Overview of Adenoidectomy

An adenoidectomy, a procedure to remove the adenoids, is one of the surgeries most often carried out on children. This operation was first developed in the 1800s by Hans Wilhelm Meyer, and it has significantly advanced over the past 150 years. Nowadays, it has very few associated risks and many studies have shown that it offers long-lasting benefits after the surgery.

An adenoidectomy is mainly performed when children have certain health issues. These include:

  • Otitis media with effusion, which is fluid build-up in the middle ear,
  • Chronic adenoiditis, a long-term inflammation of the adenoids or
  • Obstructive sleep apnea, a condition that makes breathing challenging while sleeping.

Anatomy and Physiology of Adenoidectomy

The adenoid is a patch of tissue that is high up in the throat, just behind the nose. This tissue helps your body fight off infections, especially during infancy. It starts growing from six weeks after conception and gets its blood supply from branches of facial, maxillary arteries, and the thyrocervical trunk. The adenoid grows rapidly during early childhood, reaching its maximum size by age seven and then starts to shrink.

In young children, if the adenoid gets too big, it can block the area where the nose and throat meet, resulting in difficulty breathing through the nose, which can lead to chronic mouth-breathing, disrupted sleep, and even conditions like sleep apnea. If left untreated, it can even affect the growth of the facial structure and the alignment of the teeth, leading to certain conditions like adenoid facies, which is characterized by an open mouth, protruding teeth, a high-arched palate, an outward-turned upper lip, and lack of visible creases between the nose and lips.

A large adenoid can also obstruct the Eustachian tube, which connects the middle ear to the back of the throat, and may result in conditions such as otitis media with effusion, which is the collection of fluid in the ear that can cause hearing problems. It’s also believed that some bacteria might take advantage of this situation and increase in the adenoid, potentially leading to an infection.

Why do People Need Adenoidectomy

The main reasons doctors may recommend an adenoidectomy, which is a procedure to remove the adenoids, are to treat two conditions in children: otitis media with effusion and obstructive sleep-disordered breathing. Otitis media with effusion refers to fluid build-up in the middle ear, and obstructive sleep-disordered breathing refers to issues with breathing during sleep. The adenoidectomy often happens at the same time as a tonsillectomy when there’s severe tonsil enlargement, or if the child has a history of frequent tonsillitis according to specific medical guidelines known as the Paradise criteria.

There are also other less common reasons for an adenoidectomy. These include comprehensive treatment of rhinosinusitis, a condition marked by inflamed or infected sinuses, loss of sense of smell or taste, and suspected cancer. The decision to do this surgery should always be based on detailed patient history, physical exam, and other necessary tests. With otitis media with effusion, for example, doctors might use special hearing tests (audiometry) and a test to assess the function of the ear drum and middle ear (tympanometry). In cases of sleep-disordered breathing, polysomnography (a sleep test) or sleep endoscopy (a procedure where a doctor examines the airways during sleep) may be needed to confirm the diagnosis.

When a Person Should Avoid Adenoidectomy

There aren’t any absolute reasons why someone can’t have an adenoidectomy, which is a surgery to remove the adenoids, but there are some things to consider carefully. For example, a person with a known cleft palate or hidden cleft palate (which is an opening or split in the roof of the mouth that didn’t close during early development) should be cautious. This is because after the surgery, they can develop a condition called velopharyngeal insufficiency, which can cause a nasal sounding speech and the regurgitation of food or liquid through the nose.

In such cases, a partial adenoidectomy – where only the lower third of the choana (which is the back part of the nasal passage) is removed – could be an alternative. Other things that might make an adenoidectomy risky include a high risk of bleeding and a current infection.

Equipment used for Adenoidectomy

Adenoidectomy is a medical procedure carried out using a variety of modern tools and techniques. The instruments used can include monopolar suction diathermy, which uses heat to remove tissue; curettage, which involves scraping the area to remove abnormal growths; a powered micro-debrider, a tool that cuts and removes tissue; coblation, a surgical method using radio frequency; and, various laser techniques for precision work.

