T & A in Patients with Cleft Palate and/or VPI

This webinar was originally accepted as a Teaching Course for ACPA's 77th Annual Meeting.

The course is aimed to discuss performance of tonsillectomy and adenoidectomy (T & A) in patients with cleft palate (CP) and/or velopharyngeal insufficiency (VPI). Performance of T & A in patients with CP and/or VPI is a controversial issue that has been addressed by several reports in the related scientific literature. The adenoid contributes to velopharyngeal closure during speech by reducing the space of the velopharyngeal sphincter between the soft palate, lateral pharyngeal walls and posterior pharyngeal wall. In contrast, hypertrophied tonsils not only do not contribute to velopharyngeal closure but they can hinder palatal movement especially when the growth is in a superior direction.  

When velopharyngeal surgery is performed with the objective of correcting VPI, enlarged adenoid can force the surgeon to place a pharyngeal flap or a sphincter pharyngoplasty lower than planned (according to imaging procedures) decreasing the effectiveness for restoring velopharyngeal closure and increasing the risk of airway obstruction. Thus, in selected cases adenoidectomy is a prerequisite for successfully performing surgery for correcting VPI. Another issue is the timing: should the adenoidectomy be performed in the same surgical stage as a pharyngeal flap or a sphincter pharyngoplasty or before? Moreover, if the adenoidectomy is performed before then the time between both procedures becomes also an issue.  

The objectives of this course are to discuss when T & A should be performed in patients with CP and/or VPI? How should the procedure be performed? How long should velopharyngeal surgery be delayed after T & A? 

Continuing Education

Attendees must register, attend and evaluate each webinar to receive continuing education credit. This on-demand course will be eligible through March 31, 2022. 

  • ACCME: ACPA designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credits™.  Physicians should only claim credits commensurate with the extent of their participation in the activity. The American Cleft Palate-Craniofacial Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Nursing: This nursing continuing professional development activity was approved by the North Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

To receive 1.0 contact hours:

  • Learners must attend 80% or more of the webinar.
  • Learners must complete and submit an evaluation form.

Neither the speakers nor members of the planning committee have any conflicts of interest related to the content of this activity.  Individual disclosures may be found in the “Topics” tab under their name. 


Original Seminar Date: September 29, 2020

On-Demand Release Date: September 30, 2020

On-Demand Expiration Date: March 31, 2022

Seminar Objectives
  • Learners will be able to perform adequate reviews and judgements of papers in peer review high impact journals concerning the following topics: VPI, Velopharyngeal surgery, Pharyngeal flap, T & A.
  • The learner will be able to understand the role of adenoid for velopharyngeal closure.
  • The learner will be able to explain why hypertrophied tonsils can cause VPI .
  • The learner will be able to have a rationale for deciding when to perform T & A in cases of VPI.
Seminar Information
Expiration Date:
August 29, 2022 11:55 PM
1 hour
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T & A in Patients with Cleft Palate and/or VPI
Speaker Information
Dr. Pablo Antonio Ysunza MD, PhD, CCC-SLP  [ view bio ]
Individual topic purchase: Selected
AMA PRA Category 1 Credit(s)™: 1.00
Nursing Contact Hours: 1.00
Accreditation Council for Continuing Medical Education (non-MD/DO)
AMA PRA Category 1 Credit(s)™: 1.00
This seminar is no longer available for purchase.