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Throat.pptx
- 1. Throat 1
- 2. Contents • Anatomy & physiology • S/S, investigations • Sore throat • Abscess • Dysphonia • Stridor 2
- 3. 3
- 4. This include – • the oral cavity • pharynx • larynx • major salivary glands 4
- 5. Pharynx extend from base of skull to cricopharyngel sphincter below • Nasopharynx • Oropharynx • Hypopharynx 5
- 6. Deglutition 3 stages – (1) Oral phase (2) Pharyngeal phase (3) Oesophageal phase 6
- 7. 7
- 8. 8
- 9. Functions of larynx: 1.Protect tracheobronchial tree 2.Voice production 3.Respiratory passage 9
- 10. 10
- 11. Symptoms, Signs & Examination Oral cavity • Pain • masses • ulceration • haemorrhage • halitosis • ageusia • discolouration 11
- 12. Pharynx 12
- 13. Larynx • Change of voice • respiratory difficulty / Stridor • pain • aspiration Neck lumps 13
- 14. Examination • Oral examination • ENT examination 14
- 15. • Rigid Scope 15
- 17. • Direct or Micro Laryngoscope 17
- 18. • Imagings 18
- 19. SORE THROAT 19
- 20. Sore throats • Acute pharyngitis • Acute tonsilitis • Peritonsilar abscess • blood disorders • candidiasis • glandular fever 20
- 21. Viral infection • Pharyngotonsilitis – common • associated with running nose and cough • conservative management Bacterial tonsilitis • secondary to viral infection • streptococcus,H influzae etc • dysphagia, odynophagia, fever , cervical L/N • antibiotic, analgesic, antipyretic 21
- 23. 23
- 24. Complications of tonsillectomy • Haemorrhage • Pain • Infection • Trauma 24
- 25. ABSCESS AROUND THE PHARYNX 25
- 26. Abscess around the Pharynx Peritonsillar abscess (Quinsy) Definition - an abscess between the tonsil and the adjacent lateral pharyngeal wall (superior constrictor muscle) Pathogenesis - follow an acute attack of tonsillitis usually unilateral and lies above the tonsil near the soft palate preceded by cellulitis. 26
- 27. Symptoms • Severe pain • Odynophagia • Fever • Otalgia • Salivation + dribbling • Thickened speech • Trismus 27
- 28. Signs Marked hyperaemia and edema of tonsils, palate and uvula, pushing the latter to the unaffected side Management consist of - rest, fluid, I&D , tonsillectomy ( 6 weeks ) 28
- 29. Ludwig’s Angina • Definition – cellulitis of the floor of mouth and submandibular space of neck • Pathology – usually due to infection with Hemolytic streptococcus as complication of pharyngitis or oral sepsis. • Symptoms – pain in floor of mouth ( tongue) - drolling of saliva - swelling neck - difficulty in breathing 29
- 30. Signs • Hard tender brawny swelling between the chin and neck detected on bimanual exam • Fluctuation may be negative • Fever and toxemia present • edema of glottis ( sudden death ) Management full dose of antibiotics with I & D ( Hilton’s method ) 30
- 31. Retropharyngeal abscess Definition – It is an abscess in the fascial space behind the pharyngeal muscles causes - suppuration of retropharyngeal lymph nodes - penetration of pharyngeal wall by sharp FB - caries of bodies of cervical vertebra. 31
- 32. Symptoms & Signs • Breathing difficulty • Torticollis • Pyrexia • Swelling of posterior pharyngeal wall • ill and toxic • Airway obstruction 32
- 33. Management • Medical – Antibiotics • Surgical – I&D through open mouth 33
- 34. Parapharyngeal abscess Definition - suppurative infection of the parapharyngeal space Causes - suppuration of lymph node - penetration of lateral pharyngeal wall by sharp FB - spread of infection from tonsils, peritonsillar space, lower wisdom tooth ,its surrounding gums and bones 34
- 35. Symptoms • Pain in throat especially on swallowing • pyrexia Signs • trismus • torticollis • tender red fluctuant swelling of neck • pharyngeal wall and tonsil are pushed medially 35
- 36. Management • Medical – antibiotics, analgesics • Surgical – I&D via external approach Complications • acute edema of the larynx • thrombophlebitis of jugular vein • Septicaemia • direct spread to mediastinum 36
- 38. Dysphonia (Organic causes) “An alteration in the quality of voice” • Inflammatory - acute laryngitis - chronic laryngitis • Neoplasia - Ca larynx, Papillomata • Neurological - Myasthenia gravis, Ca lung /breast, post thyroidectomy • Systemic - Hypothyroidism,Rheumatoid arthritis 38
- 39. Inflammatory lesion Acute laryngitis • Infection ~ very common ~ upper respiratory tract infection ~ associated with pain in throat ~ spontaneous resolution ~ Steam inhalation ~ referral if symptoms persist 39
