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The Complete guide to Endoscopic Adenoidectomy With Microdebredier

  • Posted on- Jan 05, 2018
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Endoscopic power assisted adenoidectomy is a procedure with minimal blood loss. It gives a complete clearance of obstructive adenoids under vision, thus providing reliable restoration of nasopharyngeal patency.

A tissue named adenoids present at the back of the throat joining at the back of the nose. The tissue that makes up the adenoids is called 'lymphoid tissue', which means that it contains white blood cells of the immune system.

During the infant period, adenoid is more prone for developing immunity against infections. Thereafter in adult time period, they won’t play any role in maintaining health, loose out until they disappear.
The classic method of adenoidectomy with different curettes is used worldwide.

Along with the recent procedures of adenoidectomy, a microdebrider is performed combined with transnasal video-endoscopic view. Reason is to recognize and proposal of the adenoidectomy using the microdebrider combined with endoscopic view, emphasizing the advantages and disadvantages compared with traditional methods.

What is an adenoidectomy?  



During the time period between 2 to 6 years, there is a more capacity of adenoid to swell up and become inflamed. A difficulty due to this can occur in breathing, mainly when your are asleep. Eustachian tube can get blocked by swollen adenoids, it connects  the throat to the middle part of the ear.

A complication due to Eustachian tube can cause a condition known as  'secretory otitis media' or 'glue ear'. This reduces the child’s hearing until the blockage is relieved. Surgery performed for the cancelling of adenoids is called an adenoidectomy.

Tonsillitis is mostly associated with swollen adenoids and are cancelled out as a part of surgery for excretion of tonsils.

Surgery is done by a specialized ENT surgeon. It is always performed under general anesthetic, so the child will be asleep during the whole procedure. It is a fairly simple operation. For avoiding bleeding of adenoids, a gauze pack is applied with pressure by your surgeon in the adenoid removal area. When the bleeding stops the pack is removed and the operation is finished.

This is a very important part of the operation and the child is not usually allowed to wake up until after any bleeding has stopped. At some cases, the surgeon could leave the pack in 24 hours after the surgery, if the bleeding is for long time period.

WHAT IS THE PROCEDURE OF ENDOSCOPIC ADENOIDECTOMY?



In this procedure, the patient is put supine in Rose's position with the head extended. The mouth is opened with a Dingmann mouth gag. Disinfection of the face and oral cavity is performed to avoid unnecessary contamination. The nasal mucosa is shrunken with 1:1000 epinephrine-rinsed cotton pledgets, which are removed 10 minutes after application.

While the soft palate is retracted using a Hurd tonsil retractor, an adenoid curette is applied to the nasopharynx transorally and the main bulk of adenoid is removed. Care is required during this process in order to avoid injury to the choana and muscular layer of the posterior pharyngeal wall, which could result in massive bleeding. Subsequently, a 4-mm or 2.7-mm, 0d` or 30d` endoscope is inserted transnasally into the nasopharynx.

Residual adenoid tissue at the superior portion of the nasopharynx and the orifice of the eustachian tube, which will be obstructed, is usually noted at this time. Under endoscopic guidance, it is removed piece by piece using either a straight or 45d` Blakesley forceps . The patency of the nasopharynx and the orifice of the eustachian tube can be demonstrated by direct visualization without damage to other structures.

WHAT IS THE PROCEDURE OF ENDOSCOPIC ADENOIDECTOMY?

An ophthalmic procedure requires endoscopic procedures, with decompressions in orbits, endoscopic DCR, and optic nerve decompression for traumatic indirect optic neuropathy.  Early, these procedures were done with the help of external care whereas due to increase  in endoscopic technique they are done endoscopicaly. Only surgeons with extensive training in, and expertise with, endoscopic techniques should perform these procedures.


WHAT ARE THE INDICATIONS OF ENDOSCOPIC ADENOIDECTOMY?



Endoscopic sinus surgery is most commonly performed for inflammatory and infectious sinus disease. The most common indications for endoscopic sinus surgery are as follows:

  •  Chronic sinusitis refractory to medical treatment
  •  Recurrent sinusitis
  •  Nasal polyposis
  •  Antrochoanal polyps
  •  Sinus mucoceles
  •  Excision of selected tumors
  •  Cerebrospinal fluid (CSF) leak closure
  •  Orbital decompression (eg, Graves ophthalmopathy)
  •  Optic nerve decompression
  •  Dacryocystorhinostomy (DCR)
  •  Choanal atresia repair
  •  Foreign body removal
  •  Epistaxis control


WHAT ARE THE CONTRAINDICATIONS OF ENDOSCOPIC ADENOIDECTOMY?



Endoscopic treatment causes no or minimal response to certain sinus conditions which inculcates difficulties in intra orbital acute sinusitis, such as orbital abscess or frontal osteomyelitis with Potts puffy tumor. An open approach, with or without additional endoscopic assistance, may be preferable in these instances.


Surgeon gets help through  preoperative CT or magnetic resonance imaging (MRI) scans. After 2 failures to endoscopically manage CSF leaks associated with CSF rhinorrhea, patients should be referred to a neurosurgeon for closure using a neurosurgical approach. Likewise, after failure to endoscopically manage frontal sinus disease, open approaches should be considered.

If sinus should be taken care early, then this kind of condition won’t occur.

Minimum cost of Endoscopic Debrider Assisted Adenoidectomy is Rs.1,15,000 to maximum Rs.2,30,000.

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