2. Anatomy
Component of Waldeyer’s ring
at Portal of upper respiratory tract
Consists of
1.Adenoid
2.Tubal tonsil (in fossa of rosenmuller)
3.Palatine tonsil
4.Lingual tonsil
5lateral pharyngeal bands
6.Some lymphoid tissue in posterior pharyngeal wall
3. The adenoid or nasopharyngeal tonsil
Also known as LUSHKA’S tonsil
It is a single mass of subepithelial lymphoid tissue at junction of roof and
posterior wall of nasopharynx with no capsule (present in tonsil)
The surface is invaginated in a series of
folds.
GERLACH’S tonsil----extension into fossa of
rosenmuller
The epithelium is pseudostratified ciliated
epithelium and is infiltrated by the
lymphoid follicles. (stratified squamous in
palatine tonsil)
4. Embryology
The formation of the adenoids begins
in the 3rd month of fetal development.
This starts with glandular primordia in the
posterior nasopharynx becoming
associated with infiltrating lymphocytes.
In the 5th month sagittal folds are
formed which are the beginnings of
pharyngeal crypts. The surface is
covered with pseudostratified
ciliated epithelium.
By the 7th month of development
the adenoids are fully formed.
5. Blood supply is from the:
Ascending pharyngeal branch of external
carotid
ascending palatine branch of facial
pharyngeal branch of internal (III part)
maxillary
ascending cervical branch of inferior
thyroid
of thyrocervical trunk
6. Venous drainage is through the
pharyngeal plexus and the pterygoid
plexus flowing ultimately into the facial and
internal jugular veins.
Innervation is derived from the
glossopharyngeal and vagus
nerves.
Efferent lymphatics drain to the
retropharyngeal nodes and the upper
deep cervical nodes.
Pterygoid plexus
7. Function
The tonsils and adenoids are part of the immune
system.
Without afferent lymphatics the lymphoid nodules in these structures are
exposed to antigen only in the crypts of the palatine tonsils and the folds of the
adenoids where it is transported through the epithelial layer.
These are involved in the production of mostly secretory IgA, which is
transported to the surface providing local immune protection.
8. Enlarged adenoid
Most common cause is physiological hypertrophy
causes
Upto age of 6 years hypertrophy and
hyperplasia of the adenoids occur caused by antigen-stimulated increased
lymphocyte
B activity due to a higher number of surface pathogens
After 6 years of age, adenoid size remains constant and
atrophies at puberty while the
nasopharynx increases in size
The human nasopharynx is a natural reservoir for bacterial species such as
Streptococcus pneumonia, Haemophilus influenzae and Moraxella
catarrhalis, which all adhere to epithelial cells. The microflora of the
nasopharynx is established early in childhood.
11. Nasal
symptoms
Most
common-
nasal
obstruction
Nasal
discharge
Voice change
Symptoms of
associated
infection like
sinusitis
Interfere with suckling in infant
Stops sucking intermittently for breath
Tires easily -----insufficient nutrition---
failure to thrive
Wet bubbly nose
Hyponasal voice
rhinolalia clausa
In older child ------mouth breathing
And obstructive sleep apnea
Sleep apnea
At night ---restless
disturbed sleep
During day ---excessive
sleepiness
d/t obstruction + associated rhinitis
12. Ear symptoms
Tubal obstruction
Retracted TM
Conductive hearing loss
Serous otitis media
d/t interference with
normal drainage
Spread of infection
Recurrent attacks of acute
otitis media
Failure of resolution of
CSOM
13. General symptoms
Adenoid facies
d/t chronic nasal
obstruction and mouth
breathing
Pulmonary HTN
Long standing nasal
obstruction
Lack of concentration
(aprosexia)
Not attentive due to
deafness and day time
sleepiness due to sleep
apnea
Nasal obstruction---hypoxia---
pulmonary vasoconstriction
14. Adenoid facies
d/t chronic nasal obstruction
Disuse atrophy of alaenasi----pinched nose
Hypoplastic maxillary
sinus -----decreased
aeration-----flat face
apparent exopthalmas
d/t Obligatory mouth breathing
Abnormal dentofacial development
High arched palate
Crowded upper teeth---bcoz
Palate is narrow also
16. Examination
1.Anterior rhinoscopy -----to rule out any other cause of nasal obstruction
2.Posterior rhinoscopy ---only in cooperative child
3.nasopharyngoscopy
4 ear examination
5. Audiometry ----conductive deafness
17. 1. X ray soft tissue lateral view of nasopharynx
Its not about size of adenoid which
is important
But its size in relation to space in
nasopharynx
18. management
treatment
symptoms
Adenoid size If adenoid
hypertrophy
Not marked
i.E symptoms are not
marked
Breathing exercises
Nasal decongestants
antihistaminic
Marked
i.e symptoms marked
adenoidectomy
19. Correct after surgery
Nasal ---snoring ,sleep apnea,rhinolalia
clausa, recurrent rhino sinusitis
Ear---recurrent ear discharge
Does not correct after
surgery
Dental malocclusion
It just prevent their recurrence after
orthodontic treatment
indications
20. contraindications
1.Cleft palate or submucous cleft palate------removal of adenoids causes
velopharyngeal insufficiency ( bcz cleft palate is associated with muscular
abnprmalities)
And hypernasal voice (rhinolalia aperta)
2.Hemorrhagic diathesis
3..acute upper respiratory tract infection
22. Steps of operation
1..done under general anaesthesia with oral endotracheal intubation
2.Pateint in rose position---Supine with head extended by placing a pillow or sandbag beneath the shoulder
why?--- to avoid aspiration----nasopharynx becomes dependent part
hyperextension avoided-----grisel syndrome---
Non traumatic subluxation of atlanto axial joint
3..surgeon stands at head end of
patient
4.boyle-davis mouth gag is inserted
23. 5.Before actual removal of adenoid ..nasopharynx is
Examined by digital palpation to assess the size of
adenoid and palpate any aberrant vessel
6.Now St. clair Thomson adenoid curette is introduced in
Nasopharynx till its free edge touches posterior border or nasal septum
And then pressed backwards to engage adenoid
24. 7..head should be slightly flexed now to avoid injury to odontoid process
8..with gentle sweeping movement in downward direction adenoids are shaved off
9..hemostasis achieved by packing for sometime
26. Post op care
1.Immediate general care
.
Pt is kept in recovery position until recovery from
anaesthesia( it ensures their airway remains clear and
open.
It also ensures that any vomit or fluid will not cause
them to choke.)
Check for bleeding from nose and mouth
Check vitals
2.diet— plenty of fluids.
gradually built from soft to solid fluids
3.Oral hygiene…gargle with salt 3-4 times a day
4.Analagesics
5 antibiotics
Adenoidectomy under endoscopic guidance can be done
