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Adenoidectomy Indications and Anatomy

Adenoids are lymphoid tissue located in the nasopharynx that can become inflamed or enlarged. They are present at birth and typically enlarge until age 6 before beginning to atrophy. Common causes of adenoid inflammation or hyperplasia include recurrent rhinitis, sinusitis, or tonsillitis. Symptoms include nasal obstruction, discharge, sinusitis, and aural symptoms like ear pain or serous otitis media. Adenoidectomy is often recommended if symptoms are marked and do not improve with medication. The procedure involves removing the adenoid tissue under general anesthesia using curettes and forceps. Post-operative care is similar to tonsillectomy and potential complications include bleeding, injury

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106 views8 pages

Adenoidectomy Indications and Anatomy

Adenoids are lymphoid tissue located in the nasopharynx that can become inflamed or enlarged. They are present at birth and typically enlarge until age 6 before beginning to atrophy. Common causes of adenoid inflammation or hyperplasia include recurrent rhinitis, sinusitis, or tonsillitis. Symptoms include nasal obstruction, discharge, sinusitis, and aural symptoms like ear pain or serous otitis media. Adenoidectomy is often recommended if symptoms are marked and do not improve with medication. The procedure involves removing the adenoid tissue under general anesthesia using curettes and forceps. Post-operative care is similar to tonsillectomy and potential complications include bleeding, injury

Uploaded by

UjjawalShriwastav
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
  • Adenoids and Other Inflammations of Nasopharynx
  • Blood and Nerve Supply
  • Aetiology of Nasopharynx Conditions
  • Clinical Features and Symptoms
  • Diagnosis and Treatment Options
  • Thornwaldt's Disease (Pharyngeal Bursitis)
  • Adenoidectomy
  • Adenoidectomy Procedures and Care

Adenoids and

other inflammations of nasopharynx


Nasopharyngeal
tonsil=adenoids;
situated
junction of roof and post. Wall of nasopharynx
Adenoids

at

Is composed of vertical ridges of lymphoid tiss. Separated


by deep clefts
Covering epithelium is

Ciliated pseudostratified columnar


Stratified squamous and
Transitional

No crypts and no capsule


*present at birth and shows physiological enlargement
upto the age of 6 years and tends to atrophy at puberty
and disappears at 20

Blood supply
Ascending palatine branch of facial artery
Ascending pharyngeal branch of external
carotid artery
Pharyngeal branch of the third part of
maxillary a.
Asc. Cervical branch of inf. Thyroid a. of
thyrocervical trunk

Lymphatics: upper jugular nodes directly


or indirectly via retro and parapharyngeal
nodes
Nerve supply: CN IX and X; referred pain
to ear

Aetiology
Recurrent attacks of rhinitis,
sinusitis or chronic tonsillitis may
cause chronic adenoid infection and
hyperplasia
Allergy

Clinical features
Nasal symptoms

Aural symptoms

Nasal obstruction-commonest
symptom
mouth breathing, interferes
with feeding and suckling in
childrespiration and feeding
cannot take place togetherchild
fails to thrive

Tubal obstruction
--retracted tm

Nasal discharge

Recurrent atacks of acute


otitis media

Sinusitis

CSOM fails to resolve

Epistaxis-nose blowing in
inflammed condtn

Serous otitis media

Voice change-toneless
General symptoms:
a. Adenoid facies: d/t chronic obstruction and mouth
breathing
-child has elongated face, with dull expression , open
mouth, prominent and crowded upper teeth and
hitched up upper lip

Diagnosis
Examination of post nasal space in some
young children adenoid mass is seeen
with mirror
Rigid or flexible nasopharyngoscope in
cooperative child
Soft tissue lateral radiograph

Tx
Symptoms not marked: breathing
exercise, decongestant nasal drops and
antihistaminics
Symptoms are marked: Adenoidectomy

Thornwaldts disease (pharyngeal bursitis)

Infection of pharyngeal bursa which is a median recess


representing attachment of notochord to endoderm of
primitive pharynx
Pharyngeal bursa is located in midline of posterior
wall of nasopharynx in the adenoid mass
Clinical picture

Persistent post nasal discharge with crusting in nasopharynx


Nasal obstruction
Obstruction to eustachian tube and serous otitis media
Dull type of occipital headache
Recurrent sore throat
Low grade fever

O/e: cystic and fluctuant swelling in


nasopharynx + crusts d/t dried discharge
Tx.
Antibiotics are give to treat infection
Marsupialization of cystic swelling
Adequate removal of its surface lining

[Link]

of

Adenoidectomy
Indications
Adenoid hypertrophy
causing snoring, mouth
breathing, sleep apnoea
syndrome or speech
abnormalities
Recurrent sinosinusitis
Chronic secretory OM
Recurrent ear discharge in
benign CSOM a/w
adenoiditis
Dental malocclusion:
doesnt correct but
prevent

Contraindications:
Cleft
palate
or
submucous
palate

there
will
be
velopharyngeal
insufficiency
Hemorrhagic diasthesis
Acute URTI

Anesthesia
General always with oral
ET intubation

Position
Same as tonsillectomy

Procedure
Boyle-Davis mouth gag is
inserted
Proper examn of nasopharynx
to assess the size of adenoids
mass and to push the lateral
adenoid pass to midline
Proper size adenoid curette
with guard is introduced into
nasophx
With gentle sweeping,
adenoids are shaved off and
small tags remaining are
removed by punch forceps
Pack the area for hemostasis

Post op care: same as


for tonsillectomy
Complications
Hemorrhage
Injury to eustachian tube
Injury to pharyngeal
musculature and
vertebrae
Velopharyngeal
insufficiency
Nasopharyngeal stenosis
Recurrence

Adenoids and other inflammations of nasopharynx • Nasopharyngeal tonsil=adenoids; situated at junction of roof and post.
• Blood supply – Ascending palatine branch of facial artery – Ascending pharyngeal branch of external carotid artery – Ph
Aetiology • Recurrent attacks of rhinitis, sinusitis or chronic tonsillitis may cause chronic adenoid infection and hyperp
Clinical features Nasal symptoms Aural symptoms Nasal obstruction-commonest symptom mouth breathing, interferes with fee
• Diagnosis – Examination of post nasal space in some young children adenoid mass is seeen with mirror – Rigid or flexibl
Thornwaldt’s disease (pharyngeal bursitis) • Infection of pharyngeal bursa which is a median recess representing attachment
Adenoidectomy • Indications – Adenoid hypertrophy causing snoring, mouth breathing, sleep apnoea syndrome or speech abn
• Procedure – Boyle-Davis mouth gag is inserted – Proper examn of nasopharynx to assess the size of adenoids mass and to

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