Adenoidectomy
Adenoidectomy
Adenoids are a collection of lymphoid tissue that are found in the nasopharynx lying just behind the posterior openings of the nasal cavities (posterior choanae). They are often large in children but tend to regress in size at around 8-9 years.
When they are large or infected they can cause the following symptoms:
- Snoring
- Purulent nasal discharge, typically frequent and prolonged colds
- Nasal blockage and mouth breathing
- Obstructive sleep apnoea
- They are also thought to have a role in glue ear. When adenoidectomy is combined with grommet insertion, there is a slightly reduced risk of recurrence of glue ear than if grommets are inserted alone.
Assessment of size
Children with adenoids often have a typical "adenoidal facies." It is helpful to have clarification that they are in fact enlarged. This can be done by simply examining the nose with an otoscope (sometimes it may be necessary to apply some topical decongestant to shrink down the nasal mucosa). Examination with a flexible fibreoptic endoscope is the most definitive means of confirming their size. Lateral neck X-rays are also used but not always accurate.
Surgery to remove the adenoids will help relieve nasal obstruction but is not always effective at reducing nasal discharge.
ADENOIDECTOMY
How we do it
The operation is performed through the mouth. A gag is used to open the mouth and a suction diathermy device is used to "vaporize" the adenoid tissue under direct vision. This is a relatively new technique and has the advantage of being a " bloodless" procedure with minimum pain following the surgery.
The older technique involved the use of a curette but this has generally been superceded by the suction diathermy technique.
Hospital stay
- Usually day surgery
- Obstructive sleep apnoea patients: overnight stay in hospital
What to expect after surgery
There may be some slight bloodstained discharge from the nose which usually settles after a few hours.
Nasal obstruction: this may not clear immediately but usually improves after a few days once the swelling following surgery has settled. There may be an unpleasant smell that is noticeable after a few days and usually disappears after a week.
Back to school
- 2-3 days
Complications
These are unusual. The most common are persistence of the offensive smell and prolonged nasal congestion
Nasal escape is very unusual and may occur in children with a submucous palatal cleft.