In order for the body to fight germs, there are tissues called lymphoid tissue behind the mouth and nose. The one behind the nose (nasal) is called tonsilla pharyngea (adenoid), the one on both sides of the throat is called tonsilla palatina (tonsil), the one at the root 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 at the mouth and nose entrance. 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 regress to the size of an adult at the age of 11.
Especially in frequent infections and allergies, these tissues do not grow and shrink more than normal. If these tissues, which are normally protective for the body, cannot do their job or become a source of infection, it is recommended to be surgically removed.
Adenoid (tonsilla pharyngea); It is recommended to be taken if it is large enough to cause constant (longer than 3 months) nasal congestion and sleeping with an open mouth and does not shrink, if it causes frequent sinusitis or otitis media, fluid accumulation in the middle ear. Sometimes, even if the tonsils and adenoids are not inflamed at all, if they are very enlarged and cause sleep apnea (intermittent breathing pauses during sleep), it should be taken again. Children with tonsil and adenoid problems are generally poor in appetite and growth-development is slower than their peers. The age of surgery is generally 3 years and above. However, if it causes sleep apnea, it is operated at a much earlier age. Because 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 nasal meats are on the side walls of the nasal entrance. Adenoid size is more common in the nursery and kindergarten period (between 3-5 years of age). Frequent infections and the presence of allergies are the most important factors in the growth of adenoid. Therefore, early treatment of upper respiratory tract infections and controlling allergies can prevent overgrowth of adenoids.
In Which Situations Is Adenoid Surgery (Adenoidectomy) Performed?
– The adenoids are large enough to cause chronic nasal congestion; Sleeping with your mouth open all the time can sometimes cause snoring, sleep apnea, swallowing problems and speech disorders, and disorders in 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 a constantly stuffy nose and mouth breathing. In this face view; The middle part of the face is flattened, the mouth is constantly open, the upper jaw protrudes forward, the palate becomes domed and narrow. Closure problems and frequent caries develop in the teeth. Sometimes patients apply to orthodontics first. There is a constant drooling appearance from the mouth. Their sleep quality is low, they are constantly turning in bed, they 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 otitis media (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
What are the Contraindications of Adenoid Surgery (Adenoidectomy)?
– 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 without correcting these conditions.
– In cases of cleft palate, velopharyngeal insufficiency, muscle hypotonia due to neurological diseases, not all of the adenoid is 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 any obstacle to the operation. The surgery itself takes about 10-15 minutes. The total time for the patient to sleep and wake up is approximately 45 minutes. Different instruments or methods can be used in surgery. These; It can be counted as Adenotome, Curette, Electrocautery, Microdebrider, Laser. Classically, the adenoid is scraped (curette).
Process and Nutrition After Adenoid Surgery (Adenoidectomy)
After 4-5 hours of follow-up after the surgery, the patient is checked and usually discharged. However; Patients who are thought to be at risk of bleeding are hospitalized for 1 night. After the surgery, a diet is applied starting from cold and soft foods and switching to warm and solid foods. It is not necessary to follow 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.
What are the Complications of the Surgery?
– Bleeding: It is seen at a rate of 0.5% after Adenoidectomy operations. Most of them are seen in the first 24 hours. Re-operation may be required for bleeding that cannot be stopped with local interventions.
– Velopharyngeal insufficiency: 0.03% to 0.06% can be seen. It is 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 an 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 seen up to 5-6 years of age, especially in children with allergies