Throat Surgery in Gandhinagar & Ahmedabad | Niraaya Hospital

Adenoids are a patch of lymphoid tissue located at the back of the nasal cavity, above the soft palate - a position that cannot be seen through the mouth or felt from outside. They are most prominent in children aged 3-7 years and naturally shrink during adolescence. In many children, however, they become chronically infected, obstructively enlarged, or both - causing a range of significant symptoms.

• Significant nasal obstruction with persistent mouth breathing, snoring, or obstructive sleep apnoea
• Recurrent acute otitis media (middle ear infections) - especially when the adenoid is a reservoir of bacteria causing Eustachian tube dysfunction
• Chronic otitis media with effusion (glue ear / secretory otitis media) causing hearing loss - adenoidectomy significantly reduces fluid recurrence and the need for repeat grommet (ventilation tube) insertion
• Chronic adenoiditis (recurrent adenoid infection) causing persistent nasal discharge, post-nasal drip, or chronic cough
• Chronic rhinosinusitis in children related to adenoid obstruction of the posterior choanae

Adenoidectomy is performed under general anaesthesia. The adenoid tissue at the back of the nasal cavity is accessed through the open mouth, visualised with a mirror or nasal endoscope, and removed using a curette, adenoid punch, microdebrider, or coblation wand. Endoscopic adenoidectomy - using a nasal endoscope passed through the nostril - provides direct visualisation and allows complete, targeted removal while sparing the Eustachian tube openings. The procedure takes 15-20 minutes and is frequently combined with tonsillectomy (adeno-tonsillectomy) when both tissues are problematic, or with grommet insertion when glue ear coexists.

Hospital stay: 1 day. Nasal congestion and mild nasal discharge for 1-2 weeks as the post-operative raw area heals. A temporary change in voice quality - slightly hypernasal or "pinched" sounding - is common for a few weeks and almost always fully resolves as the nasopharynx adapts. Most children return to school in 5-7 days.

Microlaryngeal surgery (MLS) is the collective term for procedures performed on the larynx (voice box) using a rigid suspension laryngoscope and an operating microscope or rigid endoscope - providing a magnified, precisely illuminated view of the vocal cords. All procedures are performed through the mouth under general anaesthesia - with no external incisions on the neck whatsoever. MLS represents the pinnacle of precision in ENT surgery: the working space within the larynx is only a few millimetres wide, and the entire procedure depends on hand steadiness, optical magnification, and delicate microinstruments.

Smooth, often pedunculated (stalk-like) benign outgrowths from the superficial layer of the vocal cord mucosa. Caused by vocal overuse or misuse, GERD/LPR, smoking, or a single traumatic vocal event. Present with hoarseness, voice fatigue, and a breathy or strained voice quality. Treated with microsurgical excision using cold steel microinstruments - carefully preserving the underlying vocal cord ligament and muscle to maintain post-operative voice quality. Voice therapy is an important adjunct before and after surgery.

Bilateral, symmetrical thickenings at the junction of the anterior and middle thirds of the vocal cords - the point of maximum vibration. Common in professional voice users (teachers, singers, call centre employees, lawyers). Voice therapy is the primary treatment for most nodules; microsurgical excision is reserved for nodules persisting despite adequate voice therapy.

Mucous retention cysts or epidermoid cysts within the body of the vocal cord, causing hoarseness and voice change. Excised with a mucosal microflap technique to prevent post-operative scarring and preserve vocal cord pliability.

HPV-driven warty outgrowths (papillomas) on the laryngeal mucosa - most commonly the vocal cords - causing hoarseness and in severe cases, airway obstruction. RRP is characterised by recurrence despite treatment. Managed with endoscopic debulking using a microdebrider or CO2 laser to remove bulk disease while sparing the underlying mucosal architecture. Multiple treatment sessions are typically needed.

T1a (one vocal cord) and T1b (both vocal cords) squamous cell carcinomas of the vocal cord are treated with endoscopic CO2 laser cordectomy - a curative procedure achieving cancer-free margins without any external incision and with excellent preservation of voice function. This represents a dramatic improvement over historical open surgery for early laryngeal cancer.

Narrowing of the airway immediately below the vocal cords - often from previous prolonged intubation or tracheostomy - can cause progressive breathing difficulty and a harsh, crowing breathing sound (stridor). Managed endoscopically with CO2 laser incision and balloon dilation, or in refractory cases, open surgical reconstruction.

Dr. Khushali Patel performs microlaryngeal surgeries with meticulous attention to vocal cord mucosal preservation - because maintaining voice quality after surgery is as important as removing the pathology.

The deep fascial spaces of the neck - compartments defined by layers of cervical fascia surrounding muscles, vessels, nerves, and visceral structures - can become infected when bacteria spread from the throat, tonsils, dental roots, or parotid gland. The two most clinically significant deep neck abscesses are:

Retropharyngeal Abscess: A collection of pus in the space between the back of the pharynx and the prevertebral fascia (anterior to the cervical spine). More common in young children (from infection of retropharyngeal lymph nodes, which involute after childhood) but also seen in adults. Presents with severe throat pain, high fever, difficulty swallowing and opening the mouth, neck stiffness or rigidity, and a "hot potato" voice. CT neck with contrast confirms the diagnosis and extent.

Parapharyngeal Abscess: A collection in the lateral pharyngeal space - a potential space adjacent to the tonsil and pharynx containing the internal carotid artery, internal jugular vein, cranial nerves IX-XII, and cervical sympathetic chain. Infection in this space is particularly dangerous due to proximity to these vital structures. It presents with trismus (restricted mouth opening), swelling of the neck medial to the mandible, systemic sepsis, and a bulging of the lateral pharyngeal wall.

Untreated deep neck infections expand along fascial planes and can spread into the chest (descending necrotising mediastinitis - a catastrophic complication with high mortality), rupture into the airway causing asphyxiation, or erode adjacent neck vessels (Lemierre's syndrome - internal jugular vein thrombophlebitis). Death can occur within hours in the most severe cases. These conditions require immediate hospital admission, IV antibiotics, and urgent surgical drainage.

Airway management takes absolute priority at the time of anaesthesia induction - the airway may be significantly compromised by posterior pharyngeal wall swelling. Once the airway is secured, the abscess is drained: retropharyngeal abscesses are incised and drained intra-orally (through the posterior pharyngeal wall); parapharyngeal abscesses typically require an external neck approach - an incision below and behind the angle of the mandible, opening the parapharyngeal space, evacuating pus, and irrigating the cavity. A drain is left in situ for 24-48 hours. Post-operative inpatient IV antibiotics are continued until the patient is systemically well.