Adenoidectomy: indirect visualization of choanal adenoids

A retrospective review of adenoidectomies was carried out at the Montreal Children's Hospital, Montreal, Quebec. From April 1, 1990, to November 14, 1992, the senior author (JJM) was involved in 330 adenoidectomies with or without concurrent tonsillectomy or pressure equalization tube (PET) insertion. In all cases, adenoid surgery was performed with proper soft palate retraction and indirect visual inspection using laryngeal mirrors. A subgroup of 31 patients (9.4%) was identified as having adenoid tissue extending from the nasopharynx into the choanae and posterior nasal cavity: "choanal adenoids." The characteristics of this subgroup are outlined in the hope that features may be useful in identifying potential choanal adenoids preoperatively. Furthermore, the use of indirect visualization, as opposed to the traditional "blind adenoidectomy," is proposed so that no significant residual adenoid tissue remains post-adenoidectomy.