A 5-year-old male child presented with a history of recurrent sore throat, fever, mouth breathing for the past 3 years. The parents also gives history of sleep-disordered breathing including witnessed apneic episodes. History of nocturnal enuresis also present.
- Adenoid facies present.
- Mouth breathing present.
- Oral cavity: Crowded tooth
- Oropharynx: Grade III tonsils
- Anterior rhinoscopy: normal
- Posterior rhinoscopy: Adenoid hypertrophy present.
- Ear: Bilateral tympanic membrane appears dull and bulged.
- Neck: Bilateral jugulodigastric nodes present and tender.
- Xray nasopharynx: GIII Adenoid hypertrophy.
- Diagnostic nasal endoscopy: Please see the image above.
- Routine blood: Hemoglobin, Platelets, aPTT, PTINR were normal
- Pure tone audiometry: Bilateral mild conductive hearing loss
- Tympanometry: Bilateral B curve.
- What is your diagnosis?
Diagnosis is chronic adenotonsillar hypertrophy + Bilateral otitis media with effusion + sleep-disordered breathing + occult submucosal cleft palate.
This was a retrograde diagnostic nasal endoscopy done at the time of surgery. Structures marked are
- Floor of nasal cavity/palate
- Posterior end of left inferior turbinate
- Postero-inferior end of septum showing incomplete fusion with the palate – submucosal cleft.
- As the septum is not formed completely in the posteroinferior part, posterior end of both inferior turbinates is visible.
- Adenoid tissue in nasopharynx.
Adenoidectomy in patients with a submucosal cleft can lead to velopharyngeal insufficiency.