Day surgery is an important part of the comprehensive reform of public hospitals, which is conducive to improving hospital management level, enhancing medical service efficiency, and controlling medical expenses. The National Health Commission has included tonsillectomy and/or adenoidectomy in the recommended list of daytime surgeries. However, there is no unified understanding and clinical practice of tonsillar and/or adenoid day surgery in China. Currently, there is an urgent need to develop clinical practice guidelines for tonsillar and/or adenoid day surgery to standardize the procedure. To this end, the guideline expert group developed this guideline through literature review and two rounds of Delphi voting, selecting and focusing on the clinical key issues in tonsillar and/or adenoid day surgery, in order to provide specific and feasible guidance for otolaryngologists, anesthesiologists, nursing staff, and related medical staff engaging in pediatric tonsillar and adenoid day surgery, and promote standardized management of tonsillar and/or adenoid day surgery.
Humans ; Tonsillectomy ; Adenoids/surgery* ; Adenoidectomy ; Child ; Ambulatory Surgical Procedures ; Palatine Tonsil/surgery* ; Practice Guidelines as Topic ; China

Objective:To analyze the effects of adenoidectomy, tonsillectomy and tonsillectomy combined with adenoidectomy on obstructive sleep apnea children by computational fluid dynamics numerical simulation. Methods:A case of typical tonsil with adenoid hypertrophy was selected. Mimics 21.0 software was used to establish the original preoperative model, adenoidectomy, tonsillectomy and virtual surgical models of tonsillectomy combined adenoidectomy, and the computational fluid dynamics model of the upper airway was established by ANSYS 2019 R1 software, and then the pressure and velocity of the internal flow field of the CFD model were numerically simulated. Seven planes perpendicular to the flow trace were selected as the observation planes, including the cross section of the sinusostoma complex, the anterior end of the adenoid body, the narrowest cross section of the nasopharyngeal cavity, the pharyngostoma tube, the narrowest cross section of the oropharyngeal cavity, the lower pole of the tonsil and the glottis section. The comparison indexes included pressure, flow velocity and flow distribution. Results:Compared with the original model before operation, after the adenoids were removed only, the pressure drop between the section of the ostiomeatal complex and the section of the eustachian tube decreased, the high velocity peak at the anterior end of the adenoids disappeared, and the flow trace through the middle nasal canal increased. When only bilateral tonsils were removed, the pressure drop between the eustachian tube and the glottis slowed down and the flow velocity between the eustachian tube and the glottis slowed down. Combined tonsillar-adenoidectomy resulted in the most uniform pressure distribution, the most gentle pressure change and flow rate in the upper airway, and the most ignificant increase in airflow trace through the middle nasal canal among the three operations. Conclusion:Adenoidectomy, tonsillectomy and combined tonsillar adenoidectomy can make the airflow velocity and pressure of upper respiratory tract uniform to different degrees, but there are obvious differences in the specific anatomical location and degree. The application of CFD can intuitively predict the improvement of upper airway flow field in OSA children by different surgical methods, which helps clinicians to make surgical decision.
Humans ; Sleep Apnea, Obstructive/physiopathology* ; Adenoidectomy/methods* ; Tonsillectomy/methods* ; Child ; Hydrodynamics ; Adenoids/surgery* ; Computer Simulation ; Palatine Tonsil/surgery* ; Software

Humans ; Child ; Adenoids/surgery* ; Palatine Tonsil/surgery* ; Adenoidectomy ; Hypertrophy/surgery* ; Tonsillectomy

Objective:To discuss the application of virtual endoscopy in the diagnosis of adenoid hypertrophy and the morphologic classification of adenoid. Methods:The clinical data of 97 children with adenoid hypertrophy admitted to Department of Otorhinolaryngology Head and Neck Surgery, Shenzhen University General Hospital from July 2022 to December 2022 were collected. The virtual endoscopic reconstruction of the nasopharynx was performed by cone beam computed tomography. The results of virtual endoscopic adenoid size measurement were compared with the results of nasopharyngeal CT median sagittal position and nasopharyngeal endoscopy. Virtual endoscopic classification of adenoid based on the size of the adenoids and their relationship with the torus tubarius. Results:The t-test results of the size of adenoids measured by virtual endoscopy and nasopharyngeal CT were t=1.699 and P=0.093, and the results of intra-group correlation coefficient（ICC） analysis were ICC=0.921 and P<0.01. The proportion of adenoids measured by virtual endoscopy and nasopharyngeal CT was highly consistent. The t-test results of the size of adenoids measured virtual endoscopy and nasopharyngeal endoscopy were t=1.543 and P=0.15, and the results of intra-group correlation coefficient（ICC） analysis were ICC=0.900 and P<0.01. The proportion of adenoids measured by virtual endoscopy and nasopharyngeal endoscopy was highly consistent. Among the 97 children, the morphological classification results of adenoids were 48 cases of overall hypertrophy type, 47 cases of central bulge type, and 2 cases of flat thickening type. Conclusion:The diagnosis of adenoid hypertrophy by virtual endoscopy has high accuracy, which not only avoids the invasive operation of traditional nasopharyngeal endoscopy, but also can observe the adenoid condition and its relationship with the torus tubarius from multiple angles. And, the morphological classification of adenoids using virtual endoscopy has guiding significance for perioperative preparation.
Child ; Humans ; Adenoids/surgery* ; Nasopharynx/diagnostic imaging* ; Adenoidectomy ; Endoscopy/methods* ; Hypertrophy/surgery*

