Under normal physiological conditions, the adenoids develop to the maximum at the age of 6 to 7 years, and gradually atrophy s after the age of 10 years, and basically disappear when they become adults, if the adenoids are hyperplastic and cause corresponding symptoms, they are called adenoid hypertrophy; the disease occurs mostly in children aged 3 to 5 years, and is rare in adults. The pathological hyperplasia of the adenoids occurs due to the repeated stimulation of inflammation in the nasopharynx and adjacent areas or in the adenoids themselves.
Clinical manifestations
I. Local symptoms
1. Nasal symptoms: often complicated by rhinitis and sinusitis, with symptoms such as nasal congestion and runny nose. When speaking, there is an occlusive nasal sound and snoring sound when sleeping.
2. Ear symptoms: stuffy and swollen ears, hearing loss, tinnitus.
3. Pharynx, larynx and lower respiratory tract symptoms: often cause paroxysmal cough and easily complicate bronchitis.
4. Severe cases have adenoidal appearance: long-term open-mouth breathing affects bone development, elongated maxilla, high arched palate, uneven teeth, poor bite, prominent upper incisors, thick lips, drooping jaw, and indifferent expression.
Second, systemic symptoms
1.Neuropsychiatric symptoms: sleep with many nightmares, shrieking, teeth grinding, enuresis, wheezing spasms or asthma.
2. Chronic toxicity symptoms: malnutrition, unresponsiveness, inattentiveness.
Diagnostic points
1, Adenoid face, high and narrow hard palate.
2.Nasopharyngeal examination reveals a red mass-like elevation of the posterior wall of the nasopharyngeal apex, and soft lymphoid tissue masses are palpated in the nasopharynx.
3. Lateral nasopharyngeal X-ray or CT scan can help in diagnosis.
Treatment plan and principles
1.For those who have clinical symptoms of adenoid hypertrophy, adenoidectomy should be performed as early as possible.
2.It can be removed at the same time of tonsil surgery or separately.
3.In recent years, many hospitals in China have achieved satisfactory results in removing adenoids with a suction cutter under direct nasal endoscopy.
Clinical specifications for adenoidectomy
Indications
1.Adenoid hypertrophy causes open mouth breathing, snoring 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 face” and have wasting and developmental disorders.
4.Adenoid hypertrophy with recurrent inflammation of nasal cavity and sinus or frequent upper respiratory tract infection.
Contraindications
Same as tonsillectomy. Those with cleft palate are also contraindicated because of the possibility of open nasal voice after surgery.
Operation method
General anesthesia is commonly used for the procedure. Routinely use a pillow under the shoulder in the supine head-up position. A suction device is prepared.
Suction cutter adenoidectomy method.
After general anesthesia, the oral cavity is exposed with an opener, then the soft palate is pulled up bilaterally with a thin catheter or a thin flexible tube, and the nasopharynx is viewed directly through the oral cavity with a 70-degree endoscope, and the hypertrophied adenoids are removed through the oral cavity 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 no significant bleeding from the trauma.
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 bulge and the pharyngeal mucosa.
2. Pay attention to the gentle operation when placing the catheter to protect the nasal mucosa.
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, they need to be removed at the same time to avoid reactive tonsillar hyperplasia and dyspnea after adenoids removal.