Removal of the adenoids.
In the past it was believed that the growth of the tonsil tissue in the nasopharynx occurs only in children. This problem became increasingly diagnosed in adults with improved tools for monitoring (different types of endoscopes, surgical microscope, mirror optics), which was an evidence that the above-mentioned opinion was wrong.
There are three degrees of the adenoids:
- I degree – normal breathing in the day time, while at night the blood rushes towards the adenoids, causing their swelling so that a patient can breathe only through the mouth;
- II degree – a patient breathes through the mouth day and night, and sometimes wheezes in his/her sleep;
- III degree – the adenoids get enlarged, overlapping most of the vomer, there are complications in the form of speech disorders and hearing loss.
- Treatment of I degree adenoids may be conservative: in significant nasal congestion vasoconstrictors are used;
- in acute adenoiditis antibiotics are administered (after preliminary bacterial inoculation of the nasal discharge and detection of infectious agents sensitive to them).
In the adenoids of II and III degree surgical removal is recommended. Today adenoid removal is a painless, safe and fast operation. Adenoids are removed under local or general anesthesia, under the endoscopic control. It is necessary for the complete removal of the lymphoid tissue without any residue to prevent the problem recurrence. With age, this operation is more difficult – it is conditioned by the presence of concomitant diseases, declined parameters of tissue healing process. To accelerate the damaged tissue regeneration AMC-therapy – an individual program based on autologous growth factors application and oligopeptides extracted from the patient’s platelet count in maximum concentration offered at the Institute of Plastic Surgery “Virtus” for the first time in Ukraine.
What may happen in case of adenoids enlargement?
- sleep apnea – a short stop of breathing during sleep, not infrequently provoking an elevation in blood pressure;
- adenoid tissue of II and III degree blocks the auditory passage – there is a permanent feeling of stuffiness in the ears. Ventilation disorder of the tympanic cavity badly influences hearing, and this, in turn, often leads to absent-mindedness;
- constant mouth breathing provokes disturbance in the facial skeleton growth, which results in change of occlusion and speech disorders in children;
- the adenoids of large size may change voice sonority;
- in adolescents the adenoids can cause a curvature of the spine development;
- constant nasal discharge irritates the skin of the nose vestibule, and their ingestion results in the gastrointestinal tract disorders;
- prolong shallow mouth breathing causes abnormal development of the chest, sometimes – anemia;
- in severe hypertrophy may be observed weakening of attention, memory impairment, headaches.
So, it is a high price paid for late actions.
The Institute of Plastic reconstructive surgery “Virtus” is equipped with a unique set of diagnostic equipment (endoscopic diagnosis with video fixation). Narrow Band Imaging (NBI), a powerful optical image enhancement technology, is based on the narrow band of blue and green light to illuminate the area under study, which falls in the hemoglobin absorption band. NBI (early diagnosis of malignant tumors) allows to identify problems objectively and choose the necessary method of treatment (surgical or therapeutic). Narrow band imaging is not worse than chromoendoscopy in identifying foci of precancer and early cancer.
Technique of Adenoidectomy.
Removal of adenoids by laser.
Modern laser devices show unsurpassed results in various fields of surgery. A Department of Laser Technologies of the clinic “Virtus” is equipped with the latest models of laser devices made in Germany and Italy.
The technology is classified into two types of manipulations:
- coagulation – using a focused laser beam, the surgeon removes the adenoid growths of all sizes (more frequently in large adenoids);
- valorisation – the lymphoid tissue is evaporated in layers.
The technique is ideally suited for the removal of small size adenoids. The doctor can choose the best type of the apparatus for a particular operation. For example, small adenoid vaporization is carried out by means of carbon dioxide laser.
Advantages of the laser are:
- small trauma;
- high accuracy;
- pronounced analgesic, anti-inflammatory, anti-bacterial properties of the laser beam;
- minor bleedings or their absence;
- minimum recovery period after surgery;
- high efficacy at relatively low cost.
You can see the laser device in the photo.
To perform endoscopy a special thin probe – endoscope equipped with optical systems is used. A surgeon makes the examination of the area, and a computerized system displays a large-scale image, which shows the details that cannot be seen during the routine examination.
Advantages of the endoscopic examination are:
- painlessness of the procedure;
- an excellent alternative to X-ray of the nasopharynx and absence of dangerous radiation;
- detection of abnormalities invisible during routine ENT examination;
- the possibility of visual assessment of the real extent of inflammation.
The procedure for removing the adenoids using endoscopy is carried out in several ways:
- using the so-called electrocoagulation “Loop”, heated up to a temperature required for prevention the possibility of bleeding when removing the adenoids.
- Shaver adenotomy is performed using a special microdebrider (shaver), having a fixed element with a sharp blade inside at the end. The cut off tissue is ground by the blade and removed by suction.
Advantages of shaver adenotomy are:
- sparing approach;
- accurate removal of the lymphoid tissue from the nasopharynx.
- Coblation (is a modern method of removing the soft tissue, using cold plasma electrosurgical devices with a low temperature of the beam – no more than 60°C).
Advantages of coblation are:
- prevention of the healthy tissue damage due to the minimum thickness of the plasma beam;
- reduction of bleeding due to the effects of coagulation;
- minimization of pain (during surgery and rehabilitation period) due to the complete absence of the thermal effect on the tissue;
- easy-to-use design of plasma electrodes, allowing to treat the inflamed tissue in the most remote places;
- reduced hospital-stay.
Endoscopic adenotomy may be supplemented by a laser/radiowave treatment for more careful treatment of the operated area and reduced risk of relapse. The price of adenoidectomy will vary depending on the method chosen. The surgery usually takes about an hour. The quality of the operation is of importance. If the adenoid tissue is not removed completely, there is a risk of recurrence. Besides, whatever operation technique is chosen, in some cases it is important to go through special procedures for normalization of nasal breathing and hearing restoration. This approach minimizes the risk of complications and relapses.
They are present in adenotomy, as in any other surgery:
- during the epidemic of acute infectious diseases (including 2 weeks after the end);
- blood diseases;
- severe cardiovascular disease;
- exacerbation of skin diseases, etc.
Therefore, before surgery, patients undergo examinations, including nasal endoscopy, dental health, blood count and urine tests, measuring the duration of bleeding time and blood coagulation, etc.
Children can usually return home in a few hours after surgery, the adult patients may stay in hospital for 2-3 days. Within 2 weeks – a month after adenotomy one should avoid strenuous exercises, too hot shower, visits to saunas, solariums. It’s also worth avoiding hot, stuffy premises.
Results of treatment:
- nasal breathing is improved, often immediately after surgery – snoring and air insufficiency remain in the past;
- hearing is also often restored immediately;
- endless colds no longer bother you;
- the syndrome “open mouth” disappears;
- mood and appetite improve;
there is a noticeable burst of energy.