Partial adenoidectomy.

Adenoidectomy in the presence of an inadequate palate may result in velopharyngeal insufficiency. When an adenoidectomy is indicated in a child whose palate is not fully adequate, a partial adenoidectomy may be considered. Partial adenoidectomy involves removing the upper part of the adenoid for relief of nasal obstruction while leaving the lower portion of the adenoid intact to ensure velopharyngeal competence. Fifty-eight children underwent partial adenoidectomy over a 4-year period; 55 of these children had preoperative nasal obstruction; 49 had a tonsillectomy done at the same time; and 2 had had a previous T&A. The rationale for retaining the lower portion of the adenoid includes a short soft palate, decreased palatal mobility, a mild submucous cleft palate, huge tonsils pushing the palate anteriorly, and a short hard palate. The relief of nasal obstruction was excellent. There were no primary postoperative hemorrhages, and none of the 58 children developed velopharyngeal insufficiency following partial adenoidectomy.