Atrophic rhinitis is a chronic inflammatory disease characterized by atrophy of the nasal mucosa and turbinates. It is classified as primary or secondary. Primary atrophic rhinitis has no identifiable cause, while secondary is caused by infections, surgery, or nasal septal deviations. Symptoms include a fetid odor, crusting, and nasal obstruction. Treatment involves local and systemic antibiotics, steroids, irrigation, and surgical procedures like Young's operation to reduce nasal volume and crusts.
Vasomotor rhinitis is a chronic non-allergic rhinitis caused by an imbalance of the autonomic nervous system leading to hyperactivity of the nasal mucosa. Symptoms include recurrent sneezing, rhinorrhea, and nasal obstruction. The exact cause is unknown but it involves overactivity of the parasympathetic nervous system causing vasodilation and secretion from the nasal glands. Treatment focuses on avoiding triggers, using oral or topical decongestants and steroids, and in severe cases, short term systemic steroids or surgical procedures like turbinate reduction.
1. Tuberculosis of the larynx commonly affects the posterior larynx, causing submucosal tubercles that can ulcerate, forming undermined ulcers. Symptoms include throat pain, hoarseness, and dysphagia. Diagnosis involves chest X-ray, sputum examination, laryngoscopy, and biopsy. Treatment consists of anti-tubercular drugs, vocal rest, and nutrition supplements.
2. Scleroma of the larynx is caused by Klebsiella rhinoscleromatis and commonly involves the subglottic region, presenting as a smooth red swelling. Diagnosis involves biopsy and culture. Treatment includes antibiotics, steroids, and surgery for stenosis
Tonsils and adenoids
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
This document discusses tonsils and adenoids. It defines tonsils and their anatomy, blood supply, drainage and relations. It describes acute and chronic tonsillitis and complications. It compares tonsils and adenoids and discusses signs, investigations and treatment of tonsillitis. It also discusses other conditions that can involve the tonsils like peritonsillar abscess, tonsilloliths and adenoid hypertrophy.
Waldeyer's ring consists of lymphoid tissue in the pharynx including the palatine tonsils, lingual tonsils, tubal tonsils, and adenoids. The document discusses the anatomy, histology, blood supply, innervation and functions of these structures. It also covers common conditions that involve the tonsils such as tonsillitis, peritonsillar abscess, adenoiditis and pharyngitis. The causes, signs, symptoms and treatment of these conditions are described.
Nasal polyps are non-cancerous masses of swollen nasal or sinus mucosa. There are two main types: bilateral ethmoidal polyps and antrochoanal polyps. Bilateral ethmoidal polyps commonly arise from inflammatory conditions like rhinosinusitis or disorders of ciliary motility. Antrochoanal polyps originate from the maxillary sinus near its opening and grow into the nasal cavity and nasopharynx. Symptoms include nasal obstruction, loss of smell, headache and discharge. Signs include pale grape-like masses seen on nasal examination. Treatment involves polypectomy or endoscopic sinus surgery. Recurrence is less common for antrochoanal polyps if completely removed from their
Atrophic rhinitis is a chronic inflammatory disease characterized by atrophy of the nasal mucosa and turbinates. It is classified as primary or secondary. Primary atrophic rhinitis has no identifiable cause, while secondary is caused by infections, surgery, or nasal septal deviations. Symptoms include a fetid odor, crusting, and nasal obstruction. Treatment involves local and systemic antibiotics, steroids, irrigation, and surgical procedures like Young's operation to reduce nasal volume and crusts.
Vasomotor rhinitis is a chronic non-allergic rhinitis caused by an imbalance of the autonomic nervous system leading to hyperactivity of the nasal mucosa. Symptoms include recurrent sneezing, rhinorrhea, and nasal obstruction. The exact cause is unknown but it involves overactivity of the parasympathetic nervous system causing vasodilation and secretion from the nasal glands. Treatment focuses on avoiding triggers, using oral or topical decongestants and steroids, and in severe cases, short term systemic steroids or surgical procedures like turbinate reduction.
1. Tuberculosis of the larynx commonly affects the posterior larynx, causing submucosal tubercles that can ulcerate, forming undermined ulcers. Symptoms include throat pain, hoarseness, and dysphagia. Diagnosis involves chest X-ray, sputum examination, laryngoscopy, and biopsy. Treatment consists of anti-tubercular drugs, vocal rest, and nutrition supplements.
2. Scleroma of the larynx is caused by Klebsiella rhinoscleromatis and commonly involves the subglottic region, presenting as a smooth red swelling. Diagnosis involves biopsy and culture. Treatment includes antibiotics, steroids, and surgery for stenosis
Tonsils and adenoids
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
This document discusses tonsils and adenoids. It defines tonsils and their anatomy, blood supply, drainage and relations. It describes acute and chronic tonsillitis and complications. It compares tonsils and adenoids and discusses signs, investigations and treatment of tonsillitis. It also discusses other conditions that can involve the tonsils like peritonsillar abscess, tonsilloliths and adenoid hypertrophy.
Waldeyer's ring consists of lymphoid tissue in the pharynx including the palatine tonsils, lingual tonsils, tubal tonsils, and adenoids. The document discusses the anatomy, histology, blood supply, innervation and functions of these structures. It also covers common conditions that involve the tonsils such as tonsillitis, peritonsillar abscess, adenoiditis and pharyngitis. The causes, signs, symptoms and treatment of these conditions are described.
