Indications for adenoid removal in children. Removal of adenoids in children under general anesthesia: advantages, disadvantages, consequences Surgical removal of adenoids

Adenoids, or adenoid vegetations – pathological changes pharyngeal tonsil, caused by hyperplasia of lymphoid tissue. It usually occurs in children aged 3 to 14 years; it is very rare in adults. Causes difficulty in nasal breathing, hearing loss and other disorders. Effective method The treatment for adenoids is their removal.

Types of adenoid removal operations

Currently, adenoid removal is adenotomy- carried out in several ways. The most common:

• Standard- using a special instrument, Beckmann's adenotomy.
• Endoscopic— using a shaver or microdebrider and visual control surgical field endoscopes.
• Coblation– tissue dissection using so-called “cold” plasma.

Standard operation

It can be performed both in inpatient and outpatient settings, under local anesthesia, or Beckmann’s adenoid is used to remove adenoids.

Stages of standard adetomy:

1. The tongue is fixed with a spatula at the bottom of the mouth, the adenoid is inserted into the nasopharynx along the midline and moved along the posterior edge of the vomer up to the dome of the nasopharynx. When the scalpel is pressed against the nasopharynx and vomer, the tissue to be removed enters the adenotomy ring.
2. With a short and sharp movement the tool back wall the nasopharynx is shifted downwards. In this case, the adenoid tissue is cut off; if it remains hanging on a thin strip of tissue, it is removed with forceps.
3. After this, the patient needs to clean out the nasal passages. If the operation is performed under topical anesthesia, then he can do it independently, exhaling forcefully in turn through each nasal passage.

After surgery to remove the adenoids, there is slight bleeding, which quickly stops. After the follow-up examination, the patient can leave the medical facility 2-3 hours later.

Endoscopic surgery to remove adenoids

Recently, endoscopic adenotomy has been increasingly used, with visual control of the surgical field using endoscopes. As a rule, such an operation is performed under general anesthesia, which allows for painless and quick removal of the adenoids.

Stages of endoscopic adenotomy:

1. Before surgery begins, an endoscope is inserted through the oral or nasal cavity.
2. To remove adenoids, a shaver (microdebrider) is used - this is a special cutting tool for surgical operations in the nasal cavity and nasopharynx. The tip of the shaver is inserted into the nasal cavity up to the nasopharynx. The design allows cutting off pathological tissue without damaging healthy areas, as well as suctioning blood and cut tissue.

How endoscopic surgery to remove adenoids is performed on YouTube video.

Coblation adenotomy

Coblation, or “cold destruction,” is one of the most modern technologies, based on the treatment of tissues with “cold” plasma. As a rule, it is performed under endoscopic control and local anesthesia.

Stages of coblation adenotomy:

1. Inserting an endoscope into the nasal or oral cavity.
2. Insertion of a special device connected to the apparatus into the nasopharynx.
3. Dissection and removal of adenoid tissue using a plasma beam that does not damage healthy tissue and has a coagulating effect, which reduces bleeding after surgery.

Coblation adenotomy video is available on YouTube.com

After the operation, there may be an increase in body temperature, abdominal pain, and vomiting of blood clots. As a rule, symptoms go away on their own within a day or two. Because of postoperative edema The mucous membrane may experience nasal congestion and a nasal voice. By day 10, the swelling subsides and nasal breathing is completely restored.

Under what conditions is it necessary to remove adenoids in children? Reviews of operations of this kind can be found on medical portals and parent forums. There are a variety of opinions. However, both doctors and parents unanimously say: there are situations when only surgery gives a positive effect and returns to the child full breathing. Which means - full life, without stuffy nose, snoring, drowsiness, lethargy and bad mood.

The operation to remove adenoids in children is called adenotomy. Among surgeons it is referred to as “streaming”. This is one of the most frequent, short and uncomplicated operations in ENT surgery. Adenotomy is not a type of emergency, urgent operation. Usually they prepare for it according to plan, prescribe a number of necessary examinations, and repeat diagnostics. The operation itself lasts no more than 10 minutes and is usually performed in the morning. After removal of the adenoids, the patient is under the supervision of doctors for about 5 hours, and in the evening he returns home safely. In rare cases, you have to stay overnight in the hospital if there are complications - bleeding or side effects of anesthesia. Most often, adenotomy is performed on an outpatient basis.

