Comparison between two techniques for adenoidectomy: a randomized prospective clinical study

ABSTRACT

An adenoidectomy can be performed with a variety of techniques, such as an adenoid curette, an adenotome, an adenoid punch, suction cautery, microdebrider or even laser. All these methods have their advantages and disadvantages, and the choice of instrument is usually based solely on the surgeon's personal preference; however, direct visualization during surgery and achieving complete resection of adenoids tissue without inadvertent injury of the surrounding structures are very important. The objectives and methodology of this study was to compare between the conventional Curette Adenoidectomy [CA] and Power Assisted Adenoidectomy [PAA] techniques as regards to actual operating time, estimated blood loss and completeness of adenoids resection. This prospective randomized study included 64 patients; 34 PAA and 30 CA, study was done in Green Crescent Hospital, Riyadh, Saudi Arabia. Results in this study showed that PAA was more faster than CA [P<0.05]; PAA operative time ranged between [10-20] minutes, mean=12 minutes, while CA ranged between [10-30] minutes, mean= 17 minutes. Regarding blood loss estimation, in PAA group blood loss ranged between [20-180 ml], mean= 35ml, while in CA group blood loss ranged between [30-220 ml], mean=45ml. There was a statistically significant difference between PAA and CA groups in estimated blood loss in favor of PAA. [P<0.05] Postoperative endoscopic assessment of the nasopharynx showed that PAA provided a significantly more complete resection around the choanae and torus tubaris and significantly better control of the depth of the resection for large adenoids [P<0.05] and intranasal extension [P<0.001] than curette adenoidectomy. In comparison with conventional CA technique, PAA provided significant advantages that are subjectively and objectively apparent. In this study it has been concluded that PAA saved actual operating time and reduced blood loss and provided surgeon with more satisfaction of direct visualization and complete resection of adenoids specially, in the areas of choanae, torus tubaris and intranasal extensions, however, some of the limitations of this procedure is that it is costly and needs more experience of the surgeon with the use of the microdebrider. Therefore it should be used in selected cases of large adenoids or those adenoids with intranasal extensions where it is suspected that conventional techniques fail to achieve complete resection of adenoids. Power Assisted Adenoidectomy = PAA, Curette Adenoidectomy = CA, Bovine Spongiform Encephalopathy = BSE, round per minute=rpm