Posted on June 27, 2017June 7, 2023 Written by Dr Sanu P Moideen

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 give history of sleep-disordered breathing including witnessed apneic episodes. History of nocturnal enuresis also present.

On examination

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.

Investigations done.

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.

Questions

What is your diagnosis?

Explanation

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.