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Alaskarov E. Comparison of classical, coblation, and combined adenoidectomy techniques in paediatric patients: a single-blind, prospective study. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08617-w. [PMID: 38581574 DOI: 10.1007/s00405-024-08617-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/11/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND AND OBJECTIVES Adenoidectomy is one of the most commonly performed surgeries in pediatric otolaryngological practice. This prospective study compared three different adenoidectomy techniques' intra-operative and postoperative outcomes in pediatric patients. The techniques evaluated were classical (blind curettage), coblation, and a combined approach. MATERIALS AND METHODS Ninety pediatric patients undergoing adenoidectomy were enrolled in the study. The patients were divided into three groups based on the technique used: Group A, classical adenoidectomy (blind curettage); Group B, coblation adenoidectomy and Group C, combined (blind curettage + coblation) adenoidectomy. The intra-operative time, degree of bleeding, and complications during and after the operations were recorded. RESULTS Group A had a significantly shorter operative time than the other groups. However, there was no significant difference in the mean operative time between Groups B and C. The mean amount of intra-operative bleeding differed significantly among the groups. Group B had significantly less bleeding than Group A or Group C. The amount of bleeding also differed significantly between Groups A and C. The postoperative pain scores did not differ significantly among the groups. While complications were infrequent in all groups, Group C did not exhibit a higher complication rate than Groups A and B. The absence of residual or recurrent adenoid tissue in any of the groups during long-term follow-up examinations highlights the effectiveness of all three adenoidectomy techniques in preventing adenoid regrowth. CONCLUSIONS The combined approach, which was one of the techniques studied, demonstrated an intermediate profile in terms of operative time and intra-operative bleeding compared to the classical and coblation techniques. These findings suggest that this combined approach may be a feasible option for adenoidectomy in pediatric patients, considering its similar low incidence of postoperative complications.
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Affiliation(s)
- Elvin Alaskarov
- Department of Otorhinolaryngology, İstanbul Medipol University Health Care Practice and Research Center Esenler Hospital, Istanbul, Turkey.
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Malas M, Althobaiti AA, Sindi A, Bukhari AF, Zawawi F. Comparison of the efficacy and safety of conventional curettage adenoidectomy with those of other adenoidectomy surgical techniques: a systematic review and network meta-analysis. J Otolaryngol Head Neck Surg 2023; 52:21. [PMID: 36870974 PMCID: PMC9985239 DOI: 10.1186/s40463-023-00634-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
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.
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Affiliation(s)
- Moayyad Malas
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, 21589, Jeddah, Saudi Arabia.,Department of Surgery - Section of Otolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Awwadh A Althobaiti
- Department of Surgery - Section of Otolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Abdullah Sindi
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, 21589, Jeddah, Saudi Arabia
| | - Afnan F Bukhari
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, 21589, Jeddah, Saudi Arabia
| | - Faisal Zawawi
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, 21589, Jeddah, Saudi Arabia.
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Sun YL, Yuan B, Kong F. Comparison Between Different Approaches Applied in Pediatric Adenoidectomy: A Network Meta-Analysis. Ann Otol Rhinol Laryngol 2023; 132:207-216. [PMID: 35227080 DOI: 10.1177/00034894221081612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Adenoidectomy is a surgical procedure most frequently performed by otolaryngologists. However, there are no universally accepted guidelines for the choice of the surgical approach in specific circumstances. Therefore, a network meta-analysis (NMA) is needed to summarize existing studies and provide more evidence-based medical guidelines. METHODS A systematic search of the literature was conducted in the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases from inception to 31 July 2021. A network meta-analysis of operating time, intraoperative blood loss, postoperative pain score, and incidence of postoperative residual tissue was performed. RESULTS A total of 20 studies with 2329 patients were included. Four common surgical approaches, including powered vacuum shaver adenoidectomy (PVSA), plasma field ablation adenoidectomy (PFAA), curettage adenoidectomy (CUA), and suction diathermy adenoidectomy (SDA), were compared for operative time, intraoperative blood loss, postoperative pain score, and incidence of postoperative residual tissue. There were no significant differences between the surgical techniques for the 3 endpoints, operative time, intraoperative blood loss, and incidence of postoperative residual tissue. The data showed lower postoperative pain scores for PFAA than for CUA (MD = -3.45, 95% CI [-6.01, -0.95]). There were no significant differences in other surgical approaches for postoperative pain scores. CONCLUSION There were no significant differences between PVSA, PFAA, CUA, and SDA for operative time, intraoperative blood loss, and incidence of postoperative residual tissue. PFAA had advantages over CUA for postoperative pain scores.
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Affiliation(s)
- Ya-Lei Sun
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Bin Yuan
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Fei Kong
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Shkorbotun YV, Liakh KV. MODERN APPROACHES TO CHOOSING SHAVER BLADE FOR ENDOSCOPIC SURGERY OF THE NASOPHARYNX AND PARANASAL SINUSES USING 3D MODELING. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2646-2651. [PMID: 36591748 DOI: 10.36740/wlek202211117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim: To determine the effectiveness of the use of 3D printed templates of shaver blades for choosing the optimal blade shape for endoscopic surgery of the nasopharynx and paranasal sinuses. PATIENTS AND METHODS Materials and methods: The shaver blade templates with bending angles of 40º, 60º, 90º and 120° for powered endoscopic sinus surgery were made according to the manufacturer catalog using the Asiga 3D printer and Dental TOOTH material. There were examined 100 patients who underwent endoscopic powered sinus interventions (50 - adenoidectomy, and 50 - removal of the maxillary sinus cysts). The patients with each type of intervention were divided into subgroups of 25 people. The subgroups differed by the approach to choosing shaver blades: using 3D templates - in the main subgroup, and traditional -in the control. RESULTS Results: The average number of shaver blades used for adenotomy in patients of the main group was 1.04±0.04, and in the control group - 1.36±0.09 (p<0.05). In patients of both subgroups, the 40º shaver blade, which is standard for adenotomy and recommended by most manufacturers, was most often used. In the control subgroup, it was used significantly more often. The frequency of the use of other shaver blades - 60º and 90º in both subgroups did not differ significantly and amounted to 40.0% (CI 95% 21.8; 61.1) and 36.0% (CI 95% 18.7; 57.4). CONCLUSION Conclusions: The use of 3D templates for choosing a shaver blade reduces the number of blades used in adenoidectomy by 23.5%, for maxillary sinus cysts operation - by 18.2%.
