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Objectives: Partial adenoidectomy is the selective removal of the obstructing part of adenoid tissue, thus relieves obstruction symptoms and preserves the velopharyngeal valve action. Patients with palatal dysfunction are candidates for the technique. This study describes the use of microdebrider, transnasally (guided by the nasal endoscope) to perform partial adenoidectomy in patients with submucosal cleft palate, who presented with adenoidal hypertrophy and also it discusses its effects on nasal obstruction and speech., Subjects and Methods: This prospective study was carried out on twenty-three submucosal cleft palate patients who were referred to the ORL-HN department; Zagazig University Hospitals complaining of respiratory obstruction and sleep disturbances due to adenoids hypertrophy. After preoperative nasoendoscopic and speech evaluation, transnasal endoscopic, power-assisted partial adenoidectomy was done for all patients. All patients were followed up at regular visits including nasoendoscopy and speech evaluation., Results: The procedure insured fast, safe, reliable, under vision and well controlled steps. Intraoperatively no major complications were recorded. During follow up, nasal obstruction and respiratory obstruction symptoms were improved. Speech outcome results were reported., Conclusion: The study demonstrates the feasibility of using the microdebrider for performing transnasal partial adenoidectomy (under endoscopic guidance). The procedure is precise, rapid, safe and well-tolerated with the advantage of direct visualization of a traditionally difficult-to-expose area. The study reported improvement of respiratory obstruction symptoms with good speech results., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To evaluate the results of conventional adenoidectomy, using rigid endoscopy of the nasopharynx, and to establish the role of such evaluation in facilitating complete adenoid removal via the curettage technique., Design: Descriptive rigid endoscopic evaluation of the nasopharynx before and after adenoid curettage, and following subsequent endoscopy-assisted adenoidectomy., Setting: Tertiary referral centre., Patients: Forty-one consecutive children with symptomatic adenoid hypertrophy scheduled to undergo adenoidectomy., Results: Rigid endoscopic evaluation indicated that conventional curettage, used alone, failed to completely remove adenoid tissue from the superomedial choanae and anterior vault in all cases; incomplete removal was also seen in other parts of the choanae (in 67.2 per cent of patients), the eustachian tube opening (63 per cent), the nasopharyngeal roof (61.78 per cent) and the fossa of Rosenmuller (61 per cent). Subsequent rigid endoscopy-assisted adenoidectomy successfully removed the residual adenoid tissue from all nasopharyngeal sites, except the eustachian tube opening in two cases., Conclusion: Conventional curettage adenoidectomy misses a substantial amount of adenoid tissue. Rigid endoscopy-assisted adenoidectomy improves this result by enabling localisation of any residual adenoid tissue.

A total of 13 adenoidectomies using a nasal endoscopic-guided transoral adenoid curette (not yet a published standardised method) were performed to treat snoring. Nasal endoscopy allows easy assessment of the size of the adenoids and improves the accuracy of the adenoidectomy. This technique is particularly useful for paediatric patients who have small oral cavities. The assessment and excision of the adenoids in these cases are often difficult. Using the nasal endoscope, the curette can be accurately inserted at the superior border of the adenoid, allowing the complete transoral removal of the main bulk of the adenoid tissue. All 13 patients showed considerably decreased snoring and improvements in the quality of sleep as reported by the parents and the patients. We believe that nasal endoscopic-guided transoral adenoidectomy is a viable alternative to classic adenoidectomy. This technique also has the advantage of using commonly available simple ear, nose, and throat instruments.

Recent literature has embraced the use of electrosurgery and endoscopy in adenoidectomy, with several published articles on the subject. The combination of these methods and the routine use of endoscopy have not been reported. This approach provides a direct-targeted route to the nasopharynx, improved visualization, and magnification and offers a bloodless surgical field. It allows improved evaluation of the adenoids with their peritubal extensions, their lateral and central portions, and their extension to the posterior nasal choanae and even in the posterior nasal fossae and evaluation of the posterior of the middle and inferior turbinates. It permits objective documentation of the cause of nasal obstruction with possible use in outcome assessment. It is also an effective teaching method and a motivating approach for the nursing team. Our approach has proved cost and time efficient in our minimally invasive surgical (endoscopic) operating room set-up. This article reflects the experience in a series of 96 consecutive patients performed during a 9-month period and discusses the surgical technique and patients' outcomes. The endoscope and suction cautery were systematically used for all adenoid surgery. Outcomes were evaluated using a telephone survey with a global rating questionnaire.

We describe a technique in which suction diathermy is used for adenoid ablation through a solely endoscopic transnasal approach in the older pediatric population. This procedure has proved to be both effective and convenient during other transnasal endoscopic procedures, as it provides excellent visualization of both the superior and inferior parts of the nasopharynx and results in minimal to no bleeding in the adenoid bed. In all cases to date, there has been complete resolution of preoperative problems of infection, pain, and bleeding. All patients had good control of postoperative pain. There has been no evidence of postoperative nasopharyngeal stenosis and no velopharyngeal insufficiency. Although transnasal adenoid ablation is not appropriate for the entire pediatric population, this procedure has multiple benefits when another endoscopic sinonasal procedure is planned, when there is neck instability, or when enhanced visualization of the nasopharynx is desired.