🔹
The Nasopharynx:
🔹 It extends from the base of the skull to the level of the hard palate.
At the junction of the roof and the posterior wall lies a small mass of
lymphoid tissue called the pharyngeal tonsil or adenoids. there are
smaller accumulation of lymphoid tissue laterally around the
🔹
pharyngeal opening of the auditory [eustachian] tubes.
These tubes connect the nasopharynx with the middle ear cavities.
Anteriorly the nasopharynx communicates with the nasal cavities
through the posterior nares.
The sensory nerve supply is from the trigeminal nerve.
🔹
The Oropharynx:
It extends from the the level of the hard palate to the level of the
hyoid bone.
The free edges of the soft palate forms the palatine arch which
Anatomy of pharynx
🔹
separates the oral cavity from the pharynx.
From its centre the uvula hangs downwards and from the arch on
either sides run two folds of mucous membrane raised up by bands of
Pharynx Is a fibromuscular tube lined with epithelium.It extends from the muscle fibers of the palatoglossus ana palatopharyngeus muscle to
base of the skull superiorly to the level of the sixth cervical vertebra form the palatoglossal and palatopharyngeal arches or anterior and
🔹
inferiorlly where it becomes continuous with the esophagus. posterior pillars of fauces.
The palatine tonsil lies between these folds,The glossopharyngeal
Anteriorly it communicates with the nasal cavity, the mouth and the larynx nerve as well as the trigeminal supplies sensation.
and thus divides anatomically into:
1. Nasopharynx.
2. Oropharynx.
3. Laryngopharynx {hypopharynx}. 🔹
Hypopharynx:
It extends from the level of the hyoid bone to the upper end of
esophagus. It is enclosed within the three constrictor muscles of
-There are numerous mucous gland. pharynx: superior, middle and inferior. lymphoid tissue is present in the
-The middle fibrous tissue layer consist of the pharyngobasilar fascia. base of tongue and is called the lingual tonsils. vallecula is recess
-The outer muscular layer comprise chiefly the three constrictor muscles:
superior, middle and inferior which overlap from below upwards. 🔹
between the tongue and the anterior surface of the epiglottis
On either lateral side of the aryepiglottic folds is a recess {pyriform
fossa or sinus} which form channel for food during deglutition.
The sensory supply is from IXth and Xth cranial nerves.
The tonsils:
-Are collections of lymphatic tissue located within the pharynx. They collectively
form ringed arrangement known as waldeyer”s ring.
The tonsils are classified as mucosa associated lymphoid tissue{MALT} and therefore
🔷
contain T cells, B cells and macrophages. it is the first line of defense against
Complications:
1. Liver: acute hepatitis.
Infectious Mononucleosis{Glandular Fever}
Def: 🔹
pathogens entering through the naopharynx or oropharynx.
Blood supply
1.Tonsillar branch of facial artery
2. Spleen: rupture {rare}. Is a systemic viral infection caused by Epstein barr virus {EBV}
3. CNS: meningoencephalitis, cranial nerve Aetiology: 2.Ascending pharyngeal artery from external carotid
palsies and ascending polynuritis {gullian 1. Causative organism: EBV. 3.Ascending palatine a. branch of facial artery
barre syndrome}. 2. Source of infection: mainly healthy carriers. 4.Dorsal linguae branches of lingual artery
4. CVS: myocarditis and pericarditis.
5. Heamatological: autoimmune heamolytic
3. Mode of infection: droplet infection.
4. Incubation period: 2-5 weeks. 🔹
5.Descending palatine branch of maxillary a.
Venous drainage
Veins from the tonsis drain into paratonsillar vein which joins the common facial vein
anaemia and aplastic anaemia. Incidence:
Mainly affects adolescents and young adults.
Clinical pictures: Infectious Anatomy and Physiology 🔹
and pharyngeal venous plexus
Lymphatic drainage
🔷 Investigation:
1. It varies from an asymptomatic carrier to severe systemic illness.
2. Persistent fever, headach and fatigue.
Mononucleosis
Waldeyer”s ring:
Lymphatics from the tonsil pierce the superior constrictor and drain into upper deep
cervical nodes particularly the jugulodigastric )tonsillar ( node situated below the
1. CBC:
Leukocytosis
Large a typical lymphocytes
3. Severe sore throat and dysphagia are the most common symptoms.
4. Marked hyperaemia, congestion and odema of pharyngeal mucosa and tonsils.
1. Pharyngeal tonsil.
2. Tubal tonsils X2.
🔹
angle of mandible
Nerve supply
Lesser palatine branches of sphenopalatine ganglion (CN V) and glossopharyngeal
5. Shallow yellow ulcer or a greynish white membrane may form on the tonsils. 3. Palatine tonsils X2.
2. Seriological tests: nerve provide sensory nerve supply
6. Palatal petechiae are present in some cases. 4. Lingual tonsil.
a. Positive paul-bunnel test
7. Generalized lymphadenopathy:
b. Positive monospot test
a. Cervical L.Ns enlarged is gross
3. Detection of EBV antibodies by ELIZA
b. LNs are discrete, mobile and tender. Palatine tonsils:
Are commonly referred to as the tonsils They are located within the tonsillar bed
🔷
8. Splenomegaly and hepatomegaly.
Treatment: 9. A rubelliform skin rash is almost invariable if ampicillin is mistaken prescribed. of the lateral oropharyngeal wall between the palatoglossal arch anteriorly and
Is mainly symptomatic in form of:
1. Bed rest, light diet and adequate fluids. 🔹
palatopharyngeal arch posteriorly, they form the lateral part of the waldeyer”s ring.
