Adenoidectomy Health Article

Definition

An adenoidectomy is the surgical removal of the adenoids—small lumps of tissue that lie in the back of the throat behind the nose.

Purpose

The adenoids are removed if they block breathing through the nose and if they cause chronic earaches or deafness. The adenoids consist of lymphoid tissue—white blood cells from the immune system. They are located near the tonsils, two other lumps of similar lymphoid tissue. In childhood, adenoids and tonsils are believed to play a role in fighting infections by producing antibodies that attack bacteria entering the body through the mouth and nose. In adulthood however, it is unlikely that the adenoids are involved in maintaining health, and they normally shrink and disappear. Between the ages of two and six, the adenoids can become chronically infected, swelling up and becoming inflamed. This can cause breathing difficulties, especially during sleep. The swelling can also block the eustachian tubes that connect the back of the throat to the ears, leading to hearing problems until the blockage is relieved. The purpose of an adenoidectomy is thus to remove infected adenoids. Since they are often associated with infected tonsils, they are often removed as part of a combined operation that also removes the tonsils, called a T&A (tonsillectomy and adenoidectomy).

Demographics

Demographics information is difficult to provide because adenoidectomy is routinely performed in an outpatient setting, for which demographic data are not well recorded. Good information is available from the 1970s and 1980s when the surgery was performed in an inpatient setting. In the United States in 1971, more than one million combined T&As, tonsillectomies alone, or adenoidectomies alone were performed, with 50,000 of these procedures consisting of adenoidectomy alone. In 1987, 250,000 combined or single procedures were performed, with 15,000 consisting of adenoidectomy alone. Now, almost all adenoidectomies are performed on an outpatient basis unless other medical problems require hospital admission or an overnight stay. T&A is considered the most common major surgical procedure in the United States.

Description

An adenoidectomy is performed under general anesthesia. The surgeon removes the adenoids from behind the palate. Stitches are usually not required.

Excision through the mouth

The adenoids are most commonly removed through the mouth after placing an instrument to open the mouth and retract the palate. A mirror is used to see the adenoids behind the nasal cavity. Several instruments can then be used to remove the adenoids.

• Curette removal. The most common method of removal is using the adenoid curette, an instrument that has a sharp edge in a perpendicular position to its long handle. Various sizes of curettes are available.
• Adenoid punch instrument. An adenoid punch is a curved instrument with a chamber that is placed over the adenoids. The chamber has a knife blade sliding-door to section off the adenoids that are then housed in the chamber and removed with the instrument.
• Magill forceps. A Magill forceps is a curved instrument used to remove residual adenoid, usually located deeper in the posterior nasal cavity, after attempted removal with curettes or adenoid punches.

• Electrocautery with a suction Bovie. The adenoids can also be removed by electrocautery with a suction Bovie, an instrument with a hollow center to suction blood and a rim of metal to achieve coagulation.
• Laser. The Nd:YAG laser has also been used to remove the adenoids. However, this technique has caused scarring of tissue and is usually avoided.

Excision through the nose

Adenoids may also be removed through the nasal cavity with a surgical suction instrument called a microdebrider. With this procedure, bleeding is controlled either with packing or suction cautery.

Diagnosis/Preparation

The primary methods used to determine whether adenoids need removal are:

• medical history
• physical examination
• throat bacterial cultures
• x rays
• blood tests

When the patient arrives at the hospital or the day-surgery unit, a nurse or a doctor will ask questions concerning the patient's general health to make sure he or she is fit to undergo surgery. They will also check that the patient has not had anything to eat or drink and will record pulse and blood pressure. The doctor or nurse must be informed if the patient has had any allergic or unusual reactions to drugs in the past. The patient will be asked to put on a hospital gown and to remove any loose orthodontic braces, false teeth, and jewelry. In the past, an adenoidectomy usually called for an overnight stay in hospital. However, it is increasingly more common to have this operation on an outpatient basis, meaning that the patient goes home on the same day. The surgery is usually performed early in the morning to allow a sufficient observation period after the operation.