Tonsils And Adenoids

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tonsilitis and adenoid

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Tonsils And Adenoids

  1. 1. Tonsils and Adenoids Anatomy: Pharynx : - nasopharynx - Oropharynx - Laryngopharynx.
  2. 2. Anatomy
  3. 3. 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.
  4. 5. 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.
  5. 7. Functions : <ul><li>- Concerned with immune </li></ul><ul><li>mechanism. </li></ul><ul><li>- 1st line of defense. The lymphoid tissues produce lymphocytes. </li></ul><ul><li>- T-cells produce plasma cells & help in antibody formation. </li></ul>
  6. 8. Pathology : <ul><li>Inflammatory : Bacterial (strept. & other pyogenic organisms ,viral, fungal . It can be specific or none-specific. Also can be acute or chronic . </li></ul><ul><li>Neoplastic : benign or malignant. </li></ul>
  7. 10. Ca Tonsil Lt
  8. 12. Acute tonsillitis <ul><li>Acute follicular tonsillitis </li></ul><ul><li>Acute parynchymatous T. </li></ul><ul><li>Membranous Tonsillitis </li></ul>
  9. 14. Clinical Features : <ul><li>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) </li></ul>
  10. 15. Symptoms <ul><li>-- Pyrexia </li></ul><ul><li>-- Pain on swallowing </li></ul><ul><li>-- Malaise </li></ul><ul><li>-- Constipation </li></ul><ul><li>-- Earache. </li></ul><ul><li>-- sore throat </li></ul>
  11. 16. Signs: <ul><li>- Increase in size. </li></ul><ul><li>- Follicles, membranes or congestion. </li></ul><ul><li>- enlarged tender, Jugulo-diagastric glands. </li></ul><ul><li>- Fetor (halitosis). </li></ul>
  12. 17. Differential Diagnosis : <ul><li>-Scarlet fever (strep.) </li></ul><ul><li>-Diphtheria </li></ul><ul><li>-Vincent's angina (B. Vincenti, fusiform bacilli & spirochaetes ) </li></ul><ul><li>-agranulocytosis – marked reduction in neutrophils  ulcerations & false memb. </li></ul><ul><li>-Glandular fever (viral  marked increase in monocytes & lymphocytes=mononuclear cells). </li></ul><ul><li>- leukemia (blood picture & sternal puncture). </li></ul>
  13. 18. Investigations: <ul><li>TWBC + Differential. </li></ul><ul><li>Hb% </li></ul><ul><li>Swab C/ S </li></ul><ul><li>ESR </li></ul><ul><li>ASO Titer </li></ul>
  14. 19. Treatment: <ul><li>-Bed rest </li></ul><ul><li>-Fluids </li></ul><ul><li>-Soft diet </li></ul><ul><li>-Analgesics </li></ul><ul><li>-Antibiotics: Penicillins,cephalosporins </li></ul>
  15. 21. Complications and Sequelae : <ul><li>Peritonsillar abscess </li></ul><ul><li>Retropharyngeal abscess </li></ul><ul><li>Para pharyngeal abscess </li></ul><ul><li>Rheumatic fever </li></ul><ul><li>Glumerulo-nephritis </li></ul><ul><li>chr. tonsillitis. </li></ul>
  16. 22. Chronic Tonsillitis <ul><li>-Follicular </li></ul><ul><li>-Parenchymatous </li></ul><ul><li>= Hypertrophy </li></ul><ul><li>=Atrophic </li></ul>
  17. 23. Clinical Features : <ul><li>- Rec. infection </li></ul><ul><li>- sore throat </li></ul><ul><li>- congested pillars </li></ul><ul><li>- irritating cough </li></ul><ul><li>-Increase in size. </li></ul>
  18. 24. Diff. Diag. : <ul><li>Physiological. </li></ul><ul><li>Pharyngitis </li></ul><ul><li>Malignancy </li></ul>
  19. 25. Treatment: <ul><li>- Conservative Medical </li></ul><ul><li>Treatment . </li></ul><ul><li>- Surgical : i.e Tonsillectomy . </li></ul>
  20. 26. Indications for tonsillectomy: <ul><li>- Rec. infections (> 4x per year). </li></ul><ul><li>- sleep apnoea syndrome . </li></ul><ul><li>- peritonsillar abscess. </li></ul><ul><li>- Carrier state (strep., Diphtheria bacilli). </li></ul><ul><li>- Others: Access, malign. Susp </li></ul>
  21. 27. Complications : <ul><li>Haemorrhage (primary, reactionary, secondary ). </li></ul><ul><li>Nasal regurg. </li></ul><ul><li>Septicaemia. </li></ul><ul><li>Operative complications. </li></ul>
  22. 28. ADENOIDS <ul><li>Def. : hypertrophy of the nasopharyngeal </li></ul><ul><li>tonsil sufficient to produce symptoms. </li></ul><ul><li>Commonest between the age of 3 – 7 years. </li></ul>
  23. 29. Pathology: <ul><li>- Simple inflammatory : </li></ul><ul><li>Infection or allergy </li></ul><ul><li>- Tuberculosis : Rare . </li></ul>
  24. 30. Clinical Features : <ul><li>Symptoms & Signs : </li></ul><ul><li>Nasal obstruction : - snoring , mouth breathing , nasal tone , difficult suckling in infants. </li></ul><ul><li>Adenoid facies : narrow pinched nose, open mouth, high arched palate, crowded upper incisors teeth, receding chin & idiotic look. </li></ul><ul><li>Flat or pigeon chest due to repeated respiratory infections. </li></ul><ul><li>Nasal discharge : mucopurulent . </li></ul><ul><li>E.T. obstruction : recurrent attacks of secretory or suppuritive otitis media. </li></ul><ul><li>Obstructive sleep apnea syndrome : cor pulmonale & right sided heart failure . </li></ul><ul><li>Nocturnal enuresis , hypoxemia & apathy. </li></ul>
  25. 31. Diagnosis : <ul><li>- Clinical . </li></ul><ul><li>- Posterior rhinoscopy </li></ul><ul><li>- X- ray. </li></ul>
  26. 32. Treatment: <ul><li>Medical : nasal decongestants . </li></ul><ul><li>Surgical : adenoidectomy. </li></ul>
  27. 33. Complications : <ul><li>Palatal scaring , Nasal speech (rhinolalia operta), </li></ul><ul><li>Nasal regurgitations. </li></ul><ul><li>- Remnants ? Recurrence. </li></ul>

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