Each tonsil has free medial surface which projects into the pharynx. The lateral
2. Analgesics and antipyretics.
3. Antiseptic mouth wash. 🔹
surface is covered by afibrous capsule.
The arterial supply to the tonsil derives mainly from the tonsillar branch of the
4. Antibiotics to avoid secondary bacterial
infection. 🔹
facial artery and the descending palatine artery.
🔹 The viens drain into the pharyngeal plexus.
Lymphatic drainage from the tonsil is into the upper deep cervical lymph nodes
5. Steroids:40-80 mg/day tapered over 2 weeks
given only in severe cases. {jagulodigastric lymph node}.
Physiology of pharynx:
The pharynx has several important functions:
1. Carries air to the respiratory system.
🔷 Aetiology:
1. It is an acute specific infection caused by coryne
2. Deliver food and liquid to the digestive
system.
3. Equalizes pressure in the ears and drain fluid
bacterium diphtheria {gram positive bacilli}. from the ears.
2. Source of infection: Cases or carries. 4. Tonsils are the body”s first defense against
3. Mode of infection: Droplet infection: infection.
a. Direct contact: kissing.
b. Indirect contact: through articles.
4. Incubation period: 2-5days
🔷
5. Season: common in winter and autumn 1. Acute paranchematous
Incidence: tonsillitis
1. Age:: 2-6 yrs commonest.
🔷 Pathogenesis:
1. After initial infection the organism remains on the surface of mucosa
2. Site of infection:
a. Pharynx: most common.
🔷
b. Larynx and nose: usually follows faucial diphtheria.
membrane and multiply and produces a powerfull exotoxin which leads to: c. Conjunctiva: very rare. Def:
Patchy necrosis of the mucosa: the necrotic patches rapidly fuse together
forming a necrotic dirty yellowish grey false membrane which become
adherent to tonsils.
🔷 Pathology:
This is pseudomembranous inflammation
Acute, non specific inflammation of the palatine tonsils ,usually
associated with pharyngitis {pharyngotonsillitis}.
Incidence:
2. severe inflammation of the submucosa with resultant of exudate rich in
fibrinogen which latter forms fibrin threads.
3. The exotoxin is absorped by vascular and lymphatic channels to reach the
Severe type of acute inflammatory affection of the mucous
membrane characterized by replacement of the original mucosa 🔷
It is most frequent in childhood, however it also occurs in adult.
🔹 Aetiology:
🔹
by afalse membrane. Predisposing factors: Pathological types:
blood stream producing toxemia. 2. Acute follicular tonsillitis:
A. General: 1. Acute paranchematous tonsillitis:
🔷 Investigation:
1. Lowered immunity.
2. Exposure to cold and temperature changes
The whole tonsil is infected, causing marked generalized swelling .
🔷
The surface appear reddened and more injected but not exuding frank
🔹
Throat swab: is taken from the lesion and examined by: 3, Fatigue and exhaustion. pus.
Clinical pictures:
a. Direct smear 4. Overcrowedness esp. in badly ventilated places. 2. Acute follicular tonsillitis:
Clinically diphtheria can vary from asymptomatic carrier state to
b. Cultured on enriches medium {Loffler”s serum or 5. Smoking
🔹
a rapidly fatal toxic disease. The inflammatory changes are confined to the crypts.
blood tellurite agar} to show the diphtheric baciili. B. Local: First there is infection of the lymphoid follicules with the formation of
Symptomes:
1. Post nasal discharge e.g adenoid, tonsillitis small abscess and thus the crypts become full with pus that appear as
1. Incidious onset of low grade fever, malaise, anorexia and may be
3. Recurrent URTI yellowish spots on the surface of the tonsils.
D.D.: vomiting.
4. As an initial stage of some fevers e.g exanthemata, scarlet fever.
🔹
1. Acute tonsillitis 2. Severe sore throat and dysphagia. Latter, this purulent exudate coalesce to form a non adherent yellowish
2. Vincent angina.
3. Infectious mononucleosis.
Signs:
1. Low grade fever.
Causative organisms:
1. Group A betahemlytic streptococci {streptococcus
🔹
membrane on the surface of the tonsils.
3. Acute catarrhal tonsillitis:
The inflammatory changes are marked on the surface of tonsils with
4. Acute leukaemia and a granulocytosis. 2. Marked toxemia {toxic face}.
haemolyticus} is the commonest. odema and congestion of the mucosa.
