1. Adenoids
Dr. Priyanjal Gautam
PG-3rd Yr. (MS-ENT)
NIMS, Jaipur

2. • 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-
14 yrs)

4. FEATURES :
• Pink, globular mass
• Vertical ridges on its surface
• No crypts
• Lined by ciliated columnar epithelium
• No capsule

5. BLOOD SUPPLY :
• Ascending palatine branch of facial
artery
• Ascending pharyngeal artery
• Pharyngeal branch of 3rd part of
maxillary artery

6. LYMPHATIC DRAINAGE :
• Upper deep jugular nodes
• Retropharyngeal nodes
• Parapharyngeal nodes

7. X-Ray Nasopharynx  enlarged
adenoids

8. ETIOLOGY :
• Hereditary
• Cold climate
• Specific infection like tuberculosis
• Physiological hypertrophy may be seen
between 3-10 yrs

9. SYMPTOMS :
LOCAL
• B/L nasal obstruction
• Snoring
• Mouth breathing
• Rhinolalia clausa
• Frequent rhinorrhoea
• Epistaxis
• Feeding problems in
children
• Conductive deafness due to
ET block
• Cervical lymphadenopathy
• Otitis media
• Adenoids facies
• Bronchitis
GENERAL
• Anorexia
• Lethargy
• Poor physical & mental
development
• Bed-wetting
• Pigeon chest
• Protuberent abdomen

10. Adenoids Facies
• Sunken eyes
• Narrow pinched nostrils
• Open mouth
• High-arched palate
• Crowded teeth
• Dull mask-like face
• Protruding teeth
• Drooling saliva
• Everted upper lip
• Rhinorrhoea
• Loss of nasolabial fold

11. Aural manifestations in Adenoids
• Otalgia
• Secretory otitis media
• Acute otitis media
• Atelectasis of TM
• ET block
• Chonic otitis media

12. Diagnosis :
• H/O nasal obstruction, rhinorrhoea
• Pink globular mass with vertical ridges
on post. rhinoscopy
• B/L retracted ear drums
• X-ray nasopharynx Lat. View shows
soft tissue mass

13. Differential diagnosis:
• Thornwaldt’s cyst
• High arched palate

14. Complications:
• Adenoid facies
• Otitis media with effusion
• Recurrent acute otitis media
• Rhinolalia clausa
• Chronic sinusitis
• Sleep apnea syndrome
• Decreased mental/physical development

15. Treatment :
MEDICAL
• Adequate nutrition
• Antibiotics
• Anti inflammatory
analgesics
• Nasal decongestant
drops
SURGICAL
• Adenoidectomy
• Myringotomy with
grommet insertion

16. Adenoidectomy

17. Indications :
1. Adenoid hypertrophy causing snoring,
mouth breathing, sleep apnoea
syndrome or speech abnormalities, i.e.
(rhinolalia clausa).
2. Recurrent rhinosinusitis.
3. Chronic secretory otitis media
associated with adenoid hyperplasia.

18. 4. Recurrent ear discharge in benign
CSOM associated with
adenoiditis/adenoid hyperplasia.
5. Dental malocclusion. Adenoidectomy
does not correct dental abnormalities
but will prevent its recurrence after
orthodontic treatment.

19. Contraindications :
1. Cleft palate
2. Haemorrhagic diathesis.
3. Acute URTI

20. Anaesthesia :
• Always general, with oral endotracheal
intubation.

21. Neck is extended by a sand bag under the shoulders and the
head is supported on a ring.
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© 2005 Elsevier
Rose's position

22. 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
midline.

23. 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.

24. Adenoid curette
With guard Without guard

25. 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.

26. Adenoidectomy.

27. Endoscopic Adenoidectomy
• These days adenoids can be removed
more precisely by using a debrider
under endoscopic control

28. Nasal endoscopic adenoidectomy
using curette

29. Oral endoscopic adenoidectomy
using curette

30. Micro debrider
Micro debrider Micro debrider-tip blade

31. Microdebrider adenoidectomy

32. Mirror assisted microdebrider
adenoidectomy

33. Coblation adenoidectomy
• 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.

34. Coblation adenoidectomy

35. 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.

36. Post-operative Care cont..
2. Diet
When patient is fully recovered he/she is to
take liquids, e.g. cold milk or ice cream.
3. Nasal saline drops

37. 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
weeks.

38. Complications :
1. Haemorrhage
2. Injury to eustachian tube opening
3. Injury to pharyngeal musculature and
vertebrae
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.

39. 5. Nasopharyngeal stenosis
6. Recurrence

40. Thank You…