Indications for surgical treatment of adenoids

Should a child's adenoids be removed? It is worth it if all conservative treatment methods do not have any effect, while inflammation of the adenoids (adenoiditis) becomes chronic. This means: a focus of infection remains in the adenoids, their swelling remains, and rapid growth of adenoid tissue is diagnosed. What symptoms and diseases are considered mandatory indications for adenotomy?

• Difficulty in nasal breathing. The child breathes through his mouth all the time, which provokes drying of the mucous membranes, frequent acute respiratory viral infections and complications after them. Also, difficult nasal breathing leads to restless sleep, which affects the general psycho-emotional state of the child, leading to irritability and constant fatigue.
• Holding your breath during sleep, or apnea. Life-threatening symptom. In addition, oxygen deficiency (hypoxia) negatively affects brain function and the growing body as a whole.
• Chronic otitis media. Enlarged adenoids block the auditory tube, which provokes inflammatory processes in the middle ear. Over the course of a year, the child suffers from otitis media 4 times, and hearing deterioration is also observed.
• Deformation of the facial skeleton. Exists medical term"adenoid face" Enlarged adenoids lead to abnormal changes in the maxillofacial bones. Such consequences can be irreversible if the operation is not performed in a timely manner.
• Malignant tumors. Fortunately, cases of degeneration of adenoid tissue into malignant tumor are rare.

What is important to know

The operation can be prescribed even in infancy, if so serious reasons and clear indications.

• Adenotomy is contraindicated for children suffering from bronchial asthma, heart and blood diseases. Such patients are prescribed only conservative therapy. Read about the treatment of adenoids in children without surgery in our other article.
• Frequent ARVI is not an indication for surgery. If nasal breathing persists, adenotomy is usually not prescribed.
• It is not always necessary to remove grade 3 or 4 adenoids. For example, a child may be diagnosed with grade 1 or 2 adenoids, while he or she experiences difficulty in nasal breathing, snoring or sleep apnea, complications after ARVI - otitis, sinusitis, sinusitis. These are already clear indications for adenotomy.
• Among the reviews from parents you can find the following opinion: there is no need to rush into the operation. The opinion of several highly qualified otolaryngologists will not be superfluous.
• If parents still decide to undergo surgery, it is necessary to consult with the surgeon who will operate on the baby.
• Re-diagnosis is necessary for adenoiditis. If a child has suffered from an acute respiratory viral infection, and two weeks later he is diagnosed with grade 2 or 3 adenoids, this is not yet a reason to sound the alarm and urgently “cut.” Enlarged adenoids are normal after past illness. Repeat examination may show noticeable improvement.

There are cases when the doctor recommends postponing the operation unless there are extreme indications. This is explained by the fact that adenoid tissue grows rapidly until the age of 6-7 years, after which the size of the adenoids begins to decrease. A child can “outgrow” adenoiditis, like many other childhood diseases.

Methods of adenotomy

The essence of adenotomy is the complete removal of adenoid tissue from the nasopharynx. What methods are used in modern medicine? Methods for removing adenoids in children can be classified according to the type of anesthesia and adenotomy methods using various tools and equipment.

Types of pain relief

The first operations to remove adenoids began to be carried out in late XIX century. Of course, there was no talk of any anesthesia in those days.

• Local anesthesia. In this case, the level of pain threshold, the temperament of the little patient, his psycho-emotional state and age. Doctors often offer this type of anesthesia to older children. It is carried out in the form of spraying (spreading) an anesthetic onto the mucous membranes of the nasopharynx. The child does not feel pain, but he may be frightened by the sight of blood or horrified by the procedure itself. Therefore, often when local anesthesia additionally applies intramuscular injection sedatives. The little patient is in a dull state of consciousness and is not violent. Adenotomy under local anesthesia costs less, is performed faster, has no post-anesthesia side effects and complications. Parents agree to local anesthesia, knowing the persistent character and endurance of their child.
• General anesthesia. IN western medicine This type of anesthesia is used exclusively. It is also strongly recommended by domestic doctors: not only for humane purposes (to spare the child’s psyche), but also for purely practical ones - only in calm conditions can a high-quality operation be performed and all adenoid tissue removed. Most modern clinics switch to general anesthesia. Anesthetic risks and sudden complications with general anesthesia exist. The anesthesiologist must tell you about this.
• No anesthesia. Today this fact may be shocking. Although quite recently in Russia, adenotomy was performed without anesthesia. This is explained by the fact that lymphoid tissues do not contain nerve fibers. “It doesn’t seem to hurt,” but it’s very scary. On parenting forums you can read vivid and unforgettable childhood memories: being tied to a chair, bloody aprons, etc. Many parents want to save their child from such heartbreaking scenes and generally prefer general anesthesia.

