1
|
Biradar K, Deepthi S, Kumar S, Singh R, Dutta A. Endoscopic Assisted Cold Steel adenoidectomy - A Cost Effective Modification for Better Outcome. Indian J Otolaryngol Head Neck Surg 2023; 75:3211-3215. [PMID: 37974896 PMCID: PMC10645954 DOI: 10.1007/s12070-023-03979-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/12/2023] [Indexed: 11/19/2023] Open
Abstract
Introduction Adenoidectomy is most commonly performed in children to alleviate the symptoms pertaining to adenoid hypertrophy. The conventional cold steel method utilizing adenoid curette is the most commonly performed method in the world even after the invention of endoscopes & powered instruments like coblator & microdebrider due to the cost & time factors. The conventional method being a blind procedure, carries higher rate of recurrence due to remnant tissues. The visualization of the adenoid tissue in nasopharynx through the nasal endoscope helps in better engagement of adenoids into the curette & adequate tissue clearance with reduced recurrence of symptoms. Aim To study the effect of visualization of adenoid tissue for better tissue clearance in conventional adenoidectomy. Objectives To compare the duration of surgery, blood loss & recurrence rate following conventional cold steel adenoidectomy (CSA) & endoscope assisted cold steel adenoidectomy (EACSA). Method 50 patients who underwent adenoidectomy with various indications were grouped into two groups with 25 patients each. Group A underwent (CSA)with or without tonsillectomy & Group B underwent (EACSA) with or without tonsillectomy were followed up for the duration of 3 months. The patients were evaluated for duration of surgery & post operatively for the recurrence at 3rd month of follow up. Results In our study, it was found that the tissue clearance in Group A was significantly low. The recurrence rate of 48% was observed in CSA group compared to 0% in group B with EACSA. The duration of surgery in both the procedures were comparable. Conclusion EACSA is an effective modification to CSA. It adds the benefits of endoscopic visualization of adenoid for the conventional curettage. The high recurrence rates of CA can be effectively reduced with no significant variation in duration of surgery.
Collapse
Affiliation(s)
- Kashiroygoud Biradar
- Dept of ENT & HNS, Command Hospital Air Force, Bangalore Agaram Post, Old Airport Road, Bangalore, 560007 India
| | - Sangineedi Deepthi
- Dept of ENT & HNS, Command Hospital Air Force, Bangalore Agaram Post, Old Airport Road, Bangalore, 560007 India
| | - Sanjay Kumar
- Dept of ENT & HNS, Command Hospital Air Force, Bangalore Agaram Post, Old Airport Road, Bangalore, 560007 India
| | - Roohie Singh
- Dept of ENT & HNS, Command Hospital Air Force, Bangalore Agaram Post, Old Airport Road, Bangalore, 560007 India
| | - Angshuman Dutta
- Dept of ENT & HNS, Command Hospital Air Force, Bangalore Agaram Post, Old Airport Road, Bangalore, 560007 India
| |
Collapse
|
2
|
Calvo-Henriquez C, RuedaFernandez-Rueda M, Garcia-Lliberos A, Maldonado-Alvarado B, Mota-Rojas X, Maniaci A, Iannella G, Jimenez-Huerta I. Coblator adenoidectomy in pediatric patients: a state-of-the-art review. Eur Arch Otorhinolaryngol 2023; 280:4339-4349. [PMID: 37493842 PMCID: PMC10477144 DOI: 10.1007/s00405-023-08094-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Adenoid hypertrophy is one of the main causes of nasal obstruction in 'children. Adenoid hypertrophy can be approached either with nasal corticosteroids, or surgically when medical treatment fails. Different adenoidectomy techniques have been proposed to reduce morbidity and surgical risks, with a consequent marked increase in the use of new surgical procedures in recent years, with a progressive increase in the use of coblation. This state-of-the-art review aims to systematically review the current literature on the role of coblation in adenoidectomy. METHODS The selection criteria included children submitted to adenoidectomy with coblator vs other techniques. 11 research questions were defined. 4 databases were explored by four authors: PubMed (Medline), the Cochrane Library, EMBASE and SciELO. The level of evidence and quality of the selected articles were assessed according to assessed according to the Quality Assessment Checklist of the National Institute for Health and Clinical Excellence. RESULTS 20 studies met the inclusion criteria: 2 metanalysis, 12 randomized clinical trial, 2 non-randomized clinical trial, 1 prospective cohort study, and 3 retrospective cohort study. It encompassed a total population of 8375 participants. Regarding the different surgical techniques, 18 studies (excluding metanalysis) performed coblation (n = 1550), 6 microdebridement (n = 883), 15 curettage (n = 4016), and 1 suction coagulation (n = 1926). CONCLUSION Coblator adenoidectomy appears to offer better adenoid control compared to curettage, with a possible, although not confirmed lower rate of revision surgery. Similarly, this greater resection of adenoid tissue seems to be related to a greater reduction of nasal obstruction. The advantages of this technique are mainly less surgical bleeding-although it is not clear this is a clinically relevant difference, and less postoperative pain compared to cold curettage. The difference in pain is small, as adenoidectomy is not a painful surgery in general. There is little evidence on the control of OME and comparison with other techniques such as microdebrider adenoidectomy.
