Residual Adenoid Tissue After Conventional Adenoidectomy and the Role of Intraoperative Nasal Endoscopy: A Prospective Cohort Study

TL;DR

This study finds that most patients have leftover adenoid tissue after standard surgery, and using endoscopes during surgery improves results, especially for older or revision cases.

Contribution

The study introduces the use of intraoperative nasal endoscopy to significantly reduce residual adenoid tissue in conventional adenoidectomy.

Findings

Residual adenoid tissue was detected in 61.8% of patients after conventional curettage adenoidectomy.

Age ≥ 7.5 years and revision status were strong predictors of incomplete tissue clearance.

Endoscopic completion resection significantly improved surgical outcomes with low complication rates.

Abstract

What are the main findings?

What are the main findings?

Residual adenoid tissue was detected in 61.8% of patients after conventional curettage adenoidectomy.Revision status and age ≥ 7.5 years were strong predictors of incomplete clearance.

Residual adenoid tissue was detected in 61.8% of patients after conventional curettage adenoidectomy.

Revision status and age ≥ 7.5 years were strong predictors of incomplete clearance.

What is the implication of the main findings?

What is the implication of the main findings?

Intraoperative endoscopic assessment with completion resection significantly improves surgical outcomes.Primary endoscopic adenoidectomy is recommended for children ≥ 7.5 years and for revision cases.

Intraoperative endoscopic assessment with completion resection significantly improves surgical outcomes.

Primary endoscopic adenoidectomy is recommended for children ≥ 7.5 years and for revision cases.

Background/Objectives: Conventional curettage adenoidectomy is widely performed but may leave residual tissue in anatomically hidden nasopharyngeal areas. We evaluated the impact of age and revision status on residual adenoidal tissue after conventional adenoidectomy and assessed outcomes following endoscopic completion. Methods: A prospective cohort study included 178 patients undergoing conventional adenoidectomy followed by intraoperative nasal endoscopy. Residual tissue in the nasopharyngeal roof, Fossa of Rosenmüller, and around the Eustachian tube was resected using a microdebrider. Patients were categorized into four groups based on age (<9 or ≥9 years) and surgical history (primary vs. revision). Pediatric Sleep Questionnaire (PSQ) or STOP-BANG scores were collected pre- and postoperatively. Receiver operating characteristic (ROC) and logistic regression analyses were used to identify predictors of residual tissue. Results: Residual adenoid tissue was detected in 61.8% of patients after conventional adenoidectomy, highest among those ≥9 years undergoing revision (36.4%). Age ≥ 7.5 years and revision status predicted residual tissue (AUC = 0.71). Significant postoperative symptom improvement was observed (PSQ and STOP-BANG, p < 0.001). Complication rates were low (13.5%), with no recurrences reported. Conclusions: Conventional curettage often leaves residual adenoidal tissue in older and revision cases. Endoscopic completion improves outcomes. Primary endoscopic adenoidectomy is recommended for patients aged ≥7.5 years and those undergoing revision procedures.

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