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    Throat Pharynx Adenoids ENT Lectures

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    Raju Gangadharan
    The document discusses the anatomy, development, function, diagnosis, and treatment of the adenoids. The adenoids develop in the nasopharynx during fetal development and are part of Waldeyer's ring. They help produce IgA for local immune protection against pathogens. Symptoms of adenoid hypertrophy include nasal obstruction, mouth breathing, and sleep disturbances. Adenoidectomy is recommended for recurrent infections or sleep disturbances. Risks of surgery include bleeding and airway complications.

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    Throat Pharynx Adenoids ENT Lectures

    Uploaded by

    Raju Gangadharan
    104 views33 pages
    The document discusses the anatomy, development, function, diagnosis, and treatment of the adenoids. The adenoids develop in the nasopharynx during fetal development and are part of Waldeyer's ring. They help produce IgA for local immune protection against pathogens. Symptoms of adenoid hypertrophy include nasal obstruction, mouth breathing, and sleep disturbances. Adenoidectomy is recommended for recurrent infections or sleep disturbances. Risks of surgery include bleeding and airway complications.

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    The document discusses the anatomy, development, function, diagnosis, and treatment of the adenoids. The adenoids develop in the nasopharynx during fetal development and are part of Waldeyer's ring. They help produce IgA for local immune protection against pathogens. Symptoms of adenoid hypertrophy include nasal obstruction, mouth breathing, and sleep disturbances. Adenoidectomy is recommended for recurrent infections or sleep disturbances. Risks of surgery include bleeding and airway complications.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    104 views33 pages

    Throat Pharynx Adenoids ENT Lectures

    Uploaded by

    Raju Gangadharan
    The document discusses the anatomy, development, function, diagnosis, and treatment of the adenoids. The adenoids develop in the nasopharynx during fetal development and are part of Waldeyer's ring. They help produce IgA for local immune protection against pathogens. Symptoms of adenoid hypertrophy include nasal obstruction, mouth breathing, and sleep disturbances. Adenoidectomy is recommended for recurrent infections or sleep disturbances. Risks of surgery include bleeding and airway complications.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    of 33

    ADENOIDS

    Disclaimer: The pictures used in this presentation have been obtained from a number of sources. Their use is purely for academic and teaching purposes. The contents of this presentation do not have any intended commercial use. In case the owner of any of the pictures has any objection and seeks their removal please contact at [email protected]. The se pictures will be removed immediately.

    Embryology
    The

    formation of the adenoids begins in the 3rd month of fetal development. This starts with glandular primordia in the posterior nasopharynx becoming associated with infiltrating lymphocytes. In the 5th month sagittal folds are formed which are the beginnings of pharyngeal crypts. The surface is covered with pseudostratified ciliated epithelium. By the 7th month of development the adenoids are fully formed.

    Anatomy
    The

    lymphoid tissue of the nasopharynx and oropharynx is composed of the adenoids, the tubal tonsils, the lateral bands, the palatine tonsils, and the lingual tonsils. There are also lymphoid collections in the posterior pharyngeal wall and in the laryngeal ventricles. These structures form a ring of tissue named Waldeyers ring after the German anatomist who described them.

    The adenoids or pharyngeal tonsil


    It

    is a single mass of pyramidal tissue with its base on the posterior nasopharyngeal wall and its apex pointed toward the nasal septum. The surface is invaginated in a series of folds. The epithelium is pseudostratified ciliated epithelium and is infiltrated by the lymphoid follicles.

    Blood supply is from the: Ascending palatine branch of the facial artery
    Pharyngeal

    branch of the internal maxillary artery Artery of the pterygoid canal Ascending cervical branch of the thyrocervical trunk.

    Venous

    drainage is through the pharyngeal plexus and the pterygoid plexus flowing ultimately into the facial and internal jugular veins. Innervation is derived from the glossopharyngeal and vagus nerves. Efferent lymphatics drain to the retropharyngeal nodes and the upper deep cervical nodes.

