Transient velopharyngeal incompetence (VPI) is a known complication of tonsillectomy, estimated to occur in 2.2% of cases(1). It is primarily characterised by nasal air escape, hyper nasality, and in some cases associated nasal regurgitation. It is most commonly transient resolving around 5 months post operatively(1).
This case report describes the unique case of a 15-year-old female who developed persistent Non-Nasal VPI following uncomplicated elective tonsillectomy. The patient presented with nasal regurgitation of liquids at three weeks post operatively, without accompanying hyper nasality of voice or nasal air emission. Regurgitation persisted until the time of surgical intervention at seven months. This is a clinical scenario not previously reported in the literature.
Evaluation and workup was conducted via cleft clinic MDT with history, assessment of speech, direct visual examination and nasendoscopy utilised for the diagnosis. Cicatrisation of the palatoglossal arches was identified as the underlying pathology, with bilateral cicatricial contraction resulting in tethering of the tongue base to the soft palate. The postulated pathoanatomical explanation for the persistent nasal regurgitation is the shortened palatoglossus muscle impairing closure of the velopharynx as the tongue base descends during swallowing. Surgical intervention was planned to involved the release of scarred mucosa from the palatoglossus muscle, with recruitment of transverse mucosal laxity in the pharynx to lengthen the arches. The postoperative course was uncomplicated, with the patient reporting immediate resolution of nasal regurgitation.
This case report includes a literature review, detailed description of the diagnostic workup, postulated pathoanatomy, operative intervention, and outcome gained for the evaluation and management of a unique case of non-nasal VPI secondary to cicatricial contraction of the palatoglossal arches post tonsillectomy.