The research was conducted at the Children’s Hospital of the State Scientific
Institution "Research and Practical Center of Preventive and Clinical Medicine" of
the State Administration Department, Kyiv, 2020-2024.
The aim of the study is to increase the efficacy of surgical treatment of
children with hypertrophy of the pharyngeal tonsil by improving the technique of
endoscopic power-assisted adenoidectomy.
In the process of scientific research, the data of examination of 346 children
with hypertrophy of the pharyngeal tonsil were analyzed, including 102
retrospectively and 244 prospectively.
The first stage of the study focuses on the clinical and anatomical
substantiation of choosing tips for power-assisted adenoidectomy, aimed at
improving intervention precision and minimizing the traumatic impact of
instruments on surrounding tissues. For this purpose, intraoperative measurements
of distances in the intervention area in children were conducted, and based on the
cosine theorem, parameters for the most gentle shaver tip were calculated. The type
of bite – dental age of children was taken into account as a marker of the
development process of the maxillofacial area and biological age.
It was established that the distance from the nasopharyngeal vault to the free
edge of the retracted soft palate along the midline gradually increases with age,
starting from 20.1±6.1 mm in children with formed temporary dentition and reaching
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30.9±10.2 mm in children with a mixed dentition. The change in the nasopharyngeal
angle varies differently: in children with a formed temporary dentition, it is
126.25±8.76°, increasing during the late temporary dentition period to
132.81±12.21°, and after reaching the mixed dentition, the nasopharyngeal angle
becomes sharper again – 120.54±13.72°.
Based on the calculated data provided, the following parameters for tips are
proposed: in children with a formed temporary dentition, the minimum optimal
angle is 53.53±8.76°, and the length (outer radius) is 20.1±6.1 mm; with a late
temporary dentition – 47.18±12.21° and 21.0±7.1 mm; with a mixed dentition –
59.45±13.72° and 30.9±10.2 mm, respectively. However, the manufacturer’s
recommended instrument for performing power-assisted adenoidectomy has an
angle of 40° and a working part length of 18 mm (inner radius), with 20 mm for the
outer radius. Performing adenoidectomy with a tip of this configuration is possible
only through additional stretching of the soft palate (especially in children with a
formed temporary and mixed dentition), which may lead to an occlusal function
disruption. It is a common complication, but fortunately, in the vast majority of
cases, it is transient.
Based on the data presented above, the accuracy of the calculations was
verified by comparing the frequency of nasal air emission (an indicator of soft palate
occlusal function disruption) in patients with different types of bites after
adenoidectomy performed with 60° and 40° tips. As a result, it was found that in
children with a mixed dentition, the removal of adenoid vegetation using the
standard tip (40°) was associated with a higher risk of developing velopharyngeal
insufficiency compared to those who underwent the procedure with a tip with a
greater angulation (60°); the relative risk was 2.214 (p<0.05). In patients with a late
temporary dentition, no significant difference in the frequency of occlusal function
disruption during adenoidectomy using different tips was observed. Therefore, it is
recommended to use the standard tip for adenoidectomy in these cases unless the
correction of torus tubarius is planned (in which case a rotating-window tip should
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be used). For individuals with a mixed dentition, the most gentle tip for powerassisted adenoidectomy is the 60° tip. Children with a formed temporary dentition
did not participate in this part of the study (due to age restrictions for efficient
performance of the speech therapy test), so the recommendation for them is based
only on the calculation method – it is recommended to use the 60° tip. However, the
proposed 60° tip has an inconvenient working part length for this group of children
(33 mm by outer radius), significantly exceeding the recommended 20.1±6.1 mm.
To identify predictors for increasing the clinical efficacy using the
advantages of power-assisted adenoidectomy, a study on the morphology of torus
tubarius was conducted. This anatomical area is in close contact with the pharyngeal
tonsil and is histologically similar to it (transitional ciliated epithelium, lymphoid
elements), suggesting that it may also require lavage. The morphology of torus
tubarius was studied only in children with middle ear pathology or clinically
significant recurrence of pharyngeal tonsil hypertrophy.
