Objectives To quantify the incidence of intranasal extension of adenoid tissue
and residual adenoidal obstruction of the posterior choanae following traditional
curette adenoidectomy to determine the efficiency of adenoid curettage and
the usefulness of intraoperative endoscopic examination and powered-shaver
adenoidectomy in achieving better postnasal patency.
Design Prospective intraoperative endoscopic evaluation of the posterior choanae
and nasopharynx of a case series of 130 patients before and after curette
and powered-shaver adenoidectomy.
Setting Tertiary referral center.
Patients One hundred thirty consecutive pediatric patients with obstructive adenoidal
hypertrophy undergoing adenoidectomy.
Main Outcome Measures The degree of residual postnasal obstruction due to adenoid tissue was
assessed endoscopically (grades 0-3) after curette and adjuvant powered-shaver
adenoidectomy. The presence of intranasal adenoid tissue was also recorded.
Results Following traditional curette adenoidectomy, 51 (39%) of 130 patients
had residual obstructive adenoid with 42 patients (32%) having occlusive intranasal
adenoid tissue. Having determined the presence of remaining obstructive tissue
with intraoperative nasal endoscopy in these 51 patients, complete airway
patency was achieved with powered-shaver adenoidectomy.
Conclusion The presence of intranasal extension of adenoids obstructing the posterior
choanae is common in children with adenoid hypertrophy. Traditional adenoidectomy
is ineffective in removing this tissue and may also leave obstructive tissue
high in the nasopharynx. Intraoperative nasal endoscopy allows assessment
of the completeness of surgery. Powered-shaver adenoidectomy enables complete
removal of obstructive adenoid tissue thereby ensuring postnasal patency.
