Outcomes of adenoidectomy with and without tonsillectomy in patients younger than 2 years with moderate to severe upper airway obstruction.
Int J Pediatr Otorhinolaryngol
; 149: 110841, 2021 Oct.
Article
em En
| MEDLINE
| ID: mdl-34303126
ABSTRACT
OBJECTIVES:
The effectiveness of adenotonsillectomy for obstructive sleep disorder breathing (OSDB) in children under age 2 years is unclear. The present study aimed to identify the perioperative symptoms and clinical outcomes of adenoidectomy and tonsillectomy in very young children. PATIENTS ANDMETHODS:
The present, single-center, retrospective cohort study, conducted from January 2010 to April 2020, enrolled patients under age 2 years with moderate to severe upper airway obstruction who underwent an adenoidectomy or tonsillectomy. The patients were divided according to The Brodsky grading scale into group 1 (Grade 0 to 1 tonsils) or group 2 (Grade 2 or higher tonsils), who received only an adenoidectomy. Group 3 comprised patients with a concomitant adenoidectomy and tonsillectomy. Perioperative symptoms among the groups and the cumulative revision-free status and recurrence-free status rates in groups 1 and 2 were analyzed.RESULTS:
Fifty-three patients were enrolled. The median standard deviation score (SDS) for height and weight was -0.79 and -0.31, respectively. No postoperative complications, such as bleeding, were observed. However, two patients underwent intubation preoperatively due to severe obstruction. Seven patients underwent revision surgery. The cumulative revision-free and recurrence-free rates at week 60 were 81% and 100% for Group 1 and 42% and 48.5% for Group 2, respectively. The cumulative revision-free rate and cumulative recurrence-free rate were significantly higher in Group 1 (P < 0.0001; HR 47.9; 95% CI 1.12-2050 and P < 0.007; HR 4.62; 95% CI 1.37-15.6, respectively). None of the patients in Group 3 had revision surgery or symptom recurrence.CONCLUSION:
Simple adenoidectomy in children with large tonsils carries a high risk of revision surgery. However, given the high risk of severe obstruction in very young children with OSDB, timely surgery is recommended. LEVEL OF EVIDENCE 3.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Tonsilectomia
/
Obstrução das Vias Respiratórias
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Observational_studies
/
Prognostic_studies
Limite:
Child
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Child, preschool
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Humans
Idioma:
En
Revista:
Int J Pediatr Otorhinolaryngol
Ano de publicação:
2021
Tipo de documento:
Article