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Asmaa Abdel Hamid has completed her MD at the age of 32 years from Cairo University, Egypt. She is Assistant professor of Phoniatrics Cairo University, She has many national and international publication, she is a member in Egyptian society and European Society of Phoniatrics , she is a member in cochlear implant teams and post cochlear implants rehab.in wadi elneel hospital for 7 years and now in king Abdallah medical city team in MAKKAH , KSA
Introduction: Patients with cleft palate even after repair, should not undergo adenoidectomy unless absolutely needed, and in such situations, conservative or partial adenoidectomy is performed to avoid the occurrence of velopharyngeal insufficiency. Trans-oral endoscopic adenoidectomy enables the surgeon to inspect the velopharyngeal valve during the procedure. Objective: Adenoid hypertrophy may play a role in velopharyngeal closure especially in patients with palatal abnormality, adenoidectomy may lead to velopharyngeal insufficiency and hypernasal speech. The aim of this study was to assess the effect of trans-oral endoscopic partial adenoidectomy on the speech of children with repaired cleft palate. Methods: Twenty children with repaired cleft palate underwent trans-oral endoscopic partial adenoidectomy to relieve their airway obstruction. The procedure was completely visualized with the use of a 70° 4-mm nasal endoscope, the upper part of the adenoid was removed using adenoid curette and St. Claire Thompson forceps, while the lower part was retained to maintain the velopharyngeal competence. Preoperative and postoperative evaluation of speech was performed, subjectively by auditory perceptual assessment, and objectively by nasometric assessment. Results: Speech was not adversely affected after surgery. The difference between preoperative and postoperative auditory perceptual assessment and nasalance scores for nasal and oral sentences was insignificant (p = 0.231, 0.442, 0.118 respectively). Conclusions: Trans-oral endoscopic partial adenoidectomy is a safe method, it does not worsen the speech of repaired cleft palate patients. It enables the surgeon to strictly inspect the velopharyngeal valve during the procedure with better determination of adenoidal part that may contribute in velopharyngeal closure.