3. Severe tachycardia which not proporinate with fever.
2. Haemophillus influenza, staphylococcus aureus and
4. Afalse {pseudomembrane} is formed over the tonsils which is:
Complication: pneumococci. 3. Acute catarrhal tonsillitis:
a. unilateral and has astrong foeter.
1. Respiratory complication: 3.It may start initially as viral tonsillitis followed by secondary
b. at first is yellowish white patchy and latter is dirty greyish and
A. Laryngeal obstruction due to: bacterial infection particulary in children.
a. Extension of the infection to the larynx.
may become blackish with offensive odor.
c. it lies over the tonsils and tonsillar pillars and exceeds the
Acute Faucial Diphtheria 4.Common viruses include:
b. Laryngeal odema. Adenovirus, parainfluenza and herpes simplex.
margins of tonsils and extend to involve the soft palate and
c. A detached necrotic piece from pharynx. pharynx.
B. Lung collapse and lung abscess.
Pharynx
d. It is adherent to underlying structures and on removal it leaves a
C. Bronchopneumonia and labor pneumonia. bleeding area and rapidly reforms.
2. Cardiac complication: 5. Markedly enlarged tender cervical lymph nodes on both sides of
A. Heart failure due to: the neck {bull”sneck}.
a. Toxic myocarditis {early.}
b. Vagal neuritis {late}. Acute Tonsillitis
3. kidney complication:
Acute nephritis causing albuminuria.
4. Neurological complication:
A. Palatal paralysis.
Investigation:
B. Paralysis of pharyngeal muscles. Usually not needed
C. Paralysis of laryngeal muscles. 1. Swab from the tonsils for culture and
D. Paralysis of diaphragm and intercostal muscles. sensitivity
E. Paralysis of eyes muscles. 2. CBC: leukocytosis
F. Paralysis of limb and facial muscles {very rare}. 3. Increase ESR
🔷 Treatment:
🔹
Clinical pictures:
Symptoms:
1.Fever, headach, anorexia and malaise, myalgia, arthralgia, backacke,
D.D.:
and pain in the limbs. 1. Scarlet fever.
1. Hospitalization: 2. Diphtheria.
Isolated is mandatory until three consecutive daily swab culture 2.Sever sore throat and odynophagia with referred otalgia.
3. Vincent’s angina.
🔷
are negative. 3.Change of voice [hot potato voice] if size of tonsils is huge.
4.Foetor oris. 4. Infectious mononucleosis.
Prophylaxis: 2. Complete bed rest for at least 3 weeks 5. Acute leukaemia.
1. Active immunization: DPT 3. Specific diphtheric antitoxic serum. 5.Dehydration may occur in children due to high fever and painfull
swallowing. 6. Agranulocytosis.
a. The vaccine is given in conjunction with tetanus and It should be given with in 48 hours
pertosis.
b. At age of 2,4,6 months.
Dose:
40000-100000 i.u I,m or i.v to be repeated after 24-48 hours. 🔹 Signs:
A. General:
c. Booster dose are given at age 18 month and 5 years. 4. Antibiotics:
2. Passive immunization: Pencillin 0,5 -1 million i.u/daily i.m for 10 days 1. High fever {39-40c} patient looks severelly ill.
a. 5000-10000 i.u of antitoxic serum is given i.m for Oral erythromycin may be given in pencillin allergic patients. 2. Tachycardia: proportionate to fever
contactse.g doctors,nurses ……etc 5. Glucose :50cc of 25 glucose solution given as i.v drip to B. Local:
b. It can be combined with a booster dose of the toxoid . support the cardiac muscles. 1. The tonsils appear swallow, congested {some times deeply red}.
6. Vitamins. 2. The orooharynx also appear congested and odematous.
3. Yellowish white spots maybe seen filling the crypts.
🔹
7. Antipyretics. Complications:
8. Tracheostomy may be necessary if respiratory obstruction 4. There is odema of soft palate and coated tongue. Local:
developed. 5. Enlarged, tender upper deep
Cervical { jagulodigastric } lymph nodes.
Treatment: 1.Peritonsillar abscess.
1. Bed rest, light diet and adequate fluids. 2.Parapharyngeal abscess and retropharyngeal
2. Antibiotics: abscess.
a. Benzyl pencilline 600mg\6 hour I.M daily for 3 days. 3.Ludwiges angina.
4.Extention of infection leading to otitis media,
🔹
Anatomy of Adenoids b. After the initial response , continue on oral pencilline e.g:amoxicillin
Blood supply and amoxicilline with clavulanic acid. laryngitis and bronchitis.
1.Ascending palatine branch of facial
2.Ascending pharyngeal branch of external carotid
c. Cephalosporines and macrolides are second option in patient
allergic to pencillines. 🔹
5.Chronic tonsillitis.
General :
Delayed post streptococcl diseases:
3.Pharyngeal branch of the third part of maxillary artery 3. Analesics and anti pyretics.
1.Rheumatic fever.
🔹
4.Ascending cervical branch of inferior thyroid artery of thyrocervical trunk 4. Antiseptic mouth gargles.
