Abstract
Abstract To compare powered to cold instruments for removing adenoid remnants after conventional curettage adenoidectomy. 110 patients (4 to 12 years old) scheduled for adenoidectomy with or without other surgeries (tonsillectomy, myringotomy and ventilation tube insertion) were enrolled in this prospective controlled study. We included patients with endoscopically detected adenoid remnants after curettage adenoidectomy including revision cases. Adenoidectomy was done using the adenoid curette, adenoid remnants detected endoscopically were removed by blakesley forceps (Group A) or by the microdebrider (Group B). Both groups were compared in terms of operative time, operative bleeding, post operative complications and adenoid recurrence. 20 patients were excluded due to absence of adenoid remnants after curettage and 10 more were lost for follow up, so we were left with 80 patients (42 in group A and 38 in group B). The mean age was 4.5 years for group A and 5 years for group B. The mean operative time was 10 minutes in group A and 9.5 minutes in group B, the difference was not statistically significant (p>0.05). Excessive intra operative bleeding was encountered in 1 patient of group B, which was controlled with suction cauetry. We didn’t encounter any postoperative bleeding in either group. Also, there were no other post operative complications like nasopharyngeal stenosis and velopharyngeal insufficiency, no adenoid recurrence was detected in both groups. Both the powered instruments (microdebrider) and the traditional instruments (blakesley forceps) under endoscopic control were characterized by a high level of precision, complete resection of residual adenoid with a very low incidence of post-operative bleeding and no recurrence, but we feel that powered instruments didn’t add any advantage over the traditional ones especially if the cost of the disposable blades is taken in consideration
Highlights
Adenoid hypertrophy is a common condition in children and can cause symptoms such as mouth breathing, nasal discharge, snoring, sleep apnea, and hyponasal speech [1]
Adenoid curette guided by an indirect transoral mirror and a headlight is a simple and quick procedure that has already been in use for a long time, but this method carries a high risk of recurrence unless performed by a well-experienced surgeon [3,4]
A total of 110 patients were enrolled in this study; 20 patients were excluded because of the absence of adenoid remnants after curettage and 10 more were lost to follow-up
Summary
Adenoid hypertrophy is a common condition in children and can cause symptoms such as mouth breathing, nasal discharge, snoring, sleep apnea, and hyponasal speech [1]. Adenoid curette guided by an indirect transoral mirror and a headlight is a simple and quick procedure that has already been in use for a long time, but this method carries a high risk of recurrence unless performed by a well-experienced surgeon [3,4]. After checking the operating field visually with a 70° endoscope after performing surgery, residual tissue was found in most patients close to the choanae and adjoining the torus tubarius. This finding could explain the partial relief of obstructive symptoms obtained in some patients [6]. The incidence of residual adenoid after curettage adenoidectomy varies between 39 and 95% [7,8]
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