CPT® Code 42835

1. Indications

The procedure of secondary adenoidectomy is indicated for patients who exhibit specific symptoms or conditions related to adenoid hypertrophy or residual adenoid tissue. These indications may include:

• Recurrent Upper Respiratory Infections Frequent infections that may be attributed to enlarged adenoids obstructing the airway.
• Obstructive Sleep Apnea Symptoms such as snoring, pauses in breathing during sleep, or excessive daytime sleepiness due to airway obstruction caused by enlarged adenoids.
• Chronic Nasal Congestion Persistent nasal blockage that affects breathing and quality of life.
• Difficulty Swallowing Issues related to swallowing due to obstruction in the nasopharynx.

2. Procedure

The secondary adenoidectomy procedure involves several key steps to ensure effective removal of the adenoids. The process begins with the patient being positioned appropriately, and a mouth prop is utilized to keep the mouth open and suspended, providing the surgeon with optimal access to the surgical site.

• Step 1: Anesthesia Administration The patient is administered appropriate anesthesia to ensure comfort and pain management throughout the procedure.
• Step 2: Soft Palate Retraction The surgeon carefully retracts the soft palate to expose the adenoids located in the nasopharynx.
• Step 3: Selection of Instrument An appropriately sized adenoid curette is selected and positioned at the posterior edge of the vomer, which is the bone that separates the nasal cavity from the mouth.
• Step 4: Resection of Adenoids The curette is then pushed along the vault of the nasopharynx and over the odontoid process to effectively resect the adenoids. This step may also involve the use of an adenotome or microdebrider, depending on the surgeon's preference.
• Step 5: Inspection and Removal of Remnants After the initial resection, the surgical site is thoroughly inspected for any remaining adenoid tissue. Any remnants are removed using a small curette or electrocautery to ensure complete excision.
• Step 6: Hemostasis Bleeding is controlled through cautery and/or the application of gauze sponges soaked in epinephrine to minimize blood loss during the procedure.

3. Post-Procedure

Following the secondary adenoidectomy, patients are typically monitored for any immediate complications. Post-procedure care may include pain management, hydration, and instructions for dietary modifications to facilitate recovery. Patients are advised to avoid strenuous activities and to follow up with their healthcare provider to ensure proper healing and to address any concerns that may arise during the recovery period. It is essential to monitor for signs of infection or excessive bleeding, which may require further medical attention.