The decision on the choice of anesthesia is made by the anesthesiologist after carefully studying the child’s health indicators, taking into account the presence of allergic reactions and the results necessary tests. If contraindications to general anesthesia are identified, local anesthesia is prescribed. If the child is registered with specialized specialists (cardiologist, neurologist, allergist, pulmonologist, hematologist), their consultation and conclusion is necessary.

Basic methods of surgical treatment

• Classic surgery using an adenotomy. Adenotom is a ring-shaped knife that is used to remove adenoids. At classical way a laryngeal mirror, a confident hand and keen vision of the doctor are used. The disadvantage of such operations: more intense bleeding during removal (some surgeons dispute this fact), insufficient visibility, as a result of which it is not always possible to remove the adenoid tissue efficiently. If a small piece of tissue remains, there is a risk that the adenoids will grow back. During surgery, it is sometimes necessary to resort to hemostatic agents (powdery powders, cauterization of blood vessels with laser or radio waves). In modern surgery, radio wave adenotoms have appeared, which simultaneously remove tissue and stop bleeding.
• Laser removal. Instead of an adenotomy, a laser is used. Exist different kinds laser instruments that the doctor selects depending on the category of complexity of the operation. Laser removal adenoids is considered a low-traumatic and high-precision method. The sterility of the laser provides the lowest risk of secondary infections after surgery. Tissue healing after laser adenotomy is much faster.
• Endoscopic removal of adenoids in children. The main advantage of the method is the visibility of the surgical field. Majority modern operations carried out using endoscopic control. Thanks to a video endoscope, the surgeon performs adenotomy with high precision, effectively and efficiently removing adenoid tissue.
• Cold plasma method, or coblation. The last word in otolaryngology. It is performed using a coblator - a cold plasma instrument. It has a number of advantages: bloodlessness, painlessness, the most thorough removal of adenoid tissue, reduced risk postoperative complications, quick recovery after surgery. The only negative is the price.

Postoperative period

How does the postoperative period proceed?

• As a bonus for the “ordeal,” the patient receives ice cream. Cold promotes vasoconstriction, which is indicated after removal of the adenoids.
• Pain and discomfort in the throat when swallowing may remain for several days. The doctor prescribes local anesthetics and painkillers.
• Possible vomiting with blood. This happens if the child swallows blood during surgery. For the same reason, bowel irregularities are possible.
• In the first days, the temperature may rise to 38 °C. It is strictly forbidden to use antipyretic drugs containing acetylsalicylic acid because it can cause bleeding.
• As prescribed by the doctor, it is necessary to take astringents and vasoconstrictors into the nose.
• For a week after the operation, it is forbidden to take a hot bath, go to the sauna, or be in the open sun.
• The doctor will also recommend a gentle diet: avoid hot, hard foods that irritate the mucous membrane.
• Nasal sounds and nasal congestion are explained by swelling of the mucous membranes after surgery. These symptoms usually disappear within a week.
• A special one will be useful breathing exercises, which the ENT will tell you about.
• Fresh air is shown! Avoid heavy physical activity for a month.

Only after a month can an ENT specialist adequately determine the effectiveness of surgical treatment. Although many patients experience noticeable improvement within a week. In most cases, there are positive reviews after adenotomy.

Possible complications

What can be the consequences of adenoid removal in children?

• Severe complications. Only in rare cases does intense bleeding occur during and after surgery, aspiration respiratory tract, complications after general anesthesia, palate injuries.
• Temporary decrease in immunity. Otolaryngologists assure that negative consequences after adenotomy no: the child will not get sick more often if his adenoids are removed. Immunity after adenotomy decreases, as after any other operation. After a few months, the immune system returns to normal.
• A child snores after adenoid removal. If snoring and nasal snoring continue for ten days after surgery, this is normal. The swelling will go away and the snoring will disappear. If snoring remains for a longer time after adenotomy, a mandatory consultation with an otolaryngologist is necessary.
• Secondary infection. After surgery, a wound remains in the nasopharynx, which, due to weakened immunity, can cause a secondary infection. Therefore, doctors recommend home regimen and temporary limitation of contact with the children's team in the postoperative period.

