Objective assessment of endoscopy assisted adenoidectomy

Abstract

Objectives

To objectively assess the effectiveness of endoscopy assisted adenoidectomy utilizing adenoid tissue volume measurement and to set some parameters for which patients are more legible to this procedure.

Methods

Forty three patients for whom adenoidectomy was conventionally done using adenoid curettes. Surgeon’s satisfaction for adenoid removal after curettage and digital palpation was reported. The volume of removed adenoidal tissue was measured. The remaining adenoid tissue, if any, was removed transnasally guided by endoscope. Residual adenoid volume was also was measured. The data was tabulated and statistically analyzed.

Results

The volume of adenoid removed by curettage ranged from 1 to 3.6 ml with a mean of 2.45 ml. The volume of residual adenoid removed by endoscopy after curettage ranged from 0 to 2.9 ml (mean: 0.67 ± 0.58 ml). The volume of residual adenoid after blind curettage was found to have statistically significant relation to older age of patients, preoperative larger adenoid by X-ray and Surgeon’s dissatisfaction about the completeness of removal after curettage.

Conclusion

Conventional curettage adenoidectomy misses a substantial volume of adenoid tissue. Endoscopy-assisted adenoidectomy is significantly recommended in children age  >10 years, dissatisfied surgeon after curettage and palpation, and grade 3 adenoid enlargement on X-ray.

Introduction

Whether performed alone or combined with tonsillectomy, adenoidectomy is one of the most common surgical operations in pediatric otolaryngological practice [1]. Due to the large number of adenoidectomies performed, surgeons must lay particular attention to the safety, accuracy and outcomes when choosing among different surgical techniques. Since it was first described in 1885 [2], curette adenoidectomy with pack hemostasis is considered the most commonly used surgical technique for adenoidectomy [1]. Despite the trials of indirect visualization with laryngeal mirrors, the conventional technique is more or less a blind procedure. Both Cannon et al. [3] and Havas and Lowinger [4] have drawn attention to the high percentage of residual tissue remaining after traditional adenoidectomy with curette [4], especially in the choanal and tubaric regions [5].

Since 1992, a number of authors have described visualization of the operating field, during surgery, with trans-nasal [6] or trans-oral endoscope [7]. Those authors employed curette, suction-coagulator [5], forceps [8] and transnasal or trans-oral microdebrider [4], [9] as surgical tools for the removal of the adenoids. The use of the rigid endoscope has its advantages. It allows good visualization ensuring complete removal of adenoid tissue situated even high up in nasopharynx and intranasally without damaging surrounding structures. When used transnasally there is no need to extend the neck especially in patients with instability of the cervical spine [4]. If partial adenoidectomy is appropriate, it is also possible to perform very selective removal of the adenoid tissue [1].

Despite the many advantages described by many authors for the use of the endoscopic technique, there are only few studies which objectively proved the effectiveness of this technique over the traditional one. These studies also did not provide sufficient data to abandon the traditional technique and make the endoscopic technique the standard of care.

In this work, the authors tried to objectively prove the effectiveness of the endoscopic technique, by measuring the volume of residual adenoid tissue removed through endoscopy after finishing the traditional curettage and comparing this with the volume of the whole adenoidal tissue removed; and in this way trying to set some parameters for which cases are more likely to require same setting endoscopic intervention after traditional cold curettage.