Veinous drainage 2.Acute glomerulonephritis
Primarily through the pharyngeal plexus of veins. This plexus then connects
with the pterygoid plexus, ultimately leading to drainage into the internal
🔹
jugular veins and facial veins
Lymphphatics
From the Adenoid drain into upper jugular nodes directly or indirectly via
by fatema okoff
🔹
retropharyngeal and parapharyngeal nodes
nerve supply
Through CN IX and X ,they carry sensation and reffered pain to ear due to
adenoiditis is also mediated through them
Acute Adenoiditis
🔹 Def:
Hypertrophy of the nasopharyngeal tonsil sufficient to produce
🔹
Acute pharyngitis
Def:
Acute inflammation of the mucosa and lymphoid tissue of the
🔹
symptoms.
Site:
The adenoid tissue arise at the junction of the roof and the
🔹
pharynx.
Aetiology:
1. It is usually a viral infection which is associated with viral URTI
posterior wall of the naso[pharynx {luska”s pouch}. e,g: common cold or influenza.
🔷 Incidence: 🔹
2. Secondary bacterial infection follows.
Predisposing factors:
A. General :
1. Adenoid is the commonest nasopharyngeal swelling
2. Age:
a. It is considered a disease of childhood and it is usually an adenotonsillar
1. Lowered immunity.
2. Exposure to cold and temperature changes. 3. hot path and 🔹
Clinical picture:
Symptoms:
1. Constitutional symptoms: headach, fever,
hypertrophy. exposure to air current.
anorexia, malaise. Treatment:
b. It occurs most commonly between the age of 2-12 yrs then gradually Acute Adenoiditis 4. Fatigue and exhuasion.
involution and atrophy occur at age of puberty. Acute pharyngitis 5. Overcrowdness esp. in badly ventilated places.
6. Smoking. 🔹
2. Sore throat and dysphagia.
Signs:
1. Rest in bed, light diet and adequate fluids.
2. Analgesics and antipyretics.
🔷 Aetiology:
1. It is related to repeated URTI.
B. Local:
1. Post nasal discharge e.g: adenoid, sinusitis.
1. Diffuse congestion and hyperemia of the whole
pharyngeal mucosa including the tonsils
3. Antiseptic mouth wash and gargles.
2. Recurrent URTI. 2. There may be tender enlargement of cervical
🔷
2. It occurs more in debilitated malnurched children 3. As an initial stage of some fever e.g: exanthemata, scarelet LNs.
Clinical picture: fever.
A. General manifestation:
1. Night mares and nocturnal enuresis.
2. The child is shy and friendless.
Examination: 3. Mental dullness and a pathy.
1. Adenoid facies, SOM and CHL.
4. Loss of apetite and indigestion and may be morning vomiting due to
2. Inflammed spongy gums.
swallowed mucous,
3. Arching of the hard palate.
4. Egg white post nasal discharge may be seen.
5. Vertical slite apeature of the anterior nares.
🔹
B .Effects of hypertrophy:
1. Bilateral nasal obstruction.
a. There is mouth breathing and the child has noisy respiration while awake and
6. Narrowed nasal chambers.
snoring.
7. Mucoid or mucopurulent nasal discharge.
b. OSAS
8. By digital palpation of the nasopharynx:
c. In infants there is difficulty in feeding and suckling and may be loss of weight
The adenoid tissue is felt as if toutching a punch
d. Nasal tone of voice {hyponasality or rhinlalia clousa}
of earth warm
e,. Bilateral nasal discharge
Investigation: 🔹
f. Recurrent rhinitis and sinusitis
2. E.T.Obstruction:
a. S.O.M.
1. Plain X ray lateral view:
Show a radiopaque soft tissue shadow arising from the
superior and posterior walls of the nasopharynx with 🔹
b. Recurrent ASOM.
3. Adenoid facies:
a. Open mouth with prominent incisors {prognathism}.
narrowing of the nasopharyngeal air column.
2. Audiogram and Tympanogram. b. Elevated short pinched up upper lip
3. Endoscopy: flexible and rigid. C. Atrophic ala nasi with narrow anterior nares
d. Receeding mandible with enlarged lower lib
e. Flat nasolabial fold giving the face apathic expression look
🔹
Treatment: f. High arched palate.
Adenoidectomy: 4. Oral cavity:
Usually combined with tonsillectomy a. Dental caries.
{adenotonsillictomy}. b. Bleeding gums.
c. Dry mouth.
d. Recurrent pharyngitis and tonsillitis.
🔹
e. Foeter oris.
5. Respiratory:
•A. Descending infection:
a. Laryngitis.
b. Bronchitis.
c. Chest infection.
•B. Post nasal discharge: irritative cough.
•C. Laryngesmus Stridulous {sudden nocturnal laryngeal spasm due to post
🔹
nasal discharge in children}.
6. Cardiovascular:
-A. Chronic hypoxia leads to:
a. Pulmonary hypertension
b. Cor pulmonale
c. Cardiac arrhythmia
-B. sudden death.
