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Giri O, Shenoy SV, Parvathareddy N, Puvvula P, Shetty D, Reddy N. Assessment of middle ear function after conventional or endoscopic microdebrider assisted adenoidectomy. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:417-423. [PMID: 37814977 PMCID: PMC10773544 DOI: 10.14639/0392-100x-n2593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/05/2023] [Indexed: 10/11/2023]
Abstract
Objectives To compare pre- and post-operative pure tone audiometric and impedance audiometric analysis following conventional and endoscopic microdebrider assisted adenoidectomy and compare the outcomes. Methods Patients diagnosed with chronic adenoiditis were divided in groups of 25 each. Patients in the first group underwent conventional curettage adenoidectomy, while those in second group underwent endoscopic microdebrider assisted adenoidectomy. Pre- and post-operative pure tone and impedance audiometry were performed for all patients and outcomes were compared. Results The endoscopic microdebrider assisted method resulted in significantly better outcomes compared to conventional curettage. Criteria such as hearing threshold (p value 0.004 at second follow-up), peak pressure (p value 0.045 at first follow-up) and tympanogram (p value 0.016) showed that the endoscopic method was better, while peak compliance (p value 0.340 at first follow-up) did not show any significant difference between groups. Conclusions The endoscopic microdebrider assisted method for adenoidectomy has a definite advantage of better visualisation resulting in better clearance of tissue, leading to enhanced middle ear function compared to conventional curettage.
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Affiliation(s)
| | - S Vijendra Shenoy
- Department of ENT and Head & Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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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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Kosakovskyi AL, Liakh KV, Shkorbotun YV. OPTIMIZATION OF POWER-ASSISTED ADENOIDECTOMY IN CHILDREN USING SHAVER TIPS OF VARIOUS MODIFICATION. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:2176-2181. [PMID: 37948711 DOI: 10.36740/wlek202310107] [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: 11/12/2023]
Abstract
OBJECTIVE The aim: To study the efficacy of surgical treatment of patients with adenoid vegetations by implementing a differential method for choosing a tip for endo-scopic power-assisted adenoidectomy in children depending on dentition. PATIENTS AND METHODS Materials and methods: We investigated the presence of nasal air emissions in 127 children (2-12 years old) before and after the operation. We excluded 12 patients due to the presence of nasal air emission before the operation. All patients were divided in 2 groups: I - children with aging primary dentition (55 children), II- children with mixed dentition (60 children). Depending on tips, that were used for the operation, we divided patients into two subgroups: A - 40˚ and B- 60 ˚. RESULTS Results: In 9,4% of patients have the presence of nasal air emissions before the operation. The use of 40˚ tips does not allow removal of lymphoid tissue in "hard-to-reach" areas of the nasopharynx (perichoanal and peritubular sections) in 30% of children with aging primary dentition and 42.9% with mixed dentition. CONCLUSION Conclusions: The use 40˚ tips for the adenoidectomy is accompanied by a higher risk of velopharyngeal insufficiency in children with mixed dentition compared to children who underwent the intervention with a tip with a larger bending angle and a longer working part (60°). In patients with temporary dentition, it is recommended to use a standard tip for adenoidectomy, except when correction of tubal lymphoid tissue is planned (it is necessary to use a tip with a rotating window). In patients with mixed dentition, it is recommended to use a 60° tip.
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Affiliation(s)
| | - Kateryna V Liakh
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE; STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE» STATE ADMINISTRATION DEPARTMENT, KYIV, UKRAINE
| | - Yaroslav V Shkorbotun
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE; STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE» STATE ADMINISTRATION DEPARTMENT, KYIV, UKRAINE
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朱 源, 魏 萍, 寇 巍, 姚 红. [Strategies for preventing postoperative recurrence of adenoid hypertrophy]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:807-812. [PMID: 36217664 PMCID: PMC10128558 DOI: 10.13201/j.issn.2096-7993.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Indexed: 06/16/2023]
Abstract
Adenoid hypertrophy is a common disease in pediatric otorhinolaryngology. Surgical resection is the main treatment at present, but many children still face the risk of postoperative recurrence or even secondary surgery. In order to reduce the postoperative recurrence rate and provide reference information for clinical medical staff and parents of the children, this review was carried out to analyze the domestic and foreign pertinent literature in recent years and put forward overall prevention strategies base on the related factors of recurrence.