Price issue

How much does it cost to remove adenoids for a child? There is no point in giving specific numbers. Because they depend on many factors: the category of complexity of the operation, the qualifications of the doctor, the choice of anesthesia, the method of adenotomy, the clinic, the region. The more progressive the method and the higher the qualifications of the specialist, the higher the cost. Russian parents who have gone through the financial costs of surgical treatment of their children often share personal experience in networks. What's special about this purely Russian experience?

• If this is a private, non-state clinic, then the price list must take into account absolutely all services. Often only the cost of the surgeon’s work is indicated, the rest comes up later.
• If this is a public clinic (hospital) and the money is given in an envelope, it is important to consider: to whom, how much and when to give. Separate and special “gratitude” is given to the anesthesiologist and surgeon. We must also not forget about the nurses who will look after the child. This is Russian reality.

It is necessary to immediately negotiate the full financial costs so that there are no surprises or mutual claims later.

Removal of adenoids in children is often repeated, especially if the operation is performed in early age(up to 3 years). Secondary growth of adenoids is not always explained by poorly performed surgery. There may be other reasons. For example, relapses after adenotomy are more common in children with allergies and patients with a genetic predisposition to intensive growth adenoid tissue.

Print

Adenoids are a proliferation of lymphoid tissues of the pharyngeal tonsil, which can begin for many reasons - hereditary predisposition, frequent colds, unfavorable environment, etc. A condition in which the adenoids become inflamed is called adenoiditis, and most often children are susceptible to this disease.

Removing adenoids in children is one of the most common methods of treating adenoiditis. Surgical intervention is aimed not only at eliminating pathologically changed tissues, but also at preventing a number of complications.

Symptoms

Enlargement of the pharyngeal tonsil cannot be detected during examination - even a significant degree of enlargement of lymphoid tissues can only be detected with the help of special otolaryngological devices. But, nevertheless, the symptoms of adenoiditis are sufficiently characteristic for parents to promptly notice signs of trouble and consult a doctor for a diagnosis.

Adenoids, depending on their size, may appear the following symptoms:
frequent or constant disturbance of nasal breathing (difficulty or noisy inhalation and exhalation);
during physical activity (running active games etc.) the child breathes through his mouth;
snoring during sleep;
obvious decrease in hearing acuity (the child does not respond to his name pronounced at normal volume; he sits closer to the TV or adds sound, etc.).

Adenoids have a certain feature: even with a slight increase in the pharyngeal tonsil, it can completely block the nasal passages, as a result of which the child completely lacks nasal breathing. With the same probability, grade III adenoids can only slightly reduce the patency of the nasal passages - the extent to which nasal breathing can be impaired depends not only on the size of the adenoids, but also on individual characteristics structure of the nasopharynx.

Complications of adenoids

Lack of treatment for adenoids can significantly affect the child’s development and quality of life in the future. This is easy to understand if you remember: most often this condition develops in children 3-7 years old - during the period of the most intensive formation of facial bones, dentofacial apparatus, immune and other systems.

Constant disruption of nasal breathing and the need to breathe through the mouth leads to hypoxia - a deficiency of oxygen in tissues, including brain tissue, which disrupts the intellectual and psycho-emotional development of the child.

In addition, the bone structures of the face and the ligamentous apparatus of the jaws are formed in the same way - under the influence of active breathing through the mouth, which leads to malocclusion, dental defects, and abnormal tooth growth.
Also on the list of complications of adenoids are frequent respiratory diseases, work disorders immune system(including allergic reactions), chronic otitis media, sinusitis and other ailments.

Conservative treatment of adenoids

Conservative treatment of adenoiditis, depending on the degree of tissue proliferation, symptoms and general condition health and age of the child may include the following activities:
systematic hardening aimed at increasing the body's defenses;
taking immunostimulating and restorative medications (vitamin-mineral complexes, bioactive herbal remedies, etc.);
prescribing a course of anti-inflammatory drugs;
flu vaccination before the onset of the autumn-winter season;
improving the ecology of housing (installing air humidifiers, removing “dust collectors” - carpets, heavy curtains, etc.).

But first of all, it is necessary to eliminate the causes of inflammation and proliferation of the pharyngeal tonsil - if such causes are identified. If factors that provoke the proliferation of tissues of the pharyngeal tonsil and cause their inflammation are excluded, conservative therapy may be sufficient to stop the growth of adenoids.

