Throat Pharynx AcuteTonsillitisQuinsy ENT Lectures

8/10/2019 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.
http://www.learningradiology.com/caseofweek/caseoftheweekpix2007-1/cow269arr.jpg


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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.
http://www.mdconsult.com/das/book/body/0/0/1492/f4-u1.0-B978-1-4160-2805-5..50460-2..gr4.jpg


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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

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Throat Pharynx AcuteTonsillitisQuinsy ENT Lectures