Adenoid Surgery: When Is It Necessary and How Is It Performed?

Adenoid surgery, also known as adenoidectomy, is a common procedure in children who experience breathing problems or recurrent infections due to enlarged adenoids.

The adenoids are small masses of tissue located at the back of the nose, and while they are part of the immune system, their excessive growth can cause health problems.

When Is Adenoid Surgery Necessary?

Adenoid surgery is typically indicated based on three main medical criteria:

• Obstructive Sleep Apnea: This syndrome causes pauses in breathing, known as apnea, during sleep. Children with sleep apnea may experience developmental issues, daytime fatigue, and difficulties with concentration.
• Recurrent Otitis Media: Repeated ear infections, known as otitis, can also be a reason to consider surgery, especially if the infections do not respond well to conventional treatments.
• Nasal Obstruction: When the size of the adenoids makes normal nasal breathing difficult, it can lead to poor sleep quality and other respiratory complications.

Diagnostic Methods

Before performing an adenoidectomy, it is important to assess the degree of adenoid enlargement. There are two main diagnostic methods:

Lateral Neck X-ray

This study is the most commonly used because it is less invasive. A lateral neck X-ray can classify the size of the adenoids into three grades:

• Grade 1: Obstruction less than 30%, which is considered normal in most children.
• Grade 2: Obstruction between 30% and 60%.
• Grade 3: Obstruction greater than 60%, which is usually indicative of surgery.

Nasopharyngoscopy

This method involves inserting a small camera through the nose to directly observe the adenoids. While more precise, it is a somewhat invasive procedure and is generally reserved for cases where the child has already undergone several X-rays or presents more complex symptoms.

Contraindications for Adenoid Surgery

Although the surgery is relatively safe, there are some contraindications that must be evaluated before the procedure:

• Blood Clotting Disorders: If the patient has severe clotting problems, the surgery will not be performed until a hematologist determines how to manage the risk.
• Velopharyngeal Insufficiency: This condition occurs when there are malformations in the palate, such as a submucous cleft palate. In these cases, the surgical technique may be modified to avoid complications.
• Down Syndrome: Patients with Down syndrome have a higher risk of atlantoaxial subluxation (instability in the neck vertebrae). However, this is not an absolute contraindication, as a less invasive technique, such as endoscopic surgery, may be used.

Surgical Techniques for Adenoidectomy

There are different surgical approaches for adenoid removal. The choice of technique depends on the surgeon's preference and the patient's needs.

Traditional Technique (Curettage)

This technique, known as curettage, uses an instrument to scrape and cut the adenoid tissue. Although it is an effective method, it is performed "blindly," which can increase the risk of complications.

Endoscopic Technique

The endoscopic technique is more advanced and allows the surgeon to directly visualize the adenoids during surgery. A common option within this method is the use of radiofrequency, where a device called a coblator is used to remove the adenoid tissue while controlling bleeding precisely. This technique is preferred because it reduces the risk of bleeding and postoperative complications.

Postoperative Care

After surgery, the main focus is relative rest. The child can engage in light activities such as walking or eating, but should avoid playing, running, or sun exposure for a few days.

Unlike other surgeries such as tonsillectomy, there is no need to modify the patient's diet. However, it is crucial to monitor the child's rest to ensure a full recovery.

Long-Term Expected Outcomes

Adenoid surgery usually significantly improves breathing and sleep quality. This, in turn, positively affects various aspects of childhood development, including growth, academic performance, and overall well-being.

Additionally, children who suffer from recurrent middle ear infections often experience a reduction in the frequency of these infections after adenoidectomy. It enhances the quality of life for both the child and their caregivers.