Optimization of Power-Assisted Adenoidectomy in Children Using Shaver Tips of Various Modification

Abstract

The aim: To study the efficacy of surgical treatment of patients with adenoid vegetations by implementing a differential method for choosing a tip for endo¬scopic power-assisted adenoidectomy in children depending on dentition. Materials and methods: We investigated the presence of nasal air emissions in 127 children (2-12 years old) before and after the operation. We excluded 12 patients due to the presence of nasal air emission before the operation. All patients were divided in 2 groups: I – children with aging primary dentition (55 children), II- children with mixed dentition (60 children). Depending on tips, that were used for the operation, we divided patients into two subgroups: A - 40˚ and B- 60 ˚. Results: In 9,4% of patients have the presence of nasal air emissions before the operation. The use of 40˚ tips does not allow removal of lymphoid tissue in “hard-to-reach” areas of the nasopharynx (perichoanal and peritubular sections) in 30% of children with aging primary dentition and 42.9% with mixed dentition. Conclusions: The use 40˚ tips for the adenoidectomy is accompanied by a higher risk of velopharyngeal insufficiency in children with mixed dentition compared to children who underwent the intervention with a tip with a larger bending angle and a longer working part (60°). In patients with temporary dentition, it is recommended to use a standard tip for adenoidectomy, except when correction of tubal lymphoid tissue is planned (it is necessary to use a tip with a rotating window). In patients with mixed dentition, it is recommended to use a 60° tip.