Safety of electronic molecular resonance adenoidectomy

A Comparative Study of Endoscopic Assisted Powered Adenoidectomy Versus Conventional Adenoidectomy

Adenoidectomy is one of the most common procedures performed in children today, either alone or in conjunction with tonsillectomy or insertion of ventilating tubes. The present study was planned to compare the endoscopic powered adenoidectomy versus conventional adenoidectomy. The present prospective observational randomized study was carried out in the Department of Otorhinolaryngology of a tertiary care teaching hospital of Rajasthan. Fifty patients with adenoid hypertrophy in the age group between 5-13 years were enrolled in the study and divided in to two groups viz. cases undergoing conventional adenoidectomy using curettage method (group A = 25) and cases undergoing endoscopic powered adenoidectomy (group B = 25). Intra operative time, primary bleeding, completeness of adenoid removal, depth of resection, and collateral damage were noted intra operatively in both the groups. Postoperative pain, recovery time, postoperative complications were also compared. Intra operative time taken in Group A was 25.6 ± 2.90 min while it was 35.04 ± 5.24 min in Group B. (p < 0.0001) Average blood loss in Group A was 18.4 ± 4.72 ml compared to an average blood loss of 29.32 ± 2.59 ml in Group B. (p < 0.0001) The postoperative recovery time in Group A was 4.93 days and it was 3.06 days in group B. (p = 0.00). The present study concluded that newer method of endoscopic powered adenoidectomy was found to be a safe and useful tool for adenoidectomy in terms of completeness of resection, better control of depth of resection and minimal collateral damage intra-operatively and less postoperative pain, complications and fast recovery period.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03633-4.

Comparison of the efficacy and safety of conventional curettage adenoidectomy with those of other adenoidectomy surgical techniques: a systematic review and network meta-analysis

OBJECTIVES

There is a lack of robust evidence in regards to whether the intra and post-operative safety and efficacy of conventional curettage adenoidectomy is better than those of other available surgical techniques. Therefore, this study was conducted as a systematic review and network meta-analysis of published randomized controlled trials (RCTs) with the aim of comparing the safety and efficacy of conventional curettage adenoidectomy with all other available adenoidectomy techniques.

MATERIALS AND METHODS

A systematic search of published articles was performed in 2021 using databases such as PubMed/Medline, EMBASE, EBSCO, and the Cochrane Library. All RCTs that compared conventional curettage adenoidectomy with other surgical techniques and were published in English between 1965 and 2021 were included. The quality of the included RCTs have been assessed using Cochrane Collaboration Risk of Bias Tool.

RESULTS

After screening 1494 articles, 17 were identified for comparing several adenoidectomy techniques and were eligible for quantitative analysis. Of those, 9 RCTs were analyzed for intraoperative blood loss, and 6 articles were included for post-operative bleeding. Furthermore; 14, 10, and 7 studies were included for surgical time, residual adenoid tissue, and postoperative complications respectively. Endoscopic-assisted microdebrider adenoidectomy yielded a statistically significantly greater estimate of intraoperative blood loss compared with conventional curettage adenoidectomy (mean difference [MD], 92.7; 95% confidence interval [CI] 28.3-157.1), suction diathermy (MD, 117.1; 95% CI 37.2-197.1). Suction diathermy had the highest cumulative probability of being the preferred technique because it was estimated to result in the least intraoperative blood loss. Electronic molecular resonance adenoidectomy was estimated to be more likely to result in the shortest surgical time (mean rank, 2.2). Participants in the intervention group were 97% less likely to have residual adenoid tissue than children in the conventional curettage group (odds ratio 0.03; 95% CI 0.01-0.15); therefore, conventional curettage was not considered an appropriate technique for complete removal of adenoid tissue.

CONCLUSION

There is no single technique that can be considered best for all possible outcomes. Therefore, otolaryngologists should make an appropriate choice after critically reviewing the clinical characteristics of children requiring adenoidectomy. Findings of this systematic review and meta-analysis may guide otolaryngologists when making evidence-based decisions regarding the treatment of enlarged and symptomatic adenoids in children.

