Adenoidectomy is a common surgical procedure for young children. It involves removal of the adenoids, small glands located at the back of the throat. Removal of the adenoids may result in the inability of the soft palate to adequately cover the back of the throat. Luckily, this condition is usually temporary and does not hinder normal activity.
The Adenoids
The adenoids are lumpy masses of tissue located at the back of the nasal cavity above the roof of the mouth. They help maintain body health by trapping harmful bacteria and viruses that enter the body through the mouth or nose. Additionally, adenoids produce small amounts of antibodies that help fight infection. While they do play a role in immunity, removal of the adenoids does not decrease the body's ability to fight off infection nor is there any increase in the number or severity of infections. In fact, the adenoids start shrinking at approximately age 5 and disappear completely by the teen years.
Adenoidectomy
Adenoidectomy is performed via the mouth, with no cuts or sutures required on the skin. General anesthesia is required to allow the surgeon easy access to the mouth and for the comfort of the patient. Following the procedure, sore throat and pain are common. Prescription painkillers are prescribed following surgery to control the pain. Most patients return to normal activities within one week.
The Soft Palate
The soft palate or roof of the mouth consists of muscles surrounded by a mucous membrane. It acts as a door, opening and closing to regulate air passage through the mouth and nose. During swallowing, the soft palate closes off the nasal passages to prevent food from moving up into the cavities. The soft palate also prevents air from flowing backwards from the mouth up through the nose during speech. In fact, the retraction and elevation of the soft palate facilitates the resonance for the different tones and pitches of speaking. Incomplete closure of the soft palate allows air to escape through the nose, causing speech to sound high, whiny and nasal.
Adenoidectomy and the Soft Palate
The adenoids sit at the back of the throat, filling some of the space. Enlarged adenoids, in particular, take up a great deal of room, requiring only a small soft palate to close the airway. Following adenoidectomy, the absence of adenoids creates a much larger space in the back of the throat. Frequently, the soft palate is not able to completely close the space. As a result, patients may display the characteristic nasal voice. The good news is that the soft palate stretches. This process may take several weeks or even months, but eventually the soft palate will create the proper seal over the entire space. In rare instances, the problem may persist and develop into the condition known as velopharyngeal insufficiency.
Velopharyngeal Insufficiency
Velopharyngeal insufficiency is the technical diagnostic name for any condition where the soft palate is unable to properly close and block the nasal cavities during speech and swallowing. Speech therapy is the preferred and most common course of treatment for patients developing the condition following adenoidectomy. However, if the problem cannot be rectified through therapy, additional surgery may be required. Surgical procedures to correct velopharyngeal insufficiency include pharyngeal flap surgery, where tissue from the back of the mouth is used to close the gap, or lengthening the soft palate with an implant. Surgical correction of velopharyngeal insufficiency following adenoidectomy is extremely rare.