The Nasopharynx:
🔹 It extends from the base of the skull to the level of the hard palate.
At the junction of the roof and the posterior wall lies a small mass of
lymphoid tissue called the pharyngeal tonsil or adenoids. there are
smaller accumulation of lymphoid tissue laterally around the
🔹
pharyngeal opening of the auditory [eustachian] tubes.
These tubes connect the nasopharynx with the middle ear cavities.
Anteriorly the nasopharynx communicates with the nasal cavities
through the posterior nares.
The sensory nerve supply is from the trigeminal nerve.
🔹
The Oropharynx:
It extends from the the level of the hard palate to the level of the
hyoid bone.
The free edges of the soft palate forms the palatine arch which
Anatomy of pharynx
🔹
separates the oral cavity from the pharynx.
From its centre the uvula hangs downwards and from the arch on
either sides run two folds of mucous membrane raised up by bands of
Pharynx Is a fibromuscular tube lined with epithelium.It extends from the muscle fibers of the palatoglossus ana palatopharyngeus muscle to
base of the skull superiorly to the level of the sixth cervical vertebra form the palatoglossal and palatopharyngeal arches or anterior and
🔹
inferiorlly where it becomes continuous with the esophagus. posterior pillars of fauces.
The palatine tonsil lies between these folds,The glossopharyngeal
Anteriorly it communicates with the nasal cavity, the mouth and the larynx nerve as well as the trigeminal supplies sensation.
and thus divides anatomically into:
1. Nasopharynx.
2. Oropharynx.
3. Laryngopharynx {hypopharynx}. 🔹
Hypopharynx:
It extends from the level of the hyoid bone to the upper end of
esophagus. It is enclosed within the three constrictor muscles of
-There are numerous mucous gland. pharynx: superior, middle and inferior. lymphoid tissue is present in the
-The middle fibrous tissue layer consist of the pharyngobasilar fascia. base of tongue and is called the lingual tonsils. vallecula is recess
-The outer muscular layer comprise chiefly the three constrictor muscles:
superior, middle and inferior which overlap from below upwards. 🔹
between the tongue and the anterior surface of the epiglottis
On either lateral side of the aryepiglottic folds is a recess {pyriform
fossa or sinus} which form channel for food during deglutition.
The sensory supply is from IXth and Xth cranial nerves.
The tonsils:
-Are collections of lymphatic tissue located within the pharynx. They collectively
form ringed arrangement known as waldeyer”s ring.
The tonsils are classified as mucosa associated lymphoid tissue{MALT} and therefore
🔷
contain T cells, B cells and macrophages. it is the first line of defense against
Complications:
1. Liver: acute hepatitis.
Infectious Mononucleosis{Glandular Fever}
Def: 🔹
pathogens entering through the naopharynx or oropharynx.
Blood supply
1.Tonsillar branch of facial artery
2. Spleen: rupture {rare}. Is a systemic viral infection caused by Epstein barr virus {EBV}
3. CNS: meningoencephalitis, cranial nerve Aetiology: 2.Ascending pharyngeal artery from external carotid
palsies and ascending polynuritis {gullian 1. Causative organism: EBV. 3.Ascending palatine a. branch of facial artery
barre syndrome}. 2. Source of infection: mainly healthy carriers. 4.Dorsal linguae branches of lingual artery
4. CVS: myocarditis and pericarditis.
5. Heamatological: autoimmune heamolytic
3. Mode of infection: droplet infection.
4. Incubation period: 2-5 weeks. 🔹
5.Descending palatine branch of maxillary a.
Venous drainage
Veins from the tonsis drain into paratonsillar vein which joins the common facial vein
anaemia and aplastic anaemia. Incidence:
Mainly affects adolescents and young adults.
Clinical pictures: Infectious Anatomy and Physiology 🔹
and pharyngeal venous plexus
Lymphatic drainage
🔷 Investigation:
1. It varies from an asymptomatic carrier to severe systemic illness.
2. Persistent fever, headach and fatigue.
Mononucleosis
Waldeyer”s ring:
Lymphatics from the tonsil pierce the superior constrictor and drain into upper deep
cervical nodes particularly the jugulodigastric )tonsillar ( node situated below the
1. CBC:
Leukocytosis
Large a typical lymphocytes
3. Severe sore throat and dysphagia are the most common symptoms.
4. Marked hyperaemia, congestion and odema of pharyngeal mucosa and tonsils.
1. Pharyngeal tonsil.
2. Tubal tonsils X2.
🔹
angle of mandible
Nerve supply
Lesser palatine branches of sphenopalatine ganglion (CN V) and glossopharyngeal
5. Shallow yellow ulcer or a greynish white membrane may form on the tonsils. 3. Palatine tonsils X2.
2. Seriological tests: nerve provide sensory nerve supply
6. Palatal petechiae are present in some cases. 4. Lingual tonsil.
a. Positive paul-bunnel test
7. Generalized lymphadenopathy:
b. Positive monospot test
a. Cervical L.Ns enlarged is gross
3. Detection of EBV antibodies by ELIZA
b. LNs are discrete, mobile and tender. Palatine tonsils:
Are commonly referred to as the tonsils They are located within the tonsillar bed
🔷
8. Splenomegaly and hepatomegaly.
Treatment: 9. A rubelliform skin rash is almost invariable if ampicillin is mistaken prescribed. of the lateral oropharyngeal wall between the palatoglossal arch anteriorly and
Is mainly symptomatic in form of:
1. Bed rest, light diet and adequate fluids. 🔹
palatopharyngeal arch posteriorly, they form the lateral part of the waldeyer”s ring.