Collapse
Affiliation(s)
- Christian Calvo-Henriquez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France.
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain.
- Master degree in rhinology and skull base, Universidad Internacional de Andalucía, Seville, Spain.
| | - María RuedaFernandez-Rueda
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
- Service of Otolaryngology, Hospital 12 de Octubre, Madrid, Spain
- Master degree in rhinology and skull base, Universidad Internacional de Andalucía, Seville, Spain
| | - Ainhoa Garcia-Lliberos
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
- Service of Otolaryngology, Valencia University Hospital, Valencia, Spain
- Master degree in rhinology and skull base, Universidad Internacional de Andalucía, Seville, Spain
| | - Byron Maldonado-Alvarado
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
- Service of Otolaryngology, Hospital Virgen de los Lirios, Alcoy, Spain
| | - Xenia Mota-Rojas
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
- Service of Otolaryngology, El Bierzo Hospital, Ponferrada, Spain
| | - Antonino Maniaci
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
- Department of Medical and Surgical Sciences and Advanced Technologies ''GF Ingrassia'' ENT Section, University of Catania, 95123, Catania, Italy
| | - Giannicola Iannella
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
- Department of 'Organi di Senso', University ''Sapienza'', Viale Dell'Università, 33, 00185, Rome, Italy
| | | |
Collapse
|
3
|
Shenoy VS, Samanth R, Parvathareddy N, APOORVA KV. Pediatric Oronasopharyngeal Stricture- A Rare Surgical Complication of Adeno-Tonsillectomy Abstract. Indian J Otolaryngol Head Neck Surg 2023; 75:2352-2354. [PMID: 37636660 PMCID: PMC10447637 DOI: 10.1007/s12070-023-03694-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/12/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction: Oronasopharyngeal stricture is a rare sequel of oropharyngeal surgical procedure which can cause swallowing difficulty, dyspnea, sleep related breathing disorders, incompetence at the velopharynx due to soft palatal adherence. Case: Here we present a case of nine-year-old girl who presented to us with complains of nasal obstruction since 3 months and symptoms of sleep disordered breathing. She underwent adenotonsillectomy 5 years ago and coblator assisted palatoplasty and stricture release 4 months ago. On examination adenoid facies was noted, postpalatoplasty and tonsillectomy status with stricture between the anterior and posterior tonsillar pillars. Soft palate was stuck to posterior pharyngeal wall. Computed tomography scan was done which depicted homogenously enhancing soft tissue density causing complete nasopharyngeal airway obstruction. Oronasopharyngeal stricture release was performed under general anesthesia. Infant feeding tube was inserted through the nasal cavity and introduced through the oropharynx into exterior and was tied externally which was removed on postoperative day 5. Child is on regular follow up since 5 months and asymptomatic. Discussion: Oropharyngeal stricture is reported as a rare sequela of adenotonsillectomy. Many surgical techniques have been reported for release of similar oropharyngeal and nasopharyngeal stricture patterns such as triamcinolone injection, manual dilation method, plasma hook method, division and skin grafting, local flaps like pharyngeal or palatal mucosal flaps, and free flap techniques. Conclusion: Utmost care must be taken during the surgical procedure of oropharynx to prevent collateral damage to mucosal surfaces which can result in such devastating complications. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03694-5.
