Floating the uvula : a simple intraoperative diagnosis of bifidity : can endoscopic partial adenoidectomy prevent velopharyngeal insufficiency in patients with bifid uvula?

Abstract EN

Objectives : The aim of this study is to demonstrate a simple intraoperative technique to detect bifidity of the uvula undetected preoperatively or intraoperatively in patients subjected to adenoidectomy.

The second aim is to study the efficacy of endoscopic partial adenoidectomy in patients with cleft uvula.

Patients and methods: This study was done on 214 patients (age range from 3-12 years) who were subjected for adenoidectomy.

Another three patients (2 children and one adult) had bifid uvula and were suffering from obstructive nasal symptoms (because of adenoid) were also included in the study.

Under general anesthesia, saline irrigation of the uvula was done.

Four cases were discovered to have bifid uvula.

Transnasal endoscopic partial adenoidectomy was done for the seven cases.

With the use of 0° Telescope, the adenoid tissue was removed by Strumpet forceps and Blakesley nasal forceps until the lower one third of the choanae were open.

Results : Bifid uvula was discovered in four cases by floating the uvula technique.

Postoperatively, Snoring and witnessed episodes of apnea were improved in all patients, disappearing altogether in five and persist mildly in two children in whom severity of snoring and sleep disturbance was markedly reduced.

Hyper nasality and mild nasal regurgitation of fluids were noticed in one patient.

Both symptoms were improved within five months.

There was small adhesion in the right nasal cavity in one patient.

One patient developed recurrence of nasal obstruction, snoring and sleep disturbance after 13 months.

This patient underwent another transnasal endoscopic partial adenoidectomy.

Conclusion : Floating the uvula technique is a reliable and easy method for detecting bifidity of the uvula which was not detected preoperatively.

Transnasal endoscopic partial adenoidectomy is a reliable surgical technique in treating patients with obstructive adenoid who have cleft uvula.