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. 2024 Jun 3;16(6):e61621.
doi: 10.7759/cureus.61621. eCollection 2024 Jun.

Endoscopic Powered Intracapsular Tonsillectomy and Adenoidectomy in Pediatric Obstructive Sleep Apnea With High-Risk Comorbid Disease Conditions: A Case Series

Masao Noda  1 , Ryota Koshu  1 , Mari Dias  1 , Chizu Saito  1 , Makoto Ito  1
Affiliations

Endoscopic Powered Intracapsular Tonsillectomy and Adenoidectomy in Pediatric Obstructive Sleep Apnea With High-Risk Comorbid Disease Conditions: A Case Series

Masao Noda et al. Cureus. .

Abstract

Objective: Pediatric obstructive sleep apnea (OSA) caused by adenoids or an enlarged palatine tonsil has a negative impact on physical and mental growth. Surgical removal of the tissue is effective but entails a life-threatening risk of postoperative bleeding, which is up to 30 times higher in chronic pediatric disease cases. However, endoscopes and resection devices provide safe, reliable surgical methods. Here, we report the efficacy and safety of endoscopic powered intracapsular tonsillectomy and adenoidectomy (PITA) for pediatric OSA in patients with high-risk comorbidities.

Methods: This retrospective case series included pediatric patients with OSA who underwent PITA at a single tertiary medical center between April 2017 and May 2023. Ten patients (three males and seven females; mean age 6.4 years, range 2-12 years) were included; all met the Japanese criteria for complex chronic pediatric conditions.

Results: The average operative time was 61 min; a microdebrider was used in eight cases and a coblator in two cases. Although there was no postoperative bleeding, one case experienced regrowth.

Conclusions: Our data show that an endoscopic PITA approach could reduce the risk of severe bleeding and relieve the sleeping conditions of pediatric patients with complex chronic OSA.

Keywords: adenoidectomy; endoscopy; high-risk condition; intracapsular tonsillectomy; obstructive sleep apnea; pediatrics; sleep; surgery.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Physical examination and findings of patient 2
A: Nasopharyngeal fiber scopy showed pharyngeal stenosis, particularly at the level of the oropharynx. B and C: MRI (B: coronal section, C: sagittal section) shows tonsil and adenoid hypertrophy (white triangle).
Figure 2
Figure 2. Surgery procedure of patient 2
PITA was performed with a microdebrider, a Radenoid blade attached to a 40-degree curved tip. While using a 0-degree rigid endoscope, resection was performed to leave a return membrane of the palatine tonsils and remove at least 90% of the tissue. Before (A), during (B), and after (C) the resection. PITA: Powered intracapsular tonsillectomy and adenoidectomy
Figure 3
Figure 3. Physical examination and findings of patient 5
X-ray (A) and CT-scan (B: sagittal section, C: coronal section) show adenoid and tonsil hypertrophy (blue triangle).
Figure 4
Figure 4. Surgical image of patient 5
PITA was performed with a microdebrider for patient 5. The endoscopic image shows before (A) and after (B) the PITA surgery. PITA: Powered intracapsular tonsillectomy and adenoidectomy
See this image and copyright information in PMC

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