Adenoids

Introduction
The adenoids exist as a rectangular mass of lymphatic tissue in the
nasopharynx.

Meyer first described this mucosa-associated lymphoid tissue in 1868.

The adenoids are midline structures situated on the roof and posterior wall
of the nasopharynx.

They form part of the Waldeyer ring, whose components include the
adenoids, the palatine tonsils, and the lingual tonsils.

Adenoid tissue can be found extending to the eustachian tube opening and
the fossa of Rosenmuller.

Adenoids with other lymphatic tissue in the nasopharynx are the first line of
defense against ingested or inhaled pathogens.

Structure and Function

Adenoids are pyramidal in shape, with the apex of the pyramid directed
towards the nasal septum, and the base of the pyramid present between
the roof and the posterior wall of the nasopharynx.

Histologically, the lymphoid tissue of the adenoids divides into four lobes
with seromucous glands interposed throughout the substance of the tissue.

As a portion of the Waldeyer ring, adenoids compose the lymphoid tissue

that serves as a defense against potential pathogens in the pharynx.

Adenoids, in conjunction with the lingual and palatine tonsils, are involved
in the development of T cells and B cells.
On the surface, adenoid tissue has specialized antigen-capture cells, M
cells, which uptake the pathogenic antigens and then alert the underlying B
cells.

Through this mechanism, the adenoids aid in the development of

immunologic memory throughout childhood.

Recent scientific literature has provided some evidence that adenoids also
produce T lymphocytes like the thymus gland.

The adenoids can function as a bacterial reservoir for the nasal cavity and
are implicated in the pathogenesis of chronic rhinosinusitis.

The fusion of two lateral primordia forms the adenoids during embryological
development.

Blood Supply and Lymphatics

The arterial supply of the adenoids is from the basisphenoid artery, the
ascending pharyngeal artery, the ascending palatine artery, the pharyngeal
branch of the maxillary artery, the tonsillar branch of the facial artery, and
the artery of the pterygoid canal.

The venous drainage of the adenoids is through the pharyngeal plexus.

The pharyngeal plexus and the pterygoid plexus communicate, eventually

draining into the facial veins and internal jugular veins.

The lymphatic drainage of the adenoids is through the pharyngomaxillary

space lymph nodes and the retropharyngeal lymph nodes.

Nerve Supply
The nervous supply to the adenoids is via the pharyngeal plexus.
The pharyngeal plexus contains fibers of cranial nerves IX, X, and XI. The
innervation of the adenoids originates from the vagus and the
glossopharyngeal nerves.

Muscles
The muscles found in the nasopharynx include the levator palatini and the
pharyngeal constrictors.

The superior pharyngeal constrictor muscle forms the superior aspect of

the lateral walls of the nasopharynx.

Physiologic Variants
Adenoids decrease in size with age, typically atrophying completely by the
teenage years.

Persistence of adenoid tissue into adulthood is an uncommon clinical

finding.

A disease process of the adenoids requires investigation in those

presenting with symptoms of nasal obstruction.

Immunocompromised patients, such as those diagnosed with human

immunodeficiency virus and organ transplant recipients, can exhibit
adenoid hypertrophy.

The thinking is that this finding is thought to be caused by regressed

adenoid tissue reproliferating in response to infections.

Adenoid tissue may separate into two parts in some individuals.

This variant can occur through two means: by a fissure extending from the
pharyngeal bursa or by a median fold passing towards the nasal septum
from the pharyngeal bursa.
Surgical Considerations
Adenoidectomy: An adenoidectomy is the surgical excision of adenoid
tissue.

Primary indications for adenoidectomy include otitis media with effusion of

at least 3 months duration, chronic adenoiditis, obstructive sleep apnea
lasting 3 months or greater, and recurrent upper respiratory infections.

Clinical Significance
Adenoid hypertrophy: Impaired mucociliary clearance has been implicated
as playing a role in adenoid hypertrophy, a condition typically seen in
children.

An enlarged adenoid may block breathing and be a cause of snoring or

obstructive sleep apnea.

Adenoid hypertrophy can also lead to comorbid conditions such as serous

otitis and sinusitis.

Assessing adrenal size can be achieved through flexible nasal endoscopy,

where adenoid size grading is on a scale of I to IV. This scale represents
the percentage of the posterior choana blocked by the adenoid tissue, with
grade IV representing the highest level of obstruction.

While adenoidectomy remains a common surgical treatment for adenoid

hypertrophy, intra-nasal steroids are an option as a non-surgical treatment
regimen.

Adenoiditis:
Adenoiditis refers to inflammation of adenoid tissue secondary to an
infection.
Common pathogens leading to adenoiditis are often the same as those
implicated in rhinosinusitis and include Streptococcus pneumoniae,
Hemophilus influenza, and Moraxella catharrhalis.

Nasal endoscopy showing purulent secretion of the adenoids can be useful

to confirm adenoiditis.
Figure 1. Sagittal Section of Nose, mouth, Pharynx, Larynx, Adenoid
Hypertrophy, Pathology, Obstruction of the nasal airways. Contributed by
Henry Gray (Public Domain)

Reference
Mnatsakanian, Ani, et al. “Anatomy, Head and Neck,
Adenoids.” StatPearls, StatPearls Publishing, 2020. PubMed,
http://www.ncbi.nlm.nih.gov/books/NBK538137/.

Copyright © 2020, Medical Scholar.

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