INTERVENTIONS

Adenoidectomy

Fig.1: Hypertrophy of adenoids (meats)
Endoscopic image

Indications for adenoidectomy

  • Inflammatory causes:
    1. Recurrent adenoiditis, with three or more episodes of acute adenoiditis within a year
    2. Chronic adenoiditis, with persistent rhinorrhea, nasal obstruction, halitosis and postnasal discharge, after receiving two therapeutic antibiotic regimens, lasting 14 days
    3. Recurrent otitis media, with three or more episodes in a 6-month period or four or more episodes in a one-year period
    4. Chronic secretory otitis, with bilateral fluid retention for 3 months or unilateral up to 6 months
  • Obstructive causes:
    1. Hypertrophy of adenoids, with the presence of nasal obstruction and mouth breathing
    2. Obstructive sleep apnea, which can lead to cardiopulmonary complications such as right heart failure, pulmonary hypertension, right ventricular hypertrophy
    3. Speech disorders, with the presence of male speech
    4. Developmental delay and weight gain, with the presence of fatigue during feeding
    5. Disorders of maxillofacial development, with the presence of a characteristic adenoid face
    6. Orthodontic problems and malocclusion of teeth
  • Suspected benign or malignant neoplasm

Contraindications to adenoidectomy

  1. Cleft palate
  2. Split grape, accompanied by incomplete closure of the muscles of the palate
  3. Serious bleeding disorders, such as haemophilia

Instructions after adenoidectomy

  1. The most important condition for the recovery of the patient after surgery is the intake of plenty of fluids, such as water and apple juice. Avoid acidic juices.
  2. Food should be soft and cold.
  3. Mild snoring and mouth breathing may be observed due to the presence of postoperative swelling. It will go away within 2 weeks of surgery, with the swelling going down.
  4. Decimal febrile movement, can be observed in the first twenty-four hours. On fever over 38TheC, contact the attending physician.
  5. Possible presence of food regurgitation, subsides within 2-4 weeks.
  6. Bath with warm water can be done from the second day.
  7. Avoid any vigorous physical activity for 7 days.
  8. Avoid social contact for 7 days.
  9. Blood spots may be seen in nasal secretions and saliva. If you see bright, red blood, contact your doctor immediately.

Tonsillectomy

Fig.2: Tonsillar hypertrophy, grade 4 according to Friedman

https://www.mdpi.com/732192

Tonsillectomy indications

  • Inflammatory causes:
    1. Recurrent acute tonsillitis
      • 7 or more episodes of acute tonsillitis in the last year
      • 5 or more episodes of acute tonsillitis per year in the past 2 years
      • 3 or more episodes of acute tonsillitis per year in the last 3 years
      • 1 or more episodes of acute tonsillitis per year in the past 5 years
    2. Peritonsillar abscess, especially after the first relapse
    3. Bad breath (Halitosis), due to chronic tonsillitis, unresponsive to conservative treatment
  • Obstructive causes:
    1. Hypertrophy of the tonsils, with difficulty breathing and swallowing
    2. Snoring – Obstructive sleep apnea, which can lead to cardiopulmonary complications such as right heart failure, pulmonary hypertension, right ventricular hypertrophy
  • Other causes:
    1. Unilateral tonsil hypertrophy, suspected of malignancy
    2. Cervical lymph node metastasis, of unknown primary etiology

Instructions after tonsillectomy

  • The most important condition for the patient's recovery after surgery is the intake of plenty of cold fluids, such as water and apple juice. Avoid acidic and carbonated drinks.
  • Food should be well cooked, soft and cold. In the first few days the patient may be reluctant to eat due to pain. Consequently, some weight loss may be observed, which will be fully recovered once he returns to his eating habits.
  • Mild snoring and mouth breathing may be observed due to the presence of postoperative swelling. It will go away within 2 weeks of surgery.
  • Decimal febrile movement, can be observed in the first twenty-four hours. For fever over 38, contact the treating physician.
  • Post-operative halitosis will subside within 2 weeks.
  • Possible presence of food regurgitation, subsides within 2-4 weeks.
  • Bathing with cool water can be done from the second day.
  • Avoid any vigorous physical activity for 14 days.
  • Avoid social contact for 14 days.
  • Blood spots may be seen in the saliva. If you see bright, red blood, contact your doctor immediately. Bleeding may occur up to 14 days after surgery.
  • Almost all patients will experience mild to severe pain postoperatively. Children under three complain of pain for about one week, while older children and adults for two weeks. Reflex otalgia may be observed. Pain control is carried out by taking paracetamol or ibuprofen, while taking aspirin and any other anti-inflammatory drug is prohibited.