Each tonsil has free medial surface which projects into the pharynx. The lateral
2. Analgesics and antipyretics.
3. Antiseptic mouth wash. 🔹
surface is covered by afibrous capsule.
The arterial supply to the tonsil derives mainly from the tonsillar branch of the
4. Antibiotics to avoid secondary bacterial
infection. 🔹
facial artery and the descending palatine artery.
🔹 The viens drain into the pharyngeal plexus.
Lymphatic drainage from the tonsil is into the upper deep cervical lymph nodes
5. Steroids:40-80 mg/day tapered over 2 weeks
given only in severe cases. {jagulodigastric lymph node}.
Physiology of pharynx:
The pharynx has several important functions:
1. Carries air to the respiratory system.
🔷 Aetiology:
1. It is an acute specific infection caused by coryne
2. Deliver food and liquid to the digestive
system.
3. Equalizes pressure in the ears and drain fluid
bacterium diphtheria {gram positive bacilli}. from the ears.
2. Source of infection: Cases or carries. 4. Tonsils are the body”s first defense against
3. Mode of infection: Droplet infection: infection.
a. Direct contact: kissing.
b. Indirect contact: through articles.
4. Incubation period: 2-5days
🔷
5. Season: common in winter and autumn 1. Acute paranchematous
Incidence: tonsillitis
1. Age:: 2-6 yrs commonest.
🔷 Pathogenesis:
1. After initial infection the organism remains on the surface of mucosa
2. Site of infection:
a. Pharynx: most common.
🔷
b. Larynx and nose: usually follows faucial diphtheria.
membrane and multiply and produces a powerfull exotoxin which leads to: c. Conjunctiva: very rare. Def:
Patchy necrosis of the mucosa: the necrotic patches rapidly fuse together
forming a necrotic dirty yellowish grey false membrane which become
adherent to tonsils.
🔷 Pathology:
This is pseudomembranous inflammation
Acute, non specific inflammation of the palatine tonsils ,usually
associated with pharyngitis {pharyngotonsillitis}.
Incidence:
2. severe inflammation of the submucosa with resultant of exudate rich in
fibrinogen which latter forms fibrin threads.
3. The exotoxin is absorped by vascular and lymphatic channels to reach the
Severe type of acute inflammatory affection of the mucous
membrane characterized by replacement of the original mucosa 🔷
It is most frequent in childhood, however it also occurs in adult.
🔹 Aetiology:
🔹
by afalse membrane. Predisposing factors: Pathological types:
blood stream producing toxemia. 2. Acute follicular tonsillitis:
A. General: 1. Acute paranchematous tonsillitis:
🔷 Investigation:
1. Lowered immunity.
2. Exposure to cold and temperature changes
The whole tonsil is infected, causing marked generalized swelling .
🔷
The surface appear reddened and more injected but not exuding frank
🔹
Throat swab: is taken from the lesion and examined by: 3, Fatigue and exhaustion. pus.
Clinical pictures:
a. Direct smear 4. Overcrowedness esp. in badly ventilated places. 2. Acute follicular tonsillitis:
Clinically diphtheria can vary from asymptomatic carrier state to
b. Cultured on enriches medium {Loffler”s serum or 5. Smoking
🔹
a rapidly fatal toxic disease. The inflammatory changes are confined to the crypts.
blood tellurite agar} to show the diphtheric baciili. B. Local: First there is infection of the lymphoid follicules with the formation of
Symptomes:
1. Post nasal discharge e.g adenoid, tonsillitis small abscess and thus the crypts become full with pus that appear as
1. Incidious onset of low grade fever, malaise, anorexia and may be
3. Recurrent URTI yellowish spots on the surface of the tonsils.
D.D.: vomiting.
4. As an initial stage of some fevers e.g exanthemata, scarlet fever.
🔹
1. Acute tonsillitis 2. Severe sore throat and dysphagia. Latter, this purulent exudate coalesce to form a non adherent yellowish
2. Vincent angina.
3. Infectious mononucleosis.
Signs:
1. Low grade fever.
Causative organisms:
1. Group A betahemlytic streptococci {streptococcus
🔹
membrane on the surface of the tonsils.
3. Acute catarrhal tonsillitis:
The inflammatory changes are marked on the surface of tonsils with
4. Acute leukaemia and a granulocytosis. 2. Marked toxemia {toxic face}.
haemolyticus} is the commonest. odema and congestion of the mucosa.
