Application of nasal endoscope in adenoidectomy in children

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Abstract adenoid hypertrophy is a common disease of children, adenoid face and enuresis, inattention, mental declineAdenoid (nasopharyngeal

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Abstract adenoid hypertrophy is a common disease of children, adenoid face and enuresis, inattention, mental decline

Adenoid (nasopharyngeal tonsil) is located in the posterior wall of the nasopharynx, adenoid hyperplasia of adenoid hypertrophy, vertical down can cause some or all of the anterior wall of the obstruction of the nasal cavity (1). Adenoid hypertrophy is a common disease in children, but also cause children secretory otitis media, rhinitis, sinusitis and obstructive sleep apnea hypopnea syndrome etiology, long-term repeated inflammatory stimulation will lead to children with adenoid hypertrophy, caused by compression of pharyngeal ostium of eustachian tube in secretory otitis media, the hearing loss; after blocking nostrils will cause nasal congestion, runny nose, mouth breathing, snoring, severe maxillary length, high arched palate, upper incisor malocclusion caused by prominent, thick lips, lip curl, appear adenoid face and enuresis, the attention is not centralized, mental decline, anorexia, indigestion, chest abnormal symptoms such as 2, so the adenoid hypertrophy should pay attention to. Therefore, once diagnosed, should be performed as soon as possible adenoid surgery [3]. With the development of nasal endoscopic surgery has been carried out in our hospital and the endoscopic technique, we combine the electric cutting aspirator resection of adenoid hypertrophy in 49 cases under nasal endoscope, the results are satisfactory, we will report the following information.

1 materials and methods

1.1 general data in 49 cases of children in male, female in 14 cases, aged from 4 to 13 years old, with an average of 7.4 years old, the course of disease from 6 months to 6 years. The clinical manifestations of the patients were disturbed by sleep, snoring, nasal breathing was not smooth, mouth breathing. Some associated with hearing loss, tinnitus, runny nose, cough and array "adenoid face" and other local symptoms; with some concentration, molar, enuresis and other symptoms. 15 cases of adenoidal hypertrophy, 8 cases of adenoid hypertrophy complicated with rhinitis or sinusitis, 29 cases with tonsillar hypertrophy, 11 cases with secretory otitis media (one case with rhinitis or sinusitis, secretory otitis media, both in the tonsil hypertrophy of up to 12 people, three are associated with the 1). Among them, 6 cases were treated with tonsillectomy in the hospital, and the other 3 cases had been removed from the traditional adenoids in the hospital.

The X-ray of adenoid nasopharynx lateral compression degree of airway diagnostic criteria for 4, 5; according to the lateral skull X-ray measurement range of adenoid blockage of nasopharyngeal airway 4, all cases underwent nasopharyngeal lateral X-ray examination showed hypertrophy of adenoids nasopharyngeal airway, the should the nasopharyngeal cavity stenosis, flow of air through the blocked. All the cases were in accordance with the diagnostic criteria of adenoid hypertrophy and the surgical indications of adenoid curettage (the lateral cephalometric X-ray showed adenoid hypertrophy, and the extent of the obstruction of the nasopharyngeal airway) (0.70) (5).

1.2 children were treated with general anesthesia, endoscopic and endoscopic adenoidectomy. Tracheal intubation under general anesthesia and general anesthesia for tonsillectomy, position the same head, don't back, gag exposed buccopharyngeal cavity, nasal endoscopy guided by adenoid curette fractional curettage of adenoids hypertrophy, with cutting aspirator resection remains in the lymphoid tissue of nasopharyngeal top and posterior nares, Eustachian tube round pillow around, and then check the nasal cavity under nasal endoscope, compression or electrocoagulation hemostasis; or directly to the electric cutting adenoid tissue hypertrophy of the aspirator. Tonsil resection was performed in children with enlarged tonsils and partial enlargement of the tonsils.