Collapse
Affiliation(s)
- Vijendra S Shenoy
- Dept of ENT and Head & neck surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore, India
| | - Rakshitha Samanth
- Dept of ENT and Head & neck surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore, India
| | - Navya Parvathareddy
- Dept of ENT and Head & neck surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore, India
| | - KV APOORVA
- Dept of ENT and Head & neck surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore, India
| |
Collapse
|
4
|
Winters R, Rodriguez KH. Examining the life-cycle of the Coblator II device: Increases in paediatric post-tonsillectomy haemorrhage after six years of use. World J Otorhinolaryngol 2023; 10:1-3. [DOI: 10.5319/wjo.v10.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/04/2023] [Accepted: 02/10/2023] [Indexed: 02/28/2023] Open
Abstract
All paediatric tonsillectomies were examined from 2012 – 2019 at a single tertiary-referral institution, and all were performed by one of two paediatric otolaryngologists. One exclusively used the diathermy, the other exclusively used the Coblator II. Two Coblator units were purchased simultaneously in 2012 and not replaced. There was no significant difference in number of tonsillectomies performed (1298 via diathermy, 1221 via Coblator), nor in postoperative day of bleed, patient age, indication for procedure, and no patient had an underlying coagulopathy. The most common indication for tonsillectomy in both groups was sleep-disordered breathing. There was no significant difference in postoperative haemorrhage rates between groups for the first six years of the study (0%-1.4%/year). Years 7 and 8 saw the Coblator group haemorrhage rate significantly increase (0%-0.6% diathermy group vs 2%-3% Coblator group), though still fell within accepted rate of postoperative haemorrhage. The devices were then replaced, and the differences in haemorrhage disappeared. There appears to be a significant increase in paediatric post-tonsillectomy haemorrhage when using a Coblator device greater than six years old. This may suggest a useful lifespan for the Coblator II device.
Collapse
Affiliation(s)
- Ryan Winters
- Department of Otorhinolaryngology-Head & Neck Surgery, NSW Health/John Hunter Hospital, New Lambton Heights 2305, NSW, Australia
| | - Kimsey H Rodriguez
- Department of Otolaryngology-Head & Neck Surgery, Ochsner Medical Center, New Orleans, LA 70121, United States
| |
Collapse
|
5
|
Shah HP, Brawley CC, Maurrasse S, Schumacher J, Ganesh M, Thompson DM, Ida J, Valika T. Pediatric laryngeal cleft repair with coblation: Functional comparison of a novel technique with traditional methods. Int J Pediatr Otorhinolaryngol 2022; 163:111378. [PMID: 36371939 DOI: 10.1016/j.ijporl.2022.111378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/17/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The traditional endoscopic techniques for surgical management of laryngeal clefts are carbon dioxide (CO2) laser or microlaryngeal instruments (cold steel). This study compares the functional efficacy and safety of coblation, or "cold" radiofrequency ablation, to traditional approaches for endoscopic laryngeal cleft repair. METHODS Patients who underwent endoscopic laryngeal cleft repair with CO2 laser, cold steel, or coblator at two tertiary academic centers from 2015 to 2021 were retrospectively identified. The primary outcome studied was swallowing function: pre- and postoperative swallow studies were scored according to the International Dysphagia Diet Standardization Initiative with higher scores indicating worse swallow function. Secondary outcomes included surgical complications and rates of dehiscence. RESULTS Of the 53 patients included, 14 underwent repair with CO2 laser, 23 with cold steel, and 16 with the coblator. Mean age at surgery was 2.2 ± 1.1 years for the laser group, 4.3 ± 4.0 years for cold steel, and 1.9 ± 1.4 years for the coblator group. In the laser group, 100% of clefts were type I; for the cold steel group, 82.6% of clefts were type I and 17.4% were type II; for the coblator group, 93.8% of clefts were type I and 6.3% were type II. Pre- and postoperative swallow study scores were 6.3 ± 2.8 and 4.3 ± 3.2, respectively, (p = 0.001) for the laser group, 6.9 ± 2.8 and 5.3 ± 3.1 (p = 0.071) for the cold steel group, and 7.5 ± 1.5 and 4.0 ± 2.9 (p < 0.001) for the coblator group. Mean change in swallow study scores were similar across the three groups (p = 0.212). No patients experienced postoperative dehiscence at the surgical site or complications; no revisions were required. CONCLUSIONS Cleft repair with the novel coblation technique showed significant improvements in swallow study scores without any occurrences of postoperative dehiscence or revisions. Coblation is a safe and efficacious approach for laryngeal cleft repair.
