Pediatric Pharynx Diseases

7/30/2019 Pediatric Pharynx Diseases

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Pediatric pharyngeal diseases

Ehab ZAYYAN, MD, PhD

Hacettepe University- TurkeyConsultant and Head of ENT Department

European Gaza HospitalAssist. Professor, School of Medicine

Islamic University, Gaza


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Anatomy of the

pharynx


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The pharynx

The pharynx is

located behind the

nasal cavities, the

mouth and the larynx From the skull base

till the C6

It is a musculu-membranous wall

that is deficient

anteriorly.


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Pharynx- posterior view


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The lateral andposterior walls of the

pharynx consist of 3pairs of muscles whichunite in the posteriormidline at the

pharyngeal raphe.1. Superior constrictor

muscle

2. Middle constrictor m

3. Inferior constrictormuscle.


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Nasopharynx

It lies behind thenasal cavities,

above the soft

palate.

The pharyngeal

tonsil (adenoid): a

collection of

lymphoid tissue inthe submucosa of

this region


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The Eustachian tube orifice opens into the lateral wall of

the nasopharynx

Tubal tonsils: a collection of lymphoid tissue in the

submucosa behind the opening of the auditory tube


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Nasopharyngeal examination


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Oropharynx

From the soft palate tothe upper border of the

epiglottis

Roof: undersurface of the

soft palate Floor: root of the tongue

Anterior wall:

oropharyngeal isthmus

Posterior wall: C2, C3


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Oropharynx lateralwall

Palatoglossal fold

Palatopharyngeal

fold

Uvula Palatinal tonsils


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Palatine tonsils

Two masses of lymphoid tissuelocated in the tonsillar fossa.

The tonsil is covered bymucous membrane and itsmedial surface is free projectingin the cavity of the pharynx

Tonsillar crypts on thesurface.

Fibrous capsule covers thelateral surface of the tonsil. Itseparates it from the superiorconstrictor pharyngeal muscle.


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Waldeyeres ring of lymphoid tissue

At the junction of themouth andoropharynx and thenose with the

nasopharynx there isa collection oflymphoid tissue:

1. Palatine tonsils

2. Lingual tonsils3. Pharyngeal tonsils

4. Tubal tonsils


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Hypopharynx (laryngopharynx)

From the upper

border of the

epiglottis till the

lower border ofthe cricoid

cartilage.


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Lymph drainage of the pharynx

1. Nasopharynx retropharyngeal nodes2. Tonsils and oropharynx upper deep

cervical nodes, especially the

jugulodigastric node which is called the

tonsillar node.

3. Hypopharynx vessels thru thethyrohyoid membrane upper deep

cervical nodes


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Pharyngeal diseases
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Acute pharyngitis

Mostly a viral infection

Fever, sore throat,

odynophagia, malasia

Recovery within 57days

Tx: analgesics .
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Acute tonsillitis

Very common in pediatric population

Fever, sore throat, malasia, dysphagia,neck swelling..

Etiology:

Viruses: IMN, herpes

Group A, B-hemolytic streptococci

Diphteria


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Acute tonsillitis

Diagnosis

Physical examination is

the most important

Red swollen tonsils,

follicular,membranous

Cervical

lymphadenopathy

CBC

ASOT

Cultures
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Acute tonsillitis

Treatment

Penicillin:

Penicillin G

Procaine penicillin

Benzathine penicillin

Single dose benzathine penicillin is the

best choice < 30 kg child: 600.000 IU im

>30 kg child: 1200.000 IU im


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Acute tonsillitis

Oral antibiotics (10 days of tx)

Penicillin V (oral suspension)

Amoxicillin

Erythromycin

2ndline..

Analgesia, fluids and bed rest are veryimportant


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Non-suppurative

complications of acute

tonsillitis


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Scarlet fever

Scarlet fever is secondary to acutestreptococcal tonsillitis or pharyngitis withproduction of endotoxins by the bacteria.

Manifestations include an erythematousrash, severe lymphadenopathy with a sorethroat, vomiting, headache, fever,erythematous tonsils and pharynx,

tachycardia, and a yellow exudate over thetonsils, pharynx, and nasopharynx.

A strawberry tongue with a rash and largeglossal papillae is a good diagnostic sign


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Poststreptococcal glomerulonephritis

The typical patient develops an acute nephriticsyndrome 1 to 2 weeks after a streptococcalinfection.

The infection is secondary to the presence of acommon antigen of the glomerulus with thestreptococcus.

Penicillin management may not decrease the

attack rate, and there is no evidence thatantibiotic therapy affects the natural history ofglomerulonephritis.

A tonsillectomy may be necessary to eliminate

the source of infection.


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Acute rheumatic fever

Mostly 5 15 years of age

Occurs at the 3rd to 9th day of infection

Johns criteria : major and minor Penicillin prophylaxis

Tonsillectomy


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Poststreptococcal tonsillitis

arthralgia

?????


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Suppurative complications ofacute tonsillitis


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Peritonsillar abscess

The spread of infection is from the tonsilwith pus formation between the tonsil bedand the tonsillar capsule

Fever, severe throat pain, dysphagia,odynophagia, trismus, drooling

It may lead to airway obstruction,

aspiration or parapharyngeal andretropharyngeal abscess formation

Treatment: incision and drainage, iv AB,tonsillectomy


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Parapharyngeal space abscess

Parapharyngeal space: between the lateralpharyngeal wall and the mandible

Contains dangerous structures like the carotidartery and the jugular veins.

Tonsillitis, dental infections, sinusitis,lymphadenitis.can lead to parapharyngealcellulitis or abscess

Dx: clinical, USG, CT

Tx: iv AB + incision and drainage (lateral cervicalapproach)


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R t h l


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Retropharyngeal space


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Retropharyngeal space infections

Mostly in children < 2 years Retropharyngeal space: between the pharynx

and the prevertebral fascia, extending from theskull base into the mediastinum till tracheal

bifurcation irritability, fever, dysphagia, muffled speech,

noisy breathing, stiff neck, and cervicallymphadenopathy.

Posterior pharyngeal wall bulging Cellulitis vs abscess

Tx: transoral/ external incision

R t h l b


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Retropharyngeal abscess


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Chronic tonsillitis

Recurrent acute tonsillitis

Chronic tonsillar and pharyngeal inflammation: pain,

irritation, smagma, halitosis, tonsilolithiasis

Hypertrophic tonsils


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Indications for tonsillectomy

1.Infection

Recurrent, acute tonsillitis

(more than six episodes

per year or three

episodes per year for 2years)

Chronic tonsillitis:

halitosis, persistent sore

throat, tender cervicaladenitis

Peritonsillar abscess

2. Obstruction

Excessive snoring and

chronic mouth-breathing

Obstructive sleep apnea

or sleep disturbances

3. Neoplasia Asymmetric tonsillar

hypartrophy

Adenoid diseases


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Adenoid diseases

Common in youngchildren

Adenoid hypertrophycaused by: infections,

allergy, environmental.. Symptoms

Otitis media andsinusitis

Dx: palpation, X-ray,endoscopy

Tx: Surgery


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Indications for adenoidectomy

Recurrent purulent adenoiditits Adenoid hypertrophy associated with otitis media

Adenoid hypertrophy associated with chronicsinusitis

Adenoid hypertrophy associated with excessivesnoring and chronic mouth-breathing

Sleep apnea or sleep disturbances

Speech abnormalities

Neoplasia suspesion


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Contraindications of

adenotonsillectomy

Bleeding abnormalities

Acute infections

Cleft palate??

Age???

Pediatric Pharynx Diseases

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