The tonsils are lymphoid tissues located behind the mouth and nose and helping to fight infections.The one behind the nose (nasal) is called tonsilla pharyngeal (adenoid), the one on both sides of the throat is called palatine tonsil (tonsil), the one at the base of the tongue is called tonsilla lingualis, and the one around the eustachian tube is called tonsilla tubarius. Apart from these, there are also many small lymphoid tissues in the mouth and throat. These lymphoid tissues meet the viruses and bacteria entering the body from mouth and nose. Over time, they recognize them and produce antibodies against them, allowing our immune system to develop. Especially the tonsils and adenoids grow gradually until the age of 5-6, then, begin to shrink and regress to the size of an adult at the age of 11.
Especially in frequent infections and allergies, lymphoid tissues grow more than normal and does not decrease. If these tissues, which are normally protective for the body, cannot do their job or become a source of infection, they are recommended to be surgically removed.
Adenoid (tonsilla pharyngeal). It is recommended to be removed if it is large enough to cause constant (longer than 3 months) nasal congestion and sleeping with an open mouth, if it does not shrink, causes frequent sinusitis or otitis media and fluid accumulation in the middle ear. Sometimes, even if the tonsils and adenoids are not inflamed at all, they may increase in size and cause sleep apnea (intermittent breathing pauses during sleep). In this case they also should be removed. Children with tonsil and adenoid problems generally have a poor appetite and their growth and development are slower than their peers. The age for surgery is generally 3 years and above. However, if it causes sleep apnea, the operation can be performed at a much earlier age, cause the risks of sleep apnea are higher than the risks of surgery. Removal of tonsils and adenoids that cannot do their job does not cause a deficiency in the immune system. In order to make the decision for surgery, the history of the disease and the examination are as important as the process.
Adenoids and conchae are different structures and are often confused. While the adenoids are located at the back of the nose and in the midline (nasal region), the conchae are on the sidewalls of the nasal entrance. Increased adenoid size is more common in the nursery and kindergarten periods (between 3-5 years of age).Frequent infections and the presence of allergies are the most important factors in the growth of adenoids. Therefore, early treatment of upper respiratory tract infections and controlling allergies can prevent the overgrowth of adenoids.
When Does Adenoid Surgery (Adenoidectomy) Need To Be Performed?
• If the adenoid is large enough to cause chronic nasal congestion; this leads to sleeping with an open mouth all the time and snoring, sleep apnea, swallowing problems, speech disorders, and disorders in the jaw, teeth, and facial development. Long-term complete nasal obstruction may cause growth-developmental retardation, heart-lung disease (cor pulmonale). The appearance of the so-called "adenoid face" occurs in children with constantly stuffy nose and mouth breathing. In this face type, the middle part of the face is flattened, the mouth is constantly open, the upper jaw protrudes forward, the palate becomes domed and narrow. In this situation closure problems and frequent dental caries develop in the teeth. Sometimes patients consult orthodontics first. There is a constant drooling appearance from the mouth. Their sleep quality is low, they are constantly turning in bed, try to breathe more easily by throwing their heads back.
• Growth-development retardation. It develops due to irregularities in the release of growth hormone during sleep, along with both loss of appetite and deterioration in sleep quality. Rarely, these children may be overweight due to insulin resistance.
• Chronic or recurrent Adenoiditis
• Chronic or recurrent Sinusitis
• Chronic or recurrent middle ear infection (otitis media) or fluid accumulation in the middle ear (otitis with effusion). Repeated 3-4 times a year or more.
• Chronic or recurrent lower respiratory tract infection
• Asthma and respiratory allergies that are difficult to control with drug treatments
IN WHICH SITUATIONS ADENOIDECTOMY CANNOT BE PERFORMED? (CONTRAINDICATIONS OF THE SURGERY)?
•Bleeding diathesis (blood clotting disorders)
• Uncontrollable chronic diseases (such as diabetes, high blood pressure) and risks in terms of anesthesia
• Active infection period
Adenoid surgery cannot be performed before taking these conditions under control.
In cases of cleft palate, velopharyngeal insufficiency, muscle hypotonia due to neurological diseases, the entire adenoid is not removed.
HOW IS ADENOID SURGERY (ADENOIDECTOMY) PERFORMED?
Adenoid Surgery (Adenoidectomy) is performed under general anesthesia. Before the operation, routine blood tests and the evaluation of the anesthesiologist are checked to see if there is an obstacle for the operation. The surgery itself takes about 10-15 minutes. The total time including sleep and wake up periods is approximately 45 minutes. Different instruments or methods such as Adenotome, Curette, Electrocautery, Microdebrider and Laser can be used in surgery. In the classical method the adenoid is scraped off (curette).
POSTOPERATIVE PROCESS AND NUTRITION AFTER ADENOIDECTOMY
After 4-5 hours of postoperative follow-up, the patient is checked and usually discharged. However; patients who are at risk of bleeding stay overnight in the hospital. After the surgery, the feeding starts with cold and soft foods and then is switched to warm and solid. It is not necessary to follow such a strict diet as after tonsil surgery.For children who go to school, 1 week of rest is recommended. It is recommended to spend the first 3-4 days at home.
COMPLICATIONS OF THE SURGERY
• Bleeding: Bleeding rate after Adenoidectomy is 0.5% and mostly observes in the first 24 hours. Re-operation may be required for bleeding that cannot be stopped with local interventions.
• Velopharyngeal insufficiency: observed in 0.03% to 0.06% of cases and mostly temporary. It gets better in 2-4 weeks. It is the escape of food into the nasal passages and nose as a result of the inability of the soft palate to fully close the throat during swallowing. Rarely, it can be permanent.
• Atlantoaxial subluxation
• Nasopharyngeal stenosis
• Eustachian tube damage
• Anesthesia-related complications.
DOES ADENOID RECURRENCE AFTER SURGERY?
Adenoid is not an encapsulated tissue like tonsils. It is adherent tissue in the nasal region in front of the neck vertebrae. Small pieces may be left behind in order not to damage the Eustachian tube and neck vertebrae during the surgery. Rarely, regrowth can be observed up to age of 5-6 , especially in children with allergies.