Adenoidectomy: Indications & Different surgical methods.

1. Adenoidectomy
Dr. Prasanna Datta
MS(ENT)

3. X-Ray Nasopharynx enlarged adenoids

4. • Adenoidectomy may be indicated alone
or in combination with tonsillectomy. In
the latter event, adenoids are removed
first and the nasopharynx packed
before starting tonsillectomy

5. Indications
• 1. Adenoid hypertrophy causing
snoring, mouth breathing, sleep apnoea
syndrome or speech abnormalities, i.e.
(rhinolalia clausa).
• 2. Recurrent rhinosinusitis.
• 3. Chronic secretory otitis media
associated with adenoid hyperplasia.

6. Indications cont..
• 4. Recurrent ear discharge in benign
CSOM associated with
adenoiditis/adenoid hyperplasia.
• 5. Dental malocclusion. Adenoidectomy
does not correct dental abnormalities
but will prevent its recurrence after
orthodontic treatment.

7. Contraindications
• 1. Cleft palate or submucous palate.
Removal of adenoids causes
velopharyngeal insufficiency in such
cases.
• 2. Haemorrhagic diathesis.
• 3. Acute infection of upper respiratory
tract.

8. Anaesthesia
• Always general, with oral endotracheal
intubation.

9. Position
• Rose's position, i.e. patient lies supine
with head extended by placing a pillow
under the shoulders. In this position
both the head and neck are extended.

10. Rose's position for adenoidectomy. Neck is extended by a sand bag
under the shoulders and the head is supported on a ring.
Downloaded from: StudentConsult (on 6 December 2012 06:54 PM)
© 2005 Elsevier
Rose's position

11. Steps of Operation
• 1. Boyle-Davis mouth-gag is inserted.
Before actual removal of adenoids,
nasopharynx should always be
examined by retracting the soft palate
with curved end of the tongue
depressor and by digital palpation, to
confirm the diagnosis, to assess the
size of adenoids mass and to push the
lateral adenoid masses towards the
midline.

12. • 2. Proper size of "adenoid curette with
guard" is introduced into the
nasopharynx till its free edge touches
the posterior border of nasal septum
and is then pressed backwards to
engage the adenoids. At this
level, head should be slightly flexed to
avoid injury to the odontoid process.

13. Adenoid curette
with guard Without guard

14. • 3. With gentle sweeping movement, adenoids
are shaved off . Lateral masses are similarly
removed with smaller curettes; small tags of
lymphoid tissue left behind are removed with
punch forceps.
• 4. Haemostasis is achieved by packing the
area for sometime. Persistent bleeders are
electrocoagulated under vision. If bleeding is
still not controlled, a postnasal pack is left for
24 hours

15. Adenoidectomy.

16. Endoscopic Adenoidectomy
• These days adenoids can be removed
more precisely by using a debrider
under endoscopic control

17. Nasal endoscopic adenoidectomy
using curette

18. Oral endoscopic adenoidectomy
using curette

19. micro debrider
micro debrider micro debrider-tip blade

20. Microdebrider adenoidectomy

21. Adenoidectomy using oral 70
degree endoscope

22. Endoscopic Microdebrider adenoidectomy

23. After removal of adenoids

24. Mirror assisted microdebrider
adenoidectomy

25. Coblation adenoidectomy
• It is also other wise known as cold
abalation. This technique utilises a field
of plasma, or ionised sodium
molecules, to ablate tissues. The heat
generated varies from 40 - 80 degrees
centigrade, much lower than that of
electro cautery. The major advantage of
this procedure is reduced bleeding and
reduced post operative pain.

26. Coblation adenoidectomy

27. Coblation adenoidectomy

28. Post-operative Care
1. Immediate general care
(a)Keep the patient in coma position until
fully recovered from anaesthesia.
(b)Keep a watch on bleeding from the
nose and mouth.
(c)Keep check on vital signs, e.g. pulse,
respiration and blood pressure.

29. Post-operative Care cont..
2. Diet
When patient is fully recovered he is to take
liquids, e.g. cold milk or ice cream.
3. Nasal saline drops

30. Post-operative Care cont..
4. Analgesics
Pain, locally in the throat and referred to ear,
can be relieved by analgesics like paracetamol.
There is no dysphagia and patient is up and
about early.
5.Antibiotics A suitable antibiotic can be giv
en orally or by injection for a week.
Patient is usually sent home 24 hours after
operation unless there is some complication.
Patient can resume his normal duties within 2
weeks

31. Complications
• 1. Haemorrhage, usually seen in
immediate post-operative period. Nose
and mouth may be full of blood or the only
indication may be vomitus of dark-
coloured blood which the patient had been
swallowing gradually in post-operative
period. Rising pulse rate is another
indicator. Treatment is same as for per-
operative haemorrhage. Postnasal pack
under general anaesthesia is often
required.
• 2. Injury to eustachian tube opening.

32. • 3. Injury to pharyngeal musculature and
vertebrae. This is due to hyperextension
of neck and undue pressure of curette.
Care should be taken when operating
patients of Down's syndrome as 10-20%
of them have atlanto-axial instability.
• 4. Griesel syndrome. Patient complains of
neck pain and develops torticollis. Mostly
it is due to spasm of paraspinal
muscles, but can be due to atlanto-axial
dislocation requiring cervical collar and
even traction.

33. • 5. Velopharyngeal insufficiency. It is
necessary to check for submucous cleft
palate by inspection and palpation
before removal of adenoids.
• 6. Nasopharyngeal stenosis due to
scarring.
• 7. Recurrence. This is due to regrowth
of adenoid tissue left behind.

34. Thank You