7/29/2019 Throat Pharynx Adenoids ENT Lectures
1/33
ADENOIDSDisclaimer: The pictures used in thispresentation have been obtained from anumber of sources. Their use is purely foracademic and teaching purposes. The
contents of this presentation do not have anyintended commercial use. In case the ownerof any of the pictures has any objection andseeks their removal please contact [email protected]. The sepictures will be removed immediately.
mailto:[email protected]:[email protected]:[email protected]7/29/2019 Throat Pharynx Adenoids ENT Lectures
2/33
Embryology
The formation of the adenoids begins in the3rd month of fetal development. This startswith glandular primordia in the posteriornasopharynx becoming associated with
infiltrating lymphocytes. In the 5th month sagittal folds are formed
which are the beginnings of pharyngealcrypts. The surface is covered withpseudostratified ciliated epithelium.
By the 7th month of development theadenoids are fully formed.
7/29/2019 Throat Pharynx Adenoids ENT Lectures
3/33
Anatomy
The lymphoid tissue of the nasopharynx andoropharynx is composed of the adenoids,the tubal tonsils, the lateral bands, thepalatine tonsils, and the lingual tonsils.
There are also lymphoid collections in theposterior pharyngeal wall and in thelaryngeal ventricles.
These structures form a ring of tissue named
Waldeyers ring after the German anatomistwho described them.
7/29/2019 Throat Pharynx Adenoids ENT Lectures
4/33
The adenoids or pharyngeal tonsil
It is a single mass of pyramidal tissuewith its base on the posteriornasopharyngeal wall and its apex
pointed toward the nasal septum.The surface is invaginated in a series of
folds.
The epithelium is pseudostratifiedciliated epithelium and is infiltrated bythe lymphoid follicles.
7/29/2019 Throat Pharynx Adenoids ENT Lectures
5/33
Blood supply is from
the:
Ascending palatinebranch of the facialartery
Pharyngeal branch
of the internalmaxillary artery
Artery of thepterygoid canal
Ascending cervicalbranch of thethyrocervical trunk.
7/29/2019 Throat Pharynx Adenoids ENT Lectures
6/33
Venous drainage is through the
pharyngeal plexus and thepterygoid plexus flowingultimately into the facial andinternal jugular veins.
Innervation is derived from theglossopharyngeal and vagusnerves.
Efferent lymphatics drain to theretropharyngeal nodes and theupper deep cervical nodes.
7/29/2019 Throat Pharynx Adenoids ENT Lectures
7/33
Function and Immunology
The tonsils and adenoids are part of thesecondary immune system.
Without afferent lymphatics the lymphoid
nodules in these structures are exposed toantigen only in the crypts of the palatinetonsils and the folds of the adenoids where itis transported through the epithelial layer.
These are involved in the production ofmostly secretory IgA, which is transported tothe surface providing local immune
protection.
7/29/2019 Throat Pharynx Adenoids ENT Lectures
8/33
Acute adenoiditis symptoms include purulentrhinorrhea, nasal obstruction, fever, and sometimes
otitis media. This can be difficult to differentiate from an acute
upper respiratory infection but tends to have alonger and more severe course.
7/29/2019 Throat Pharynx Adenoids ENT Lectures
9/33
Acute adenoiditissymptoms include
purulent rhinorrhea,nasal obstruction,fever, andsometimes otitis
media. This can be difficult
to differentiate froman acute upper
respiratory infectionbut tends to have alonger and moresevere course.
7/29/2019 Throat Pharynx Adenoids ENT Lectures
10/33
Recurrent acuteadenoiditis is 4 ormore episodes of
acute adenoiditis in a6-month period withintervening periods ofwellness.
Chronic adenoiditissymptoms includepersistent rhinorrhea,postnasal drip,malodorous breath,
and associated otitismedia or extraesophageal refluxlasting at least 3months.
7/29/2019 Throat Pharynx Adenoids ENT Lectures
11/33
Obstructive adenoid hyperplasia
includes symptoms of chronicnasal obstruction, rhinorrhea,snoring, mouth breathing, and ahyponasal voice.
Obstructive sleep apnea inchildren is clinically marked byloud snoring, apneic episodeswhile sleeping, daytimesomnolence, behavioralproblems, and enuresis
7/29/2019 Throat Pharynx Adenoids ENT Lectures
12/33
Adenoid facies or long facesyndrome. It is the long, open-mouthed,
face of children with adenoidhypertrophy.
The mouth is always open
because upper airwaycongestion has made patientsobligatory mouth breathers.
