Powered partial adenoidectomy

Abstract

Objective: To confirm our clinical impression that the powered microdebrider is superior to curettes for performing partial adenoidectomy (removal of the superior one half to three fourths of the adenoid pad).

Design: Observational study of 100 children undergoing partial adenoidectomy with the powered microdebrider compared with 40 children undergoing conventional partial adenoidectomy with curettes.

Setting: Private and public tertiary care centers.

Patients: All patients younger than 20 years undergoing partial adenoidectomy at the respective institutions during the study period.

Interventions: Partial adenoidectomy as indicated for chronic otitis media, airway obstruction, or chronic or recurrent tonsillitis with either the powered microdebrider or curettes.

Main outcomes measures: Operative time (with specific quantification of the time required for tissue removal and hemostasis), blood loss, complications, and subjective ease of use.

Results: Operative time was 59% shorter for the microdebrider group (mean, 3 minutes 22 seconds; range, 1 minute 6 seconds to 12 minutes 45 seconds) than for the conventional group (mean, 8 minutes 8 seconds; range, 1 minute 2 seconds to 22 minutes 0 seconds) (P<.001). Blood loss was comparable for both groups (powered group: mean, 2.0 mL/kg; range, 0.4 to 9.4 mL/kg; conventional group: mean, 2.0 mL/kg; range, 0.3 to 6.7 mL/kg; P=.34). There were no intraoperative or postoperative complications in either group. Surgeon satisfaction with the microdebrider was high.

Conclusions: The powered microdebrider for partial adenoidectomy is quicker and is not associated with blood loss or complications above that of conventional partial adenoidectomy. The degree of control afforded by the microdebrider technique is of utmost value in preventing complications such as velopharyngeal insufficiency, and this is now our procedure of choice.