Endoscopic Guided Power-Assisted Adenoidectomy Using Proper Combination of Endoscope and Microdebrider ; 6 Years of Surgical Experience

Chang, Jin Soon; Noh, Kyung Kook; Kim, Ki Jun; Chung, Yoon Mi; Jun, Byoung Sam; Jun, Byung Hoon

Abstract

BACKGROUND AND OBJECTIVES
Because of its advantage over the conventional method, power-assisted adenoidectomy has become an increasingly popular procedure in adenoidectomy. The purpose of this paper is to find the best combination of endoscope and microdebrider to achieve the most successful outcome in patients with various configuration of adenoid vegetation.
SUBJECTS AND METHOD
One hundred ninety-one patients who underwent adenoidectomy in the department of Otolaryngology at Inje University Seoul Paik Hospital from January 2000 to February 2006 were reviewed by charts and recorded video tapes for the techniques that we applied to these patients.
RESULTS
Four different combinations can be created from two different angles of endoscope and microdebrider ; transnasal 0degrees endoscopic guided transnasal adenoidectomy using straight microdebrider (TNTN), transnasal 0degrees endoscopic guided transoral adenoidectomy using curved microdebrider (TNTO), transoral 70degrees endoscopic guided transnasal adenoidectomy using straight microdebrider (TOTN) and transoral 70degrees endoscopic guided transoral adenoidectomy using curved microdebrider (TOTO). TOTO was the most frequent combination for simple adenoid vegetation. However, it is not suitable for removal of adenoid located high in the pharyngeal roof. In this case, we added TNTO to TOTO. The least frequent combined technique was TNTN, which has inherent limitation to use in small sized nares and younger age. In this situation, TOTN is a better alternative to use.
CONCLUSION
From six years of experience, we confirmed that endoscopic guided powerassisted adenoidectomy should be performed with proper combination of endoscope and microdebrider based on the location and configuration of adenoid vegetation. The most ideal combination we consistently applied for removal of adenoid is as follows ; first, TNTO, secondly, TOTO. Lastly, TOTN could be useful in selected cases.