Superior Adenoidectomy in Children with Palatal Abnormalities

Abstract

When treating a child with a palatal abnormalityfor otitis media ora nasal obstruction, otolaryngologists ofte nface the question ofwhether the benefit s ofadenoidectomy are worth the risk of the development of velopharyngea l insufficiency. Treatment options fo r these patients include a complete adenoidec tomy, a partial adenoidectomy, or no surgical intervention. In this retrospective study, we describe the outcomes of22 such patients who were treated with a superior adenoidectomy performed with a St. Clair adenoid forceps under indirect vision with a laryngeal mirror. All patie nts expe rienced a complete or near-complete resolution of their nasal obstruction, and none developed permanent velopharyngea l insufficiency. Only three patie nts expe rienced a recurrence of otitis media. Our experience suggests that superio r adenoidectomy is a safe and effective procedure.

Pediatric Adenoidectomy Under Vision Using Suction‐Diathermy Ablation

“…A series of 22 superior adenoidectomies in children with palatal abnormalities was reported using the St. Clair adenoid forceps guided by mirror visualization, 13 with complete or near‐complete resolution of nasal obstruction and with no permanent velopharyngeal insufficiency. Partial adenoidectomy is more surgically precise using suction‐diathermy ablation under vision.…”

Sleep Disordered Breathing and Obstructive Sleep Apnea in the Cleft Population

“…There is a concern that adenoidectomy in the cleft population could result in VPI if the velopharyngeal closure is assisted by the adenoid pad. This has prompted many to do a partial adenoidectomy, removing the bulk of the superior adenoid to improve the airway, but retaining the inferior rim of adenoid tissue to assist in velopharyngeal closure during speech 15,16 . The hope is that the airway improvement, even with a partial adenoidectomy, could be beneficial for the cleft child with OSA.…”

Partial adenoidectomy by suction diathermy in children with cleft palate, to avoid velopharyngeal insufficiency

“…In this context, partial adenoidectomy (lateral or horizontal) has gained popularity at a number of centres, using a variety of methods. These include excision by transnasal (endoscopic) and transoral (mirror-assisted) approaches, using instruments such as the Barnhill adenoid curette [20], Blakesley cutting forceps [24,26], the microdebrider [27], St Clair adenoid forceps [28] and suction diathermy [29]. Case series have demonstrated the efficacy of these techniques, most often in children with SCP, with no reported cases of post-operative VPI.…”

“…This reflects the historical reluctance of otolaryngologists to undertake adenoidectomy in such cases, particularly when the adenoid curette was the only instrument available, and before the sequelae of nasal obstruction and sleep-disordered breathing were appreciated fully. Nonetheless, the combined cohort of reported patients with palatal anomalies who have safely undergone partial adenoidectomy is substantial [15,24,[26][27][28]. Furthermore, this series exclusively comprises children who have previously undergone surgical correction of overt cleft palate, and are therefore considered to be at very high risk of VPI after adenoid resection.…”