Adenotomy is an operation on the adenoids. It is carried out at any age. In children, such an intervention is indicated when the presence of overgrown formations poses a greater he alth risk than their removal. These are difficulties, and often the impossibility of nasal breathing, hypoxia, accompanied by developmental delays, persistent hearing impairment and chronic otitis media that threaten complications, asthma, malocclusion and 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 enter the respiratory system. The tonsils form the so-called pharyngeal lymphatic ring of Pirogov, there are only 6 of them.
The most famous are palatine, with inflammationwho develop angina. They are visible visually when examining the oral cavity.
The 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 becomes a picture of adenoids. Thus, its protective function is transformed into a problem, it begins to grow more than it needs to maintain immunity. This happens as a result of frequent colds. Such an enlarged tonsil itself begins to create a problem for breathing and serves as a focus of infection, as it often becomes inflamed. And although at first conservative treatment helps to some extent, the pathology continues to progress and leads patients to the surgeon.
Adenoid symptoms
So, the main symptoms:
- Nasal congestion occurs not only against the background of a runny nose, but also without catarrhal manifestations.
- Rhinitis 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 develops. The ear hurts and hearing is reduced.
- Adenoiditis occurs when the tonsil itself becomes inflamed as a result of an accumulated infection. 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 disturbed, the mouth is constantly ajar, the type of such a face 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 deteriorate, the child lags behind his peers in studies. Anemia develops, appetite decreases. The baby is overtired, pale, retarded.
- Closing the nose and breathing through the mouth causes unheated and unpurified air to enter the throat, which is fraught with frequent respiratory infections. They have a negative effect on the adenoids, and a vicious circle occurs.
Degrees of adenoid growth
There are 3 degrees of adenoid growth:
- nasal passages at 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 sniffing, snoring at night is rare. During the day, the child does not feel discomfort.
With adenoids of the 2nd degree, night snoring is present, breathing through the nose is difficult, the mouth is ajar.
At stage 3, air can no longer enter through the nose. Snoring becomes constant, a person can only breathe through his mouth. Nasal congestion becomes constant, discharge from the nose is mucous or with pus. The voice is nasal, appetite is constantly reduced, the child quickly gets tired. In diagnosis, the degreeenlargement of the adenoids is indicated necessarily.
The decision on the need for surgical treatment is recommended by the ENT doctor, but the last word is up to the parents. Surgery is usually recommended if there is no desired effect from conservative treatment. Parents should be aware of the consequences of not having surgery and the risk of complications.
Indications for surgery
There is a single clear indication for adenotomy in children all over the world:
- lack of nasal breathing;
- shortness of breath and snoring;
- sleep disorders;
- recurrent otitis and hearing loss;
- frequent colds, sinusitis;
- occlusion and adenoid facial changes.
When is the best time to have surgery?
The time for removal must be chosen carefully. The child should not get sick at least during the last month. In case of exacerbation of colds, the operation is postponed.
According to doctors, summer is not the best time for surgery, because there is an increased risk of complications in the form of infections and bleeding. Best removed in late summer and early autumn.
At what age is it better to remove?
The age of the child practically does not affect the effectiveness of the operation. Although it is not necessary to operate on a child under 2 years old, since at this age the nasopharyngeal tonsil still determines the immunity of the baby. It reaches its maximum size at 3-7 years. After 7 years, the activity of lymphoid tissue decreases, there are fewer relapses. Best removed at preschool age.
Contraindications for adenotomy
The operation must be postponed in the following cases:
- respiratoryinfections;
- less than 1 month has passed since the last vaccination;
- allergies;
- oncology.
How is adenoid surgery performed in children?
Adenotomy in school-aged children and adults is most often performed on an outpatient basis. The last dinner before the intervention is no later than 19:00. Further water and drink are excluded completely. For girls and women, surgery is not performed during menstruation.
Features of anesthesia
The method of anesthesia is determined by the age of the patient. Until the age of 7, it is better to use general anesthesia. For schoolchildren and adults, a local one is also suitable. Both types of pain relief have their pros and cons.
Pros of local anesthesia:
- no "postanesthetic period";
- no toxic effects of anesthesia;
- no risk of swallowing stomach contents.
Disadvantages of local anesthesia:
- fear of surgery and strangers;
- pain;
- the effect of being present at your operation.
Benefits of general anesthesia:
- no pain and no fear;
- less risk of bleeding;
- the doctor acts more carefully, the patient does not distract him or twitch.
Flaws:
- risk of aspiration of stomach contents;
- difficult recovery from anesthesia;
- toxic effect of narcotic drugs.
Classic adenoid surgery
Classic or standard adenotomy is performed usingspecial tool - Beckman's adenotome. The patient sits, opens his mouth wide, and the adenotome is inserted into the oral cavity. The surgeon must cover all the adenoids with the adenoid ring and then excise them with a single movement. They are then removed through the mouth. The duration of the intervention is 10 minutes. After removal, the child goes to the ward and can be discharged home on the same day if there are no complications.
