Adenoids are the hypertrophied lymphoid tissue of the nasopharynx.
They occur commonly in children, as a result of acute inflammations.
Possibly the suckling process of the child produces a partial vacuum of
the epipharynx and thus causes excessive blood supply to the part and
therefore excessive growth of these soft tissues.
Adenoids, however, are not confined to children but frequently occur in
adults. In all cases they are a source of much annoyance and often the
cause of acute and chronic disease.
=Symptoms and Diagnosis.=—Mouth breathing, head colds, partial
deafness, etc. are the common symptoms. The flattened nose, the high
arch of the hard palate and the stupid appearance of the face are
diagnostic. By direct palpation to the nasopharynx the nature and
extent of the adenoid mass can be determined and this is the best
method of diagnosis.
=Treatment.=—Many methods of non-surgical treatment have been employed,
but there is nothing as satisfactory as complete surgical removal.
Adenoid tissue has no known function different from that of other
lymphoid tissue and there is always sufficient to perform any necessary
function without excess of adenoid growth. The excessive adenoid
growth is in every case a detriment to normal development, because it
impairs nasal respiration and usually causes chronic nasopharyngitis
and thus reduces resistance against all diseases of childhood. There
is therefore, no excuse, much less a reason, why excessive adenoid
growths should not be removed surgically, provided it is properly and
thoroughly done.
The operation for removing adenoids requires in children, a general
anesthetic. In adults, a local anesthetic is used by some operators.
I have found it best to first break the adenoid mass away from the
side walls of the pharynx digitally. A LaForce or Gradle adenotome is
then used to remove the adenoid mass. If either of these instruments
is properly used it will always remove the greater part of the
adenoid mass without undue trauma or injury to any of the pharyngeal
structures. Curets should never be used because they almost never
remove the adenoid mass properly, but they usually do injure the
pharynx. Many cases of pharyngeal adhesions, Eustachian tube occlusion
and nasopharyngitis result from direct injury caused by curets.
After the adenoid mass has been removed the finger is inserted into the
pharynx and any adenoid growths in the posterior nares are removed.
The pharyngeal fossæ are also thoroughly freed from adenoid tissue and
adhesions and the orifices of the pharyngeal portions of the tubes are
gently dilated. This method insures complete removal of all excessive
adenoid tissue, and normal functions of the nasopharynx. Adenoids thus
removed do not return.
After the surgical work has been completed the nasopharyngeal tract
should be thoroughly irrigated with hot salt mixture solution.
This thoroughly cleanses the membranes, hastens healing, prevents
hemorrhage and avoids post-operative infection. Irrigation of the
nasopharynx should be continued for some days or until all evidences
of inflammation have ceased. The pharynx should then be examined to be
sure that no adhesions have developed from inflammation, but if the
operation is carefully done, complications will never result.