الفهرس 
Pathogenesis of adenotonsillar diseaseOnly 14 pages are availabe for public view
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Abstract
Adenoid hypertrophy is a common problem frequently encountered by practitioners especially in the field of pediatric Otorhinolaryngology. Symptoms mainly are due to nasal obstruction caused by the large adenoids and their effect as a septic focus in the body and on the surrounding structures. Adenoidectomy is the cornerstone of the treatment. Pioneers of adenoidectomy have developed novel techniques and instruments in order to increase the speed of the procedure and to decrease intraoperative complication and reduce postoperative morbidity. One of the most common postoperative morbidities is the recurrence of adenoidal hypertrophy. Many surgeons were interested in preventing this problem. They added new steps, used new instruments and even changed the standard curettage operative technique in order to prevent recurrence. The most believed cause of adenoidal recurrence is residual intraoperative adenoid tissue which is usually hidden and difficult to be reached due to the blind nature of the conventional curettage adenoidectomy technique. To overcome this, surgeons started to do digital palpation of the operative bed after curettage to palpate for any missed adenoid tissue, used a mirror through the oral cavity to visualize the nasopharynx and even used suction catheters introduced through the nose to retract the soft palate for better visualization of the nasopharynx. Despite all these trials, direct visualization and assessment of the adenoid, remains the best way for complete removal of the adenoid and hence preventing its recurrence. The introduction of fiberoptic endoscopies in the clinical practice has greatly affected this area of interest. Adenoidectomy, as a surgical procedure, was greatly affected by the use of endoscopy to achieve the aimed target of complete removal of the adenoids. Some surgeons used the zero degree-angled trans-nasal endoscopy to help in direct visualization of the adenoid and completely removing it with the feasibility of doing completion adenoidectomy at the same time for any detected residual adenoid tissue. Others used the 70 degree-angled endoscope through the oral cavity for visualization of the adenoid and its bed. In both techniques, complete visualization and removal of the adenoid achieved a great reduction in the number of adenoid recurrence. Advances in adenoidectomy were not limited only to the use of endoscopies for visualization of the adenoid and removal of any residual after its removal. In fact, direct and detailed visualization of the nearby important structures such as the eustachian tube openings and the choanae was possible. The introduction of new instruments for dealing with residual adenoid tissue which was located near such areas helped greatly in preserving these important structures with complete removal of the residual tissue. For example, the use of the microdebrider for such purpose has greatly facilitated the procedure, reduced the operative time and both intraoperative and postoperative complications. It is also obvious that such advances in the operative technique of adenoidectomy are not accompanied with much prolongation in the operative time. Also, it is clear that no or minimal cost is needed for them to be done. Not to be forgotten, the use of fiber-optic nasal endoscopy, either rigid or flexible, provided an easy and fast measure to diagnose the cause of nasal obstruction, detect any associated conditions such as nasal allergy and to identify the exact anatomical details and/or any variations or abnormalities in the areas of the nose and throat. Flexible endoscopes in particular were easier and safer for use in pediatric population who are not under the effect of anesthesia. In the present study, the main goal of the research group was to accurately detect the value of endoscopic examination of the nasopharynx after conventional adenoidectomy and to study the effect of this extra-step on the detection and removal of any residual adenoid tissue and hence reducing the recurrence rate of adenoidal hypertrophy. Patients were gathered and randomly divided into two groups. One of them underwent the standard procedure of conventional adenoidectomy and the other was further subjected to endoscopic examination of the nasopharynx and removal of the residual adenoid tissue. Both groups were followed at fixed time intervals and the recurrence was identified. The first three follow up intervals which were weekly for one month, then monthly for three months postoperatively showed no recurrence in both groups. However, at the last follow up interval, which is 3 months postoperatively, there was considerable difference between both groups with the recurrence rate much higher in the group which had the standard conventional curettage adenoidectomy without the use of endoscopy for residual detection and removal. The use of nasal endoscope during the operation greatly facilitated the control of intraoperative bleeding and reduced the occurrence of postoperative hemorrhage. The procedure was longer with the use of nasal endoscope when compared to the conventional procedure. from this we concluded that the use of endoscope is a substantial step after adenoidectomy for detection of any residual adenoid especially in hidden areas and also for preservation of the integrity of these areas during the process of residual removal. Also, the use of endoscope caused prolongation in the operative time but gave the benefit of facilitating the control of intraoperative bleeding and reducing the postoperative bleeding. Complete or near complete removal of the adenoid tissue during adenoidectomy is the best way to reduce the recurrence of adenoidal hypertrophy. This also has contributed maximally to reduction of the intraoperative complications and postoperative morbidity. The use of endoscopies in the field of Otorhinolaryngology is now very popular without the need for special expertise or high financial burden on the healthcare facility and the patient as well.