- 40. • Non-infected ~ shouting ~ foreign bodies ~ fumes, tobacco, smokes or chemicals ~ may produce edema and respiratory embarrassment 40
- 41. • Inflammatory polyps ~ not uncommon ~ history similar to acute laryngitis ~ removal under microlaryngoscope 41
- 42. Neoplastic lesions • Ca larynx - Old age, male - Smoking, alcohol - Hoarseness of voice, stridor - Direct laryngoscopy and biopsy - Surgery and Radiotherapy 42
- 43. • Juvenile recurrent respiratory papilloma - children - human papilloma virus - Warty lesions - larynx, trachea, bronchi, pharynx 43
- 45. Systemic causes • Hypothyroidism – chronic edema of vocal cord • Angioneurotic edema – type I allergic response • Rheumatoid arthritis – fixation of cricoarytenoid joint Management of dysphonia • treat the underlying causes 45
- 46. 46
- 47. It is a noisy and difficult breathing due to partial obstruction of upper airway. 47
- 48. A case of stridor due to malignant infiltration to trachea from Ca thyroid 48
- 49. Causes of stridor 1.Congenital (a) Laryngeal stenosis (b) Laryngomalacia – congenital softness of larynx (c) Laryngeal web 2.Traumatic (a) External – blow on larynx e g. dash-board injury 49
- 50. (b) Internal – foreign body corrosive substances fumes 3.Infection Acute laryngotracheobronchitis Acute epiglottitis Ludwig’s angina Diphtheria 50
- 51. 4.Tumour (a) Benign – Papillomas (Juvenile recurrent respiratory papillomatosis) (b) Malignant – Ca larynx 5.Neurological (a) Bilateral recurrent laryngeal nerve palsy (b) Bulbar palsy 6. Miscellaneous Angioneurotic edema 51
- 53. Laryngeal web 53
- 59. Ca larynx 59
- 60. Emergency Management • Important to realize that relief of stridor is more important than knowing causes of stridor. • Oxygen inhalation Tracheostomy – don’t wait for obvious cyanosis 60
- 61. Definitive Management 1. Confirmation of diagnosis 2. Remove the cause when possible, or timely referral when removal of cause is not possible. 3. Regular follow-up 61
- 62. Tracheostomy An operation where by an opening made in the anterior wall of trachea and converted it to stoma 62
- 63. Indications 1. Relief of upper airway obstruction 2. Protection of tracheo-bronchial tree & to facilitate tracheal toilet 3.Treatment of respiratory insufficiency - to reduce dead space - to institute IPPR 63
- 64. Standard Method of Tracheostomy 1. Anaesthesia – LA or GA 2. Position – Supine position Extended neck (pillow under the shoulder) 1 2 64
- 65. 3.Incision – Horizontal incision at midway between cricoid and suprasternal notch 3 4 5 65
- 66. - Strap muscles are separated laterally 4. Procedure 66
- 67. Thyroid isthmus is lifted up or divided 67
- 68. • A circular opening is made over 3rd and 4th tracheal ring in adult and midline slit is made in children 68
- 69. - Tracheostomy tube is inserted with dilator 69
- 70. 70
- 71. - Bleeding points were secured - Tracheostomy tube was secured with tape. 71
- 72. 72
- 73. Complications 1.Haemorrhage and infection 2.Dislodgement of tube (proper applying of tape) 3.Injury to surrounding structures 73
- 74. 4.Surgical emphysema, pneumothorax 5.Tube blockage – by dry mucous forming crusts 6.Subglottic stenosis – of 1st ring was cut 7.Decannulation problem 74
- 75. 75
- 76. Foreign Bodies Inhaled foreign bodies(airpassage) • under 4 years (75%) • features depend on types and location in laryngotracheobronchial tree • vegetable materials – severe mucosal react: • may be rapidly fetal • first aids 76
- 77. 77
- 78. Clinical features • Child previously healthy with sudden onset • aphonia, wheezing,stridor,choking, coughing • chest and neck X’ray • Scopy Treatment Scopy and removal 78
- 79. Swallowed Foreign bodies • sharp / round • Sites – • mostly – tonsils, • root of tongue, • Valeculla • Pyriform fossa, • post cricoid • oesophagus 79
- 80. clinical features • foreign body sensation • dysphagia • odynophagia • regurgitation • s/s of complication (abscess) • always believe the patient! 80
- 81. Diagnosis and treatment • site of foreign (midline/lateral?) • external tenderness • Inspection of oral cavity , oropharynx • Indirect laryngeal mirror to inspect – root of tongue, valeculla, hypopharynx and larynx • Lateral Neck X’ray (some are radiolucent) • Oesophagoscope • Removal with forceps • important to expect underlying pathology in meat bolus in oesophagus 81