Tonsillectomy, and Adenoidectomy

Tonsillectomy, and Adenoidectomy
By:Babak Saedi
Assistant professor of Tehran university


Introduction
History
Anatomy
Tonsils
* Plica triangularis
* Gerlach’s tonsil
Adenoids
* Fossa of Rosenmüller
* Passavant’s ridge
Blood Supply
Tonsils
* Ascending and descending palatine arteries
* Tonsillar artery
* 1% aberrant ICA just deep to superior constrictor

Adenoids
* Ascending pharyngeal, sphenopalatine arteries
Histology
Tonsils
* Specialized squamous
* Extrafollicular
* Mantle zone
* Germinal center
Adenoids
* Ciliated pseudostratified columnar
* Stratified squamous
* Transitional
Common Diseases of the Tonsils and Adenoids
* Acute adenoiditis/tonsillitis
* Recurrent/chronic adenoiditis/tonsillitis
* Obstructive hyperplasia
* Malignancy
Acute Adenotonsillitis
Etiology
GABHS most important pathogen because of potential sequelae
* Throat culture
* Treatment
Microbiology of Adenotonsillitis
* Streptococcus pyogenes (Group A beta-hemolytic streptococcus)
* H.influenza
* S. aureus
* Streptococcus pneumoniae
Tonsil weight is directly proportional to bacterial load.
Acute Adenotonsillitis
Differential diagnosis
Infectious mononucleosis
Malignancy: lymphoma, leukemia, carcinoma
Diptheria
Scarlet fever
Agranulocytosis
Medical Management
Obstructive Hyperplasia
Unilateral Tonsillar Enlargement
Apparent enlargement vs true enlargement
Non-neoplastic:
* Acute infective
* Chronic infective
* Hypertrophy
* Congenital
Neoplastic
Peritonsillar Abscess
ICA Aneurysm
Pleomorphic Adenoma
Other Tonsillar Pathology
* Hyperkeratosis, mycosis leptothrica
* Tonsilloliths
Candidiasis
Syphilis
Retention Cysts
Supratonsillar Cleft
Indications for Tonsillectomy
AAO-HNS:
Indications for Adenoidectomy
Obstruction:
* Chronic nasal obstruction or obligate mouth breathing
* OSA with FTT, cor pulmonale
* Dysphagia
* Speech problems
* Severe orofacial/dental abnormalities
Infection:
* Recurrent/chronic adenoiditis (3 or more episodes/year)
* Recurrent/chronic OME (+/- previous BMT)
PreOp Evaluation of Adenoid Disease

* Triad of hyponasality, snoring, and mouth breathing
* Rhinorrhea, nocturnal cough, post nasal drip
* “Adenoid facies”
* “Milkman” & “Micky Mouse”
* Overbite, long face, crowded incisors
PreOp Evaluation of Adenoid Disease
Differential diagnoses
* Allergic rhinitis
* Sinusitis
* GERD
* For concomitant sinus disease, treat adenoids first
Evaluate palate
* Symptoms/FH of CP or VPI
* Midline diastasis of muscles, bifid uvula
* CNS or neuromuscular disease
* Preexisting speech disorder?
TONSIL SIZE
Avoid gagging the patient
Complications
#1 Postoperative bleeding
Other:
* Sore throat, otalgia, uvular swelling
* Respiratory compromise
* Dehydration
* Burns and iatrogenic trauma
Rare Complications
* Velopharyngeal Insufficiency
* Nasopharyngeal stenosis
* Atlantoaxial subluxation/ Grisel’s syndrome
* Regrowth
* Eustachian tube injury
* Depression
* Laceration of ICA/ pseudoaneursym of ICA

Tonsillectomy, and Adenoidectomy.ppt