Child ; Humans ; Adenoids/surgery* ; Hypertrophy/surgery*

Objective: To assess the incidence of symptomatic torus tubarius hypertrophy (TTH) in recurred OSA in children, and to explore the preliminary experience of partial resection of TTH assisted with radiofrequency ablation. Methods: From January 2004 to February 2020, 4 922 children, who diagnosed as OSA and received adenotonsillectomy at the Department of Otolaryngology, The 4th Medical Center of the PLA General Hospital, were retrospectively reviewed. There were 3 266 males and 1 656 females, the age ranged from 1 to 14 years old(median age of 5.0 years). Twenty-two cases were identified with recurrence of OSA syndrome, and the clinical data, including sex, age of primary operation, age of recurrence and presentation, and opertation methods were analyzed. Follow-up was carried out by outpatient visit or telephone. Graphpad prism 5.0 software was used for statistical analysis. Results: Twenty-two cases were identified as recurred OSA and received revised surgery in 4 922 cases. Among these 22 cases, 11 cases were diagnosed as TTH resulting in an incidence of 2.23‰(11/4 922), 1 case was cicatricial adhesion on tubal torus (0.20‰, 1/4 922), 10 cases were residual adenoid combined with tubal tonsil hypertrophy (2.03‰, 10/4 922). Median age of primary operation was 3.0 years (range:2.4 to 6.0 years) in 11 TTH cases. Recurrent interval varied from 2 months to 5.5 years (2.4±1.9 years) after first operation. Age of revised partial resection of TTH was 7.0±2.7 years (range: 4.0 to 12.0 years). Average time interval between primary operation and revised operation was 3.5±2.1 years (range: 0.5 to 6.0 years). Individualized treatments were carried out based on partial resection of TTH assisted with radiofrequency ablation. All of 11 cases received satisfied therapeutic results without nasopharyngeal stenosis occured. Twenty-two cases were followed up for 1.6 to 13 years (median follow-up time was 6.2 years). Conclusions: TTH contributed to recurred OSA in child. TTH might be misdiagnosed as tubal tonsil hypertrophy. Partial resection of TTH assisted with radiofrequency ablation was a safty and effective treatment.
Adenoidectomy ; Adenoids/surgery* ; Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Hypertrophy/surgery* ; Infant ; Male ; Retrospective Studies ; Sleep Apnea, Obstructive/surgery*

Objective: To study voice changes in children after adenotonsillectomy or adenoidectomy and the relationship with the vocal tract structure. Methods: Fifty patients were recruited in this study prospectively, aged from 4 to 12 years old with the median age of 6. They were underwent adenotonsillectomy or adenoidectomy in Beijing Tongren Hospital, Capital Medical University from July 2019 to August 2020. In the cases, there are 31 males and 19 females. Thirty-six patients underwent adenotonsillectomy and 14 patients underwent adenoidectomy alone. Twenty-two children (13 males, 9 females) with Ⅰ degree of bilateral tonsils without adenoid hypertrophy and no snoring were selected as normal controls. Adenoid and tonsil sizes were evaluated. Subjective changes of voice were recorded after surgery. Moreover, voice data including fundamental frequency(F0), jitter, shimmer, noise to harmonic ratio(NHR), maximum phonation time(MPT), formant frequencies(F1-F5) and bandwidths(B1-B5) of vowel/a/and/i/were analyzed before, 3 days and 1 month after surgery respectively.SPSS 23.0 was used for statistical analysis. Results: Thirty-six patients(72.0%,36/50) complained of postoperative voice changes. The incidence was inversely correlated with age. In children aged 4-6, 7-9, and 10-12, the incidence was 83.3%(25/30), 63.6%(7/11) and 44.4%(4/9) respectively. Voice changes appeared more common in children underwent adenotonsillectomy(77.8%,28/36) than in those underwent adenoidectomy alone(57.1%,8/14), but there was no statistical difference. After operation, for vowel/a/, MPT(Z=2.18,P=0.041) and F2(t=2.13,P=0.040) increased, B2(Z=2.04,P=0.041) and B4(Z=2.00,P=0.046) decreased. For vowel/i/, F2(t=2.035,P=0.050) and F4(t=4.44,P=0.0001) increased, B2(Z=2.36,P=0.019) decreased. Other acoustic parameters were not significantly different from those before surgery. The F2(r=-0.392, P =0.032) of vowel/a/and F2(r=-0.279, P=0.048) and F4 (r=-0.401, P =0.028) of vowel/i/after adenotonsillectomy were significantly higher than those of adenoidectomy alone. Half of patients with postopertive voice changes can recover spontaneously 1 month after surgery. Conclusions: Voice changes in children underwent adenotonsillectomy or adenoidectomy might be related to their changes in formants and bandwidths. The effect of adenotonsillectomy on voice was more significant compared with that of adenoidectomy alone. The acoustic parameters did not change significantly after surgery except MPT.
Adenoidectomy ; Adenoids/surgery* ; Child ; Child, Preschool ; Female ; Humans ; Male ; Speech Acoustics ; Tonsillectomy ; Voice Quality

