Definition & Overview
Adenoidectomy is a surgical procedure for removing a mass of infected adenoids located behind the nasal passages.
The adenoids are lymphoid tissues found in the roof of the mouth near the tonsils. These glands play an important role in the immune system by producing antibodies that fight infections that enter through the mouth or nose. For a variety of reasons, the adenoids can become enlarged, and when this happens, the condition can lead to ear infections, blockage of the Eustachian tubes, and impairment in the respiratory process.
Adenoid removal is typically done on children and adolescents, as the adenoids usually disappear on their own when one reaches adulthood. In the majority of cases, the procedure is performed alongside tonsillectomy, the removal of tonsils, since these parts are in close proximity that any infection in the area can affect both of them.
Who Should Undergo & Expected Results
Adenoidectomy is performed on children suffering from enlarged adenoids, which symptoms include breathing difficulties, loud snoring, and episodes of not breathing for up to 20 seconds during sleep. Such symptoms have a significant impact on child development and their performance during daytime, especially at school.
Adenoid removal can also be performed on children suffering from recurrent otitis media, caused by bacterial infection to the middle ear. One of its possible causes is the chronic inflammation of the adenoids or dysfunction of the Eustachian tube. However, adenoidectomy is only recommended if the condition did not respond to antibiotics or if the symptoms are persistent and impair hearing.
An infection of the adenoids is also associated with the occurrence of chronic sinusitis among children. When the patient becomes unresponsive to medications and has difficulty breathing due to the obstruction of the airways, adenoid removal is recommended to provide patient with long-term relief.
The majority of patients who have undergone adenoidectomy have reported very good outcomes following surgery. Compared to other surgical procedures, recovery usually takes a shorter period. Quality of life improvements include breathing easier through the nose, reduced instances of ear infections, and avoidance of fluid build up in the ear and Eustachian tube.
How Does the Procedure Work?
This procedure is typically performed in an outpatient setting and usually lasts an hour. After the patient is given general anaesthesia, a small tool is placed inside the mouth to keep it open. The palate is then retracted, and the surgeon locates the adenoids using a mirror. To remove the adenoid tissue, the surgeon will use a curette, a tool shaped like a spoon and Magill forceps. The gland can also be removed using radiofrequency energy or through electrocautery in which electricity is used to heat and dissolve the tissue, as well as close the remaining tissue to stop the bleeding.
Another technique for adenoids removal is the use of a microdebrider. Instead of making an incision in the mouth, the surgeon would make an incision through the nose to remove the adenoid tissues.
Possible Complications and Risks
One of the complications associated with adenoid removal is bleeding, which can occur during and after the procedure. This is considered a major concern and in rare instances, requires a blood transfusion.
The neck and throat could also be sore for several days, with accompanying hoarseness of voice. Some patients also report stiffness of neck and experience muscle spasms as well as a permanent change in voice.
Another possible complication is a condition known as nasopharyngeal insufficiency, in which the surgery on the roof of the mouth causes the soft palate muscle to close improperly. This allows air to escape through the nose and the patient is unable to pronounce some consonant letters properly.
Meanwhile, rare complications include inflammation of the nasopharynx, nasopharyngeal stenosis, and regrowth of adenoid tissue, which may necessitate another adenoidectomy. Other nearby parts, such as the Eustachian tube and the mandibular condyle, can also be injured during the procedure.
Wetmore RF. Tonsils and adenoids. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 375.
Wooley AL, Wiatrak BJ. Pharyngitis and adenotonsilar disease. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Elsevier Mosby; 2010:chap 196.