Adenoidectomy | Tonsillectomy | Combined Technique

Power-assisted adenoidectomy


Illustration of power-assisted
adenoidectomy
This technique uses a microdebrider (pronounced "MI-cro-duh-BREE-der"), a powered instrument that has a very small rotating tip. It is designed to remove both hard tissue (bone) and soft tissue.

Some ENT (ear, nose and throat) specialists began using this device for adenoid removal about eight years ago, and it has several advantages:

  • More effective treatment for chronic ear infections
  • More precise tissue removal and reduced risk
  • Faster procedure with less blood loss
  • Improved visualization and access to anatomy
  • More effective treatment for chronic ear infections
The power-assisted adenoidectomy is more effective in treating chronic ear infections because the microdebrider removes adenoid tissue more completely than other techniques, even while leaving a very thin ridge of tissue between the nose and mouth to prevent serious complications.

At a May 2003 national meeting of ENT specialists, researchers presented a study that highlighted the differences between powered, curette, and suction cautery adenoidectomies. The study looked at 1270 children that had received an adenoidectomy and a second set of vent tubes because of recurring ear infections.

Researchers followed these children for one year and recorded how many of them had to have a third set of vent tubes because the ear infection had returned, even after an adenoidectomy was performed.

The children in the study who underwent a power-assisted adenoidectomy were much less likely to require an additional vent tube operation due to subsequent ear infections.

The results of the study were:

  • Out of the 75 children who received a curette adenoidectomy, 9.3% (seven children) needed an additional vent tube operation.
  • Out of the 743 children who received a suction cautery adenoidectomy, 23.3% (175 children) needed an additional vent tube operation.
  • Out of 452 powered adenoidectomy patients, only 3.5% (16 children) needed an additional vent tube operation.
  • 16 cases of transient and 3 cases of permanent velopharyngeal insufficiency (VPI) were noted, mostly in suction cautery patients.

More precise tissue removal and reduced risk
With other adenoidectomy methods, it can be difficult to control the amount of tissue being removed. If too much is removed, other tissues nearby may be damaged and complications can ensue. If too little adenoid tissue is removed, the adenoids may regrow and the disease may return.

As a powered instrument, the microdebrider offers the surgeon greater precision and control. This helps reduce the risk of unintentional damage to nearby tissues while removing the maximum amount of disease-causing tissue.

Clinical studies have demonstrated that the microdebrider allows for more complete adenoid removal, which is particularly important in cases where the adenoids need to be removed due to recurring infections.

In addition, the power-assisted adenoidectomy may reduce the risk of velopharyngeal insufficiency (VPI), a complication that can occur when the muscular opening between the back of the nose and throat is inadvertently damaged.

This muscular opening is called the nasopharnygeal sphincter or Passavant's Ridge. Temporary or permanent VPI can result when this muscle is injured, a condition in which there is 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.

Faster procedure, less blood loss
All adenoid surgery involves some degree of bleeding. Using the microdebrider, there is slightly less blood loss during surgery as compared to a curette adenoidectomy. In addition, the surgeon can remove the adenoids more quickly with the microdebrider than with other techniques. This is particularly significant in cases where the adenoids are quite large, such as in obstructive sleep apnea.

Improved visualization and access to anatomy
With improved visualization and access, the surgeon can remove tissue more precisely and safely. Unlike curette adenoidectomies, the surgeon can directly see the adenoid tissue while using the microdebrider to remove it. The shape of the microdebrider also provides improved access to the difficult region where the adenoids are located.

Disadvantage
Although it shortens the length of the surgery, the cost for a power-assisted adenoidectomy is about $100.00 more per surgery than using a curette. However it is less expensive than some of the more recently popularized radiofrequency techniques.

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Adenoidectomy techniques

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Combined tonsillectomy and adenoidectomy (T&A) techniques

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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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