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Tonsillectomy and Adenoidectomy

The first 300 words of the full text of this article appear below.

	Objectives

 
After completing this article, readers should be able to:

1. Describe the indications for a tonsillectomy and adenoidectomy.
   
2. Know the complications of a tonsillectomy and adenoidectomy.
   
3. Recognize the serious outcomes that may be associated with tonsillar or adenoidal hypertrophy or both.
   
4. Discuss the importance of proper evaluation of velopharyngeal insufficiency in a child being considered for tonsillectomy, adenoidectomy, or both.
   

	Introduction

 
Although the number of tonsillectomy and adenoidectomy procedures has declined over the past 50 to 60 years, these operations continue to be among the procedures performed most commonly in the United States, second only to myringotomy with tube insertion. According to the most recent compilation of national health statistics (1996), more than 287,000 children younger than age 15 years underwent tonsillectomies with and without adenoidectomy; approximately 129,000 children underwent adenoidectomy without tonsillectomy.

Despite being common procedures, the indications for tonsillectomy and adenoidectomy remain controversial. There have been few randomized, controlled clinical trials to help the primary care practitioner recommend which children to refer for tonsillectomy or adenoidectomy. Clinicians often feel pressured by parents and families to recommend such procedures. Tonsillectomies are performed most commonly on children who have obstructive sleep apnea syndrome (OSAS) and recurrent throat infections. The primary indication for adenoidectomy is adenoid hypertrophy, with resultant upper airway obstruction.

	Anatomy

 
Waldeyer ring is a ring of lymphatic tissue in the oral cavity and nasopharynx. Tonsils and adenoids are part of this lymphatic ring. The term tonsil usually refers to the palatine tonsil, which is bounded anteriorly by the palatoglossus muscle (anterior tonsillar pillar) and posteriorly by the palatopharyngeus muscle (posterior tonsillar pillar). The palatine tonsils form the lateral aspects of the ring. The adenoids, or pharyngeal tonsils, located in the nasopharynx, form the superior aspect of the ring. The lingual tonsil, which resides at the base of the tongue, forms the . . . [Full Text of this Article]

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