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Affiliation(s)
- Yaroslav V Shkorbotun
- STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE» STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE; SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE
| | - Kateryna V Liakh
- STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE» STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE; SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE
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Liakh K, Shkorbotun Y. ANATOMICAL RATIONALE FOR CHOOSING A BLADE FOR POWER-ASSISTED ADENOIDECTOMY IN CHILDREN DEPENDING ON DENTITION. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2070-2075. [PMID: 36256930 DOI: 10.36740/wlek202209104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The aim: To study the anatomic features of the facial skull structures in children of various ages depending on dentition. PATIENTS AND METHODS Materials and methods: One hundred and forty-four children aged 2-12 years were divided into 4 groups depending on dentition. They underwent anthropometric measure¬ments during adenoidectomy. Based on the cosine theorem, the calculated values were obtained. RESULTS Results: The distance from choana to the free edge of the retracted soft palate gradually increases from 2.01±0.61 cm in children with stable primary dentition up to 3.09±1.02 cm with mixed dentition. Palato-nasopharyngeal angle in children with stable primary dentition is 126.25±8.76°, in children with aging primary dentition - 132.81±12.21°, and in children with mixed dentition - 120.54±13.72°. CONCLUSION Conclusions: The optimal configuration of the blade for power-assisted adenoidectomy in children with stable primary dentition has an angle of 53.53±8.76°, and the length of the working part of 2.01±0.61 cm, in children with aging primary dentition - 47.18±12.21° and 2.10±0.71 cm, with mixed dentition - 59.45±13.72° and 3.09±1.02 cm, respectively.
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Affiliation(s)
- Kateryna Liakh
- STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE», KYIV, UKRAINE; NATIONAL UNIVERSITY OF HELTHCARE NAMED AFTER P. L. SHUPYK, KYIV, UKRAINE
| | - Yaroslav Shkorbotun
- STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE», KYIV, UKRAINE
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Tulaci KG, Arslan E, Tulaci T, Dinek A, Yazici H. Comparison of transnasal and transoral routes of microdebrider combined curettage adenoidectomy and assessment of endoscopy for residue: a randomized prospective study. Eur Arch Otorhinolaryngol 2020; 278:797-805. [PMID: 32989492 DOI: 10.1007/s00405-020-06385-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study is to investigate the frequency and locations of residual adenoid tissue in conventional curettage adenoidectomy (CA) via transnasal endoscopic examination at the end of the operation and to determine the most appropriate technique for residual adenoid tissue removal by transoral or transnasal microdebrider usage. METHODS Sixty-three patients aged 4-12 years who were scheduled for CA were included in this randomized prospective study in a tertiary reference center. Patients who underwent CA had the endoscopic residual tissue exploration at the end of surgery. The amount and locations of residual tissue were recorded. Patients with > 20% residual tissue were divided into two groups according to randomization list for removing the residual tissue, depending on the use of transoral microdebrider (TOMD) and transnasal microdebrider (TNMD). Two procedures were compared in terms of duration, bleeding, pain, post-anesthesia care unit (PACU) transfer time, and complications. RESULTS Residual tissue was detected in 38 patients (60.2%). The most common location of residual tissue was peritubal area (41.3%). The TOMD group had lower surgical duration, blood loss, pain scores and shorter PACU transfer time (p = 0.001, p = 0.002, p˂0.001, and p = 0.006, respectively). CONCLUSION Endoscopic exploration at the end of CA should be considered to avoid residual tissue retention. Furthermore, if residual tissue is present, the use of TOMD is easier, faster, and associated with lower morbidity than the use of TNMD.
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Affiliation(s)
- Kamil Gokce Tulaci
- Departments of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Balikesir University Health Practice and Research Hospital, 10440, Cagis, Balikesir, Turkey.
| | - Erhan Arslan
- Departments of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Balikesir University Health Practice and Research Hospital, 10440, Cagis, Balikesir, Turkey
| | - Tugba Tulaci
- Departments of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Balikesir University Health Practice and Research Hospital, 10440, Cagis, Balikesir, Turkey
| | - Aziz Dinek
- Departments of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Balikesir University Health Practice and Research Hospital, 10440, Cagis, Balikesir, Turkey
| | - Hasmet Yazici
- Departments of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Balikesir University Health Practice and Research Hospital, 10440, Cagis, Balikesir, Turkey
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Comparison of Endoscope-Assisted Coblation Adenoidectomy to Conventional Curettage Adenoidectomy in Terms of Postoperative Eustachian Tube Function. J Craniofac Surg 2019; 31:919-923. [PMID: 31764564 DOI: 10.1097/scs.0000000000006039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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