Comparison of adenoidectomy methods: examining with digital palpation vs. visualizing the placement of the curette.
OBJECTIVE
To evaluate the effectiveness of adenoidectomy by defining the remnant volume and localization in nasopharynx, following being satisfied with completeness of removal of the adenoid tissue with digital palpation.


METHODS
A prospective study conducted on 99 patients undergoing adenoidectomy+/-tonsillectomy. The main mass of the patient's adenoid tissue was removed with a sharp adenoid curette without visualization and the surgeon was allowed to palpate the adenoid bed and repeat the curettage until satisfied with completeness of removal. Then nasopharynx was visualized with a laryngeal mirror for defining the anatomical localization of the residual adenoid tissue and curettage completed under indirect mirror visualization. The volumes of the adenoid tissue excised at both stages were measured.


RESULTS
By blunt curettage and digital palpation, only 20.2% of the patients (20) had no residual adenoid tissue. In patients who had residual adenoid tissue, the proportion of the median percentage of residual adenoid tissue to total adenoid tissue was 19.98% (range 3.22-50%). The anatomical localization of the residual adenoid tissue were, along the torus tubarius on either side of the nasopharynx in 9 (11.4%), on the pharyngeal roof near choanal openings in 64 (81%), along the torus tubarius on either side of the nasopharynx+on the pharyngeal roof near choanal openings in 5 (6.3%), and on the pharyngeal roof near choanal openings+on the posterior wall of nasopharynx in 1 (1.3%) patients. There was no difference found among surgeons in the percentage and the location of the residue left (p>0.05).


CONCLUSIONS
Digital palpation is not a dependable technique and visualization of the nasopharynx is crucial for a complete adenoidectomy.
Ark
Nebil
N
Fatih University Faculty of Medicine, Department of Otorhinolaryngology Head and Neck Surgery, Turkey. nebilark@hotmail.com
Kurtaran
Hanifi
H
Ugur
K Serife
KS
Yilmaz
Turker
T
Ozboduroglu
Akin Altug
AA
Mutlu
Cemil
C
D000233:Adenoidectomy / Q000295:instrumentation* / Q000379:methods*; D000234:Adenoids / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005336:Fiber Optic Technology / Q000295:instrumentation; D005385:Fingers; D006801:Humans; D006984:Hypertrophy / Q000473:pathology / Q000601:surgery; D007223:Infant; D008297:Male; D009305:Nasopharynx / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures / Q000295:instrumentation*; D010173:Palpation; D011446:Prospective Studies; D014068:Tonsillectomy / Q000295:instrumentation* / Q000379:methods*; D014796:Visual Perception