Adenotomy - operation on adenoids. It is carried out at any age. In children, such an intervention is indicated when the presence of overgrown formations poses a greater risk to health than their removal. This refers to difficulties, and often the impossibility of nasal breathing, hypoxia, accompanied by developmental delays, persistent hearing impairment and chronic otitis media, which can lead to complications, asthma, malocclusion and an adenoid face.
What are adenoids?
In the oral cavity and nasopharynx there are tonsils - accumulations of lymphoid tissue. They perform a protective function, becoming an obstacle when pathogens try to penetrate the respiratory system. Tonsils form the so-called pharyngeal lymphatic ring of Pirogov, there are only 6 of them.
The most famous are palatine, with inflammation of which angina develops. They are visually visible when examining the oral cavity.
An unpaired nasopharyngeal tonsil is located in the nasopharynx, and only an ENT doctor can see it with a special mirror. Its growth for various reasons and becomes a picture of adenoids. Thus, its protective function is transformed into a problem, it begins to grow more than necessary to maintain immunity. This occurs as a result of frequent colds. Such an enlarged tonsil itself creates a problem for breathing and serves as a focal point of infection, as it often becomes inflamed. And although at first, conservative treatment helps to some extent, pathology continues to progress and leads patients to the surgeon.
Symptoms of Adenoids
So, the main symptoms are:
- Nasal congestion occurs not only against a runny nose, but also without catarrhal manifestations.
- Runny nose becomes frequent and difficult to treat.
- The baby's sleep is superficial, with poor falling asleep. In the morning the child wakes up irritated, naughty, he has nightmares. At night, he sleeps with his mouth open and often snores.
- Voice change is nasal.
- Due to the proliferation of lymphoid tissue, the lumen of the auditory tube narrows or closes, as a result of which otitis media develops. The ear hurts and the hearing decreases.
- Adenoiditis occurs with inflammation of the tonsil itself as a result of a layered infection. It is accompanied by a rise in temperature, signs of intoxication and an increase in lymph nodes.
- The long existence of adenoids leads to changes in the bone tissue of the face: the lower jaw lengthens, the bite is broken, the mouth is constantly ajar, the type of such a person is called adenoid. With late treatment, these changes are irreversible.
- Chronic lack of oxygen leads to brain hypoxia. First of all, the general condition is disturbed, headaches appear, memory and attention worsen, the child lags behind peers in school. Anemia develops, appetite decreases. The baby is fatigued, pale, and lags behind in development.
- Closing the nose and breathing with the mouth causes unheated and uncleaned air to enter the throat, which is fraught with frequent respiratory infections. They negatively affect adenoids, and a vicious cycle occurs.
The degree of growth of adenoids
There are 3 degrees of overgrowth of adenoids:
- the nasal passages in the first stage are blocked by 1/3;
- on the second - up to 2/3;
- on the third - more than 2/3.
At stage 1, the child has only periodic sniffling, snoring at night is rare. During the day, the child does not feel discomfort.
With adenoids of the 2nd degree, there is night snoring, nose breathing is difficult, the mouth is ajar.
At stage 3, air can no longer flow through the nose. Snoring becomes constant, a person can only breathe through the mouth. Nasal congestion becomes constant, nasal discharge is mucous or with pus. The voice is nasal, appetite is constantly reduced, the child quickly gets tired. In the diagnosis, the degree of adenoid increase is indicated.
The decision on the need for surgical treatment is recommended by the ENT doctor, but the last word is up to the parents. Usually, surgery is recommended if there is no proper effect from conservative treatment. Parents should be aware of the consequences of refusing surgery and the risk of complications.
Indications for surgery
All over the world there are unified clear indications for adenotomy in children:
- lack of nasal breathing;
- shortness of breath and snoring;
- sleep disturbances;
- repeated otitis media and hearing loss;
- frequent colds, sinusitis;
- bite and adenoid changes in the face.
When is the best time to do surgery?
The time for removal must be carefully selected. The child should not be ill at least during the last month. With exacerbation of colds, the operation is postponed.
According to doctors, summer is not the best time for surgery, because the risk of complications in the form of infections and bleeding is increased. Optimum removal in late summer and early fall.
At what age is it better to remove?
The age of the child has practically no effect on the effectiveness of the operation. Although it is not necessary to operate on a child younger than 2 years old, since at this age the nasopharyngeal tonsil still determines the immunity of the baby. It reaches its maximum size in 3-7 years. After 7 years, the activity of lymphoid tissue decreases, relapses are less. Best removed at preschool age.
Contraindications to adenotomy
The operation must be postponed in the following cases:
- respiratory infections;
- less than 1 month after the last vaccination;
- allergies
- oncology.
How is the operation on adenoids in children?
Adenotomy in school children and adults is most often performed on an outpatient basis. The last dinner before the intervention - no later than 19 hours. Further, water and drink are completely excluded. In girls and women, surgery is not performed during menstruation.
Features of anesthesia
The method of anesthesia is determined by the age of the patient. Up to 7 years, general anesthesia is better to use. For schoolchildren and adults, the local one is also suitable. Both types of anesthesia have their pros and cons.
Pros of local anesthesia:
- there is no "post-anesthetic period";
- no toxic effects of anesthesia;
- there is no risk of ingestion of gastric contents.
Disadvantages of local anesthesia:
- fear of surgery and strangers;
- pain;
- the effect of being present at one’s operation.
Benefits of general anesthesia:
- no pain or fear;
- less risk of bleeding;
- the doctor acts more accurately, the patient does not distract him or twitch.
Disadvantages:
- risk of aspiration of the contents of the stomach;
- difficult exit from anesthesia;
- toxic effect of anesthetic drugs.
