Adenoid hypertrophy causing obstructive sleep apnea in children after pharyngeal flap surgery

  • Mosaad Abdel-AzizEmail author
  • Mahmoud El-Fouly
  • Essam A. A. Elmagd
  • Ahmed Nassar
  • Assem Abdel-Wahid



Pharyngeal flap surgery used for treatment of velopharyngeal insufficiency (VPI) may be followed by obstructive sleep apnea (OSA) especially if the patient has developed adenoid hypertrophy. However, adenoidectomy may adversely affect speech in these patients. The aim of this study was to assess the effectiveness of transnasal endoscopic power-assisted adenoidectomy in relieving OSA in patients with adenoid hypertrophy who underwent pharyngeal flap surgery, and the impact of the procedure on their speech.


Transnasal endoscopic power-assisted adenoidectomy for nine children presenting with adenoid hypertrophy was performed. The patients had previously undergone pharyngeal flap surgery for treatment of VPI. Flexible nasopharyngoscopy was used in the diagnosis of adenoid hypertrophy. Pre- and postoperative polysomnography with measurement of apnea–hypopnea index (AHI) was done. Additionally, auditory perceptual assessment of speech (APA) and nasalance scores was measured pre- and postoperatively.


All patients were shown to have OSA by polysomnography, and a larger adenoid size was significantly associated with a higher AHI. We achieved a significant improvement in AHI after adenoidectomy. However, six patients still demonstrated OSA, albeit with a reduced severity. Speech was not adversely affected postoperatively as the APA and nasalance scores showed non-significant changes.


Adenoid hypertrophy may be encountered in children who undergo pharyngeal flap surgery, which may cause OSA. Transnasal endoscopic power-assisted adenoidectomy is a safe and effective method for treatment of OSA in those patients without prejudicing the pharyngeal flap, and it has no adverse effect on speech.


Adenoid hypertrophy Pharyngeal flap Obstructive sleep apnea Velopharyngeal insufficiency Adenoidectomy 



Very thankful to the staff members of the Phoniatric unit of our institute for their efforts in diagnosis and referral of the patients.


Self-funded. There are no financial disclosures.

Compliance with ethical standards

Conflict of interest

There are no conflicts of interest.

Ethical approval

The study protocol was approved by the Research Ethics Committee of the Faculty of Medicine of Cairo University (N-64-2011).

Supplementary material

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Supplementary file1 (MP4 5926 kb)
405_2019_5633_MOESM2_ESM.mp4 (2.4 mb)
Supplementary file2 (MP4 2497 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Otolaryngology, Faculty of MedicineCairo UniversityCairoEgypt
  2. 2.Department of OtolaryngologyAswan UniversityAswanEgypt
  3. 3.Department of Otolaryngology, Faculty of MedicineFayoum UniversityFayoumEgypt

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