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Adenoids
Adenoids are masses of lymphatic tissue located in the nasopharynx that can become enlarged. Symptoms of enlarged adenoids include nasal obstruction, mouth breathing, and ear infections. Adenoidectomy is the surgical removal of the adenoids and indications include recurrent infections and airway obstruction. The procedure involves using curettes or microdebriders to gently remove the adenoids under anesthesia. Post-operative care focuses on pain management, antibiotics, and monitoring for potential complications like bleeding or injury.
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Adenoids
- 1. Adenoids Dr. Priyanjal Gautam PG-3rdYr. (MS-ENT) NIMS, Jaipur
- 2. • Synonym: Nasopharyngealtonsil • 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)
- 4. FEATURES : • Pink,globular mass • Vertical ridges on its surface • No crypts • Lined by ciliated columnar epithelium • No capsule
- 5. BLOOD SUPPLY : •Ascending palatine branch of facial artery • Ascending pharyngeal artery • Pharyngeal branch of 3rd part of maxillary artery
- 6. LYMPHATIC DRAINAGE : •Upper deep jugular nodes • Retropharyngeal nodes • Parapharyngeal nodes
- 7. X-Ray Nasopharynx enlarged adenoids
- 8. ETIOLOGY : • Hereditary •Cold climate • Specific infection like tuberculosis • Physiological hypertrophy may be seen between 3-10 yrs
- 9. SYMPTOMS : LOCAL • B/Lnasal 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
- 10. Adenoids Facies • Sunkeneyes • 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
- 11. Aural manifestations inAdenoids • Otalgia • Secretory otitis media • Acute otitis media • Atelectasis of TM • ET block • Chonic otitis media
- 12. Diagnosis : • H/Onasal 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
- 13. Differential diagnosis: • Thornwaldt’scyst • High arched palate
- 14. Complications: • Adenoid facies •Otitis media with effusion • Recurrent acute otitis media • Rhinolalia clausa • Chronic sinusitis • Sleep apnea syndrome • Decreased mental/physical development
- 15. Treatment : MEDICAL • Adequatenutrition • Antibiotics • Anti inflammatory analgesics • Nasal decongestant drops SURGICAL • Adenoidectomy • Myringotomy with grommet insertion
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- 17. Indications : 1. Adenoidhypertrophy 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.
- 18. 4. Recurrent eardischarge 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.
- 19. Contraindications : 1. Cleftpalate 2. Haemorrhagic diathesis. 3. Acute URTI
- 20. Anaesthesia : • Alwaysgeneral, with oral endotracheal intubation.
- 21. Neck is extendedby 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
- 22. 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.
- 23. 2. Proper sizeof "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.
- 24. Adenoid curette With guardWithout guard
- 25. 3. With gentlesweeping 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.
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- 27. Endoscopic Adenoidectomy • Thesedays adenoids can be removed more precisely by using a debrider under endoscopic control
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- 30. Micro debrider Micro debriderMicro debrider-tip blade
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- 33. Coblation adenoidectomy • Itis 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.
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- 35. 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.
- 36. 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
- 37. 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.
- 38. 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.
- 39. 5. Nasopharyngeal stenosis 6.Recurrence
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