Comparison of Conventional Curettage Adenoidectomy Versus Endoscopic Powered Adenoidectomy: A Randomised Single-Blind Study

Globally adenoidectomy is increasingly being performed in isolation for children who have middle ear effusion or chronic otitis media, chronic rhinosinusitis and nasopharyngeal obstruction causing sleep apnoea and mouth breathing. Several techniques have been described lately including endoscopic powered adenoidectomy with debrider. The present study was undertaken to compare the effectiveness of endoscopic powered adenoidectomy (EA) with respect to conventional adenoidectomy (CA). It is a prospective study of 60 patients requiring adenoidectomy consisting of 33 males and 27 females randomized into group A with 30 patients undergoing conventional adenoidectomy with curette and 30 patients undergoing endoscopic powered adenoidectomy with micro-debrider. The demographic data (age, sex, adenoid hypertrophy grade assessed by Clemens and Mcmurray scale) in both groups were not statistically significant (p > 0.05). However, significant differences were observed in mean operative time of both groups (CA-29.12 ± 6.70, EA-37.80 ± 6.90 min, p < 0.05). The intra-operative blood volume loss was 21.30 ± 5.80 ml, 28.24 ± 6.93 ml in CA and EA respectively. No significant difference was seen in post-operative pain assessed by Visual Analogue Scale (VAS) (p-0.39). Complete removal of adenoids was seen in 83.3% cases with EA versus 53.3% with CA (p < 0.05). The residual adenoids noted after the CA and EA in Grade I was 23.3% and 13.3% respectively while in CA, grade II with 16.7% and grade III with 6.7% cases had residual adenoids. Injury to surrounding structure was seen in 16.7% and 10% of CA and EA respectively. However, no difference in complication rate was observed between the study groups (p > 0.05). We conclude that endoscopic powered adenoidectomy is more complete, accurate, with less post-operative pain and lower incidence of recurrence in comparison with conventional adenoidectomy.

Safety Parameters of Quantum Molecular Resonance Devices During Thyroid Surgery: Porcine Model Using Continuous Neuromonitoring

OBJECTIVES

Quantum molecular resonance (QMR) devices have been applied as energy-based devices in many head and neck surgeries; however, research on their use in thyroid surgery is lacking. This study aimed to investigate the safety parameters of QMR devices during thyroidectomy when dissection was adjacent to the recurrent laryngeal nerve (RLN).

METHODS

This study included eight piglets with 16 RLNs, and real-time electromyography (EMG) signals were obtained from continuous intraoperative neuromonitoring (C-IONM). QMR bipolar scissor (BS) and monopolar unit (MU) were tested for safety parameters. In the activation study, QMR devices were activated at varying distances from the RLN. In the cooling study, QMR devices were cooled for varying time intervals, with or without muscle touch maneuver (MTM) before contacting with the RLN.

RESULTS

In the activation study, no adverse EMG change occurred when QMR BS and MU were activated at distances of 2 mm or longer from the RLNs. In the cooling study, no adverse EMG change occurred when QMR BS and MU were cooled in 2-second intervals or immediately after MTM.

CONCLUSION

QMR devices should be carefully used when performing RLN dissection during thyroid surgery. According to the activation and cooling safety parameters in this study, surgeons can avoid RLN injury by following standard procedures when using QMR devices.

Evaluation of endoscopic assisted suction coagulation adenoidectomy versus traditional curettage technique

Background

Adenoidal hypertrophy is a common condition in children and can cause symptoms such as mouth breathing, nasal discharge, snoring, sleep apnea, and hyponasal speech. The curettage adenoidectomy has some disadvantages, especially the intranasal extension of the adenoid tissue that makes this technique inadequate. This study is conducted to evaluate and compare between assisted suction coagulation adenoidectomy and traditional curettage techniques.

