Plasma is a new technology that has been gradually applied to clinical work in recent years. Plasma is the fourth state of existence of matter (solid, liquid, gas) and is composed of a large number of charged particles in an unbound state. Arthrocare, Inc. invented and patented the “plasma” technology Coblation, that is, 100 KHz ultra-low frequency electrical energy to excite the medium (Nacl) to generate plasma in the temperature range of 40 ~ 70 ℃ protein reversible denaturation, by The sound waves generated by “plasma” break the molecular bonds and directly cleave proteins and other biological macromolecules into O2, CO2, N2 and other gases, thus completing a variety of functions such as tissue cutting, perforation, ablation, crumpling and hemostasis at the cost of “minimally invasive”. However, the high price of plasma equipment has limited the introduction and use of many hospitals, so many patients and families do not know enough about the effectiveness of the procedure, and even some industry colleagues are skeptical, believing that plasma can do tonsils, but not adenoids, such as the tip of the knife is easy to plug, not easy to remove clean and other problems. In fact, these are all problems when not skilled in the use of the plasma, when strictly according to the instructions and skilled use, these situations will not be a problem at all. The following is a brief description of the surgical methods of adenoidectomy, and also some recent before and after comparison pictures of adenoid hypertrophy patients using plasma excision are attached to the article to enrich the relevant knowledge, correct and objective understanding, and promote the use of plasma technology. A. Adenoid scraping generally requires general anesthesia (also mucosal anesthesia), with the child lying supine, an opener is placed, and a suitable type of adenoid scraper is inserted through the mouth, and the operator pushes the scraper to scrape down the adenoids smoothly, usually with 1-3 strokes. The glandular body scraping spoon used is shown in the figure below. The width and curvature of the spatula may not be suitable for each patient’s nasopharynx, especially in the case of the adenoids shown in the sketch on the far right of the figure below. In addition, there are disadvantages such as easy bleeding, damage to the soft palate, pharyngeal orifice of the eustachian tube, and round pillow, which in turn may cause nasopharyngeal adhesions and secondary otitis media. Although it is currently possible to operate under 70-degree nasal endoscopy with the aid of bright vision through the oral cavity to improve the surgical effect, it is an indisputable fact that this purely mechanical cutting “cold weapon” method is rarely used in ENT clinical work. In recent years, with the development of nasal endoscopic technology and equipment, the adenoids can be removed under 70° endoscopy, either through the nasal cavity or through the oral cavity, using an electric suction cutter (as shown below) to crush the adenoids, and after removal, the bleeding can be stopped with epinephrine gauze compression, and the active bleeding point can be stopped with radiofrequency or bipolar electrocoagulation. The disadvantage of leaving adenoid tissue in the nasopharyngeal roof and posterior nostril area during transoral adenoid scraping is solved. Due to the relatively narrow nasal cavity in children, nasal endoscopic adenoids removal via nasal cavity is sometimes difficult and prone to mucosal injury, bleeding and adhesions, while the transoral operation has a clear view, the lens and the tip do not interfere with each other, less bleeding, high precision, and no damage to the nasal cavity. The disadvantage is that special endoscopic imaging system and cutting instruments are needed, which will also increase medical costs. The working principle of plasma melting and cutting has been introduced earlier, and its cutting principle makes it truly minimally invasive, and children often have no discomfort, little pain, and quick recovery after surgery. Because children often suffer from both tonsillar hypertrophy and adenoid hypertrophy, adenoid fusion surgery can be performed right after plasma removal of the tonsils, reducing the need to replace/replace instruments (e.g., suction cutters), which directly shortens the operation and reduces operative time. As for the easy retention of adenoid tissue, these problems can be handled easily with proper retroflexion of the plasma knife, either under indirect nasopharyngoscopy or endonasal endoscopy via the oral cavity. Patients should also be aware that some units will advertise ordinary radiofrequency ablation as plasma surgery and then title it as a minimally invasive gimmick to attract patients. The disadvantages of plasma are that units are more expensive when purchasing plasma equipment and patients using knives, which can increase overall medical costs; proficiency requires foot and hand coordination, proper use of knives, proper saline infusion, etc. In doing tonsil plasma melting and excision still need to have the accumulated skills of conventional tonsil surgery (especially peeling surgery), otherwise the tonsils cannot be removed strictly along the perineum, resulting in easy bleeding, repeated over-cutting, as well as aggravating the injury and postoperative response recovery time. Before and after adenoid plasmapheresis The following are the pictures of some patients before and after adenoid plasmapheresis, because the pictures were not taken at the exact same location when the electronic nasopharyngoscopy was done, and the pictures were not taken at the same hospital and the same nasopharyngoscopy equipment before and after the surgery, which affects the visualization of some comparisons. However, it is easy to see that plasma can effectively remove the adenoid tissue at the top of the nasopharynx and even the adenoids growing into the posterior nostril. Since the tonsil melting can be observed by opening the mouth and pressing the tongue after the tonsil melting procedure, similar pictures are available on some websites and are therefore not uploaded. It is important to note that some studies have found that patients with adenoids and tonsillar hypertrophy have significantly reduced ciliary clearance of the nasal mucosa, so they often have rhinosinusitis at the same time, so we should not neglect the treatment of this after surgery. Special attention is needed: if the accompanying sinusitis is heavy, you need to first medication, and then consider surgery after the symptoms are healed or significantly improved, regardless of anesthesia safety and post-operative recovery will be better, so do not be partial to believe that surgery can solve everything. V. Must adenoids be removed? Many professional magazines, websites and experts in this field have already given the right answer to this question: adenoids are a piece of lymphatic tissue in the pharynx, which reaches its peak at the age of 6 to 7 years after birth as the body grows and develops. During childhood, it secretes immunoglobulins in order to adapt to the body’s defense and resistance to disease, and to receive stimulation from external pathogens to enhance the child’s own immune defense capabilities. With age, the autoimmune function is gradually improved and perfected, and then gradually atrophies and degenerates in adolescence. Due to the weak resistance of the pediatric organism and susceptibility to acute rhinitis, acute tonsillitis and colds, the adenoids become inflamed and enlarged, occupying the respiratory channel and causing a series of ear, nose, throat and tracheal diseases, the consequences and hazards of which are no longer listed. Therefore, if conservative treatment is ineffective and the adenoids are really enlarged, it is better to operate early. For children younger than 3 or 4 years old, it is important to be more thorough and careful in selecting the indications for surgery. When sleeping, the child can be placed on his or her side or in a semi-recumbent position to alleviate the symptoms of respiratory distress, but when the infant cannot sleep, cannot feed or has poor hearing that prevents learning language, then only early surgery can be considered. Secondly, keep the room air fresh and moist in general, which also helps to reduce the symptoms of dyspnea.