The pathological hyperplasia of adenoids due to repeated inflammatory stimulation and the corresponding symptoms are called adenoid hypertrophy.
I. Clinical manifestations
(A) local symptoms.
1, nasal symptoms: often complicated by rhinitis, sinusitis, nasal congestion and runny nose and other symptoms. When speaking, there is an occlusive nasal sound and snoring sound when sleeping.
2, ear symptoms: ear stuffiness and swelling, hearing loss, tinnitus.
3. Pharynx, larynx and lower inspiratory tract symptoms: often cause paroxysmal cough and easily complicate bronchitis.
4.Severe cases have adenoidal appearance: long-term open mouth whistling, affecting bone development, long maxilla, high arch of palate, uneven teeth, poor bite, protruding upper incisors, thick lips, drooping jaw, indifferent expression.
(B) Systemic symptoms: mainly chronic toxicity, nutritional developmental disorders and reflex neurological symptoms. The child has poor general development and nutritional status, as well as dreamy sleep, waking up easily, teeth grinding, slow reaction, inattention and irritable temperament.
Second, examination
1, adenoid face.
Due to long-term open mouth whistling, resulting in jaw and facial skeletal dysplasia, the maxilla becomes longer, the palate is high arched, the teeth are not aligned, the upper incisors protrude, thick lips, lack of expression, the so-called “adenoid face”.
2.Oropharyngeal examination: It can be seen that there are secretions from the nasopharynx attached to the posterior wall of the oropharynx, often accompanied by palatal tonsillar hypertrophy.
3, anterior nasal microscopy After the nasal mucosa is fully converged, a red mass elevation in the nasopharynx is seen in some children.
4.Indirect nasopharyngoscopy or fiber/electron nasopharyngoscopy: red mass-like elevation of the posterior wall of the nasopharyngeal apex can be seen, and the surface is mostly orange flap-like with longitudinal grooves. Electronic nasopharyngoscopy has a clear image, and the obstruction of the posterior nostril and the compression of the pharyngeal orifice of the eustachian tube can be observed (Figure 1). At present, fiberoptic nasopharyngoscopy is generally used, and it can be examined regardless of age.
5.Nasopharyngeal palpation: palpation of the nasopharynx with the finger can palpate a soft mass at the posterior wall of the nasopharynx.
6. X-ray lateral nasopharyngeal film can show the thickening of soft tissue in the nasopharynx.
3. Diagnostic points
1.Adenoids face, high and narrow hard palate.
2. Fiberoptic nasopharyngoscopy shows a red mass elevation in the posterior wall of the nasopharyngeal apex, soft lymphatic tissue masses are palpated in the nasopharynx, and palpation
It is rarely used at present, and may be used in the absence of fiberoptic nasopharyngoscopy at the primary level.
3. Lateral nasopharyngeal X-ray or CT scan can help in diagnosis.
IV. Indications for surgery
1.Adenoid hypertrophy causes open mouth whistling, snoring, breath-holding or occlusive nasal sound.
2.Adenoid hypertrophy can block the pharyngeal orifice of the eustachian tube and cause secretory otitis media and hearing loss or cause recurrent purulent otitis media that cannot be cured.
3. Those who have formed “adenoid facies” and have wasting and developmental disorders.
4.Adenoid hypertrophy with recurrent inflammation of the nasal cavity and sinuses or frequent infection of the upper whistle tract.
V. Contraindications to surgery
Same as tonsillectomy. Those who have cleft palate may have open nasal voice after surgery, so they are also among the contraindications.
Operation methods and procedures
General anesthesia is commonly used. Routinely use the supine head position with a pillow under the shoulder. Prepare the suction device.
Suction cutter adenoidectomy method.
After general anesthesia, the mouth is exposed with an opener, then the soft palate is pulled up bilaterally with a fine catheter or a fine flexible tube, and the nasopharynx is viewed directly through the mouth with a 70-degree endoscope, and the hypertrophied adenoids are removed through the mouth with a curved suction cutter head. The bleeding is then stopped by compression with gauze or cotton balls. The bleeding point can be coagulated with bipolar electrocoagulation or high-frequency electric knife. Observe for 5 minutes and end the procedure after there is no obvious bleeding on the trauma.
VII. Precautions
1. When using the suction cutter, always pay attention to the opening of the suction cutter tip to prevent excessive proximity to important structures so as not to damage the cervical spinal muscular membrane, the eustachian tube
Do not step on the suction cutter during the process of entering and taking out the oral cavity, so as not to accidentally injure the normal tissues of the oral cavity.
2. Pay attention to the gentle operation when placing the catheter to protect the nasal mucosa from cutting injuries.
3.The adenoids at the posterior nostril should be removed thoroughly to avoid affecting the postoperative effect, and attention should be paid to stop bleeding thoroughly to reduce the chance of secondary bleeding after surgery.
4, if combined with tonsillar hypertrophy or chronic tonsillitis, need to be removed at the same time, so as to avoid reactive hyperplasia of the tonsils after adenoids removal, resulting in poor inspiration.
5. Be gentle when using the opener to avoid damaging the teeth and oral mucosa.
Do not accidentally injure the mucosa around the eustachian tube and the round pillow of the eustachian tube, and do not cut too deeply into the adenoids near the posterior pharyngeal wall, otherwise they will bleed easily.