Collapse
Affiliation(s)
- Hemali P Shah
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - Craig Cameron Brawley
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Sarah Maurrasse
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Jane Schumacher
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Meera Ganesh
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dana Mara Thompson
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jonathan Ida
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Taher Valika
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| |
Collapse
|
6
|
Prussin AJ, Babajanian E, Error M, Grimmer JF, Ku J, McRae B, Meier J, Thiesset H, Skirko JR. Radiofrequency Ablation vs Electrocautery Blinded Randomized Trial: Impact on Clinically Meaningful Outcomes. Otolaryngol Head Neck Surg 2020; 164:1186-1192. [PMID: 33079009 DOI: 10.1177/0194599820964737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze patients' return to normal activity, pain scores, narcotic use, and adverse events after undergoing tonsillectomy or adenotonsillectomy with monopolar electrocautery or radiofrequency ablation. STUDY DESIGN Randomized double-blinded clinical trial based on prospective parallel design. SETTING Academic medical center and tertiary children's hospital between March 2018 and July 2019. METHODS Inclusion criteria included patients aged ≥3 years with surgical indication of recurrent tonsillitis or airway obstruction/sleep-disordered breathing. Patients were randomly assigned to monopolar electrocautery or radiofrequency ablation. Patients were blinded to treatment assignment. Survey questions answered via text or email were collected daily until postoperative day 15. The primary outcome was the patient's return to normal activity. Secondary outcomes included daily pain score, total amount of postoperative narcotic use, and adverse events. RESULTS Of the 236 patients who met inclusion criteria and were randomly assigned to radiofrequency ablation or monopolar electrocautery, 230 completed the study (radiofrequency ablation, n = 112; monopolar electrocautery, n = 118). There was no statistically significant difference between the groups in the number of days for return to normal activity (P = .89), daily pain scores over 15 postoperative days (P = .46), postoperative narcotic use (P = .61), or return to hospital for any reason (P = .60), including bleeding as an adverse event (P = .13). CONCLUSIONS As one of the largest randomized controlled trials examining instrumentation in tonsillectomy, our data do not show a difference between monopolar electrocautery and radiofrequency ablation with regard to return to normal activity, daily pain scores, total postoperative narcotic use, or adverse events.
Collapse
Affiliation(s)
- Aaron J Prussin
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - Eric Babajanian
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - Marc Error
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - J Fredrik Grimmer
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - Jessica Ku
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - Bryan McRae
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - Jeremy Meier
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - Heather Thiesset
- Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Jonathan R Skirko
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| |
Collapse
|
7
|
Rinaldi V, Costantino A, Moffa A, Cassano M, Mantovani M, Casale M, Pignataro L. Postoperative Pain and Wound Healing After Coblation-Assisted Barbed Anterior Pharyngoplasty (CABAPh): An Observational Study. Indian J Otolaryngol Head Neck Surg 2019; 71:1157-62. [PMID: 31750142 DOI: 10.1007/s12070-018-01577-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022] Open
Abstract
Despite the numerous progresses in the palatal surgery, one of the critical aspect of snoring and OSA surgery is the postoperative pain. Over the last decades several surgical palatal procedures have been proposed. Our aim was to evaluate the tolerability of the coblation-assisted barbed anterior pharyngoplasty (CABAPh) in terms of postoperative pain and wound healing, compared with bipolar assisted barbed anterior pharyngoplasty (BAPh). An observational study on 20 patients with simple snoring was conducted. The outcomes measured to assessing pain were a 10 cm visual analog scale (VAS) and the dose of paracetamol + codeine administrated postoperatively. The wound healing was evaluated using a 3-point scale. The other parameters indicative of both pain and surgical repair were food intake and weight loss postoperatively. The mean overall pain (VAS scale) was significantly less in the CABAPh group (M 3.7; CI 3.34-4.06) compared with the BAPh (M 4.73; CI 4.28-5.19) with a P = 0.003. The mean wound healing after 4 weeks was significantly less in CABAPh group (M 2.7; CI 3.12-2.28) compared with the BAPh (M 2.1; CI 2.45-1.75) with a P = 0.02. There were no statistically significant difference with regard to food intake (P = 0.09) and weight loss (P = 0.94). The CABAPh was able to achieve a greater pain reduction and a faster wound healing compared with bipolar forceps.
Collapse
|