The Operative instruments include 70° and 30° rigid endoscope ,straight and up-biting angled forceps , adenoid curettage, angled suction diathermy, angled suction for maxillary sinus, Boyle–Davis mouth gag and plastic suction catheter .
The patient is placed in a supine position with the neck fully extended. After intubating the patient with an oro-endotracheal tube, is applied to keep the mouth open. The soft palate is palpated for the presence of a submucosal cleft. The posterior and lateral nasopharyngeal walls are palpated for pulsation. A plastic suction catheter is passed through each nostril and retrieved through the mouth , mild traction is needed to see the nasopharynx .
The surgeon stands on the head side of the patient and a 70° endoscope to examine the nasopharynx.
In some cases as in choanal adenoid and in the tubal tonsils , the surgeon stands on the right side of the patient .
A 30° rigid endoscope is used to evaluate the nasopharynx and Cotton pledgets with a mixture of 4% lidocaine and 1:100,000 epinephrine are placed in the nasal cavities to shrink the nasal mucosa. Then a transnasal adenoidectomy is done “Adenoid tissue in the nasopharynx was removed under direct visualization with straight or up-biting forceps”.
During the EA, the patient’s Eustachian tube orifices were visualized, and damage to this area was avoided. Once the patient’s adenoids had been removed, hemostasis was then obtained transorally and transnasally as indicated.
And in case of submucosal cleft palate, we perform an upper 1/2 ‘‘partial’’ adenoidectomy, combined transoral endoscopic adenoidectomy and transnasal endoscopic adenoidectomy was done.
Haemostasis was done by angled suction diathermy and the nasopharyngeal pack and revaluation of what was been removed and removal of the residual tissue is done on table, this can be repeated if needed.
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