Adenoid cystic carcinoma (ACC) is a malignant neoplasm of glands commonly occurs in salivary glands. Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare form of ACC that primarily presents on the skin. Herein, we represent a rare case of PCACC occurred in the umbilicus in a 66-year-old Korean male patient. The patient visited our center with erythematous indurated patch on the umbilicus diagnosed as ACC by incisional biopsy at another center. The diagnosis of PCACC was confirmed by additional histopathologic examination and imaging study. We proceeded Mohs micrographic surgery and reconstructed umbilicus with tacked purse string suture. Local recurrence and distant metastasis were not observed during 30-month follow-up. We report this rare case of PCACC on the umbilicus so that dermatologist can aware of the rare disease. Furthermore, we recommend MMS and tacked purse string suture as effective methods for treatment of PCACC and immediate umbilical reconstruction.
Adenoids ; Aged ; Biopsy ; Carcinoma, Adenoid Cystic ; Diagnosis ; Follow-Up Studies ; Humans ; Male ; Mohs Surgery ; Neoplasm Metastasis ; Rare Diseases ; Recurrence ; Salivary Glands ; Skin ; Sutures ; Umbilicus

Tonsillectomy and(or) adenoidectomy are effective procedures for children with chronic tonsillitis, diseases associated with the tonsil and other adenotonsillar diseases, and obstructive sleep apnea-hypopnea syndrome. Since the tonsil and adenoid gland play a dual role in fluid and cell immunity, whether adenotonsillectomy results in the abnormal immune function in children after the surgery has always been the focus of attention. This review focuses on the alterations and impacts on immunity in children after tonsillectomy and/or adenoidectomy. Recent studies confirmed that in short term the immune index may be slightly reduced after the tonsil and adenoid resection in children, however, the decline has no clinical significance because the remaining mucosa-associated lymphoid tissue can compensate for removal of the tonsils and adenoids. Over time, the immune index tends to be normal. The children's postoperative short-term decline in the immune index will gradually recover to the preoperative level or there is no significant difference compared with that in normal children. Therefore, long-term immune function did not decline after tonsil and adenoid resection in children.
Adenoidectomy ; Adenoids ; surgery ; Child ; Humans ; Immunity, Cellular ; Palatine Tonsil ; surgery ; Postoperative Period ; Tonsillectomy ; Tonsillitis ; surgery

OBJECTIVE: To observe the clinical effect of endoscope-guided low temperature plasma ablateing adenoidectomy with tympanic membrane incision drainage and tympanic membrane indwelling catheter to treat secretory otitis media of children. METHOD: Fifty-two cases (98 ears) of secretory otitis media in children with adenoid hypertrophy were treated. Respectively endoscope-guided tympanic membrane incision drainage parallel low temperature plasma ablateing adenoidectomy and endoscope-guided tympanic membrane indwelling catheter parallel low temperature plasma ablateing adenoidectomy. RESULT: In group A, 30 cases of 58 ears, cure 36 ears, improving 14 ears, invalid 8 ears, the effective rate was 86.2%. In group B, 22 cases of 40 ears, cured 32 ears, improvement in 6 ears, invalid 2 ears, the effective rate was 95.0%. According to statistical analysis of curative effect, there was no significant difference by effective rate between two groups. CONCLUSION For the patients with secretory otitis media caused by adenoidal hypertrophy, the endoscope-guided tympanic membrane incision drainage parallel low temperature plasma ablateing adenoidectomy can be regarded as a kind of method to reduce the risk of tympanic membrane perforation.
Adenoidectomy ; methods ; Adenoids ; pathology ; Catheters, Indwelling ; Child ; Cold Temperature ; Humans ; Middle Ear Ventilation ; methods ; Otitis Media with Effusion ; surgery ; Tympanic Membrane Perforation