Results

One hundred twenty-two patients with symptomatic adenoid hypertrophy such as nasal obstruction, snoring, and mouth breathing were included in our study. Patients underwent adenoidectomy either traditional curettage adenoidectomy (60 patients as group A) or endoscopic assisted suction coagulation adenoidectomy (62 patients as group B). Patients were scheduled for follow-up visits with respect to operative time, operative and postoperative complications. The mean age of groups A and B were 6.57+2.8 and 7+2.8 ranging from 3 to12 years. There was a statistically significant difference between groups as regard intraoperative blood loss, trauma, postoperative complications as neck stiffness and bad odor plus postoperative endoscopic and radiological grading after the operation.

Conclusions

Suction coagulation diathermy adenoidectomy is alternative to cold adenoidectomy with significantly fewer intraoperative complications such as blood loss and trauma of prevertebral muscle plus post-operative complications such as primary or secondary bleeding and rhinolalia aperta.

Hemostatic Control with Gelatin Sponge and Quantum Molecular Resonance Coagulation in a Case of Glomus Tympanicum

Surgical removal of tumor is the primary treatment of choice for glomus tympanicum (GT). However, because the tumor has abundant blood flow, bleeding control is crucial, and preoperative embolization may be performed. Here, we report the case of a 46-year-old female who visited our hospital with a complaint of right pulsatile tinnitus. A red pulsatile mass was found in the right tympanic cavity, and she was diagnosed with class B1 GT and subsequently underwent surgical treatment. We judged that bleeding could be controlled by intratympanic cavity manipulation alone and decided to perform transmeatal tumor resection without preoperative arterial embolization. After creating a tympanomeatal flap and performing an atticotomy, some pieces of Spongel^® were inserted between the tumor and the tympanic wall. The Spongel^® absorbed the blood and created a space between the tumor and tympanic wall, which allowed for the insertion of the tip of the Vesalius^® handpiece to coagulate the tumor. The coagulation caused the tumor to shrink, thereby widening the space and allowing for further resection. Although the surgical manipulation caused bleeding, complete resection was achieved by the application of Spongel^® and coagulation with Vesalius^®. Since the tip of the Vesalius^® was not burned, hemostasis was successfully achieved, and the operation proceeded while maintaining a clear field of view. There was little bleeding and no postoperative complications. The patient was discharged on the sixth postoperative day. One year after surgery, pure tone audiometry showed no change in the level of bone conduction. Spongel^® and Vesalius^® are useful tools that allow to safely perform surgeries even in narrow spaces such as the tympanic cavity.

Comparison of Endoscope-Assisted Coblation Adenoidectomy to Conventional Curettage Adenoidectomy in Terms of Postoperative Eustachian Tube Function

INTRODUCTION

Adenoidectomy is one of the most common surgical procedures performed in children in otorhinolaryngology practice. This study aims to compare the conventional curettage adenoidectomy (CCA) and the endoscope-assisted coblation adenoidectomy (EACA) in terms of the postoperative Eustachian tube function and the surgical outcomes.

METHODS

A prospective, randomized, controlled study was carried out at a tertiary referral center and private hospital. Seventy-two adenoid hypertrophy patients without middle ear disease were randomly assigned to 2 groups to be operated via CCA and EACA techniques prior to surgery. Parameters including middle ear pressure values (MEPV), operative time, intraoperative hemorrhage, postoperative residual adenoid tissue, and postoperative pain were compared between groups.

RESULTS

In the CCA group for both ears, there was a statistically significant difference between preoperative mean MEPV and mean MEPV of postoperative day 1, while MEPV returned to normal ranges at the postoperative day 7. No statistically significant differences were observed in mean MEPV on preoperatively and 1st and 7th postoperative days in the EACA group for both right and left ears. Mean operative time was significantly higher in the EACA group compared to the CCA group (P < 0.001). Eight (22.2%) out of 36 patients who underwent CCA had a residual adenoid tissue postoperatively, while there was no residual adenoid tissue in any patients who operated via the EACA technique. Mean pain score on postoperative day 1 and 2 and blood loss were significantly less in the EACA group than the CCA group.

