X-Ray Adenoid-which view is better-Open Mouth or close mouth

Soft tissue x-ray of Adenoid in lateral position. Compare the view obtained with open mouth and close mouth.

I often see x ray of lateral view of adenoids taken with mouth open. Perhaps that is common belief with radiology technician that all x rays ordered by ENT Surgeon have to be taken with mouth open.

You yourself note that how misleading is the x ray with mouth open. What we are seeking from this x ray is that air passage between adenoid tissues and soft palate. If we keep mouth open, then that air column never forms. So such cases many undergo mistakenly for adenoidectomy.

I hope that my radiologist and ENT friends will spread this message to x ray technicians and correct the positioning of the child for such x rays.

How common are symptomatic adenoids causing otitis media witheffusionin adult patients. ?

This 39 year gentleman presented with recurrent right side otitis media with effusion. Nasal endoscopy showed a mass in Nasopharynx blocking right side Eustachian tube. A MRI was done which suggested it to be Adenoids.a biopsy was also done which showed it to be reactive hyperplasia of lymphoid tissue.  

Right side Grommet was put.  

 

Endoscopic powered adenoidectomy

This is one surgery in ENT where a blind person can do this surgery. Are you surprised?. I am not kidding. In fact, this surgery is still done blindly by many ENT Surgeons. Adenoid tissues, which are like tonsils but placed behind the nose, is not easily visible. In a child of 3-4 yrs of age, sometimes it is not possible to put typical 4 mm nasal telescopes through nose which is commonly available with ENT surgeons. So, surgeon feels the adenoid tissues through putting a finger through the mouth and with help of specially designed shavers, shaves them off without actually seeing them.

This is no more scene now specially with availability of angled microdebriders. This is wonderful to work like as you are working on a video game but here the real stake is a youngster kid and a little overconfidence may prove detrimental. you have to be very careful not to go too deep with Microdebrider unless it will chop off normal mucosa also.

A typical Microdebrider blade costs roughly around Rs. 6000 INR and most of the insurance company have not recognized this cost and the efforts involved in this endoscopic surgery precluding this as a viable option for many of ENT colleagues. Microdebrider itself costs around 400000/- INR. No wonder, this is not widely available.

Consent form for Adenoidectomy

CONSENT INFORMATION – PATIENT COPY

ADENOIDECTOMY

PLEASE READ THIS SHEET BEFORE YOU CONSENT FOR YOUR PROCEDURE

This information sheet provides general information to a person having an Adenoidectomy. It does not provide advice to the individual. It is important that the content is discussed between the patient and the concerned doctors who understand the level of fitness and medical condition.

Adenoids

What are Adenoids?

Adenoids are like tonsils but are present behind your nose and functions like tonsils. They help in fighting infections and sometimes gets enlarged in response to infection. They usually starts increasing by age of 2 and keep increasing up to 7 year of age and regressed thereafter.

If they are our fighters then how do they trouble us?

Yes, they are fighters but if they are unable to fight, they start increasing their size . This increase in size compromises the air passage behind the nose of the child, causing a difficulty in breathing especially while sleeping.

What are the symptoms of Adenoid enlargement?

Child may present with mouth breathing, snoring at night, ear pain, tiredness, malocclusion of teeth, recurrent chest infections, typical facial appearance in which nostril are visible from inside, depressed cheek and pursed like lips known as Adenoid facies.

Is Adenoid removal is bad for child’s Immunity?

No, in fact this is small fighter in comparison to overall immunity of body. The child needs good breathing for proper oxygenation which is much more important.

What is Adenoidectomy?

Adenoid removal is a surgery to shave off the adenoid glands. These glands are located behind your nose and when enlarged cause difficulty in breathing especially during the night. Often, adenoid removal is done at the same time during removal of tonsils. Adenoid removal is also called adenoidectomy. Most adenoidectomies are done on children.

How the Adenoidectomy is done? Whether any external incision will be given to baby?

Your child will not be given any external incision for the surgery and he wouldn’t feel the pain either.
Your child will be given general anesthesia before surgery. This means they will be unconscious and unable to feel pain.
The surgeon will insert a small instrument into your child’s mouth to prop it open.
The surgeon will remove the adenoid glands with a curette (a spoon-shaped medical device) or a microdebrider (a medical device used to cut away soft tissue).
Bleeding will be controlled with packing material, which will absorb blood, and with cauterization.
Your child will stay in the recovery room after surgery until they are awake and can breathe easily, cough, and swallow. Most patients can go home several hours after this surgery.

Is my child not very young for a surgery?

Though Adenoids peak at 7 years of age and regresses thereafter but enlarged symptomatic adenoids can be seen as young as 2 years and even in adults. It’s not the age but the severity of symptoms which dictates the indication of surgery.

What are the risks involved in surgery?

Risks for any anesthesia are: Reactions to medicines, breathing problems
Risks for any surgery are:
Bleeding: This is the main risk and occurs very rarely. The bleeding is likely to occur in first few hours of surgery and if it is significant enough, the child may again be taken to operation theatre and bleeding point may be cauterized. Child may require packing of the operated area and blood transfusion

What Precautions are required after Surgery?

If the surgery is only adenoidectomy, then your child can be discharged on the same day or after an overnight stay in the hospital. They require nasal drops, antibiotics, anti allergic and a pain killer in the first week. Diet is as the child likes.