Adenoid

ADENOID/NASOPHARYNGEAL TONSIL/LUSCHKA’S TONSIL

ANATOMY OF ADENOID

• Sub epithelial collection of lymphoid tissue at the junction of posterior wall and roof of nasopharynx.
• Forms a part of inner waldeyer ring along with palatine and tubal tonsils.
• Increases in size up to 6 yrs, tends to atrophy after that, completely disappears at the age of 20yrs
• No crypts, no capsule (present in palatine tonsil)
• Blood supply

1. Ascending palatine branch of facial artery
2. Ascending pharyngeal branch of external carotid artery
3. Pharyngeal branch of third part of maxillary artery
4. Ascen
5. ding cervical branch of inferior thyroid artery

 ADENOID ENLARGEMENT

CLINICAL FEATURES OF ADENOID ENLARGEMENT

• Nasal obstruction is the commonest symptom
• Mouth breathing.
• Recurrent URTI,Nasal discharge, sinusitis, epistaxis, voice change-Rhinolalia Clausa.
• ET obstruction: Conductive hearing loss- CSOM, SOM
• Adenoid is a common cause of Eustachian Disease
• Adenoid facies: elongated face with dull expression, open mouth, prominent and crowded upper teeth, hitched up upper lip, high arched palate
• Pulmonary hypertension and Cor pulmonale
• Aprosexia – lack of concentration.
• Failure to thrive.

ASSESMENT OF ADENOID ENLARGEMENT

• Size of adenoids may well be assessed using lateral radiograph of nasopharynx and Nasal Endoscopy and CT scan is not necessary

TREATMENT

• For the treatment of enlarged adenoids when symptoms are not marked breathing excercise, decongenstant nasal drops and antihistaminics are used and when symptoms are marked, adenoidectomy is done.

ADENOIDECTOMY

• In the conventional method, St Clair Thompson’s adenoid curette is used.
• Newer methods of Adenoid removal include Electrocautery,Laser,Coblation,Debrider 

Indications

• Adenoid hypertrophy causing snoring, mouth breathing, sleep apnea or speech abnormalities
• Recurrent URTI
• Chronic otitis media with effusion.
• Common cause of serous otitis media in children is growth of adenoid.
• In that case Adenoidectomy with grommet insertion is done.
• Serous otitis media in adults should arouse suspicion of nasopharyngeal carcinoma and hence the treatment aims at removal of carcinoma
• Dental malocclusion
• Recurrent ear discharge

Contraindications

• Cleft palate or submucous palate
• Hemorrhagic diathesis
• Acute upper respiratory tract infection

Complications

Hemorrhage:

• Primary,Reactionary,Secondary
• Damage to the Eustachian Tube Orifice- leading to Otits media and Conductive hearing loss
• Hypernasality of speech
• Velopharyngeal insufficiency
• Grisel’s Syndrome:
• Torticollis can occur as a complication of adenoidectomy due to ligamentous laxity secondary to inflammatory process following adenoidectomy. It is called as Grisel syndrome.
• This is M/C in patients of Down syndrome as children with Down’s already have asymptomatic atlantoaxial instability which mani­fests after surgery.
• Retropharyngeal Abscess

Exam Question

• Adenoidectomy with grommet insertion is treatment of choice for Serous otitis media in children .
• Best line of management in a patient presenting with mouth breathing, recurrent serous otitis media and adenoid facies is Adenoidectomy.
• Treatment of a  child with recurrent URTI with mouth breathing and failure to grow with high arched palate and impaired hearing is Grommet insertion  with Adenoidectomy and tonsillectomy (to remove the causative factor).
• Common cause of eustachian diseases is due to Adenoids.
• Next step of management in a child has adenoidectomy done but has effusion in middle ear is Grommet insertion.
• Regarding adenoids ,there is failure to thrive,high arched palate and mouth breathing is seen.
• The inner Waldeyer’s group of lymph nodes constitutes of Tonsils, Lingual tonsils ,Adenoids.
• Indication for Adenoidectomy in children include Recurrent respiratory tract infections, Chronic serous otitis media and Multiple adenoids.
• Torticollis can occur as a complication of adenoidectomy due to ligamentous laxity secondary to inflammatory process following adenoidectomy.
• In a patient with hypertrophied adenoids, the voice abnormality that is seen is Rhinolalia Clausa.
• Complications of adenoid­ectomy include Retro pharyngeal abscess,Velopharyngeal insufficiency and Grisel syndrome.
• Adenoidectomy results in hypernasality of speech.
• CT scan is not routinely preferred to assess Adenoid size.