Laser treatment of adenoids in children

Laser therapy is one of the proven methods of treating adenoids in children, which is used comprehensively, in combination with drug therapy. The laser beam, operating in a special frequency mode, stimulates local immunity (in the nasopharynx area), which eliminates the inflammatory process and reduces the growth rate of lymphoid tissues. This treatment method is prescribed taking into account the individual characteristics of adenoiditis, and in some cases can be carried out with a significant increase in adenoids, up to stage III.

In addition, exposure to a laser beam eliminates the infectious component of inflammation, which helps alleviate the symptoms of the disease and speed up recovery.

Surgical treatment of adenoids in children

Conservative treatment does not always bring a positive effect. This may be due to anatomical features nasopharynx in a child, the presence genetic predisposition to adenoiditis, the inability to eliminate provoking factors. In such cases, surgical treatment of adenoids is recommended, in which pathologically overgrown tissue is removed.

Surgery to remove adenoids is always performed as planned and is not considered an emergency: even if complete absence nasal breathing, before surgery there is always time to prepare the child and conduct a full examination.
The age of the child, the degree of proliferation of lymphoid tissues and other factors are not determining for the operation: only if there are indications, surgical intervention is prescribed.

A few days before surgery, the child may be prescribed hemostatic, antibacterial, anti-inflammatory, antihistamine or other drugs if the attending physician sees the need to take them. In addition, before the operation, it is necessary to carry out sanitation of the oral cavity with the treatment of carious teeth and/or removal of teeth affected by caries and not subject to treatment.

Indications for adenoid removal

Circumstances under which it is indicated surgical removal adenoids include the following:
ineffectiveness or low efficiency conservative treatment;
constant violation of nasal breathing (the child breathes mainly through the mouth);
hearing impairment, decreased hearing acuity.

Contraindications to adenoid removal

Surgery to remove adenoids is contraindicated in following cases:
diseases affecting blood clotting;
systemic infectious diseases V acute stage;
acute inflammatory process in the nasopharynx;
the child is under 2 years of age (up to 2 years of age, surgery can be performed according to vital signs, for example, in the complete absence of nasal breathing in combination with frequent tonsillitis, laryngotracheitis, which increases the risk of suffocation during sleep or when high speed growth of adenoids with complications on the hearing organs).

Adenoid removal techniques

In modern surgical practice, adenoid removal can be performed using the traditional method, using physical instruments or using a laser.

The duration of the operation, including preparation and anesthesia, is about 10-15 minutes. Preference is given to local anesthesia, which is carried out using an injection of an anesthetic or a special aerosol that “freezes” the tissue. In both cases, the sensitivity of the operated area is reduced to zero, but the central nervous system(as is the case with general anesthesia).

Traditional adenoid removal

With this method, the doctor uses a special knife (an instrument in the form of a loop of sharpened wire on a handle), which is inserted through the mouth to the anatomical border of the nasopharynx. After this, the doctor “presses” the loop into the overgrown tissue, which slips inside the loop. With one forward movement, the surgeon cuts off the adenoids - the operation lasts no longer than 1-2 minutes.

Laser removal of adenoids

Laser adenoid removal is considered the preferred surgical method. This is primarily due to the minimal risk of infection of the operated area and the prevention of bleeding.

The laser beam has a coagulating effect - at the moment of contact of the beam with the mucous membrane of the nasopharynx, simultaneous excision of pathological tissues and “cauterization” of blood vessels is carried out. This reduces the chance of bleeding to almost zero. Another advantage of the laser is the sterility of the beam, which prevents both wound infection during surgery and minimizes the threat of postoperative infections.

Possible complications

The most common complication after adenoid removal is their recurrence. This is due to the fact that none of the surgical methods is able to completely remove pathological tissues, which can regenerate after some time.

Re-growth of adenoids is especially common in children for whom relapse prevention measures have not been taken and have not been eliminated. harmful factors(parents smoking in the presence of the child, dusty premises, deficiency nutrients etc.).

To avoid post-operative health problems, you must follow the following rules for preparing for and undergoing surgery: recovery period:
within 3-5 days after surgery, exclude from the child’s diet foods that irritate the mucous membrane: nuts, seeds, crackers, carbonated drinks, etc.
make sure that the child does not become hypothermic;
if the child attends school or kindergarten, it is better to leave it at home for the first few days after removal of the adenoids;
if the operation is scheduled for the “epidemiological” period - from October to March - be sure to carry out the prevention of acute respiratory viral infections according to the plan provided to you by the doctor. Given the child's vulnerability in postoperative period, such a preventive measure can become a reliable means of preventing both infectious complications, and re-growth of adenoids after surgery.

