A very pronounced collection of lymphoepitelial tissue, Waldeyer’s ring, lies at the opening of the upper aerodigestive tracts. It is constituted of the pharyngeal tonsils (adenoids), palatine tonsils, lingual tonsils, tubal tonsils and tubopharyngeal plicae.
There is now no doubt about the immune specific function of the various lymphoepithelial organs in Waldeyer’s ring. The adenoid products Ig A that is important as first defense system that protects the body against invasion of microorganism and foreign molecules.
Adenoid hypertrophy is very common in children because of the rhythm of growth of the lymphatic tissue.
The disease is caused by above-average Hypertrophy of the lymphoepithelial tissue of the pharyngeal ring which is very immunobiologically active during childhood.
The main symptom of adenoid Hypertrophy is the nasal obstruction leading to mouth breathing, difficulty in feeding especially in small children, noisy respiration, snoring, typical adenoid facies (dull facial expression, open mouth, dilated and flattened nasolabial folds,”gothic” palate and protruding upper incisor teeth ).Some patients have sleeping apnea that is the stop of breathing during the sleeping time.
Obstruction of the nasopharynx may be responsible for:
-Aural diseases including obstruction of the Eustachian tube, chronic tubal and middle ear catarrh, serous effusion, recurrent acute otitis mediaThe symptoms of chronic mouth breathing, snoring and propensity to infection make the doctors think in adenoid Hypertrophy . Examination by posterior rhinoscopy shows the enlarged adenoid and lateral x- ray normally shows a bulge projection into the nasopharyngeal air passage.
It includes choanal atresia, foreign bodies in the nose, nasopharyngeal angiofibroma and malignant tumors of the nasopharynx
Conservative treatment by change of climate and drugs is not satisfactory in the majority of the cases.
Surgical treatment is by adenoidectomy. There are some different opinions about it among Otorrhynolaryngologist, Pediatrics and Allergists. Nowadays the adenoid is seen as a lymphatic tissue and the indication of surgery is very judicious.There is absolute indication of surgery in cases of severe obstructive of the airways causing Obstructive sleeping apnea syndrom (OSAS ) and cor pulmonale. Relative surgery indications are recurrent otitis media, recurrent sinusitis, oral and facial deformities.
The surgery is realized under general anesthesia and adenoid is removed with Beckman’s ring adenotome which separates the adenoid at its base. As the adenoid grows principally between 3-5 years, when possible we should postpone the surgery until this time .If it is done before this time there is possibility of growth of this lymphoid organ and necessity of another surgery.
1) ARMSTRONG P., WASTIE M.L. Diagnostic Imaging 3.ed. p 418,1992.
2) BECKER W., NAUMANN H.H, PFLALTZ C.R, Ear nose and Throat disease 2.ed. p 307,312,320-322, 1994.
3) HUNGRIA H, Otorrinolaringologia 6.ed. p 141-142,1991.
4) Manual de Otorrinolaringologia da Sociedade Brasileira de Pediatria ,p 60-62, 82.
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