2 Results

After the operation were given intravenous antibiotics for 3 to 5 days to control inflammation, dexamethasone 3 ~ 5mg/d, 2 ~ 3 days of intravenous drip to relieve the soft palate and uvula edema; 49 patients in 15 cases of children with adenoidal hypertrophy, after 3 ~ 5 days, mouth breathing, snoring disappeared, nasal patency in 13 cases, the cure rate was 86.67%. Concurrent rhinitis, sinusitis, nasal and the corresponding symptomatic treatment, 3 cases were completely cured within 6 months, obviously improved in 5 cases. All the children with tonsil hypertrophy were treated with both adenoids and tonsils. 11 cases of patients with secretory otitis media after operation in part myringotomy or middle ear catheter, most ear symptoms subsided, and hearing improved, no case of recurrence of otitis media. After more than 12 months of follow-up, most of the children were satisfied with the effect, no one case of surgical complications, no recurrence.

3 discussion

Under normal physiological conditions, the development of adenoid in children from 6 to 7 years old was the largest, and gradually decreased after puberty. If adenoid hypertrophy and the corresponding symptoms caused by adenoid hypertrophy [6]. Adenoidal hypertrophy is one of the common diseases in children, with chronic tonsillitis, tonsil hypertrophy and 3 children with upper respiratory tract, is caused by stenosis or obstruction of the most common reasons. Tonsillectomy and / or adenoidectomy are the most common treatment for children with this disorder. The traditional adenoidectomy, look bad, increases the difficulty of the operation and safety of adenoidal resection is not easy and easy to cause trauma, the most common trauma in the torus tubarius palate and etc., postoperative easy to induce secretory otitis media or the original treatment of secretory otitis media no more. In this group there were 3 patients had underwent traditional adenoidectomy, because the residues still blocked due to hyperplasia of nose, postoperative symptoms improved significantly and reoperation. Carried out in our department adenoidectomy under nasal endoscope, we deeply appreciate the nasal endoscopic adenoidectomy can accurately resection of the thyroid gland and can avoid the eustachian tube and its surrounding tissue injury. Application of nasal endoscopy combined with electric cutting and suction technology, and supporting the imaging system for adenoidectomy, the operation can be carried out in the open, and the application of electric cutting aspirator can quickly and accurately complete the adenoidectomy or debris removal and maintain clear operation field, ensure the operation safety. Moreover, it can prevent the formation of excessive scar and promote wound healing. At the same time, it can avoid the damage of important structure and reduce the bleeding. Therefore, the author believes that endoscopic adenoidectomy with traditional adenoidectomy has the following advantages: (1) direct and clear view: in the TV monitor can magnify the nasopharynx surgical field, with open operation, clear vision characteristics; (2) the operation is accurate and complete resection, can the residual adenoidectomy clean under direct vision; (3) to avoid the important structure damage (to avoid damage to the palate and torus tubarius); (4) and less bleeding, easy bleeding; (5) after operation, quick recovery and less complication. But at the same time in the operation process is also found in nasal endoscopic adenoidectomy, there is pollution, disadvantages of lens operation path is narrow and long nasal approach, and for adenoid hypertrophy is particularly serious, and the lymphoid tissue around the torus tubarius difficult to separate or choanal completely blocked patients also, through intraoral approach 7. The children adenoidal hypertrophy patients should be combined with the technical conditions of the child itself pathological characteristics and the suitable operation method, choose the best method, can best solve the symptoms, alleviate the pain of patients is the key.

[reference]

1 Guo Yude. Modern pediatric otorhinolaryngology. Beijing: People's Medical Publishing House, 2000175

2 Wang Xuemei, He Xiaosong, et al., et al. Analysis of adenoid hypertrophy in children: a report of 110 cases. Journal of Otorhinolaryngology,, 2004, 18:6.

3 yellow Xuanzhao, Wang gybo. Practical otolaryngology. Beijing: People's Medical Publishing House, 1998348-349.

4 Cheng Ren Min, Wang Qiyou, Song Jianjing, et al. Measurement of surgical indications of adenoid and tonsil hypertrophy. Chinese Journal of Otorhinolaryngology, 1999, 34:244.

5 Zou Mingshun. The clinical value of the measurement of the ratio of nasopharyngeal carcinoma in children: Chinese Journal of Radiology, 1997, 31:190-192.

The 6 field hospital of Hunan Medical University. Department of Otolaryngology Head and neck surgery. Beijing: People's Medical Publishing House, 2004159

7 Cai Xiaolan, Liu Hongying, fan Xianliang. Treatment of hypopnea syndrome in children with obstructive sleep apnea. Chinese Journal of Otorhinolaryngology, 2004, 39:499.

 

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