Adenoidectomy | Tonsillectomy | Combined Technique

Curette adenoidectomy


Image of an
adenoid curette
Most adenoidectomies today are performed with a curette. A curette is a manual surgical instrument that looks something like a small, stainless steel "window" attached to a handle. The inside edge of the top of the "window" is very sharp.

Since the adenoids are located very high in the throat behind the nose, the surgeon has to insert a tiny mirror to be able to see them. Then the surgeon will position the curette under the mirror, remove the mirror, and "swipe" the adenoids from the back of the throat.

The curette technique is currently the most popular adenoidectomy method among surgeons. While it is generally effective and relatively safe, the curette method does have considerable disadvantages.

Disadvantages

The main drawbacks of the curette technique include:
  • Less precise removal and potentially less effective treatment
  • Bleeding may be increased
  • Risk of neck pain and velopharyngeal insufficiency (VPI)
  • Lack of vision
Less precise removal and potentially less effective treatment
The adenoids are in an anatomical area that is difficult to access, and a curette does not easily fit into this region. This makes it harder to be precise, and harder to remove the adenoid tissue completely with a curette adenoidectomy. It is especially difficult to remove the tissue towards the back of the nose, next to and beside the septum, and on the sides behind the opening to the ear (eustachian tube).

This deficiency of the curette technique can be particularly important when the adenoids are being removed to treat recurring infections. If enough adenoid tissue is left behind, then it may persist as a source of chronic infection.

Bleeding may be increased
All adenoid surgery involves some degree of bleeding. But the curette method can cause more bleeding, because the tissue removal may not be complete or the curette may cut into the muscle tissue behind the adenoids.

Risk of neck pain and velopharyngeal insufficiency (VPI)
When the surgeon uses a curette to "swipe" the adenoids from the back of the throat, it is difficult to control the depth of tissue removal. For this reason, complaints of neck pain are not uncommon following a curette adenoidectomy, though the pain normally resolves in less than a week.

In rare cases, the muscular opening between the back of the nose and throat (nasopharyngeal sphincter or Passavant's Ridge) may be accidentally injured. This can result in temporary or permanent velopharyngeal insufficiency (VPI).

VPI causes hypernasal speech, or an excessive nasal sound to the voice. VPI can also affect normal drinking and eating by allowing liquids to flow into the nose from the back of the mouth.

Lack of vision
In a curette adenoidectomy, the surgeon cannot see the adenoids while removing them. The surgeon has to verify the location of the adenoids with a mirror, place the curette under the mirror, and then remove the mirror to be able to "swipe" the adenoids.

This makes it harder to be precise and easier to damage adjacent tissues, which can occasionally result in the complication of velopharyngeal insufficiency (VPI), as described above.

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Version 2.1.0 This webpage was first published on September 08, 2005, and was last updated on August 31, 2007.
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