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Affiliation(s)
- 源 朱
- 重庆医科大学附属儿童医院耳鼻咽喉头颈外科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病研究教育部重点实验室 儿科学重庆市重点实验室(重庆,400014)Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - 萍 魏
- 重庆医科大学附属儿童医院耳鼻咽喉头颈外科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病研究教育部重点实验室 儿科学重庆市重点实验室(重庆,400014)Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - 巍 寇
- 重庆医科大学附属儿童医院耳鼻咽喉头颈外科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病研究教育部重点实验室 儿科学重庆市重点实验室(重庆,400014)Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - 红兵 姚
- 重庆医科大学附属儿童医院耳鼻咽喉头颈外科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病研究教育部重点实验室 儿科学重庆市重点实验室(重庆,400014)Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
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Wadia J, Dabholkar Y. Comparison of Conventional Curettage Adenoidectomy Versus Endoscopic Powered Adenoidectomy: A Randomised Single-Blind Study. Indian J Otolaryngol Head Neck Surg 2022; 74:1044-1049. [PMID: 36452556 PMCID: PMC9702398 DOI: 10.1007/s12070-020-02122-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/27/2020] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
| | - Yogesh Dabholkar
- Department of ENT, Dr. D. Y. Patil Hospital and Research Centre, Navi Mumbai, India
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Rosso C, Pisani A, Stefanoni E, Pipolo C, Felisati G, Saibene AM. Nasal autoinflation devices for middle ear disease in cleft palate children: are they effective? ACTA OTORHINOLARYNGOLOGICA ITALICA 2021; 41:364-370. [PMID: 34533540 PMCID: PMC8448179 DOI: 10.14639/0392-100x-n1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/01/2021] [Indexed: 11/23/2022]
Abstract
Objective Cleft lip palate (CLP) and cleft palate (CP) patients have a higher incidence of otitis media with effusion (OME) and conductive hearing problems. This article aims to evaluate the effectiveness of a 6-month course of self-administered autoinflation therapy in paediatric CP/CLP patients in terms of conductive hearing loss (CHL) and OME prevalence. Methods Fifty-one patients with surgically corrected CP/CLP and diagnosis of OME received indication to 6-months autoinflation therapy with an Otovent® device. Clinical evaluation, tympanogram and pure tone audiometry were carried out at the time of prescription (T0), at the end of treatment (T1) and at 6-month follow-up (T2). Patients were divided in 2 groups based on therapeutic compliance (29 compliant children, group A, vs 22 non-compliant children, group B). Results Case series showed better audiological results and tympanometries at both time points (p < 0.001). Group A showed better outcomes at tympanograms and at each frequency, but were statistically significant only in terms of CHL at 250 and 1000 Hz frequencies at T1 (respectively 0.024 and 0.012). Conclusions Nasal autoinflation therapy accelerates improvement of OME and hearing thresholds at short-/mid-term, leading to an earlier improved hearing performance.
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Affiliation(s)
- Cecilia Rosso
- Department of Otorhinolaryngology, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Antonia Pisani
- Department of Otorhinolaryngology, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Elisa Stefanoni
- Department of Otorhinolaryngology, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Carlotta Pipolo
- Department of Otorhinolaryngology, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Felisati
- Department of Otorhinolaryngology, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alberto Maria Saibene
- Department of Otorhinolaryngology, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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Rosso C, Bulfamante AM, Pipolo C, Fuccillo E, Maccari A, Lozza P, Scotti A, Pisani A, Castellani L, De Donato G, Tavilla MC, Portaleone SM, Felisati G, Saibene AM. Adenoidectomy for middle ear disease in cleft palate children: a systematic review. Eur Arch Otorhinolaryngol 2021; 279:1175-1180. [PMID: 34453572 PMCID: PMC8897369 DOI: 10.1007/s00405-021-07035-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/08/2021] [Indexed: 11/24/2022]
Abstract
Purpose Cleft palate children have a higher incidence of otitis media with effusion, more frequent recurrent acute otitis media episodes, and worse conductive hearing losses than non-cleft children. Nevertheless, data on adenoidectomy for middle ear disease in this patient group are scarce, since many feared worsening of velopharyngeal insufficiency after the procedure. This review aims at collecting the available evidence on this subject, to frame possible further areas of research and interventions. Methods A PRISMA-compliant systematic review was performed. Multiple databases were searched with criteria designed to include all studies focusing on the role of adenoidectomy in treating middle ear disease in cleft palate children. After duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for clinical indications and outcomes. Results Among 321 unique citations, 3 studies published between 1964 and 1972 (2 case series and a retrospective cohort study) were deemed eligible, with 136 treated patients. The outcomes were positive in all three articles in terms of conductive hearing loss improvement, recurrent otitis media episodes reduction, and effusive otitis media resolution. Conclusion Despite promising results, research on adenoidectomy in treating middle ear disease in the cleft population has stopped in the mid-Seventies. No data are, therefore, available on the role of modern conservative adenoidectomy techniques (endoscopic and/or partial) in this context. Prospective studies are required to define the role of adenoidectomy in cleft children, most interestingly in specific subgroups such as patients requiring re-tympanostomy, given their known risk of otologic sequelae. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-021-07035-6.
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Affiliation(s)
- Cecilia Rosso
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo E Carlo Hospital, Università Degli Studi Di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Antonio Mario Bulfamante
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo E Carlo Hospital, Università Degli Studi Di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo E Carlo Hospital, Università Degli Studi Di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Emanuela Fuccillo
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo E Carlo Hospital, Università Degli Studi Di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Alberto Maccari
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo E Carlo Hospital, Università Degli Studi Di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Paolo Lozza
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo E Carlo Hospital, Università Degli Studi Di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Alberto Scotti
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo E Carlo Hospital, Università Degli Studi Di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Antonia Pisani
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo E Carlo Hospital, Università Degli Studi Di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Luca Castellani
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo E Carlo Hospital, Università Degli Studi Di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Giuseppe De Donato
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo E Carlo Hospital, Università Degli Studi Di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Maria Chiara Tavilla
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo E Carlo Hospital, Università Degli Studi Di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Sara Maria Portaleone
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo E Carlo Hospital, Università Degli Studi Di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo E Carlo Hospital, Università Degli Studi Di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo E Carlo Hospital, Università Degli Studi Di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy.
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MUZ S, ATİLLA MH. COMPLICATIONS OF TRANSORAL ENDONASAL-CONTROLLED COMBINED ENDOSCOPIC ADENOIDECTOMY. ENT UPDATES 2020. [DOI: 10.32448/entupdates.798459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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