Treatment Options for Deviated Palate in Adults
Surgical correction through septoplasty is the primary treatment option for a deviated palate in adults, particularly when associated with nasal obstruction and functional impairment. 1
Anatomical Considerations
The palate serves as a critical structure separating the oral and nasal cavities. Deviation can occur due to:
- Congenital factors (e.g., cleft palate)
- Developmental abnormalities
- Traumatic injuries
- Compensatory growth patterns
Assessment Parameters
Before determining treatment, a thorough evaluation should include:
- Degree of deviation
- Functional impairment (breathing, speech)
- Associated nasal or facial asymmetries
- Impact on quality of life
Treatment Algorithm
1. Conservative Management
- Limited role in true structural deviations
- May include:
- Speech therapy for minor functional impairments
- Nasal steroids if mucosal inflammation contributes to symptoms
2. Surgical Correction Options
A. Septoplasty
- Gold standard for significant septal deviations affecting the palate
- Techniques include:
B. Turbinate Reduction Surgery
- Often performed concurrently with septoplasty
- Addresses compensatory turbinate hypertrophy on the side opposite the deviation 1
- Caution: Some studies fail to show long-term benefit when performed alone 1
C. Maxillomandibular Surgery
- For severe cases, especially with associated sleep apnea
- Maxillomandibular advancement (MMA) can address both palatal deviation and airway obstruction 2
- Success rates between 67-100% for improving respiratory parameters 2
D. Multilevel Surgery (MLS)
- Addresses multiple sites of obstruction
- Requires thorough preoperative evaluation including nasofibroscopy and cephalometric examination 1
- May include combination of procedures targeting the palate, nasal septum, and base of tongue
Special Considerations
Cleft Palate Patients
- Nearly all patients with cleft palate develop otitis media with effusion due to abnormal eustachian tube function 1
- Require multidisciplinary approach with continued monitoring even after palate repair 1
- Adult patients with untreated cleft palate may benefit from primary repair, though more challenging than in infancy 3
- Common long-term concerns include nasal obstruction (44%), septal deviations (47%), and oronasal fistulas (29%) 4
Obstructive Sleep Apnea
- Transverse maxillary deficiency is moderately associated with greater degree of septal deviation 5
- Comprehensive evaluation of both endonasal and extranasal structures is recommended 5
- MMA surgery may be considered for patients with severe OSA who cannot tolerate CPAP 2
Postoperative Care
- One night of inpatient hospitalization is typically necessary following extensive procedures like MMA surgery 2
- Close monitoring for airway patency and pain management
- Follow-up to assess functional improvement and potential need for adjunctive procedures
Potential Pitfalls
Inadequate Preoperative Assessment: Failure to differentiate between physiological and pathological deviation can lead to suboptimal outcomes 1
Isolated Procedure Selection: Addressing only one component of a multilevel problem may result in persistent symptoms 1
Unrealistic Expectations: Patients should understand that while functional improvement is likely, perfect symmetry may not be achievable
Ignoring Contributing Factors: Allergic and non-allergic rhinitis can cause mucosal swelling that may mimic or exacerbate symptoms of structural deviation 1
The management of deviated palate in adults requires careful consideration of anatomical factors, functional impairment, and patient-specific goals. Surgical intervention, particularly septoplasty with possible adjunctive procedures, offers the best chance for meaningful improvement in both form and function.