CONCLUSION

Endoscope-assisted coblation adenoidectomy may serve a reasonable alternative to conventional curettage adenoidectomy because it provides Eustachian tube functions preserved, decreased intraoperative hemorrhage, complete resection of the adenoid tissue, and lower pain score.

Comparative analysis of conventional cold curettage versus endoscopic assisted coblation adenoidectomy

Objective

To compare conventional cold curettage adenoidectomy with endoscopic assisted coblation adenoidectomy in terms of operative time, primary blood loss, post-operative residual tissue and post-operative pain.

Methods

This prospective non-randomised study was carried out on 60 patients aged 5–12 years. One group underwent conventional cold curettage adenoidectomy and the other underwent endoscopic assisted coblation adenoidectomy, with 30 patients per group.

Results

Mean operation duration was significantly higher for endoscopic assisted coblation adenoidectomy. Mean blood loss was 44.33 ml in conventional cold curettage adenoidectomy and 32.47 ml in endoscopic assisted coblation adenoidectomy. The pain grade was significantly lower in endoscopic assisted coblation adenoidectomy. Forty per cent of patients who underwent conventional cold curettage adenoidectomy had adenoid tissue post-surgery, while it was completely absent in endoscopic assisted coblation adenoidectomy patients.

Conclusion

Coblation adenoidectomy has significant advantages over conventional adenoidectomy in terms of reduced blood loss, no post-operative residual tissue and lower pain grade on day 1 after surgery.

Endoscopic assisted adenoidectomy versus conventional curettage adenoidectomy: a meta-analysis of randomized controlled trials

Adenoidectomy, surgical removal of hypertrophic adenoids, is a common operation in children worldwide. The purpose of this study was to compare the operative effectiveness, and included total operative time, blood loss and complications, between endoscopic assisted adenoidectomy and conventional curettage adenoidectomy. EMBASE, PubMed, Cochrane Library, and China National Knowledge Infrastructure and symposiums and review articles were used to choose relevant randomized controlled trials. A meta-analysis was performed to analyze the data for total operative time, blood loss and complications. Seven studies fit the inclusion criteria, and included 331 patients treated with endoscopic assisted adenoidectomy, and 251 patients treated with conventional curettage adenoidectomy. The meta-analysis demonstrated that compared with conventional curettage adenoidectomy, endoscopic assisted adenoidectomy had a shorter operative time (SMD −1.09; 95 % CI −1.29 to −0.90; p < 0.00001), less blood loss (MD −19.74; 95 % CI −22.75 to −16.73; p < 0.00001), and fewer complications (OR 0.15; 95 % CI 0.07–0.35; p < 0.0001). Endoscopic assisted adenoidectomy has advantages over conventional curettage adenoidectomy with regard to total operative time, blood loss and complications.

Molecular resonance tonsillectomy in children: comparative study over standard techniques in an 11-year study

OBJECTIVES

Learn the molecular resonance (MR) technology for tonsillectomy. An analysis of outcomes of MR compared to standard cold-knife (CK) and monopolar cautery (MPC) for pediatric tonsillectomy offers new possibilities, lowering postoperative morbidity.

STUDY DESIGN

Eleven-year, prospective, randomized, 3-group trial.

SETTING

Tertiary care pediatric institution.

SUBJECTS AND METHODS

Eight hundred and seventy-three children undergoing adenotonsillectomy were randomly assigned to MR (n = 283), CK (n = 279), or MPC (n = 279) techniques. Outcome measures included intraoperative time, blood loss, postoperative pain, weight loss, and histopathologic examination on excised tonsils.

RESULTS

Histopathologic evaluation revealed reduced thermal injury with MR over MPC (43 µm vs 186, P < .001), statistically associated with reduced muscular, blood vessel, and nerve fiber damage compared to CK (P < .001). Blood loss was minimal in MR. Significant reduced pain scores were related to MR (P < .002). Two MR, 15 CK, and 12 MPC patients experienced delayed bleeding.

