Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy.
OBJECTIVE
To quantify the incidence of intranasal extension of adenoid tissue and residual adenoidal obstruction of the posterior choanae following traditional curette adenoidectomy to determine the efficiency of adenoid curettage and the usefulness of intraoperative endoscopic examination and powered-shaver adenoidectomy in achieving better postnasal patency.


METHODS
Prospective intraoperative endoscopic evaluation of the posterior choanae and nasopharynx of a case series of 130 patients before and after curette and powered-shaver adenoidectomy.


METHODS
Tertiary referral center.


METHODS
One hundred thirty consecutive pediatric patients with obstructive adenoidal hypertrophy undergoing adenoidectomy.


METHODS
The degree of residual postnasal obstruction due to adenoid tissue was assessed endoscopically (grades 0-3) after curette and adjuvant powered-shaver adenoidectomy. The presence of intranasal adenoid tissue was also recorded.


RESULTS
Following traditional curette adenoidectomy, 51 (39%) of 130 patients had residual obstructive adenoid with 42 patients (32%) having occlusive intranasal adenoid tissue. Having determined the presence of remaining obstructive tissue with intraoperative nasal endoscopy in these 51 patients, complete airway patency was achieved with powered-shaver adenoidectomy.


CONCLUSIONS
The presence of intranasal extension of adenoids obstructing the posterior choanae is common in children with adenoid hypertrophy. Traditional adenoidectomy is ineffective in removing this tissue and may also leave obstructive tissue high in the nasopharynx. Intraoperative nasal endoscopy allows assessment of the completeness of surgery. Powered-shaver adenoidectomy enables complete removal of obstructive adenoid tissue thereby ensuring postnasal patency.
Department of Otolaryngology, Sydney Childrens Hospital, Sydney, Australia.
Thomas
T
Havas
David
D
Lowinger
D000233:Adenoidectomy / Q000295:instrumentation / Q000379:methods*; D000234:Adenoids / Q000473:pathology*; D000293:Adolescent; D000402:Airway Obstruction / Q000209:etiology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000150:complications / Q000601:surgery; D007223:Infant; D007430:Intraoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome