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tonsilitis and adenoid
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Tonsils and Adenoids
Anatomy: Pharynx: - nasopharynx
- Oropharynx
- Laryngopharynx .
Anatomy
Definition: - Ovoid lymphoid tissue with fibrous capsule laterally over the superior constrictor muscles. Its surface is covered with stratified squamous epithiluim & crypts. It has a medulla & cortex like all other lymphoid tissues. It is
part of the Walderyers ring .
Blood Supply: From upper & lower poles . - Tonsilar branch of facial artery from the ext. carotid.- Descending palatine -------- > internal maxillary artery.- Ascending palatine -------- facial artery - Ascending pharyngeal ---- external carotid.
- Dorsalis linulae ------- lingual - Paratonsillar vein -----> jugular vien.
Functions:
• - Concerned with immune
mechanism.
• - 1st line of defense. The lymphoid tissues produce lymphocytes.
• - T-cells produce plasma cells & help in antibody formation.
Pathology:
• Inflammatory : Bacterial (strept. & other pyogenic organisms ,viral, fungal . It can be specific or none-specific. Also can be acute or chronic .
• Neoplastic : benign or malignant.
Ca Tonsil Lt
Acute tonsillitis
• Acute follicular tonsillitis
• Acute parynchymatous T.
• Membranous Tonsillitis
Clinical Features:
• Usually at 3-7 years age but it can occur at any age with equal sex distribution. Commoner in overcrowded areas (barracks, hostels, camps, schools...i.e infectious)
Symptoms• -- Pyrexia
• -- Pain on swallowing
• -- Malaise
• -- Constipation
• -- Earache.• -- sore throat
Signs:
• - Increase in size.
• - Follicles, membranes or congestion.
• - enlarged tender, Jugulo-diagastric glands.
• - Fetor (halitosis).
Differential Diagnosis:
• -Scarlet fever (strep.)• -Diphtheria• -Vincent's angina (B. Vincenti, fusiform
bacilli & spirochaetes ) • -agranulocytosis – marked reduction in
neutrophils ulcerations & false memb. • -Glandular fever (viral marked increase in
monocytes & lymphocytes=mononuclear cells).
• - leukemia (blood picture & sternal puncture).
Investigations:
• TWBC + Differential.
• Hb%
• Swab C/ S
• ESR
• ASO Titer
Treatment:
• -Bed rest
• -Fluids
• -Soft diet
• -Analgesics
• -Antibiotics: Penicillins,cephalosporins
Complications and Sequelae:
• Peritonsillar abscess
• Retropharyngeal abscess
• Para pharyngeal abscess
• Rheumatic fever
• Glumerulo-nephritis
• chr. tonsillitis.
Chronic Tonsillitis
• -Follicular
• -Parenchymatous• = Hypertrophy
• =Atrophic
Clinical Features:
• -Rec. infection• -sore throat• -congested pillars• -irritating cough
• -Increase in size.
Diff. Diag: .
• Physiological.
• Pharyngitis
• Malignancy
Treatment:
• - Conservative Medical
Treatment.
• - Surgical : i.e Tonsillectomy.
Indications for tonsillectomy:
• - Rec. infections (> 4x per year).
• - sleep apnoea syndrome .
• - peritonsillar abscess.
• - Carrier state (strep., Diphtheria bacilli).
• - Others: Access, malign. Susp
Complications:
• Haemorrhage (primary, reactionary, secondary ).
• Nasal regurg.
• Septicaemia.
• Operative complications.
ADENOIDS
• Def. : hypertrophy of the nasopharyngeal
tonsil sufficient to produce symptoms.
Commonest between the age of 3 – 7 years.
Pathology:
• - Simple inflammatory:
Infection or allergy
• - Tuberculosis: Rare .
Clinical Features:
Symptoms & Signs : • Nasal obstruction: - snoring , mouth breathing , nasal
tone , difficult suckling in infants.• Adenoid facies: narrow pinched nose, open mouth, high
arched palate, crowded upper incisors teeth, receding chin & idiotic look.
• Flat or pigeon chest due to repeated respiratory infections. • Nasal discharge : mucopurulent . • E.T. obstruction: recurrent attacks of secretory or
suppuritive otitis media.• Obstructive sleep apnea syndrome: cor pulmonale & right
sided heart failure . • Nocturnal enuresis , hypoxemia & apathy.
Diagnosis:
• - Clinical .
• - Posterior rhinoscopy
• - X- ray.
Treatment:
• Medical : nasal decongestants .
• Surgical : adenoidectomy.
Complications:
• Palatal scaring , Nasal speech (rhinolalia operta),
• Nasal regurgitations.
• - Remnants ? Recurrence.