What is
Adenoidectomy?
The adenoids are a mass of
lymphoid tissue located behind the nasal passages. Infected
adenoids may become enlarged or chronically infected, and
subsequently lead to obstructed breathing, snoring/sleep
apnea, sinus or ear infections, or other problems.
Adenoidectomy is a surgical procedure performed to remove
the adenoids.
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Effects
of Adenoidectomy
Most
children have less
trouble breathing through the nose and
fewer and milder
sore throats and
ear infections after adenoidectomy.
In rare
cases, adenoid tissue that has been removed
may grow back, but this usually does not
cause a problem.
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Candidates
for Adenoidectomy
Enlarged adenoids are blocking the
airway, which may be suspected if the child:
o
Has enlarged adenoids
o
Snores excessively
o
Has
trouble breathing through the nose (nasal
obstruction)
o
Has episodes of not breathing during
sleep
(sleep
apnea)
The child has
chronic ear infections that:
o
Interfere with child's education
o
Persist despite antibiotic treatment
o
Recur 5 or more times in a year
o
Recur 3 or more times a year during a 2-year period
Adenoidectomy may be recommended if the
child has
chronic or repeated bouts of
tonsillitis.
The adenoids normally shrink as the child
reaches adolescence, and adults rarely need
adenoidectomy
Notify Your Doctor If Your Child Has:
-
A sudden increase in the amount of
bleeding from the nose unrelieved by
pressure, ice, and head elevation.
-
A fever greater than 101.5 degrees F
which is persistent despite increasing
the amount of fluid they drink, cool
baths, and acetaminophen/Tylenol. A
child with a fever should try to drink
approximately one-half cup of fluid each
waking hour.
-
Persistent sharp pain or headache which
is not relieved by the pain medication
they were prescribed.
Increased swelling or redness of the
nose or eyes.
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Your
Consultation
In most situations, the surgery is performed
as an outpatient at either the hospital or
the surgicenter. In both facilities, quality
care is provided without the expense and
inconvenience of an overnight stay. An
anesthesiologist will monitor your child
throughout the procedure. usually, the
anesthesiologist will call the night before
surgery to review the medical history. If
he/she is unable to reach you the night
before surgery, he/she will talk with you
that morning. If your doctor has ordered
preoperative laboratory studies, you should
arrange to have these done several days in
advance.
Your child should not take aspirin, or any
product containing aspirin, within 10 days
of the date of your surgery. Non-steroidal
anti-inflammatory medications (such as
ibuprofen/Advil or naproxen/Aleve) should
not be taken within 7 days of the date of
surgery. Many over-the-counter products
contain aspirin or non-steroidal
anti-inflammatory type drugs, so it is
important to check all medications
carefully. If there is any question, please
call your doctor's office or consult your
pharmacist. Acetaminophen/Tylenol is an
acceptable pain reliever. Often, your doctor
will give you several prescriptions for
post-operative pain at the visit BEFORE the
operation. It is best to have these filled
prior to the date of your surgery.
It is advised that you be honest and up
front with your child as you explain his/her
upcoming surgery. Encourage your child to
think of this as something the doctor will
do to made them healthier. Let them know
that they will be safe and that you will be
close by. A calming and reassuring attitude
will greatly ease your child's anxiety. You
can assure them that most children have
minimal pain following an adenoidectomy. Let
them know that if they do have pain, it will
only be for a short time, and that they can
take medicines which will greatly reduce it.
Your child must not eat or drink anything 6
hours prior to their surgery time. This even
includes water, candy, or chewing gum.
Anything in the stomach increases the
chances of an anesthetic complication.
If your child is sick or has a fever the day
before surgery, call the doctor's office. If
your child wakes up sick the day of surgery,
still proceed to the surgical facility as
planned. Your doctor will decide if it is
safe to proceed with surgery. However, if
your child has
chickenpox,
do not bring your child to the office or to
the surgical facility.
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The Adenoidectomy
Procedure
It is important that you know precisely what
time you are to check in with the surgical
facility, and that you allow sufficient
preparation time. Bring all papers and forms
with you, including the preoperative orders
and history sheets. Your child is to wear
comfortable loose fitting clothes (pajamas
are OK). Leave all jewelry and valuables at
home. He/she may bring a favorite toy,
stuffed animal, or blanket.
During Surgery
In the operating room, the anesthesiologist
will usually use a mixture of gas and an
intravenous medication for the general
anesthetic. In most situations, an IV will
have been started either in the preoperative
holding room or after the child has been
given a mask anesthetic. During the
procedure, your child will be continuously
monitored by pulse oximeter (oxygen
saturation) and heart rhythm (EKG). The
surgical team is well trained and prepared
for any emergency. In addition to the
surgeon and the anesthesiologist, there will
be a nurse and a surgical technician in the
room.
After the anesthetic takes effect, the
doctor will remove the adenoids through the
mouth. There will be no external incisions.
The base of the adenoids will be cauterized
with an electrical cauterizing unit. The
whole procedure usually takes less than 45
minutes. Your doctor will come to the
waiting room to talk with you once your
child is safely in the recovery room.
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Recovery
After surgery, your child will be taken to
the recovery room where a nurse will monitor
him/her. You will probably be invited into
the recovery room as your child becomes
aware of their surroundings and starts
looking for you. Your child will be able to
go home the same day as the surgery once
he/she has fully recovered from the
anesthetic. This usually takes several
hours.
It is best for your child to eat a light,
soft, and cool diet as tolerated once they
have recovered fully from the anesthetic.
Avoid hot liquids for several days. Even
though they may be hungry immediately after
surgery, it is best to feed them slowly to
prevent postoperative nausea and vomiting.
