Removal Of Adenoids In Children: Reviews, Under General And Local Anesthesia, Video

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Removal of adenoids in children: reviews of doctors, indications, methods

The content of the article:

Indications for the removal of adenoids
Preparing for surgery
Methods for removing adenoids
Recovery after surgery
Postoperative period: what to look for
Video

Removal of adenoids in children - a necessary measure or not? Pediatricians have no consensus on this. Several decades ago, it was believed that surgery was the only treatment for adenoids, and the earlier it was performed, the better. However, this approach has allowed the accumulation of clinical experience, which confirms that surgical intervention on the adenoids is not always justified, not always effective, and sometimes can lead to rather serious adverse consequences. At the same time, there are situations when it is impossible to do without removal of the adenoids. Currently, adenotomy (surgery to remove adenoids) in children is carried out according to strict indications.

The decision to remove the adenoids is made by the attending physician together with the child's parents

Indications for the removal of adenoids

In accordance with the recommendations of the famous Ukrainian pediatrician Komarovsky, adenoids should be removed surgically only when conservative therapy is ineffective and there are vital indications for surgery, i.e. serious health complications caused by adenoids. In all other cases, the doctor recommends conservative treatment.

Children's otolaryngologists explain their skepticism about adenotomy as a method of choice as follows:

The operation does not guarantee recovery, especially the classical (blind) surgery. The reason is the remnants of lymphoid tissue, which is able to grow again, leading to a relapse. The solution is an adenotomy under visual control using endoscopic techniques, but not all clinics have the necessary equipment for this.
There is a risk of developing quite serious consequences, for example, an overgrowth of scar tissue in the Eustachian tubes or paralysis of the soft palate.
Removing the tonsils weakens the body's defenses. The pharyngeal ring, of which the pharyngeal tonsil is a part, prevents the infection from entering the body through breathing. Removing tonsils in children puts them at further risk of frequent respiratory problems.

However, sometimes the risk associated with adenotomy is significantly less than the risk of further presence of adenoids, in which case surgery is necessary.

Indications for adenotomy:

complete absence of nasal breathing, the child breathes only through the mouth;
frequent inflammation of the middle ear (otitis media), hearing loss;
frequent tonsillitis (infection from the nasopharyngeal tonsil spreads to the palatine);
relapses of paratonsillar abscess.

At what age can adenoids be removed? In the presence of absolute indications, adenotomy can be performed in patients of any age. If circumstances allow you to wait, it is better not to operate on children under three years of age, as they have a higher risk of relapse.

The decision on whether to remove adenoids from a child by surgery is made by the attending ENT doctor together with the child's parents, explaining in detail to them what the operation is about, why such treatment will be optimal, and what to do if undesirable consequences arise.

Preparing for surgery

After the decision on surgical intervention is made, preoperative preparation is carried out, which, first of all, includes a complete examination of the child. The doctor collects anamnesis, including family history, paying attention to past and existing diseases, drug allergies, etc. They conduct laboratory tests of blood and urine to get an idea of the state of health, if necessary, and other studies.

Before the operation, you should visit the dentist and, if necessary, have the oral cavity sanitized. It is also necessary to cure all diseases of an infectious and inflammatory nature.

If the child has other pathologies, in addition to the adenoids, medical correction may be required.

Methods for removing adenoids

Adenoids in children are excised under local anesthesia, as this exposes the body to a lower drug load and is easier for the child to tolerate, however, in some situations (for example, lability of the nervous system), adenoids can be removed in children under general anesthesia.

Adenotomy consists in surgical excision of the pathologically enlarged adenoid tissue with a scalpel, as well as by means of electrocoagulation (coblation, or cold plasma) and laser surgery.

Surgical removal of adenoids is performed with a special instrument - an adenotome

In the classic operation, a ring-shaped knife - adenotome is used to remove adenoids. After removal of the adenoid tissue, profuse bleeding develops, which usually stops quickly. If this does not happen, it is necessary to examine the nasopharynx, where scraps of tissue are found, after the removal of which the blood stops. An improved modification of this method is endoscopic excision of the adenoids, which provides a good view of the operating field and greater accuracy of the intervention, which means less risks.

A high-tech method is coblation - cutting the pathologically enlarged nasopharyngeal tonsil using electromagnetic radiation, acting in the radio frequency range. This allows you to create a cloud of so-called cold plasma, which, being precisely directed, makes a tissue incision with coagulation in the area of the incision. Such a cold plasma removal of adenoids in children has the most positive reviews from doctors - there is no bleeding, severe postoperative edema, pain, deep tissues are not damaged. At present, this method has practically replaced electrocautery, which is more painful and associated with a high risk of complications.

Laser removal of the hypertrophied nasopharyngeal tonsil provides effective and rapid removal of the adenoids. The effectiveness of laser removal of adenoids in children is comparable to that of coblation; the method has practically no side effects. Laser treatment of adenoids can be performed in two versions - a single operation and gradual, over several procedures, irradiation of adenoids with a laser of lower power, as a result of which they gradually involution. Such gradual removal requires minimal anesthesia - it is enough to treat the mucous membrane of the nasopharynx with lubrication with an anesthetic spray.

The advantages of coblation and laser removal methods are minimal trauma to healthy tissues, little or no bleeding, the ability to treat hard-to-reach places, minimal pain both during surgery and during rehabilitation, and quick recovery.

In some cases, they resort to combined treatment - for example, the body of the amygdala is surgically excised, followed by treatment of the residual lymphoid tissue with a laser.

Those interested can watch the video of adenoid removal in children.

Recovery after surgery

On the day of surgery or during the next day, the child may experience an increase in body temperature (usually not higher than 38 ° C). In this case, the children are given an antipyretic agent, but drugs that contain acetylsalicylic acid cannot be taken, as this can provoke bleeding. Products based on ibuprofen or paracetamol are suitable.

One or two vomiting of blood clots is possible. It is associated with the swallowing of blood by the child during surgery and is not a dangerous complication.

After the operation, the improvement of nasal breathing does not occur immediately, in the next few days there is a nasal voice, nasal congestion, a runny nose against the background of postoperative edema, which, as a rule, disappears within 10 days after surgical treatment. To alleviate the condition in the postoperative period, pain relievers, local vasoconstrictor, astringent and drying drugs are prescribed. Respiratory gymnastics can speed up the restoration of patency of the nasal passages.

Respiratory gymnastics helps the child recover faster after surgery

After adenotomy for 3-10 days (until the tissues are completely healed), dietary nutrition is indicated. Food should provide mechanical, thermal and physical sparing. This means that you need to take it warm, softened (puréed), refuse products that irritate the mucous membrane (sour, too sweet, spicy). At the same time, meals should be regular, in small portions, balanced in composition and high in calories.

Until complete recovery after surgery (1-2 weeks), you should avoid excessive physical activity, do not take hot baths and showers, limit your stay in direct sunlight, in stuffy and hot rooms. Hypothermia is likewise undesirable.

Postoperative period: what to look for

If a child has a fever for several days after the operation, bad breath develops, and the general condition worsens, but does not improve, this may be a sign of the onset of inflammation. In this case, you should immediately consult a doctor.