The disadvantage of the method is that the surgeon's actions are blind and parts of the lymphoid tissue may remain, which will relapse in the future. Another disadvantage is the persistence of the feeling of pain. Plus method - low price and availability.
Endoscopic Adenotomy
Currently, endoscopic adenotomy is used more often than others. It is distinguished by accuracy, safety, lack of bleeding. Indispensable in the event of relapse. Reviews about her are only positive.
Endoscopic adenotomy is very effective when the adenoids, as it were, creep along the wall of the larynx, do not grow into the lumen. These adenoids block the auditory tube, the permanent dysfunction of which causes otitis media and acquired conductive hearing loss.
The course of endoscopic adenotomy is visually controlled 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 general, but children usually tolerate it well.
Endoscopic shaver adenotomy – what is it? This is a variant of endoscopic removal of adenoids.shaver technology. Shaver - a special device - a micro-cutter with a rotating head, placed in a hollow tube. The tip itself is immovable. An endoscopic tube with a micro-camera is inserted through the nasal passage, and the nasopharynx is completely visible to the doctor.
The blade grinds the cut off tissue, which is then sucked out and brought out. There is no risk of excised tissue getting into the windpipe.
Endoscopic adenotomy with a microdebrider through the nose has the advantage that it is less traumatic - he althy tissue is not damaged, there is no bleeding and no relapses either. Scars do not form. This method is by far the best.
Restriction to endoscopic adenotomy using a shaver method (microdebrider) will be only the narrowness of the nasal passages in a child. Then it becomes problematic to insert the tube. The operation is not possible in any clinic due to the high cost of equipment.
Reviews of endoscopic shaver adenotomy are only positive. Most parents believe that the operation, although expensive, is worth it.
Stages of implementation
Endoscopic adenotomy is usually elective. A few days before it, desensitizing agents are preemptively prescribed, vasoconstrictor drops to reduce swelling, to reduce the likelihood of infection. The operation of endoscopic adenotomy in children takes about an hour.
After the procedure is over, the child must be supervised by an adult caregiver in the ward. After about an hour, the child can be given a little drink, in the evening it is allowed to eat. Food must be warmsoft. Discharge is made the next day.
For 2 weeks, the child must be protected from colds, because he becomes vulnerable during this period. Physical activities are limited during the month.
Adenoid removal by laser
Excision is performed with a laser scalpel, under the influence of which the affected tissues are heated and destroyed. This is due to the evaporation of water from the cells.
With this type of intervention, there is no bleeding and infection, because the laser has disinfectant properties. Painlessness and quick recovery can also be noted.
Cons:
- high cost;
- exposure depth is not controlled and he althy tissue may be damaged;
- need special equipment and trained personnel;
- with large growths, the laser is not enough;
- operation takes 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. Tubes are inserted into the oral cavity of a sitting child, which relieve him of the adenoids.
Pros:
- freezing tissues and blood vessels removes any pain;
- bloodlessness;
- briefness of the procedure - 2-3 seconds;
- quick checkout.
Cons - high cost and applicability only for small adenoids.
Radio wave method
Radio wave endoscopic adenotomy is performed by the "Surgitron" apparatus. He has a nozzlethat 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 a minimally invasive one, is the high qualification of the surgeon.
Post-operative period
Endoscopic adenotomy in children requires bed rest on the first day. After a few days, walks are possible, kindergarten or school is allowed at least after 2 weeks.
The temperature may rise slightly on the first day. It is necessary to give the child Paracetamol or Ibuklin, but not Aspirin.
2-3 days nasal congestion and soreness in the nasopharynx due to swelling and trauma may occur. Treatment is not required, everything passes by itself. Within 1, 5 months the diet has to be observed. Physical activities are excluded for a month.
Personal hygiene: daily brushing your teeth 2 times a day, rinsing your mouth and throat with an antiseptic solution after meals. You can swim only after 2 weeks.
The 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) may be bleeding, secondary infection, acute otitis media, recurrence of adenoiditis. To exclude such phenomena, the doctor will prescribe antibiotic therapy.
Reviews
Reviews about endoscopic adenotomy are extremely enthusiastic:
- new technologies against old barbaric methods;
- endoscope made available;
- became better at studying and breathing calmly;
- the benefit is undeniable.
Another problem may be hearing loss with adenoids, which can lead to otitis media. Then it is necessary to carry out an adenotomy with tympanopuncture (puncture of the eardrum to restore hearing).
Reviews of endoscopic adenotomy with tympanopuncture of both ears speak of the complexity of the condition, lengthy preparation, but good results. The only downside is finding the right clinic.