Occasionally, a child may vomit one or two
times immediately after surgery. However, if
vomiting persists, your doctor may prescribe
medication to settle the stomach. It is
important to remember that a good overall
diet with ample rest promotes healing.
They will be prescribed antibiotics after
surgery, and should finish all the pills
that have been ordered. Some form of a
narcotic will also be prescribed (typically,
acetaminophen/Tylenol with
codeine),
and is to be taken as needed. If you have
any questions or you feel that your child is
developing a reaction to any of these
medications, you should consult your doctor.
You should not give any other medications,
either prescribed or over-the-counter,
unless you have discussed it with your
doctor.
An appointment for a checkup should be made
10 to 14 days after the procedure. Call the
office to schedule this appointment.
It is not unusual for children to have nasal
stuffiness following surgery. The nasal
stuffiness may last for several months as
swelling decreases. Saline nose drops (Ocean
Spray) can be used to help dissolve any
clots and decrease
edema.
You may notice persistent or even louder
snoring for several weeks. A temporary
change in voice is common following surgery,
and will usually return to normal after
several months. Your child, of course, will
sound less "nasal" following surgery.
Bleeding is rare following an adenoidectomy.
They may have some very light nasal
bleeding, if it is minor, pediatric
Neosynephrin nose drops can be used. If it
is persistent and bright red in color, call
your doctor. On occasion, blood at the
corner of the eye may be noticed.
Most patients require at least 7-10 days off
from work or school. After 3 weeks, exercise
and swimming can usually be resumed, but no
diving for two months. You should plan to
stay in town for 3 weeks to allow for
postoperative care and in case you have
bleeding.
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Risks
Your child's surgery will be performed
safely and with care in order to obtain the
best possible results. You have the right to
be informed that the surgery may involve
risks of unsuccessful results,
complications, or injury from both known and
unforeseen causes. Because individuals
differ in their response to surgery, their
anesthetic reactions, and their healing
outcomes, ultimately there can be no
guarantee made as to the results or
potential complications.
The following complications have been
reported in the medical literature. This
list is not meant to be inclusive of every
possible complication. They are listed here
for your information only, not to frighten
you, but to make you aware and more
knowledgeable concerning this surgical
procedure.
·
Failure to resolve the ear or sinus
infections, or relieve nasal drainage.
·
Bleeding. In very rare situations, the need
for blood products or a
blood
transfusion. You have the right,
should you choose, to have autologous (blood
from yourself) or designated donor directed
blood prepared in advance in case an
emergency transfusion is necessary. You are
encouraged to consult with your doctor if
you are interested.
·
A permanent change in voice or nasal
regurgitation (rare).
·
Need for further and more aggressive surgery
such as sinus, nasal, or tonsil surgery.
·
Infection.
·
Failure to improve the nasal airway or
resolve snoring,
sleep apnea,
or mouth breathing.
Need for
allergy
evaluation, treatments, or environmental
controls. Surgery is neither a cure nor a
substitute for good allergy control or
treatment.
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Frequently Asked
Questions
Q:
What are moles?
A:
A mole
or nevus may be described as a dark spot or irregularity
found in the skin. Generally, they first come into view in
childhood or during the teen years. Moles differ in color,
size and shape. Some are flesh-colored, yellow-brown or
black. They may be flat or raised, smooth, hairy or warty
looking.
Q:
What causes moles?
A:
Some
people are born with moles and other moles emerge after some
time. Sun exposure seems to take part in the growth of moles
and may even play a role in the development of atypical, or
dysplastic moles. The role of heredity cannot be
underemphasized. Many families have a type of mole known as
dysplastic (atypical), which can be linked with a higher
frequency of
melanoma or
skin cancer.
Q: How is
the Adenoidectomy performed?
A: The
surgeon employs a scalpel to cut the mole and a border of
good skin surrounding it. The surgeon will decide on the
size of this border. Stitches are positioned either deep
within the skin, or on the upper surface, depending on the
depth of the excision.
For the procedure that entails no stitches, a scalpel is
applied to shave the mole allowing it to be flush with the
surrounding skin. Next, via an electrical instrument, the
doctor cauterizes the area to prevent any bleeding. A
topical antibiotic is applied to decrease risk of infection.
Shaving eliminates the protruding surface of the mole,
although it can leave mole cells beneath the skin and may
grow back.
Q: What
should I expect after the mole is removed?
A: The
quantity of discomfort subsequently differs on the method
used. If there is discomfort, it can be alleviated with
prescribed pain medication. A scab will likely develop and
then heal within a week or two. In addition, any redness
that takes place will vanish within two to four weeks. Most
scars that do appear slowly fade over time.
Q: What
are the risks and limitations of mole removal?
A: The
most probable risk that can happen is infection. The risks
associated with mole removal also depend upon the technique
used. One common condition that can come about after the
excision procedure is scarring. More or less scars fade
away, but some can be permanent. Scars can be removed by way
of skin resurfacing or other scar revision procedures.
Q:
What preventive measures should I take?
A:
Doctors remove many moles everyday, but there is constantly one recurring
theme that dermatologists tell people: Be aware of your body
and any moles that have changed over time. This is
particularly true for moles that are dark or flat.
Customarily, people will consult doctors and be extremely
concerned about raised, lightly colored moles, but they are
not concerned about the dark, black, melanoma (skin
cancer) next to the mole. This is truly important.
Moreover, it is imperative to stay out of the sun and wear
sunscreen when you are outside. If you do go to your
dermatologist for evaluation, be receptive to a full body
mole screening since it is important to look over your
entire body rather than ignore areas that you may not be
able to inspect on a regular basis.
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