    Function and Immunology


    The

    tonsils and adenoids are part of the secondary immune system. Without afferent lymphatics the lymphoid nodules in these structures are exposed to antigen only in the crypts of the palatine tonsils and the folds of the adenoids where it is transported through the epithelial layer. These are involved in the production of mostly secretory IgA, which is transported to the surface providing local immune protection.

    Acute

    adenoiditis symptoms include purulent rhinorrhea, nasal obstruction, fever, and sometimes otitis media. This can be difficult to differentiate from an acute upper respiratory infection but tends to have a longer and more severe course.

    Acute

    adenoiditis symptoms include purulent rhinorrhea, nasal obstruction, fever, and sometimes otitis media. This can be difficult to differentiate from an acute upper respiratory infection but tends to have a longer and more severe course.

    Recurrent

    acute adenoiditis is 4 or more episodes of acute adenoiditis in a 6-month period with intervening periods of wellness. Chronic adenoiditis symptoms include persistent rhinorrhea, postnasal drip, malodorous breath, and associated otitis media or extra esophageal reflux lasting at least 3 months.

    Obstructive

    adenoid hyperplasia includes symptoms of chronic nasal obstruction, rhinorrhea, snoring, mouth breathing, and a hyponasal voice. Obstructive sleep apnea in children is clinically marked by loud snoring, apneic episodes while sleeping, daytime somnolence, behavioral problems, and enuresis

    It

    is the long, open-mouthed, face of children with adenoid hypertrophy. The mouth is always open because upper airway congestion has made patients obligatory mouth breathers. The most common presenting symptoms are chronic mouth breathing and snoring. The most dangerous symptom is sleep apnea

    Adenoid facies or long face syndrome.

    The characteristic facial appearance consists of: Underdeveloped thin nostrils Short upper lip Prominent upper teeth Crowded teeth Narrow upper alveolus

    High-arched

    palate Hypoplastic maxilla Eustachian blockage causing glue eardeafness The deafness and inattentiveness interferes with the learning Child grows with lowered intelligence and understanding

    Diagnosis

    Posterior Rhinoscopy

    Nasopharygoscopy

    Nasopharygoscopy

    Nasopharygoscopy

    X-Ray soft tissue nasopharynxlateral view

    X-Ray soft tissue nasopharynxlateral view

    CT Scan

    Adenoidectomy-Indications
    Four

    or more episodes of recurrent purulent rhinorrhea in prior 12 months in a child <12. One episode documented by intranasal examination or diagnostic imaging. Persisting symptoms of adenoiditis after 2 courses of antibiotic therapy. Sleep disturbance with nasal airway obstruction persisting for at least 3 months. Hyponasal or nasal speech

    Otitis

    media with effusion >3 months or second set of tubes Dental malocclusion or orofacial growth disturbance documented by orthodontist. Cardiopulmonary complications including cor pulmonale, pulmonary hypertension, right ventricular hypertrophy associated with upper airway obstruction. Otitis media with effusion over age 4.

    Adenoidectomy-Indications

    Contraindications
    A

    submucous cleft palate which may lead to velopharyngeal insufficiency after surgery. If the adenoid obstruction is severe enough, then only superior half adenoidectomy is performed. Avoid surgery in patients with hemoglobin less than 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 uncontrolled systemic diseases (ie. leukemia).

    Jennings's Mouth Gag

    St. Claire Thomson Adenoid Curette

    Position for Adenoidectomy

    Adenoidectomy

    Adenoidectomy Specimen

    Complications
    The

    incidence of mortality from adenotonsillar surgery ranges from 1 in 16,000 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 first 24 hours, and secondary bleeding, around 7-10 days post operatively.

    Other

    risks include:

    Vomiting Dehydration Airway obstruction due to edema Pulmonary edema Fever, velopharyngeal insufficiency Dental injury Burns Nasopharyngeal stenosis.

    Atlantoaxial

    subluxation can occur in patients with Down syndrome. Atlantoaxial joint laxity because of Grisels syndrome. This is vertebral body decalcification and laxity of the anterior transverse ligament between the atlas and the axis from inflammation or infection in the nasopharynx. Spontaneous subluxation occurs about 1 week post operatively with pain and torticollis.

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