Dr. Priyanjal Gautam
PG-3rd Yr. (MS-ENT)
• 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-
• Pink, globular mass
• Vertical ridges on its surface
• No crypts
• Lined by ciliated columnar epithelium
• No capsule
BLOOD SUPPLY :
• Ascending palatine branch of facial
• Ascending pharyngeal artery
• Pharyngeal branch of 3rd part of
1. Adenoid hypertrophy causing snoring,
mouth breathing, sleep apnoea
syndrome or speech abnormalities, i.e.
2. Recurrent rhinosinusitis.
3. Chronic secretory otitis media
associated with adenoid hyperplasia.
4. Recurrent ear discharge in benign
CSOM associated with
5. Dental malocclusion. Adenoidectomy
does not correct dental abnormalities
but will prevent its recurrence after
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
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.
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.
• 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.
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.
Post-operative Care cont..
When patient is fully recovered he/she is to
take liquids, e.g. cold milk or ice cream.
3. Nasal saline drops
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
2. Injury to eustachian tube opening
3. Injury to pharyngeal musculature and
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.