A combined method of transoral and transnasal endoscopic adenoidectomy

Objective: Conventional adenoidectomy is usually performed with either a curette or an adenotome under blind or indirect visualization. The possibility of injury to the eustachian tube or posterior choanae can not be excluded during surgery. We present a safe and more effective technique, which can be performed using endoscopic direct visualization during the whole procedure. Patients and Methods: Between January 1995 and December 1999, 105 children underwent this new surgical procedure under general anesthesia. All procedures were performed under endoscopic direct visualization. Using guidance via a 4.0 mm or 2.7 mm 70° endoscope, there was a clear operative field transorally. The adenoid curette was applied transorally to the nasopharynx to remove the main bulk of the adenoids and a 90° Blakesley forceps was also used to perform a peritubal adenoidectomy under intraoral visualization. To remove any residual adenoid tissue obstructing the orifice of the eustachian tube or posterior choanae, we adopted a transnasal approach with a 45° or straight Blakesley forceps using a 4.0 mm or 2.7 mm 0° or 30° endoscope for guidance. Epinephrine-and H₂O₂-rinsed gauze was packed in the nasopharynx for post-operative hemostasis. Results: The method was successfully applied in all patients. None of the 105 patients had complications, such as post-operative nasopharyngeal hemorrhage or injury to the eustachian tube or posterior choanae. Conclusions: The combined method of a transoral 70° and transnasal 0° or 30° endoscopic approach offered a clear and stable operative field. The surgical procedures were all performed under direct visualization. Damage to the eustachian tube or posterior choanae was not a problem. This method has the potential to become the procedure of choice for adenoidectomy.