CONCLUSION

MR for pediatric tonsillectomy resulted in reduced histopathologic thermal injury, lower pain scores, and reduced postoperative morbidity compared with CK and MPC techniques in an 11-year study.

[S1 Clinical guideline"adenoids and adenoidectomy"]

On behalf of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery, a clinical guideline for adenoids and adenoidectomy was developed in 5 consensus meetings after taking into consideration the current literature. This guideline was released by the presidium on 13 April 2011. Anatomy, pathology and pathophysiology, symptoms, diagnosis, therapy, and course are presented.

Comparison of post-tonsillectomy pain with two different types of bipolar forceps: low temperature quantum molecular resonance device versus high temperature conventional electrocautery

CONCLUSION

The low temperature device did not show any advantages over the conventional high temperature electrocautery in terms of the postoperative pain, operation time, and complications in pediatric tonsillectomy.

OBJECTIVE

To compare post-tonsillectomy pain following the use of two different instruments with the same bipolar forceps techniques: low temperature quantum molecular resonance (QMR) device versus conventional high temperature electrocautery.

METHODS

Pediatric patients admitted from July 2008 through January 2009 were included. The participants underwent bilateral tonsillectomy; one side by the QMR device and the other by the bipolar electrocautery. The sides for each instrument were counterbalanced by the order of presentation. The postoperative pain was measured using the faces pain rating scale.

RESULTS

In all, 33 patients with a mean age of 7.6 years were enrolled. The postoperative pain, operation time, and complications in 33 sides dissected by the electrocautery and 33 sides by the QMR device were compared. The average operation times with each device were not statistically different. The mean ratings of the perception of pain related to each instrument were not different on operation day and postoperative day 1, day 4, and day 7 (p = 0.133, 0.057, 0.625, and 1.0, respectively). There was no postoperative complication in any of the patients.

Tonsillectomy in children: a five-factor analysis among three techniques--reporting upon clinical results, anesthesia time, surgery time, bleeding, and cost

OBJECTIVES

Improved technology claims better clinical results for adenotonsillectomy (T&A) in children, and promoters of each technique announce many virtues over one another, year after year. However, cost remains one variable that is not always thoroughly addressed. In this study, monopolar cautery (MPC) T&A was compared with coblation (CAT) and molecular resonance (MR) techniques in a pediatric population.

STUDY DESIGN

Prospective analysis of 96 patients (32 for each surgical modality: MPC, MR, or CAT).

SETTING

Tertiary care pediatric institution.

SUBJECTS AND METHODS

Clinical results, anesthesia and surgery time, bleeding, and cost among these three established techniques were compared. P-values of P < .05 were considered significant for all comparisons.

RESULTS

The CAT and MPC had similar operative times (mean 19.2 and 21.1 minutes, respectively, P = NS), whereas the MR group had overall saving of 7.8 minutes in surgery (P < .05). In terms of cost of technology, the cost of the MPC and MR groups was 90.6% and 83.7% less than the CAT group, respectively.

CONCLUSIONS

This study demonstrated that MR technique of T&A enabled the surgical team to save a significant amount of time, whereas CAT added substantial costs, compared to MR and standard cautery techniques.

Endoscopic adenoidectomy with microdebrider

To describe endoscopic power assisted adenoidectomy and review the experience with the procedure demonstrating its safety and efficacy. Prospective study of 44 patients aged between 7 to 15 years undergoing power assisted adenoidectomy between Jan 2004 and July 2006. Tertiary care private teaching hospital. Forty four consecutive children with adenoid hypertrophy undergoing power assisted adenoidectomy. Therapeutic endoscopic adenoidectomy using microdebrider. Operative time, blood loss, complications, completeness and depth of removal, surgeon's satisfaction and recovery period. The average operative time was 12 min (range: 8-16 min) and average blood loss was 30 ml (range: 24-42 ml). Complete resection was possible under vision with few complications. The surgeon satisfaction was high and post-operative recovery good. Power assisted adenoidectomy is quick, precise and safe. There is good visualization during resection thus improving precision and ensuring complete removal of adenoid tissue.