Classic adenoid removal operation
Classical or standard adenotomy is performed using a special tool - Beckman adenotomy. The patient sits, opens his mouth wide, and is inserted into the oral cavity with an adenotome. The surgeon should cover all the adenoids with the adenotome ring and then excise them with a single movement. Then they are extracted through the mouth. The duration of the intervention is 10 minutes. After removal, the child enters the ward and can be discharged home on the same day in the absence of complications.
The minus of the method is that the surgeon’s actions occur blindly and parts of the lymphoid tissue may remain, which in the future will give a relapse. Another minus is the preservation of a pain. The plus of the method is low price and availability.
Endoscopic adenotomy
Currently, endoscopic adenotomy is used more often than others. It is characterized by accuracy, safety, and the absence of bleeding. Indispensable for relapses. Reviews about her are only positive.
Endoscopic adenotomy is very effective when the adenoids, as it were, spread along the wall of the larynx and do not grow into the lumen. Such adenoids block the auditory tube, the constant dysfunction of which causes otitis and acquired conductive hearing loss.
The progress of endoscopic adenotomy is visually monitored using special equipment, which gives such high accuracy. Under the control of the monitor, the lymphoid tissue is removed exactly in the right place and completely. Anesthesia is common, but children usually tolerate it well.
Endoscopic shaver adenotomy - what is it? This is an option for endoscopic removal of adenoids by shaver technique. Shaver - a special device - microfreza with a rotating head, placed in a hollow tube. The end part itself is stationary. An endoscopic tube with a microcamera is inserted through the nasal passage, and the nasopharynx is completely visible to the doctor.
The blade crushes the cut off tissue, which is then sucked off and brought out. There is no risk of excised tissue getting into the respiratory throat.
An endoscopic adenotomy through the nose through a microdebrider has the advantage that it is less traumatic - healthy tissue is not damaged, there is no bleeding and no relapses either. Scars do not form. Today this method is the best.
The restriction to endoscopic adenotomy by the shaver method (microdebrider) will be only the narrowness of the nasal passages in the child. Then it becomes problematic to enter the handset. The operation is not possible in any clinic due to the high cost of equipment.
Reviews about shaver endoscopic adenotomy are only positive. Most parents believe that the operation, although expensive, is worth it.
Stages
Endoscopic adenotomy is usually planned. A few days before it, desensitizing agents, vasoconstrictor drops are preventively prescribed to reduce swelling, to reduce the likelihood of infection. The operation of endoscopic adenotomy in children takes about an hour.
After the procedure, the child should be under the supervision of an adult caring in the ward. After about an hour, the child can be given a little drink, by the evening it is allowed to eat. Food should be warm, soft. The next day, an extract is made.
Within 2 weeks, the child must be protected from colds, because he becomes vulnerable during this period. Physical activity for a month is limited.
Laser Adenoid Removal
Excision is performed with a laser scalpel, when exposed, the affected tissue heats up and collapses. This is due to the evaporation of water from the cells.
With this type of intervention, bleeding and infections do not happen, because the laser has disinfecting properties. You can also note painlessness and quick recovery.
Minuses:
- high price;
- the depth of exposure is not controlled and healthy tissues can be damaged;
- need special equipment and trained personnel;
- with large growths of the laser is not enough;
- the operation lasts a long time.
Cryotherapy of adenoids in children
Cryotherapy is the removal of adenoids with liquid nitrogen. The method is almost painless, applicable for small growths. To a sitting child, tubes are inserted into the oral cavity, which relieve him of adenoids.
Pros:
- freezing tissues and blood vessels removes any pain;
- bloodlessness;
- brevity of the procedure - 2-3 seconds;
- quick check out.
Cons - high cost and applicability only with small sizes of adenoids.
Radio wave method
Radio wave endoscopic adenotomy is performed by the Surgitron apparatus. He has a nozzle that emits radio waves. The vessels are simultaneously coagulated.
Pros: high accuracy, safety, efficiency.
Cons: high price, the likelihood of scarring in the tissues of the pharynx.
The main condition for the success of any operation, especially minimally invasive, is the high qualification of the surgeon.
Postoperative period
Endoscopic adenotomy in children requires bed rest on the first day. After a few days, walks are possible, in a kindergarten or school it is allowed at least 2 weeks later.
On the first day, the temperature may increase slightly. It is necessary to give the child "Paracetamol" or "Ibuklin", but not "Aspirin".
For 2-3 days, nasal congestion and soreness in the nasopharynx due to edema and trauma can be noted. Treatment is not required, everything goes by itself. Within 1.5 months, a diet should be followed. Physical activity is excluded for a month.
Personal hygiene: daily brushing 2 times a day, rinsing the mouth and throat with a solution of antiseptics after eating. You can swim only after 2 weeks.
Carrying out an operation in winter requires the exclusion of hypothermia of the child's body, the prohibition of thermal inhalations, visits to baths and saunas.
Possible complications
Among the complications (and they rarely develop), bleeding, secondary infection, acute otitis media, recurrence of adenoiditis can occur. To exclude such phenomena, the doctor will prescribe antibacterial therapy.
Reviews
Endoscopic adenotomy reviews are extremely enthusiastic:
- new technologies against old barbaric methods;
- an endoscope has become available;
- began to study better and breathe calmly;
- undoubted benefit.
Another problem may be hearing loss with adenoids, which can lead to otitis media. Then you have to carry out an adenotomy with tympanopuncture (puncture of the tympanic membrane to restore hearing).
Reviews of endoscopic adenotomy with tympanopuncture of both ears indicate the complexity of the condition, long preparation, but good results. The downside is only in finding the right clinic.