3. Severe tachycardia which not proporinate with fever.
2. Haemophillus influenza, staphylococcus aureus and
4. Afalse {pseudomembrane} is formed over the tonsils which is:
Complication: pneumococci. 3. Acute catarrhal tonsillitis:
a. unilateral and has astrong foeter.
1. Respiratory complication: 3.It may start initially as viral tonsillitis followed by secondary
b. at first is yellowish white patchy and latter is dirty greyish and
A. Laryngeal obstruction due to: bacterial infection particulary in children.
a. Extension of the infection to the larynx.
may become blackish with offensive odor.
c. it lies over the tonsils and tonsillar pillars and exceeds the
Acute Faucial Diphtheria 4.Common viruses include:
b. Laryngeal odema. Adenovirus, parainfluenza and herpes simplex.
margins of tonsils and extend to involve the soft palate and
c. A detached necrotic piece from pharynx. pharynx.
B. Lung collapse and lung abscess.
Pharynx
d. It is adherent to underlying structures and on removal it leaves a
C. Bronchopneumonia and labor pneumonia. bleeding area and rapidly reforms.
2. Cardiac complication: 5. Markedly enlarged tender cervical lymph nodes on both sides of
A. Heart failure due to: the neck {bull”sneck}.
a. Toxic myocarditis {early.}
b. Vagal neuritis {late}. Acute Tonsillitis
3. kidney complication:
Acute nephritis causing albuminuria.
4. Neurological complication:
A. Palatal paralysis.
Investigation:
B. Paralysis of pharyngeal muscles. Usually not needed
C. Paralysis of laryngeal muscles. 1. Swab from the tonsils for culture and
D. Paralysis of diaphragm and intercostal muscles. sensitivity
E. Paralysis of eyes muscles. 2. CBC: leukocytosis
F. Paralysis of limb and facial muscles {very rare}. 3. Increase ESR
🔷 Treatment:
🔹
Clinical pictures:
Symptoms:
1.Fever, headach, anorexia and malaise, myalgia, arthralgia, backacke,
D.D.:
and pain in the limbs. 1. Scarlet fever.
1. Hospitalization: 2. Diphtheria.
Isolated is mandatory until three consecutive daily swab culture 2.Sever sore throat and odynophagia with referred otalgia.
3. Vincent’s angina.
🔷
are negative. 3.Change of voice [hot potato voice] if size of tonsils is huge.
4.Foetor oris. 4. Infectious mononucleosis.
Prophylaxis: 2. Complete bed rest for at least 3 weeks 5. Acute leukaemia.
1. Active immunization: DPT 3. Specific diphtheric antitoxic serum. 5.Dehydration may occur in children due to high fever and painfull
swallowing. 6. Agranulocytosis.
a. The vaccine is given in conjunction with tetanus and It should be given with in 48 hours
pertosis.
b. At age of 2,4,6 months.
Dose:
40000-100000 i.u I,m or i.v to be repeated after 24-48 hours. 🔹 Signs:
A. General:
c. Booster dose are given at age 18 month and 5 years. 4. Antibiotics:
2. Passive immunization: Pencillin 0,5 -1 million i.u/daily i.m for 10 days 1. High fever {39-40c} patient looks severelly ill.
a. 5000-10000 i.u of antitoxic serum is given i.m for Oral erythromycin may be given in pencillin allergic patients. 2. Tachycardia: proportionate to fever
contactse.g doctors,nurses ……etc 5. Glucose :50cc of 25 glucose solution given as i.v drip to B. Local:
b. It can be combined with a booster dose of the toxoid . support the cardiac muscles. 1. The tonsils appear swallow, congested {some times deeply red}.
6. Vitamins. 2. The orooharynx also appear congested and odematous.
3. Yellowish white spots maybe seen filling the crypts.
🔹
7. Antipyretics. Complications:
8. Tracheostomy may be necessary if respiratory obstruction 4. There is odema of soft palate and coated tongue. Local:
developed. 5. Enlarged, tender upper deep
Cervical { jagulodigastric } lymph nodes.
Treatment: 1.Peritonsillar abscess.
1. Bed rest, light diet and adequate fluids. 2.Parapharyngeal abscess and retropharyngeal
2. Antibiotics: abscess.
a. Benzyl pencilline 600mg\6 hour I.M daily for 3 days. 3.Ludwiges angina.
4.Extention of infection leading to otitis media,
🔹
Anatomy of Adenoids b. After the initial response , continue on oral pencilline e.g:amoxicillin
Blood supply and amoxicilline with clavulanic acid. laryngitis and bronchitis.
1.Ascending palatine branch of facial
2.Ascending pharyngeal branch of external carotid
c. Cephalosporines and macrolides are second option in patient
allergic to pencillines. 🔹
5.Chronic tonsillitis.
General :
Delayed post streptococcl diseases:
3.Pharyngeal branch of the third part of maxillary artery 3. Analesics and anti pyretics.
1.Rheumatic fever.
🔹
4.Ascending cervical branch of inferior thyroid artery of thyrocervical trunk 4. Antiseptic mouth gargles.