TriVerse versus molecular resonance–harvested grafts in single-stage Baha surgery

Objectives: To assess complications occurring in patients with a bone-anchored cochlear stimulator (Baha) following split-thickness skin graft harvested with two surgical modalities: the TriVerse (TV) system and the molecular resonance generator (MR).

Study Design: Prospective, randomized, two-group (TV and MR) study of 24 patients who underwent Baha surgery.

Setting: Tertiary care institution.

Subjects and Methods: All patients (5 children, age range 6-14 yrs, median 8.3 yrs, and 16 adults, age range 30-73 yrs, median 60 yrs) underwent the one-stage procedure. The skin flap was harvested by use of the TV in 12 cases (2 children, 10 adults) and the MR generator in 12 (3 children, 9 adults). The main outcome measures were wound healing time, number of follow-up visits, degree of soft tissue reactions around the abutment, and need for revision surgery were examined.

Results: There was a clear difference between the TV- and MR-harvested skin graft groups in relation to severity of skin reactions and complete healing time. The TV group required from three to seven (median 4) visits as outpatients during the initial observation period until healing was complete. The MR group required only one to three (median 2) visits. Complete healing time was significantly lower in the MR group (range 7-12 days, median 10 days) compared to the TV group (range 15-28 days, median 16 days). In the TV group, two patients required in-office revision of the skin graft because of partial necrosis.

Conclusions: In our experience, the MR-harvested split-thickness skin graft is superior to the TV technique.

Molecular resonance vs. coblation tonsillectomy in children

BACKGROUND

Quantum molecular resonance coagulation is an innovative technology that uses molecular resonance to cut and coagulate precisely, cleanly, and hemostatically at low tissue temperature levels. This technology offers a new possibility for tonsillectomy.

OBJECTIVES

To compare molecular resonance (MRT) with coblation (CAT) devices for pediatric tonsillectomy.

STUDY DESIGN

Prospective, two-group, randomized trial in a tertiary care pediatric institution. One hundred fifty-seven children for whom tonsillectomy was indicated were randomly assigned to receive MRT (n = 79) or CAT (n = 78). Main outcome measures included intraoperative time, blood loss, postoperative pain, and weight loss. Histopathologic examination was performed on all excised tonsils. Patients, parents, and pathologist were blinded to surgical modality.

RESULTS

Histopathologic evaluation revealed significantly reduced thermal injury with MRT than with CAT (43 microns vs. 126, respectively, P < .001), and was statistically associated with reduced muscular, blood vessel, and nerve fiber damage. No intraoperative blood loss was observed in patients following MRT. Statistically significant reduced pain scores were related to the MRT (P < .002). In addition, the MRT method showed a quick return to normal diet with even weight gain during the 10-day postoperative period. One child in the CAT group experienced delayed bleeding and required readmission.

CONCLUSIONS

Molecular resonance for pediatric tonsillectomy resulted in significantly reduced histopathologic thermal injury and lower pain scores compared with coblation. Further studies are advised to support these data.

Blunt dissection versus electronic molecular resonance bipolar dissection for tonsillectomy: operative time and intraoperative and postoperative bleeding and pain

OBJECTIVE

To compare operative time, intraoperative and postoperative bleeding and pain using two different techniques for tonsillectomy: electronic molecular resonance bipolar tonsillectomy and blunt dissection tonsillectomy.

METHODS

From January 2005 to December 2006, a prospective, randomised study was performed in 800 children, aged from 3 to 10 years, admitted to the ENT (Ear Nose Throat) Unit of Giannina Gaslini Institute, Genoa, Italy to undergo tonsillectomy. Patients were randomised into two surgical groups, Group A (electronic molecular resonance tonsillectomy, EMRBT) and Group B (blunt dissection tonsillectomy). Operative time, intraoperative blood loss and postoperative complications were recorded. During 10 days after surgery, children and their parents were also asked to provide a rating of the patients' current pain intensity using a visual analogue scale. In this period, the parents were also asked to note the analgesic drugs administered.

