Nofal Ahmed Abdelfattah Bayomy, Alnemr Mohamed Abdelmohsen, Sweed Ahmed Hassan, Abdulmageed Alsayed
ENT Department, Reem Hospital, Abu Dhabi, United Arab Emirates.
Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Int Arch Otorhinolaryngol. 2024 Feb 16;28(3):e487-e491. doi: 10.1055/s-0044-1779434. eCollection 2024 Jul.
Adenoidectomy is one of the most common procedures performed by otolaryngologists. Traditional adenoid curettage is performed blindly, which can result in inadequate removal of the adenoid and injury to the surrounding structures. To perform transnasal endoscopic examinations to assess the nasopharynx after conventional curettage adenoidectomy. The present prospective study included 100 children with a mean age of 4.2 ± 3.07 years. It is composed of two steps: conventional curettage adenoidectomy by a resident trainee; and endoscopic evaluation of the nasopharynx through a 0° telescope to assess adenoidal remnants, injury to the surgical field or adjacent structures, and bleeding points. Adenoid remnants were observed in 42% of the cases after conventional adenoid curettage in multiple locations, such as the roof of the nasopharynx over the choana (24%), the tubal tonsil (12%), the posterior pharyngeal wall (4%), and the posterior end of the nasal septum (2%). Injury to the surgical field and adjacent structures was observed in 46% of the cases (posterior pharyngeal wall: 23%; lateral pharyngeal wall: 11%; Passavant ridge: 10%; and the Eustachian tube orifice: 2%). Endoscopic bleeding was observed in 29% of the cases; 13% of the cases were from adenoid remnants, 10%, from the mucosa, and 6%, from the pharyngeal muscles. Bleeding was mild in 19% of the cases, moderate in 9%, and severe in 1%. Endoscopic evaluation of the nasopharynx following conventional adenoid curettage provides important data regarding adenoid remnants, injury to the surgical field or nearby structures, and bleeding points, which aids in the provision of optimal care and in the achievement of a better outcome.
腺样体切除术是耳鼻喉科医生最常进行的手术之一。传统的腺样体刮除术是在盲视下进行的，这可能导致腺样体切除不彻底以及对周围结构的损伤。
在传统腺样体刮除术后进行经鼻内镜检查以评估鼻咽部情况。
本前瞻性研究纳入了100名平均年龄为4.2±3.07岁的儿童。该研究包括两个步骤：由住院实习医生进行传统腺样体刮除术；通过0°望远镜对鼻咽部进行内镜评估，以评估腺样体残留、手术区域或相邻结构的损伤以及出血点。
在传统腺样体刮除术后，42%的病例在多个部位观察到腺样体残留，如后鼻孔上方的鼻咽顶部（24%）、咽鼓管扁桃体（12%）、咽后壁（4%）和鼻中隔后端（2%）。46%的病例观察到手术区域和相邻结构的损伤（咽后壁：23%；咽侧壁：11%；帕萨万特嵴：10%；咽鼓管开口：2%）。29%的病例观察到内镜下出血；13%的病例出血来自腺样体残留，10%来自黏膜，6%来自咽部肌肉。19%的病例出血轻微，9%为中度，1%为重度。
传统腺样体刮除术后对鼻咽部进行内镜评估可提供有关腺样体残留、手术区域或附近结构的损伤以及出血点的重要数据，这有助于提供最佳护理并取得更好的治疗效果。
