Retrospective Analysis On Three Different Methods Of Adenoidectomy In Children

BackgroundThe adenoid, or nasopharyngeal tonsil, is one of the import parts of the Waldeyerring that is located in the roof of the nasopharynx. Adenoid comes into being beforechildbirn; it reaches the largest at the age of about6or7years normally and atrophiesgradually after puberty,followed by vanishing generally until adult life; if adenoidalhyperplasia causes corresponding symptoms, that is called adenoid hypertrophy,which is a pathological phenomenon.Adenoid hypertrophy is a common disease in Otolaryngology and Pediatrics,which can cause symptoms such as obstructive sleep apnea hypopnea syndrome,chronic sinusitis, as well as secretory otitis media and so on. If adenoid hypertrophyis not treated immediately and effectively, it can cause adenoid face as well asdevelopment and growth retordation in children. So, as soon as the adenoidhypertrophy is diagnosed accurately, the patients must receive an operation early. Thetraditional surgical method is the classic transoral curette adenoidectomy. Althoughadenoid residue and damage caused in normal nasopharynx structures were found inthis method because of blindly operation; It is possible to provide a direct and clearview of the surgical area with the development of endoscopic technology. Althoughvarious surgical approaches spring up, there is no consistent view on what are thevalid rate and advantages and disadvantages of three different surgical methods ofendoscopic adenoidectomy around the world. ObjectiveTo compare the advantages and disadvantages among endoscopic transoralcurette adenoidectomy, endoscopic-assisted transoral adenoidectomy andendoscopic-assisted transoral radiofrequency adenoidectomy.MethodsClinical data of87cases who received adenoidectomy were retrospectivelyanalysed. The patients were randomly divided into three groups (group A: endoscopictransoral curette adenoidectomy, group B: endoscopic-assisted transoraladenoidectomy, group C: endoscopic-assisted transoral radiofrequencyadenoidectomy when they were admitted to our hospital).The effective rate of snoring,nasal obstruction, rhinorrhea and hearing were also compared among the three groupsafter operation; the data of postoperative blood loss, duration of postoperative pain,duration of nasal obstruction and complication were collected and analysed.ResultsAll patients had been followed up for average5.2months (rang3to12months).The total effective rate of snoring, nasal obstruction, rhinorrhea and hearing in threegroups was separately more than81.00%, no significant difference was found in thetotal effective rate nor in the rate of postoperative blood loss among the three groups(P>0.05);Both group A and group B had more severity of postoperative pain thangroup C, there were significant differences in severity of postoperative pain amongthe three groups (P<0.05); duration of postoperative pain and nasal obstruction ingroup B was shorter than group C; the differences between duration of postoperativepain and nasal obstruction of two groups were statistically significant (P<0.05); therate of adenoidal residue in group A was higher than that in group B; the differencebetween the rates of adenoidal residue of two groups was statistically significant(P<0.05); the rate of postoperative soft palate edema or injury in group C was higherthan that in group B; there were significant differences between both of two groups(P<0.05). there was no nasal cavity adhesion, injury of the Eustachian tube,Nasopharyngeal stenosis, atresia of Nasopharynx or Nasopharyngeal regurgitation occurred in any of the groups.Conclusions1. No significant difference was found among the three groups in the totaleffective rate.2. This study showed that endoscopic-assisted transoral adenoidectomy usingpower system is the best surgical approach of choice for the treatment of adenoidhypertrophy, which provides a clear operative view that allows the surgeons toremove adenoids more accurately and effectively with less complications and fewerintraoperative injury.