In order to understand whether a child has it, you should consult an ENT doctor, who will make the correct diagnosis during the examination. During the examination, palpation of the adenoids is used with a finger inserted through the mouth into the posterior lower part of the nasopharynx, as well as posterior rhinoscopy - examination of the nasopharynx using a mirror inserted through the mouth. In addition, they can be assigned instrumental methods examinations:

• X-ray of the nasopharynx and paranasal sinuses nose,
• Endoscopic diagnosis - insertion of a fiberscope into the nose followed by visual examination of the adenoids.

Based on the examination, the degree of enlargement of the adenoids is revealed:

• 1st degree– adenoids block the openings connecting the nasal passages with the pharynx by less than 1/3, the child is bothered by night snoring and frequent

• 2nd degree– the choanae are closed by a third or half of the lumen, the child breathes poorly through his nose during sleep and while awake,
• 3rd degree– the lumen of the choanae is completely blocked by the adenoids, the child experiences significant pain; in the absence of treatment for a long time, malocclusion and an adenoid type of face are formed.

Adenoid removal operations

Prescription of treatment and determination of surgical tactics is strictly individual only based on the results of a doctor’s examination. In general we can say that:

Grade 1-2 adenoid growths can be treated conservatively, while with grade 3 the adenoids should be removed.

As a complement to drug treatment in the early stages of adenoid vegetations, the method is currently successfully used laser therapy– treatment of adenoids with laser beam, eliminating swelling and having a bactericidal effect on the surface of the adenoids. Thanks to this laser action, a gradual decrease in size is observed. nasopharyngeal tonsil and restoration of nasal breathing. The course of treatment consists of 10-15 daily procedures, which should be repeated every six months. The advantages of laser therapy include painlessness, safety, and good effectiveness. No disadvantages were identified in the method.

Surgery

Adenotomy surgery in children is possible using several methods:

Indications for adenotomy:

• Adenoid vegetations 3 degrees,
• Frequent colds, complicated by purulent tonsillitis,
• Night sleep disturbances, hearing loss, constant headaches, formation of an adenoid type of face.

Contraindications:

1. Children under two years of age,
2. Acute infectious diseases - ARVI, etc.
3. Congenital anomalies of the facial skeleton (cleft palate, cleft lip),
4. The first month after vaccination,
5. Oncological diseases,
6. Blood diseases
7. Allergic diseases in the acute stage.

What anesthesia is used during adenotomy surgery?

The choice of anesthesia is controversial issue for parents of a child scheduled for surgery.

Of course, general anesthesia carries a certain risk, in particular for children with allergies and those with neurological problems, but in recent years, pediatric anesthesiology has made great progress, and now you can safely trust the anesthesiologist examining the child before surgery. Regarding adenotomy, we can say that general anesthesia is preferable to local anesthesia. This is due to the fact that during short nap child under general anesthesia at the doctor's office better access and an overview of the surgical field, as well as the small patient himself does not experience negative emotions about the operation, since he simply won’t remember it later.

Advantages of general anesthesia:

General anesthesia in children is carried out by endotracheal administration of fluorotane and nitrous oxide to the patient by an anesthesiologist. In this case, the operation is performed in the supine position. After the adenotomy is completed (20-30 minutes), as the patient awakens, he may experience lethargy, drowsiness, nausea and vomiting. Such symptoms of recovery from anesthesia administered with fluorotane are relatively rare.

Lately, doctors have been trying to use local anesthesia less often, since, despite the lack of painful sensations, any child will experience fear, cry, scream, and escape from the hands of the staff. This will not only bring a lot of unpleasant emotions to the baby and parents, but can also interfere with the quality removal of the adenoids. Anesthesia is carried out by lubricating or irrigating the nasopharynx with a spray of lidocaine, dicaine and other local anesthetics.

Regardless of what anesthesia is used, the child is given intravenous or intramuscular sedatives 20-30 minutes before the operation.

How is the operation performed?

