Adenoidectomy or Surgery of Adenoid Tissue is a surgical removal of adenoid tissue. It may indicated alone or in combination with tonsillectomy. ln the latter event, adenoids are removed first and the nasophaynx packed before doing tonsillectomy.
The adenoids are enlarged lymphoid tissue, present in the nasopharynx at the junction of its roof and posterior wall. This is composed of vertical ridges of lymphoid tissues, separated by deep cleft and covered by ciliated columnar epithelium. lt is present at birth, show physiological enlargement and tends to atrophy at puberty. When became hypertrophied, sufficient to produce symptoms and occurs most commonly between the ages of three to seven years.
Pathology of adenoid enlargment and inflammation
Inflammatory changes occur in assertion with rhinitis and tonsillitis. Recurrent attacks of rhinitis, sinusitis or tonsillitis may cause chronic adenoid infection leading to its hypertrophy. Allergy of the upper respiratory tract may also contribute to the enlargement of adenoids. the symptoms of adenoids enlargement are produced due to respiratory obstruction and blockage of Eustachian tube.
The indications of adenoidectomy are adenoid hypertrophy causing snoring, mouth breathing, sleep apnoea syndrome or speech abnormalities i.e. (rhinolia clausa), Chronic secretory otitis media associated with adenoid hyperplasia, Recurrent rhinosinusitis, In dental malocclusion but adenoidectomy does not correct dental abnormalities but will prevent its recurrence after orthodontic treatment. Recurrent ear discharge in chronic secretory otitis media associated with adenoiditis or hyperplasia,
Always done with general Anesthesia, with endotracheal intubations.
Rose Position, i.e, patient lies supine with head extended by placing a pillow under the shoulder. A rubber ring is placed under the head to stabilize it. Hyperextension should be prevented.
Steps of Surgical Procedure
- Boyle Davis mouth gag is first inserted. But 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, ti assess the size of adenoids mass and to push the lateral adenoid masses towards the midline.
- 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 adenoid. At this level, head should be slightly flexed to avoid injury to the odontoid process.
- With gentle sweeping movements, adenoids are shaved off and lateral masses are similarly removed with smaller curettes, small tags of lymphoid tissue which is left behind. are removed with punch forceps.
- Haemostasis is achieved by packing the area for few hours. Persistent bleeders are electrocoagulated. lf bleeding is not controlled. then post nasal packing is done for 24 hours.
These days adenoids can be removed more precisely by using derider under endoscopic control.