RESULTS

Duration of surgery and blood loss were significantly much lower in the group undergoing electronic molecular resonance bipolar tonsillectomy (p<0.0001). Postoperative pain scores resulted significantly different between the two methods on days 5 (p=0.05) and 8 (p=0.001) in evaluations by mothers. Moreover, in evaluations by patients pain scores resulted significantly different between the two methods on days 3 (p=0.02), 8 (p=0.005) and 9 (p=0.01). We found no difference between boys and girls in pain scores in the 10 days considered, nor between children older than 5 yrs and children younger than or aged 5 years. No statistically significant differences between the two techniques were found in the use of analgesics in all postoperative evaluations.

CONCLUSIONS

This study showed that the use of electronic molecular resonance bipolar tonsillectomy, compared to blunt dissection, has several advantages. Reduced operative time and intraoperative bleeding make EMRBT more cost effective and allow an increased number of operations. Concerning postoperative pain, the two techniques did not present significant differences in the use of analgesics. The number of postoperative bleeding episodes was also similar in the two groups of patients.

Prospective, randomized, single-blind, controlled study to compare two methods of performing adenoidectomy

OBJECTIVE

To compare adenoidectomy using suction-diathermy ablation to curettage adenoidectomy with respect to operative time and adenoid regrowth at 6 months after surgery.

STUDY DESIGN

A prospective, randomized, single-blind, study to compare two methods of performing adenoidectomy. A group of 100 children, undergoing adenoidectomy alone or in combination with tonsillectomy, were randomized into two groups and underwent either suction diathermy or curettage adenoidectomy by a single surgeon.

SETTING

A tertiary care Paediatric Hospital.

METHOD

Indication for surgery, adenoidal size, duration of surgery and complications were recorded and compared. Six-month follow-up was conducted and adenoidal size and symptom status were recorded and compared. Statistical analysis was performed using Microsoft Excel.

RESULTS

One hundred patients participated in this study and underwent adenoidectomy alone or adenotonsillectomy. Ninety-two patients returned for follow-up and 91 patients completed the study. The two treatment groups were well matched for age and gender. The main indications for both groups were snoring, nasal obstruction and obstructive sleep apnoea. For adenoidectomy alone there was no significant difference in duration of surgery between the curette and suction diathermy groups. When performing tonsillectomy and adenoidectomy together suction diathermy took significantly longer to complete than curettage (P<0.001). Overall 96% of patients' symptoms had either improved or resolved. The post-operative comparison at 6 months showed a significant difference in the residual adenoidal size between the two groups, the suction diathermy group being generally smaller than the curettage group.

CONCLUSIONS

Suction diathermy was better at reducing the adenoidal size 6 months after surgery. Although the difference in size was statistically significant it did not seem to be of clinical significance.

Incidence of unexpected pathology in routine adenoidectomy specimens

OBJECTIVE

The aim of this study was to determine the incidence of unexpected pathologies in adenoidectomy specimens and necessity for histopathologic evaluation of adenoid tissue.

MATERIALS AND METHODS

All patients younger than 16 years who underwent routine adenoidectomy were reviewed. Patients were excluded if the primary surgery was other than routine adenoidectomy such as nasopharyngeal biopsy for suspicion of malignancy or other pathology.

RESULTS

One thousand one hundred eighty-four patients (683 males, 501 females) were involved in this study. The mean age was 7.53+/-3.24 years, ranging between 2 and 16 years. There was no patient with unexpected pathology among 1184 routine and primary adenoidectomy procedures. However, one patient had unexpected pathology among 33 revision adenoidectomy procedures (3%).

CONCLUSIONS

There was no occult pathology in routine primary adenoidectomy. The incidence of unexpected pathology in revision adenoidectomy was 3%. Microscopic evaluation of adenoid tissue gives some knowledge about histological properties and rarely some unexpected pathologies. Searching for malignancy is unnecessary in routine primary adenoidectomy cases without any other clinical, radiological and laboratory findings.