The most common presenting
symptoms are chronic mouthbreathing and snoring.
The most dangerous symptom issleep apnea
7/29/2019 Throat Pharynx Adenoids ENT Lectures
13/33
The characteristicfacial appearance
consists of:Underdeveloped
thin nostrils
Short upper lipProminent upper
teeth
Crowded teeth
Narrow upperalveolus
7/29/2019 Throat Pharynx Adenoids ENT Lectures
14/33
High-arched palate
Hypoplastic maxilla
Eustachian blockagecausing glue ear-deafness
The deafness andinattentivenessinterferes with thelearning
Child grows withlowered intelligence
and understanding
7/29/2019 Throat Pharynx Adenoids ENT Lectures
15/33
Diagnosis
7/29/2019 Throat Pharynx Adenoids ENT Lectures
16/33
Posterior Rhinoscopy
7/29/2019 Throat Pharynx Adenoids ENT Lectures
17/33
Nasopharygoscopy
7/29/2019 Throat Pharynx Adenoids ENT Lectures
18/33
Nasopharygoscopy
7/29/2019 Throat Pharynx Adenoids ENT Lectures
19/33
Nasopharygoscopy
7/29/2019 Throat Pharynx Adenoids ENT Lectures
20/33
X-Ray soft tissue nasopharynx-
lateral view
7/29/2019 Throat Pharynx Adenoids ENT Lectures
21/33
X-Ray soft tissue nasopharynx-
lateral view
7/29/2019 Throat Pharynx Adenoids ENT Lectures
22/33
CT Scan
7/29/2019 Throat Pharynx Adenoids ENT Lectures
23/33
Adenoidectomy-Indications
Four or more episodes of recurrentpurulent rhinorrhea in prior 12 monthsin a child
7/29/2019 Throat Pharynx Adenoids ENT Lectures
24/33
Adenoidectomy-IndicationsOtitis media with effusion >3 months or
second set of tubes
Dental malocclusion or orofacial growthdisturbance documented by
orthodontist.Cardiopulmonary complications
including cor pulmonale, pulmonaryhypertension, right ventricular
hypertrophy associated with upperairway obstruction.
Otitis media with effusion over age 4.
7/29/2019 Throat Pharynx Adenoids ENT Lectures
25/33
ContraindicationsA submucous cleft palate which may lead to
velopharyngeal insufficiency after surgery. Ifthe adenoid obstruction is severe enough,then only superior half adenoidectomy isperformed.
Avoid surgery in patients with hemoglobin lessthan 10.
Perform surgery at least 2 weeks after the last
attack of acute tonsillitis.Wait at least 6 weeks after polio vaccination.
Avoid surgery in patients with uncontrolledsystemic diseases (ie. leukemia).
7/29/2019 Throat Pharynx Adenoids ENT Lectures
26/33
Jennings's Mouth Gag
7/29/2019 Throat Pharynx Adenoids ENT Lectures
27/33
St. Claire Thomson Adenoid
Curette
7/29/2019 Throat Pharynx Adenoids ENT Lectures
28/33
Position for Adenoidectomy
7/29/2019 Throat Pharynx Adenoids ENT Lectures
29/33
Adenoidectomy
7/29/2019 Throat Pharynx Adenoids ENT Lectures
30/33
Adenoidectomy Specimen
7/29/2019 Throat Pharynx Adenoids ENT Lectures
31/33
Complications
The incidence of mortality fromadenotonsillar surgery ranges from 1 in16,000 to 1 in 35,000 cases.
Anesthetic complications and hemorrhage
cause the majority of deaths.
The prevalence of hemorrhage ranges from
0.1% to 8.1%.
It is divided into primary bleeding, in the first24 hours, and secondary bleeding, around7-10 days post operatively.
7/29/2019 Throat Pharynx Adenoids ENT Lectures
32/33
Other risks include:
Vomiting
Dehydration
Airway obstruction due to edema
Pulmonary edema Fever, velopharyngeal insufficiency
Dental injury
Burns Nasopharyngeal stenosis.
7/29/2019 Throat Pharynx Adenoids ENT Lectures
33/33
Atlantoaxial subluxation can occur in
patients with Down syndrome.Atlantoaxial joint laxity because of Grisels
syndrome. This is vertebral bodydecalcification and laxity of the anteriortransverse ligament between the atlas andthe axis from inflammation or infection in thenasopharynx.
Spontaneous subluxation occurs about 1week post operatively with pain andtorticollis.
Top Related