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The Tonsils and Adenoids in Pediatric Patients

Introduction. 1994 140,000 U.S. children under the age of 15 had adenoidectomies and 286,000 had adenotonsillectomiesThis is down from a peak of over 1 million in the 1970'sThese are the most common major surgical procedures in children.. History. Celsus first described tonsillectomy in 30 A.D.Pa

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The Tonsils and Adenoids in Pediatric Patients

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    1. The Tonsils and Adenoids in Pediatric Patients Gordon Shields, MD Ronald Deskin, MD June 19, 2002 UTMB

    2. Introduction 1994 140,000 U.S. children under the age of 15 had adenoidectomies and 286,000 had adenotonsillectomies This is down from a peak of over 1 million in the 1970’s These are the most common major surgical procedures in children.

    3. History Celsus first described tonsillectomy in 30 A.D. Paul of Aegina wrote his description in 625 A.D. 1867 Wilhelm Meyer reports removal of “adenoid vegetations” through the nose with a ring knife. 1917 Samuel J. Crowe published his report on 1000 tonsillectomies, used Crowe-Davis mouth gag Part of Waldeyer’s ring after the German anatomist who described them

    4. Embryology Adenoids begin forming in 3rd month of fetal development Glandular primordia on posterior pharynx are infiltrated by lymphocytes. Covered by pseudostratified ciliated epithelium Fully formed by 7 month

    5. Palatine tonsils begin development in 3rd month of fetal development From ventral second pharyngeal pouches 8-10 buds of epithelium grow into pharyngeal walls, form crypts Lymphocytes infiltrate Branching of crypts occurs last trimester

    6. Anatomy of the adenoids Single pyramidal mass of tissue based on posterior-superior nasopharynx Surface folded without true crypts Blood supply – ascending palatine branch of facial artery, ascending pharyngeal artery, pharyngeal branch of internal maxillary artery Innervation – glossopharyngeal and vagus No afferent lymphatics, efferents drain to retropharyngeal and upper deep cervical nodes

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