Adenoidectomy is the surgical procedure in which the adenoids—also known as pharyngeal tonsils or adenoid vegetation—are removed. It is usually performed in pediatric patients and is often associated with other surgeries such as tonsillectomy and/or the placement of transtympanic ventilation tubes.
It is important to note that there is a risk that, once removed, the adenoids may regrow over time; however, in most cases this regrowth is asymptomatic.
Endoscopic view through the left nasal cavity showing adenoid hypertrophy
Main Indications for Adenoidectomy or Adenoid Surgery
- Adenoid hypertrophy causing airway obstruction:
This may contribute to the development of OSAHS (Obstructive Sleep Apnea–Hypopnea Syndrome) or chronic mouth breathing, which can lead to abnormalities in dental and palatal development. - Recurrent acute otitis media in children older than 3 years
- Chronic and/or recurrent sinusitis
Contraindications (Relative)
- Severe coagulation disorders
- Children at risk of developing velopharyngeal insufficiency, typically those with a short palate, cleft palate, muscle weakness, or hypotonia associated with neurological diseases, Kabuki syndrome, among others. This situation can be improved by performing a partial adenoidectomy and planning postoperative rehabilitation.
- Down syndrome, in which approximately 10% of patients may have atlantoaxial subluxation. Positioning the patient in a neutral position allows the surgery to be performed safely.
Surgical Technique of Adenoidectomy
There are many methods for the surgical removal of the adenoids. The most common approach is transoral removal. With the patient under general anesthesia, in the supine position, and with the aid of a mouth gag, either indirect visualization with a mirror or palpation of the adenoid tissue is performed. Different instruments can then be used for resection.
Curette
- Cold steel excision with curettes or punch: the most commonly used and successful method
- Electrocautery with suction (Bovie)
- Microdebrider
- Laser
- Radiofrequency (Coblation)
Finally, bleeding control is achieved using compression and hemostatic agents or electrocautery.
Adenoids can also be removed through the nasal route using a microdebrider, but this approach is less commonly used.
Postoperative Course After Adenoid Surgery
Children usually recover well from this procedure; hospitalization is generally not required, or only a short observation period after general anesthesia. Nasal obstruction due to inflammation and healing tissue is normal, and pain is usually well controlled with analgesics. Temporary voice changes may also occur and typically resolve within a couple of weeks.
Complications of Adenoidectomy
Bleeding from the surgical site is the most common immediate complication, occurring in approximately 0.5% of cases. Bleeding is usually seen through the nose (epistaxis) and, in mild cases, can be controlled with topical vasoconstrictors. In cases of significant bleeding, a return to the operating room under general anesthesia may be necessary.
Velopharyngeal insufficiency is an uncommon complication, occurring in less than 0.05% of cases. It is transient in more than half of patients and usually resolves spontaneously within 2–4 weeks postoperatively. It presents as nasal regurgitation of food due to incomplete closure of the palate against the lateral and posterior walls of the nasopharynx, where the adenoids were previously located.
Other rare complications described include torticollis, nasopharyngeal stenosis, Grisel syndrome, temporomandibular joint (TMJ) injury, and Eustachian tube injury
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