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Adenoidectomy with Suction Electrocautery Technique

Adenoidectomy is among the most common surgical procedures performed in children.  The two major indications are nasopharyngeal airway obstruction and recurrent or chronic infections of the nasopharynx.  This surgery is often carried out with a combined tonsillectomy which is performed for similar indications.  The technique used in this video is suction electrocautery, a recently developed technique that allows for more precision and minimal blood loss compared with more traditional techniques.

Soham Roy (University of Texas Medical School at Houston)

Thomas Mitchell (University of Texas Medical School at Houston)

Adenoidectomy with Suction Electrocautery Technique: A Crowe-Davis mouth gag is placed to provide adequate visualization of the oral cavity. A red rubber catheter is passed from the nose through the nasopharynx and back out through the mouth to provide anterior retraction of the soft palate. A dental mirror is placed in the oropharynx to enable adequate visualization of the nasopharynx. Suction electrocautery is used to remove the adenoid tissue. Hemostasis is achieved and the nasopharynx is irrigated. Prior to cessation of anesthesia, an orogastric tube should be used to suction fluid from the stomach.
Obstruction or chronic/recurrent infections of the nasopharynx
Active local infection, certain hematologic disorders, certain pharyngeal anatomical abnormalities
The patient is placed under general anesthesia. A Crowe-Davis mouth gag is placed to provide adequate visualization of the oral cavity. A red rubber catheter is passed from the nose through the nasopharynx and back out through the mouth to provide anterior retraction of the soft palate. Finally, a dental mirror is placed in the oropharynx to enable adequate visualization of the nasopharynx and adenoids.
Patient-elicited history significant for chronic/recurrent infections and/or nasal obstruction PLUS direct visualization of hyperplastic adenoid tissue in the nasopharynx.
The adenoid tissue is a soft mass of lymphoid tissue in the posterior nasopharynx, situated close to the anterior opening of the Eustachian tube.
Suction electrocautery is a recently developed technique that allows for rapid achievement of hemostasis and minimizes blood loss during adenoidectomy (versus traditional cold curettage). Advantages: minimal blood loss Disadvantages: increased risk of thermal burns or accidental fire
Intra-operative: bleeding, thermal burns Post-operative: pain, infection, bleeding, nasopharyngeal stenosis
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American Academy of Otolaryngology Head and Neck Surgery: Adenoidectomy Clinical Indicators https://www.societyformiddleeardisease.org/Content/ClinicalIndicators/Adenoidectomy-CI_Final-May-2012.pdf

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