Throat Pharynx AcuteTonsillitisQuinsy ENT Lectures
Transcript of Throat Pharynx AcuteTonsillitisQuinsy ENT Lectures
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Tonsils
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Tonsils are largelymphoid tissue
situated in thelateral wall of theoropharynx.
They form lateral
part of theWaldeyer's ring.
Tonsil occupiesthetonsillar fossabetween divergingpalato-pharyngealand palatoglossal
folds
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Tonsil has two surfaces, medial andlateral; two bordersanterior and
posterior; two polesupper andlower; two developmental foldsplica triangulris and plica
semilumris; and one cleftintratonsillar cleft.
edial surfaceis covered by
s!uamous epithelium and presents"#-$% cryptsusually plugged withepithelial and bacterial debris
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&ateral surfaceextends deep tosurrounding boundaries. t is coated
with a fibrous sheet, an extensionof pharyngobasilar fascia calledcapsule of the tonsil.
The capsule is loosely attached tothe muscular wallbut antero-inferiorly it is attached firmly to the
side of the tongue (ust in front ofinsertion of palatoglossus andpalatopharyngeus muscles
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Tonsils-)ross * icroscopic
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+ed of the tonsilcomprises of
&oose aerolartissue
haryngobasilarfascia
uperior
constrictormuscle
:
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Blood Supply of tonsil
Tonsillar branch ofthe dorsal lingual
scending palatine
branch of facialartery
Tonsillar branch offacial artery
scendingpharyngeal
/escending palatine
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cute tonsillitis ainly a disease
of childhoodbutis also seen inadults.
ay occur
primarily asinfection of thetonsilsthemselves ormay secondarilyoccur as a resultof 01T following
viral infection.
2rganisms3
+eta-haemolyticstreptococcus
taphylococcus
4aemophilusinfluen5ae
neumococcus
The part played
by viruses inacute tonsillitisis un6nown.
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athology-" The process of inflammation
originating within the tonsil isaccompanied by hyperemiaand oedema with conversionof lymphoid follicles in to
small abscesseswhichdischarge into crypts.
When inflammatory exudatecollects in tonsillar crypts
these present as multiplewhite spots on inflamedtonsillar surface giving rise toclinical picture of folliculartonsillitis.
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7atarrhal tonsillitis
When tonsils areinflamed as partof the
generalisedinfection of theoropharyngeal
mucosa it iscalled catarrhaltonsillitis.
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embranous tonsillitis.
ome timesexudation fromcrypts maycoalesce to forma membrane overthe surface oftonsil, giving rise
to clinical pictureof membranoustonsillitis.
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arenchymatous tonsillitis
When the wholetonsil isuniformly
congested andswollen it iscalled acute
parenchymatoustonsillitis
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7omplications
7hronic tonsillitis
eri tonsillarbscess
ara haryngealpace bscess
cute 2 cute nephritis
1480T7 9ever
&aryngeal edema epticemia
/ifferential/iagnosis
carlet fever /iphtheria
:incent'sinfection
granulocytosis
)landular fever
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ymptoms3
/iscomfort in
throat /ifficulty in
swallowing
)eneralisedbody ache
9ever 8arache and
Thic6 speech
igns3
wollen
congested tonsilswith exudates
8nlarged tender
ugulo-diagastriclymph nodes
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7omplications-"
&ocal3evere swellingwith spread ofinfection andinflammation to the
hypopharynx andlarynx mayoccasionally produceincreasing respiratory
obstruction, althoughit is very rare inuncomplicated acutetonsillitis.
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7omplications-$ eritonsillar abscessis one of the
complications of acute tonsillitis andits development means that infectionhas spread outside tonsillar capsule.
pread of infection from tonsil ormore usually from a peritonsillarabscess through the superior
constrictor muscle of the pharynxfirst results in cellulitis of the nec6and later in parapharyngeal space
abscess.
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7omplications-< The systemic or general
complicationsof acute tonsillitis arerare and almost confined tochildhood.
epticemia30ntreated acutetonsillitis can result in septicemiawith septic abscesses, septic
arthritis and meningitis
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Peritonsillar Abscess or Quinsy t is a collection of
pus between fibrouscapsule of the tonsilusually at its upperpole and the superior
constrictor muscle ofpharynx.
t usually occurs as a
complication of theacute tonsillitis or itmay apparently arisede novowith no
preceding tonsillitis.
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+acteriology
The bacteriology of acutetonsillitis and peritonsillarabscess is different although one
is a complication of the other. The bacteriology of the !uinsy is
characteri5ed by mixed flora with
multiple organisms both aerobicand anaerobic.
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7linical 9eatures 9it and young adultwith a prior history of
repeated attac6s of acute tonsillitis. receded by a sore throatfor $-< days
which gradually becomes severe andunilateral.
t this stage patient is ill with fever, oftena headache and severe throat pain madeworse by swallowing.
There might be referred otalgia, pain andswelling in the nec6 due to infectivelymphadenopathy. The patient>s voice
develops a characteristicAplummy> !uality.
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igns ll loo6ing patient
yrexia 2ften with severe
trismus
tri6ing asymmetrywith oedema andhyperaemia of the softpalate.
8nlarged hyperaemicand displaced tonsil
0sually enlarged lymph
nodes in / region.
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Treatment Preferably admitted to hospital and treated
with analgesics and antibiotics. In a patient with an early peritonsillar
abscess which is really a peritonsillar
cellulitis incision and drainage are notrecommended.
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ndications for B/include mar6ed bulging
of soft palate or failureof an assumed Tab torespond to ade!uateantibiotics. This is
underta6en at thepoint of maximumbulge.
nterval tonsillectomyafter C wee6s.
bscess tonsillectomy.
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7omplications
Duinsy is apotentially lethal
condition haryngeal *
&aryngealoedema
arapharyngealspace abscess