Effects of oropharyngeal surgery on velopharyngeal competence.

PURPOSE OF REVIEW: This article addresses the question of whether it is safe to perform pharyngeal surgery on children who are at risk for speech disorders. Patients with orofacial clefts or craniofacial disorders often have speech and resonance disorders that affect their understandability. They are also prone to develop sleep apnea or other diseases that affect Waldeyer's ring.

RECENT FINDINGS: There is increasing recognition of sleep disordered breathing and obstructive sleep apnea syndrome (OSAS) in the group of children who have, or are at risk of developing, speech disorders. Often, these children have a dysfunctional velopharyngeal valve which results in velopharyngeal insufficiency (VPI) and unintelligible speech. There are also children, otherwise thought to be normal, who develop VPI after adenoidectomy or tonsillectomy. Greater knowledge of the causes for VPI has led to the strategies limiting the risk of speech disorders after tonsillectomy or adenoidectomy.

SUMMARY: Children at risk for VPI who have OSAS may not experience deterioration of their speech understandability when a careful tonsillectomy with or without partial adenoidectomy is done. Coordination between the treating providers is paramount for successful outcomes for both the problems.