Each of these methods can be used successfully to perform an adenoidectomy. However, which tool or technique is used ultimately depends on the preference of the surgeon performing the procedure.

Who is needed to perform Adenoidectomy?

An adenoidectomy is a surgery to remove the adenoids. This can be done with the help of a special kind of nurse known as a scrub nurse and a doctor specialized in putting people to sleep during surgeries, known as an anesthetist. For this operation, the surgeon does not need another doctor to assist.

Preparing for Adenoidectomy

After being anesthetized and a breathing tube is inserted in the patient, the patient lays on their back with a support cushion placed under their shoulder to make the neck stretching easy. This position is essential to carry out the surgery. If they also need to have a procedure to add tiny tubes into their eardrums, this usually happens before the adenoidectomy (surgery to remove adenoids). If the doctors need to remove the tonsils as well, this procedure can happen either before or after adenoidectomy.

The doctors then use a tool called a Crowe-Davis gag to open the mouth wide and get a clear view of the throat. This tool is also used to ensure that the mouth stays open during the surgery. In patients who don’t have teeth, a different tool known as the McIvor mouth gag can be used. A rolled towel, a special surgical stand, or metal rods could be used to keep these tools in place. Doctors will then check the soft area at the back of the mouth to see if it has an unusual split or cleft. They might also check the back of the nasal cavity to see how large the adenoids are and to look for unusual vibrations that might suggest misplaced major arteries.

Following this, the doctors use a suction device through the nose to clear any fluids. This device can also help move the soft area at the back of the mouth forward. A special medical swab can be placed between the nose and the device to avoid damaging the skin due to pressure.

How is Adenoidectomy performed

There are numerous ways doctors can remove your adenoids, including laser removal, coblation, endoscopic removal, and power-assisted removal using a device called a microdebrider. Your surgeon will decide the best method for your situation, but rest assured all these techniques have been proven to work well.

Monopolar Suction Diathermy

One method is called monopolar suction diathermy. It involves using a special electrical device that can burn and suck away tissues at the same time. The surgeon manipulates this device under mirror-aided vision and removes the adenoid tissue systematically, from top to bottom and from the back to the front of your throat. The surgeon ensures there’s no damage to the surrounding areas and a smooth contour is left in the space where the adenoids were. Once the procedure is done, the surgeon checks to see there’s no bleeding and ensures a little amount of adenoid tissue is left near a certain ridge as it’s necessary to avoid any issues with your voice post-operation. Rarely, nasal packing may be required.

Other methods like plasma ablation (Coblator), microdebrider, or laser removal follow a similar procedure, except these devices don’t need to be manually bent to the correct angle like the suction diathermy device.

Curettage

Another method is curettage. For this, a special tool called an adenoid curette is used. Under indirect visualization using a dental mirror, the surgeon scrapes away your adenoids, from top to bottom in a firm, controlled movement. The surgeon may repeat it and continue to check until all the adenoids have been removed. To stop any bleeding, the surgeon might fill the space with swabs, especially if a tonsillectomy (removal of tonsils) is also being done.

After your adenoids have been removed, the surgeon will clean away any blood clots using a suction catheter and ensure that there’s no more bleeding. The surgeon will also take special care while removing the throat retractor to avoid removing the breathing tube accidentally.

Possible Complications of Adenoidectomy

After undergoing a surgery to remove the tonsils or adenoids, known as adenoidectomy or tonsillectomy, you may experience some common or rare aftereffects.

Common occurrences after surgery can be:

– Pain, which usually resolves on its own. Over-the-counter painkillers like paracetamol or ibuprofen usually help with this.
– Your voice might sound different than usual. This is generally seen as a good change since it corrects a previously muffled or nasal voice.

In some cases, a small number of patients may experience the regrowth of adenoids, which might need another surgery. This is particularly more common in patients who had the surgery due to infections or frequent ear inflammation, also known as otitis media.

