Roentgenography of Adenoids

In these days of rapid advances in diagnostic technic we are inclined to overlook the value of the x-ray film in the diagnosis of simple ailments. Scanning the literature, one is impressed with the paucity of articles dealing with lesions of the epipharynx, particularly adenoids. Pancoast, Pendergrass, and Schaeffer (4) briefly mention adenoids in their excellent textbook. Young (5) passes them off with a few sentences. Adenoid vegetations were pointed out on the roentgen film as early as 1898 by Mignon (Paris). Grandy (1) gave a roentgenographic description of adenoids in 1925, and Groth (2) submitted a comprehensive paper on the roentgen aspects of the epipharynx and adenoids in 1933. Anatomy The pharynx is a vertical musculomembranous passage, flattened anteroposteriorly, extending from the base of the skull above to the beginning of the esophagus below. Posteriorly it is in relationship with the cervical vertebrae; laterally, with the internal and common carotid arteries, the internal jugular vein, the sympathetic and last four cranial nerves. Anteriorly it communicates above with the nasal cavity, beneath this with the oral cavity, and below with the laryngeal cavity. The pharynx is divided into three parts: the nasopharynx or epipharynx, which, according to the anatomical textbooks, is exclusively respiratory in function; the oropharynx, which is both respiratory and alimentary; and the laryngopharynx, which is almost entirely alimentary. On the ventral wall of the nasopharynx are the two choanae (posterior nares), separated by the vomer of the nasal septum. The floor of the nasopharynx is the upper surface of the soft palate. Above and behind bilaterally on the lateral wall is located the pharyngeal recess (fossa of Rosenmüller), while below and in front on the lateral walls are found the openings of the eustachian tubes and their elevated boundaries. The posterior wall of the nasopharynx slopes forward above the level of the anterior arch of the atlas to become confluent with the roof or fornix of the pharynx. The mucosa of the fornix—and to a certain extent, also, the posterior wall—especially in children, is thrown into numerous folds which contain much lymphoid tissue, both diffuse and in the form of numerous characteristic nodules with crypt-like invaginations of the surface epithelium. This area constitutes the pharyngeal tonsil, or adenoids. According to Symington, the involution of the adenoids begins at about six to seven years and is usually completed at ten years. When the patient is not phonating, the nasopharynx is open and the resulting clear area is readily observed on the x-ray film as a translucent passage, averaging approximately 1 cm. in its anteroposterior diameter. During phonation, as also during swallowing, the soft palate contracts and elevates, tending to encroach upon the nasopharynx and to obstruct communication between the oropharynx and nasopharynx.