Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Adenoids
Dr. Priyanjal Gautam
PG-3rd Yr. (MS-ENT)
NIMS, Jaipur
• Synonym: Nasopharyngeal tonsil
• Adenoids is the hypertrophied mass of
lymphoid tissue situated at the junction of
roof ...
FEATURES :
• Pink, globular mass
• Vertical ridges on its surface
• No crypts
• Lined by ciliated columnar epithelium
• No...
BLOOD SUPPLY :
• Ascending palatine branch of facial
artery
• Ascending pharyngeal artery
• Pharyngeal branch of 3rd part ...
LYMPHATIC DRAINAGE :
• Upper deep jugular nodes
• Retropharyngeal nodes
• Parapharyngeal nodes
X-Ray Nasopharynx  enlarged
adenoids
ETIOLOGY :
• Hereditary
• Cold climate
• Specific infection like tuberculosis
• Physiological hypertrophy may be seen
betw...
SYMPTOMS :
LOCAL
• B/L nasal obstruction
• Snoring
• Mouth breathing
• Rhinolalia clausa
• Frequent rhinorrhoea
• Epistaxi...
Adenoids Facies
• Sunken eyes
• Narrow pinched nostrils
• Open mouth
• High-arched palate
• Crowded teeth
• Dull mask-like...
Aural manifestations in Adenoids
• Otalgia
• Secretory otitis media
• Acute otitis media
• Atelectasis of TM
• ET block
• ...
Diagnosis :
• H/O nasal obstruction, rhinorrhoea
• Pink globular mass with vertical ridges
on post. rhinoscopy
• B/L retra...
Differential diagnosis:
• Thornwaldt’s cyst
• High arched palate
Complications:
• Adenoid facies
• Otitis media with effusion
• Recurrent acute otitis media
• Rhinolalia clausa
• Chronic ...
Treatment :
MEDICAL
• Adequate nutrition
• Antibiotics
• Anti inflammatory
analgesics
• Nasal decongestant
drops
SURGICAL
...
Adenoidectomy
Indications :
1. Adenoid hypertrophy causing snoring,
mouth breathing, sleep apnoea
syndrome or speech abnormalities, i.e....
4. Recurrent ear discharge in benign
CSOM associated with
adenoiditis/adenoid hyperplasia.
5. Dental malocclusion. Adenoid...
Contraindications :
1. Cleft palate
2. Haemorrhagic diathesis.
3. Acute URTI
Anaesthesia :
• Always general, with oral endotracheal
intubation.
Neck is extended by a sand bag under the shoulders and the
head is supported on a ring.
Downloaded from: StudentConsult (o...
Steps of Operation :
1. Boyle-Davis mouth-gag is inserted.
Before actual removal of adenoids,
nasopharynx should always be...
2. Proper size of "adenoid curette with
guard" is introduced into the
nasopharynx till its free edge touches
the posterior...
Adenoid curette
With guard Without guard
3. With gentle sweeping movement, adenoids are
shaved off . Lateral masses are similarly removed
with smaller curettes; sm...
Adenoidectomy.
Endoscopic Adenoidectomy
• These days adenoids can be removed
more precisely by using a debrider
under endoscopic control
Nasal endoscopic adenoidectomy
using curette
Oral endoscopic adenoidectomy
using curette
Micro debrider
Micro debrider Micro debrider-tip blade
Microdebrider adenoidectomy
Mirror assisted microdebrider
adenoidectomy
Coblation adenoidectomy
• It is also other wise known as cold
abalation. This technique utilises a field
of plasma, or ion...
Coblation adenoidectomy
Post-operative Care :
1. Immediate general care
(a) Keep the patient in coma position until
fully recovered from anaesthes...
Post-operative Care cont..
2. Diet
When patient is fully recovered he/she is to
take liquids, e.g. cold milk or ice cream....
Post-operative Care cont..
4. Analgesics : I/V or oral
5. Antibiotics : Orally or I/V for a week.
 Patient is usually sen...
Complications :
1. Haemorrhage
2. Injury to eustachian tube opening
3. Injury to pharyngeal musculature and
vertebrae
4. G...
5. Nasopharyngeal stenosis
6. Recurrence
Thank You…
Adenoids
Upcoming SlideShare
Loading in …5
×

