Current techniques of adenoidectomy

Published on 05/05/2015 by admin

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Last modified 05/05/2015

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Chapter 66 Current techniques of adenoidectomy


The use of a curette to remove the adenoids dates back to some of the earliest attempts at this procedure and remains an incredibly popular technique worldwide. The original design of Jacob Gottenstein has been modified and many different lengths, widths and curvatures are available. The basic principle is that of a sharp horizontal knife-edge that is designed to cut through the base of the adenoid bed. The instrument is designed to follow the natural curvature of the nasopharyngeal skull base (Fig. 66.1).

The curette may be passed blindly into the nasopharynx, or the laryngeal mirrors may be used to guide the cutting edge into position. Visualization of the fossa of Rosenmuller helps guide appropriate curette size. The curette is placed against the vomer and then pushed through the adenoid tissue to the more resistant deeper layers. The handle is pulled toward the head and the surgeon’s other hand acts as a fulcrum at approximately the level of the incisors. The curette is swept in an arc through the adenoid tissue until the level of Passavant’s ridge, which is the inferior aspect of the dissection. After the initial pass, the adenoid bed is inspected for the completeness of the procedure. If there is residual adenoid tissue left behind, it must be removed using either a smaller curette or St Claire-Thompson forceps. A tonsil sponge is then generally placed into the nasopharynx to aid in hemostasis. These sponges may contain medications such as oxymetazoline or can be used alone. It is our preference to finalize hemostasis using a suction monopolar cautery using mirror guidance although other techniques including pressure packing, bismuth subgallate and silver nitrate have been described. Once final hemostasis is achieved, the nasopharynx and oropharynx should be irrigated and the stomach emptied of its contents prior to extubation.

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