Adenotomy can be performed both on an outpatient basis (most often) and inpatient conditions. The issue of hospitalization is decided individually, but, as a rule, the length of stay in the hospital is no more than three to four days. The child should not be fed in the morning before surgery, as general anesthesia may be used. After being examined by a doctor and taking the temperature, the patient is escorted to the operating room, where general or local anesthesia is performed on a chair. Further stages of the operation have their own characteristics depending on the methodology.

Endoscopic adenoid removal is the most modern and gentle surgical technique. Under general anesthesia, an endoscope is inserted into the nose of the patient, allowing the adenoids to be examined and the extent of the action to be outlined. Next, depending on the instruments that the doctor has, the adenoids are removed using a scalpel, radiofrequency knife or microdebrider. In the latter case, the adenoids are removed through the nose. Due to the fact that this technique requires more expensive equipment and more qualified specialists, not every clinic can offer endoscopic adenotomy. Most often, such services are provided in private medical centers.

Snapshot endoscopic removal adenoids

One of the varieties endoscopic surgery is a method of coblation removal of adenoids - the introduction into the cavity of the nasopharynx of an instrument that has a destructive effect on tissue using cold plasma.

Laser adenotomy can be performed under local anesthesia, however, due to the fact that traditional tissue excision is more reliable, many doctors first remove the adenoids with a scalpel or adenotomy, and then use a laser beam to cauterize the remaining areas of the adenoids.

Manual excision of adenoids using an adenotomy is carried out as follows: a laryngeal mirror is inserted through the child’s mouth, lifting the soft palate and uvula, and allowing the doctor to examine the area of ​​adenoid vegetations in more detail. After examination, a special loop is placed on the tonsil, which has sharp edges, and the adenoids are cut off with this loop. Then electrocoagulation of the bleeding vessels is carried out, and, if necessary, tamponade with hemostatic solutions.

Adenotomy

Adenotomy generally takes no more than 20 minutes. After the operation, the child’s nose is examined again by the doctor, then he is transported from the operating room to the observation room, and after 4-5 hours, if there are no complications and if his condition is satisfactory, he can go home. The child's one-day stay in the hospital is accompanied by one of the parents.

Video: removal of adenoids in children (endoscopic method)

Postoperative period – what is possible and what is not?

In the postoperative period it is possible slight increase temperatures up to 38 0, easily relieved with suppositories or paracetamol-based syrup, pain and a feeling of congestion in the nasopharynx, disappearing after a couple of days. The child should not be fed for two hours after the operation, and should follow a light diet for 7-10 days - exclude hot, spicy, salty foods that irritate the oropharynx, and drink more fluids. Also, the child should not be bathed for several days, especially in a hot bath or sauna, and the number of contacts should be limited to avoid viral infection.

In the first 7-10 days, reflex swelling develops in the nasal cavity mucous membrane, in connection with which it should be used vasoconstrictor drops in the nose for a course of at least 5 days and drops based on silver (protargol, collargol) for ten days or more (up to a month).

In the first month after surgery, the child should receive fortified high-calorie foods and consume more fresh vegetables and fruits, rest more and gain strength.

Possible complications

It is worth considering possible complications of adenoiditis if surgery is refused are:

1. Otitis and hearing loss caused by obstruction of the auditory tubes, covered by overgrown adenoids,
2. Impaired mental performance and decreased academic performance due to chronic hypoxia brain,
3. Allergic diseases, up to bronchial asthma caused by frequent colds with the acquisition of an allergic component of the runny nose and its complications.

In the same time, complications after surgery They occur rarely in children, and the main one is bleeding caused by incomplete cutting of the adenoid tissue. The likelihood of such a complication is extremely low if the operation is performed endoscopically and under general anesthesia, since physical activity the patient, interfering with the operation, in this case is minimized.

Also considered a complication of adenotomy recurrence of adenoid vegetations. This is due to the use of local anesthesia, when the child prevents the doctor from fully grasping the base of the adenoids with a loop and completely removing the tissue. The incidence of regrowth of adenoids when using general anesthesia has decreased significantly in recent years - from 20-30% with local anesthesia up to 1-2% in general.

In conclusion, it should be noted that the unconscious fear of parents who are informed about the need to remove their child’s adenoids is caused by their own unpleasant memories or stories of friends about operations accompanied by large amounts of blood and performed on conscious children. The latest achievements of doctors in the field of otorhinolaryngology make it possible to discard such fears and perform the operation competently, efficiently and without pain.

Video: what are adonoids and the procedure for performing the operation