossa with congenital aural atresia and mastoiditis: a case report.
Abdel-Aziz M.
Source
Department of Otolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt. mosabeez@yahoo.com.
Abstract
ABSTRACT:
BACKGROUND:
Congenital cholesteatoma may be expected in abnormally developed ear, it may cause bony erosion of the middle ear cleft and extend to the infratemporal fossa. We present the first case of congenital cholesteatoma of the infratemporal fossa in a patient with congenital aural atresia that has been complicated with acute mastoiditis.
CASE PRESENTATION:
A sixteen year old Egyptian male patient presented with congenital cholesteatoma of the infratemporal fossa with congenital aural atresia complicated with acute mastoiditis. Two weeks earlier, the patient suffered pain necessitating hospital admission, magnetic resonance imaging revealed a soft tissue mass in the right infratemporal fossa. On presentation to our institute, Computerized tomography was done as a routine, it proved the diagnosis of mastoiditis, pure tone audiometry showed an air-bone gap of 60 dB. Cortical mastoidectomy was done for treatment of mastoiditis, removal of congenital cholesteatoma was carried out with reconstruction of external auditory canal. Follow-up of the patient for 2 years and 3 months showed a patent, infection free external auditory canal with an air-bone gap has been reduced to 35db. One year after the operation; MRI was done and it showed no residual or recurrent cholesteatoma.
CONCLUSIONS:
Congenital cholesteatoma of the infratemporal fossa in cases of congenital aural atresia can be managed safely even if it was associated with mastoiditis. It is an original case report of interest to the speciality of otolaryngology.
PMID: 22731118
[PubMed – in process]
PMCID: PMC3438033
Int J Pediatr Otorhinolaryngol. 2012 Jul;76(7):1012-6. Epub 2012 Apr 13.
Repair of submucous cleft palate with Furlow palatoplasty.
Abdel-Aziz M, El-Hoshy H, Naguib N, Talaat N.
Source
Department of Otolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt. mosabeez@yahoo.com
Abstract
OBJECTIVE:
Submucous cleft palate is a congenital anomaly caused by abnormal insertion of the levator veli palatini muscles to the posterior border of the hard palate, normally these muscles unite together to form the levator sling. Velopharyngeal insufficiency (VPI) may occur in about 10% of cases, our previous treatment protocol was pharyngeal flap that may result in obstructive breathing. Furlow technique seems to be a more physiologic solution as it reconstructs the levator sling. The aim of this study was to determine the efficacy of Furlow palatoplasty in treatment of submucous cleft palate cases presented with VPI.
METHODS:
This prospective study was conducted on 15 children with symptomatic submucous cleft palate. All cases were treated by Furlow double opposing Z-plasty technique for repositioning of levator muscles, preoperative and postoperative speech evaluation was done using auditory perceptual assessment and nasometry, while velopharyngeal closure was assessed with flexible nasopharyngoscopy.
RESULTS:
Significant improvement of speech and overall nasalance score were achieved. Flexible nasopharyngoscopy showed complete velopharyngeal closure of 13 cases (86.7%), while one case needed secondary pharyngoplasty for correction of residual VPI and the parents of the other case refused secondary surgery as the speech improvement of their child was satisfactory.
CONCLUSIONS:
Furlow palatoplasty technique is an effective method in treatment of VPI in cases of submucous cleft palate as it has high success rate with no morbidity.
Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
PMID: 22503447
——————————————————————————————-

Laryngoscope. 2012 Mar;122(3):528-32. doi: 10.1002/lary.22457. Epub 2012 Jan 17.
Hypertrophied tonsils impair velopharyngeal function after palatoplasty.
Abdel-Aziz M.
Source
Department of Otolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt. mosabeez@yahoo.com
Abstract
OBJECTIVES/HYPOTHESIS:
When tonsillar hypertrophy obstructing the airway is encountered in a child with a repaired cleft palate and velopharyngeal insufficiency, the surgeon may opt for tonsillectomy to relieve the airway obstruction, with possible effects on velopharyngeal closure. The aim of this study was to assess the impact of hypertrophied tonsils on velopharyngeal function in children with repaired cleft palate and to measure the effect of tonsillectomy on velopharyngeal closure and speech resonance.
STUDY DESIGN:
Case series.
METHODS:
Twelve children with repaired cleft palate and tonsillar hypertrophy underwent tonsillectomy to relieve airway obstruction. Preoperative and postoperative evaluation of velopharyngeal function was performed. Auditory perceptual assessment of speech and nasalance scores were measured, and velopharyngeal closure was evaluated by flexible nasopharyngoscopy.
RESULTS:
Preoperative impairment of velopharyngeal function was detected. However, significant postoperative improvement of speech parameters (hypernasality, nasal emission of air, and weak pressure consonants measured with auditory perceptual assessment) was achieved, and the overall postoperative nasalance score was improved significantly for nasal and oral sentences. Reduction of velopharyngeal gap size was detected after removal of hypertrophied tonsils. Although the improvement of velopharyngeal closure was not significant, three cases demonstrated complete postoperative closure with no gap.
CONCLUSIONS:
Hypertrophied tonsils may impair velopharyngeal function in children with repaired cleft palate, and tonsillectomy is beneficial for such patients as it can improve the velopharyngeal closure and speech resonance. Secondary corrective surgery may be avoided in some cases after tonsillectomy.
Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
PMID: 22252734