Adenoids

  • Be the first to comment

Adenoids

  1. 1. Adenoids Dr. Priyanjal Gautam PG-3rd Yr. (MS-ENT) NIMS, Jaipur
  2. 2. • Synonym: Nasopharyngeal tonsil • Adenoids is the hypertrophied mass of lymphoid tissue situated at the junction of roof & post. wall of nasopharynx. • The mass of lymphoid tissue is termed as Adenoids only when it is hypertrophied. • It usually undergoes atrophy by puberty (13- 14 yrs)
  3. 3. FEATURES : • Pink, globular mass • Vertical ridges on its surface • No crypts • Lined by ciliated columnar epithelium • No capsule
  4. 4. BLOOD SUPPLY : • Ascending palatine branch of facial artery • Ascending pharyngeal artery • Pharyngeal branch of 3rd part of maxillary artery
  5. 5. LYMPHATIC DRAINAGE : • Upper deep jugular nodes • Retropharyngeal nodes • Parapharyngeal nodes
  6. 6. X-Ray Nasopharynx  enlarged adenoids
  7. 7. ETIOLOGY : • Hereditary • Cold climate • Specific infection like tuberculosis • Physiological hypertrophy may be seen between 3-10 yrs
  8. 8. SYMPTOMS : LOCAL • B/L nasal obstruction • Snoring • Mouth breathing • Rhinolalia clausa • Frequent rhinorrhoea • Epistaxis • Feeding problems in children • Conductive deafness due to ET block • Cervical lymphadenopathy • Otitis media • Adenoids facies • Bronchitis GENERAL • Anorexia • Lethargy • Poor physical & mental development • Bed-wetting • Pigeon chest • Protuberent abdomen
  9. 9. Adenoids Facies • Sunken eyes • Narrow pinched nostrils • Open mouth • High-arched palate • Crowded teeth • Dull mask-like face • Protruding teeth • Drooling saliva • Everted upper lip • Rhinorrhoea • Loss of nasolabial fold
  10. 10. Aural manifestations in Adenoids • Otalgia • Secretory otitis media • Acute otitis media • Atelectasis of TM • ET block • Chonic otitis media
  11. 11. Diagnosis : • H/O nasal obstruction, rhinorrhoea • Pink globular mass with vertical ridges on post. rhinoscopy • B/L retracted ear drums • X-ray nasopharynx Lat. View shows soft tissue mass
  12. 12. Differential diagnosis: • Thornwaldt’s cyst • High arched palate
  13. 13. Complications: • Adenoid facies • Otitis media with effusion • Recurrent acute otitis media • Rhinolalia clausa • Chronic sinusitis • Sleep apnea syndrome • Decreased mental/physical development
  14. 14. Treatment : MEDICAL • Adequate nutrition • Antibiotics • Anti inflammatory analgesics • Nasal decongestant drops SURGICAL • Adenoidectomy • Myringotomy with grommet insertion
  15. 15. Adenoidectomy
  16. 16. Indications : 1. Adenoid hypertrophy causing snoring, mouth breathing, sleep apnoea syndrome or speech abnormalities, i.e. (rhinolalia clausa). 2. Recurrent rhinosinusitis. 3. Chronic secretory otitis media associated with adenoid hyperplasia.
  17. 17. 4. Recurrent ear discharge in benign CSOM associated with adenoiditis/adenoid hyperplasia. 5. Dental malocclusion. Adenoidectomy does not correct dental abnormalities but will prevent its recurrence after orthodontic treatment.
  18. 18. Contraindications : 1. Cleft palate 2. Haemorrhagic diathesis. 3. Acute URTI
  19. 19. Anaesthesia : • Always general, with oral endotracheal intubation.
  20. 20. Neck is extended by a sand bag under the shoulders and the head is supported on a ring. Downloaded from: StudentConsult (on 6 December 2012 06:54 PM) © 2005 Elsevier Rose's position
  21. 21. Steps of Operation : 1. Boyle-Davis mouth-gag is inserted. Before actual removal of adenoids, nasopharynx should always be examined by retracting the soft palate with curved end of the tongue depressor and by digital palpation, to confirm the diagnosis, to assess the size of adenoids mass and to push the lateral adenoid masses towards the midline.
  22. 22. 2. Proper size of "adenoid curette with guard" is introduced into the nasopharynx till its free edge touches the posterior border of nasal septum and is then pressed backwards to engage the adenoids. At this level, head should be slightly flexed to avoid injury to the odontoid process.
  23. 23. Adenoid curette With guard Without guard
  24. 24. 3. With gentle sweeping movement, adenoids are shaved off . Lateral masses are similarly removed with smaller curettes; small tags of lymphoid tissue left behind are removed with punch forceps. 4. Haemostasis is achieved by packing the area for sometime. Persistent bleeders are electro- coagulated under vision. If bleeding is still not controlled, a postnasal pack is left for 24 hours.
  25. 25. Adenoidectomy.
  26. 26. Endoscopic Adenoidectomy • These days adenoids can be removed more precisely by using a debrider under endoscopic control
  27. 27. Nasal endoscopic adenoidectomy using curette
  28. 28. Oral endoscopic adenoidectomy using curette
  29. 29. Micro debrider Micro debrider Micro debrider-tip blade
  30. 30. Microdebrider adenoidectomy
  31. 31. Mirror assisted microdebrider adenoidectomy
  32. 32. Coblation adenoidectomy • It is also other wise known as cold abalation. This technique utilises a field of plasma, or ionised sodium molecules, to ablate tissues. The heat generated varies from 40 - 80 degrees centigrade, much lower than that of electro cautery. The major advantage of this procedure is reduced bleeding and reduced post operative pain.
  33. 33. Coblation adenoidectomy
  34. 34. Post-operative Care : 1. Immediate general care (a) Keep the patient in coma position until fully recovered from anaesthesia. (b) Keep a watch on bleeding from the nose and mouth. (c) Keep check on vital signs, e.g. pulse, respiration and blood pressure.
  35. 35. Post-operative Care cont.. 2. Diet When patient is fully recovered he/she is to take liquids, e.g. cold milk or ice cream. 3. Nasal saline drops
  36. 36. Post-operative Care cont.. 4. Analgesics : I/V or oral 5. Antibiotics : Orally or I/V for a week.  Patient is usually sent home 24 hours after operation unless there is some complication. Patient can resume his normal duties within 2 weeks.
  37. 37. Complications : 1. Haemorrhage 2. Injury to eustachian tube opening 3. Injury to pharyngeal musculature and vertebrae 4. Griesel syndrome. Patient complains of neck pain and develops torticollis. Mostly it is due to spasm of paraspinal muscles, but can be due to atlanto-axial dislocation requiring cervical collar and even traction.
  38. 38. 5. Nasopharyngeal stenosis 6. Recurrence
  39. 39. Thank You…