As for rare complications, you should note that:

– Any loose teeth or fillings might get injured during surgery. It’s necessary to let the surgeon know beforehand to avoid any dental injuries.
– There’s a minor risk of bleeding during surgery that may result in a blood clot. To prevent any life-threatening complications from the dislodging of this clot, surgeons will make sure to clear the space behind the nasal cavity.
– Bleeding after the surgery is unlikely, but in case of prolonged bleeding, it may require a revisit to the operating room to be managed.
– In rare situations, an issue known as Grisel syndrome could occur, which is an unwanted movement in the neck bones. This might require management from a neurosurgery team.
– In very rare cases (between 1 in 1,500 to 1 in 10,000), patients may develop hypernasal speech and nasal regurgitation, symptoms of a condition known as velopharyngeal insufficiency. If this occurs, further treatment or surgery may be needed.

Overall, the surgeon will take all necessary precautions to prevent these rare complications and ensure a safe and smooth procedure.

What Else Should I Know About Adenoidectomy?

Adenoidectomy is a common surgery that’s often used to treat ear infections with fluid buildup (also called otitis media with effusion) in children. This operation is typically performed alongside another procedure called myringotomy, in which a small hole is made in the eardrum to drain the fluid and a tiny tube, or grommet, is inserted to prevent future buildup. The decision to perform an adenoidectomy is backed up by high-quality scientific evidence.

This surgery can also help children with sleep disorders that affect their breathing. In short, an adenoidectomy is a noteworthy and reliable treatment that can provide relief for children suffering from these conditions.

Frequently asked questions

1. What are the specific health issues that indicate I need an adenoidectomy? 2. Are there any risks or complications associated with the surgery? 3. How will the surgery be performed? What tools or techniques will be used? 4. What can I expect during the recovery period? Are there any common or rare aftereffects? 5. Is there a possibility of the adenoids regrowing after the surgery?

Adenoidectomy, the surgical removal of the adenoid, can have several effects. It can improve breathing through the nose, alleviate symptoms of chronic mouth-breathing and disrupted sleep, and potentially treat conditions like sleep apnea. It can also prevent the obstruction of the Eustachian tube, reducing the risk of conditions like otitis media with effusion and hearing problems.

You may need an adenoidectomy if you have chronic or recurrent infections of the adenoids, which are causing symptoms such as difficulty breathing, snoring, sleep apnea, or frequent ear infections. However, it is important to consult with a healthcare professional to determine if an adenoidectomy is necessary in your specific case.

A person should not get an adenoidectomy if they have a known cleft palate or hidden cleft palate, as it can lead to complications such as velopharyngeal insufficiency. Additionally, a high risk of bleeding or a current infection may make the procedure risky.

The text does not provide specific information about the recovery time for Adenoidectomy.

To prepare for an adenoidectomy, the patient should follow the instructions provided by their doctor or surgeon. This may include fasting before the surgery, stopping certain medications, and arranging for someone to drive them home after the procedure. It is important to communicate any medical conditions or concerns to the healthcare team and to ask any questions about the surgery or recovery process.

The complications of Adenoidectomy include pain, changes in voice, regrowth of adenoids, dental injuries, bleeding during surgery, bleeding after surgery, Grisel syndrome (unwanted movement in the neck bones), and velopharyngeal insufficiency (hypernasal speech and nasal regurgitation).

Symptoms that may require Adenoidectomy include fluid build-up in the middle ear (otitis media with effusion), issues with breathing during sleep (obstructive sleep-disordered breathing), severe tonsil enlargement, frequent tonsillitis, comprehensive treatment of rhinosinusitis, loss of sense of smell or taste, and suspected cancer.

There is no information provided in the given text about the safety of adenoidectomy in pregnancy. It is recommended to consult with a healthcare professional for specific advice regarding medical procedures during pregnancy.

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