Veinous drainage 2.Acute glomerulonephritis
Primarily through the pharyngeal plexus of veins. This plexus then connects
with the pterygoid plexus, ultimately leading to drainage into the internal
🔹
jugular veins and facial veins
Lymphphatics
From the Adenoid drain into upper jugular nodes directly or indirectly via
by fatema okoff
🔹
retropharyngeal and parapharyngeal nodes
nerve supply
Through CN IX and X ,they carry sensation and reffered pain to ear due to
adenoiditis is also mediated through them
Acute Adenoiditis
🔹 Def:
Hypertrophy of the nasopharyngeal tonsil sufficient to produce
🔹
Acute pharyngitis
Def:
Acute inflammation of the mucosa and lymphoid tissue of the
🔹
symptoms.
Site:
The adenoid tissue arise at the junction of the roof and the
🔹
pharynx.
Aetiology:
1. It is usually a viral infection which is associated with viral URTI
posterior wall of the naso[pharynx {luska”s pouch}. e,g: common cold or influenza.
🔷 Incidence: 🔹
2. Secondary bacterial infection follows.
Predisposing factors:
A. General :
1. Adenoid is the commonest nasopharyngeal swelling
2. Age:
a. It is considered a disease of childhood and it is usually an adenotonsillar
1. Lowered immunity.
2. Exposure to cold and temperature changes. 3. hot path and 🔹
Clinical picture:
Symptoms:
1. Constitutional symptoms: headach, fever,
hypertrophy. exposure to air current.
anorexia, malaise. Treatment:
b. It occurs most commonly between the age of 2-12 yrs then gradually Acute Adenoiditis 4. Fatigue and exhuasion.
involution and atrophy occur at age of puberty. Acute pharyngitis 5. Overcrowdness esp. in badly ventilated places.
6. Smoking. 🔹
2. Sore throat and dysphagia.
Signs:
1. Rest in bed, light diet and adequate fluids.
2. Analgesics and antipyretics.
🔷 Aetiology:
1. It is related to repeated URTI.
B. Local:
1. Post nasal discharge e.g: adenoid, sinusitis.
1. Diffuse congestion and hyperemia of the whole
pharyngeal mucosa including the tonsils
3. Antiseptic mouth wash and gargles.
2. Recurrent URTI. 2. There may be tender enlargement of cervical
🔷
2. It occurs more in debilitated malnurched children 3. As an initial stage of some fever e.g: exanthemata, scarelet LNs.
Clinical picture: fever.
A. General manifestation:
1. Night mares and nocturnal enuresis.
2. The child is shy and friendless.
Examination: 3. Mental dullness and a pathy.
1. Adenoid facies, SOM and CHL.
4. Loss of apetite and indigestion and may be morning vomiting due to
2. Inflammed spongy gums.
swallowed mucous,
3. Arching of the hard palate.
4. Egg white post nasal discharge may be seen.
5. Vertical slite apeature of the anterior nares.
🔹
B .Effects of hypertrophy:
1. Bilateral nasal obstruction.
a. There is mouth breathing and the child has noisy respiration while awake and
6. Narrowed nasal chambers.
snoring.
7. Mucoid or mucopurulent nasal discharge.
b. OSAS
8. By digital palpation of the nasopharynx:
c. In infants there is difficulty in feeding and suckling and may be loss of weight
The adenoid tissue is felt as if toutching a punch
d. Nasal tone of voice {hyponasality or rhinlalia clousa}
of earth warm
e,. Bilateral nasal discharge
Investigation: 🔹
f. Recurrent rhinitis and sinusitis
2. E.T.Obstruction:
a. S.O.M.
1. Plain X ray lateral view:
Show a radiopaque soft tissue shadow arising from the
superior and posterior walls of the nasopharynx with 🔹
b. Recurrent ASOM.
3. Adenoid facies:
a. Open mouth with prominent incisors {prognathism}.
narrowing of the nasopharyngeal air column.
2. Audiogram and Tympanogram. b. Elevated short pinched up upper lip
3. Endoscopy: flexible and rigid. C. Atrophic ala nasi with narrow anterior nares
d. Receeding mandible with enlarged lower lib
e. Flat nasolabial fold giving the face apathic expression look
🔹
Treatment: f. High arched palate.
Adenoidectomy: 4. Oral cavity:
Usually combined with tonsillectomy a. Dental caries.
{adenotonsillictomy}. b. Bleeding gums.
c. Dry mouth.
d. Recurrent pharyngitis and tonsillitis.
🔹
e. Foeter oris.
5. Respiratory:
•A. Descending infection:
a. Laryngitis.
b. Bronchitis.
c. Chest infection.
•B. Post nasal discharge: irritative cough.
•C. Laryngesmus Stridulous {sudden nocturnal laryngeal spasm due to post
🔹
nasal discharge in children}.
6. Cardiovascular:
-A. Chronic hypoxia leads to:
a. Pulmonary hypertension
b. Cor pulmonale
c. Cardiac arrhythmia
-B. sudden death.