    Be the first to comment

    Login to see the comments

  • HariKrishnaAmmireddy

    Sep. 10, 2020
  • lilianphilemon95

    Sep. 14, 2020
  • SudiptoDas52

    Oct. 10, 2020
  • BhashaJyoti

    Oct. 24, 2020
  • ShivangiSingh260

    Oct. 27, 2020
  • DrChandramohanIndapu

    Nov. 15, 2020
  • PratikPagi

    Nov. 19, 2020
  • TanapatBoonbumrungchai

    Nov. 30, 2020
  • monumuraleedharan9

    Jan. 11, 2021
  • LinetMaari

    Feb. 6, 2021
  • ASIYAS

    Mar. 2, 2021
  • JinaJamoh

    Mar. 10, 2021
  • PratikshaKc2

    Mar. 16, 2021
  • SurekhaBhalekar3

    Apr. 7, 2021
  • SajnaIbrahim1

    Apr. 16, 2021
  • Adarshkumar188

    Apr. 22, 2021
  • AfnanYaseen1

    May. 31, 2021
  • AleenaKarimpil

    Jun. 7, 2021
  • HuneyChoudhary

    Jun. 14, 2021
  • keerthanreddy11

    Jul. 9, 2021

Views

Total views

32,662

On Slideshare

0

From embeds

0

Number of embeds

28

Actions

Downloads

1,227

Shares

0

Comments

0

Likes

132

×