Nasal polyps are non-cancerous masses of swollen nasal or sinus mucosa. There are two main types: bilateral ethmoidal polyps and antrochoanal polyps. Bilateral ethmoidal polyps commonly arise from inflammatory conditions like rhinosinusitis or disorders of ciliary motility. Antrochoanal polyps originate from the maxillary sinus near its opening and grow into the nasal cavity and nasopharynx. Symptoms include nasal obstruction, loss of smell, headache and discharge. Signs include pale grape-like masses seen on nasal examination. Treatment involves polypectomy or endoscopic sinus surgery. Recurrence is less common for antrochoanal polyps if completely removed from their
This document discusses diseases of the external ear. It begins by describing the anatomy of the external ear canal. It then categorizes conditions affecting the external ear into congenital, inflammatory, reactive, traumatic, and tumors. Under congenital conditions it discusses preauricular sinus, congenital ear swellings, fistulas and anomalies. It provides details on preauricular sinus including embryology, clinical features, management and associated syndromes. It also discusses other congenital conditions such as ear swellings, fistulas and atresia. The document further describes inflammatory conditions including erysipelas, perichondritis and malignant otitis externa. It also covers reactive, traumatic, and neoplastic conditions of the external
RETROPHARYNGEAL ABSCESS
Retropharyngeal abscess ia an infection of the retropharyngeal space
Retropharyngeal space is a potential space posterior to the pharynx and the cervical oesophagus
Often presents late, most times in airway obstruction
It is life threatening,adequate care and management is needed
Mortality and morbidity often follows delayed or missed diagnosis
This document discusses chronic rhinosinusitis (CRS). It defines CRS and outlines its main subtypes and symptoms. It describes the histopathology and pathomechanisms involved, as well as common comorbidities. Diagnosis involves nasal endoscopy, CT scans, and allergy testing. Treatment includes topical corticosteroids, antibiotics, antifungals, and surgery for refractory cases.
This document contains 11 multiple choice questions regarding the OSCE examination for Ear, Nose and Throat. Each question provides images, descriptions of patient presentations, and asks for diagnoses, management plans, or other clinical information. The answers to each question are also provided.
Chronic tonsillitis has several causes including complications from acute sinusitis or subclinical infections of the tonsils or sinuses. It most commonly affects children and young adults. There are three main types: chronic follicular tonsillitis where the tonsillar crypts are full of infected material; chronic parenchymatous tonsillitis with enlarged lymphoid tissue; and chronic fibroid tonsillitis where the tonsils are small but infected. Clinical features include recurrent sore throats, throat irritation, bad breath, and difficulty swallowing. Examination may show enlarged or small tonsils with pus or debris. Complications can include peritonsillar abscess, tonsilloliths, or intratonsillar
This document provides an overview of adenotonsillar diseases, including the anatomy and functions of the tonsils and adenoids. It discusses acute infections like tonsillitis, peritonsillar abscesses, and infectious mononucleosis. Chronic diseases covered include chronic tonsillitis, tonsillar hypertrophy, and adenoid hypertrophy. The document also reviews surgical indications and techniques for tonsillectomy and adenoidectomy.
Nasal polyps can be either antrochoanal polyps, typically seen in children, or ethmoid polyps, more common in adults. Antrochoanal polyps originate in the maxillary sinus and extend backwards towards the nasopharynx, while ethmoid polyps originate in the ethmoid sinuses and grow forwards, often bilaterally. Treatment involves surgical removal of antrochoanal polyps and may require postoperative antibiotics to prevent recurrence, whereas ethmoid polyps are usually first treated medically with steroids and antihistamines and only require surgery if medical treatment fails or for large polyps.
Diseases of middle ear;csom(safe&unsafe)&cholesteatoma dr.davis thoma...ophthalmgmcri
This document discusses chronic suppurative otitis media (CSOM), including the types, symptoms, signs, investigations, and treatment options. It describes CSOM as a long-standing middle ear infection characterized by continuous or intermittent ear discharge through a perforated eardrum. The two main types are tubotympanic disease, confined to the anterior middle ear, and atticoantral disease, involving the posterior middle ear and associated with bone erosion and possible cholesteatoma formation. Treatment involves medical management with antibiotics and surgery such as myringoplasty, tympanoplasty, and mastoidectomy depending on the severity and extent of disease.
This document describes the indications, techniques, and postoperative care for septoplasty surgery. It indicates that septoplasty is performed to correct a deviated nasal septum causing obstruction or other issues. The key steps described are making an incision, raising mucoperichondrial flaps, removing deviated cartilage and bone, and re-approximating the flaps. Potential complications are also outlined.
palatine tonsil, its anatomy, diseases and their managementVaibhav Lahane
The document provides information on the anatomy, physiology, and diseases of the palatine tonsils. It discusses the embryology, blood supply, innervation, and lymphatic drainage of the tonsils. Common diseases covered include acute and chronic tonsillitis, peritonsillar abscess, and tonsilloliths. The tonsils play an important role in the immune system as part of Waldeyer's ring.
Acute mastoiditis is an inflammation of the mucosal lining of the mastoid air cells caused by bacteria or viruses. It presents with earache, fever, and ear discharge. On examination, the mastoid area is tender and the posterior meatal wall may be sagging. Complications can include abscesses, meningitis, or thrombophlebitis if left untreated. Treatment involves antibiotics and sometimes myringotomy or cortical mastoidectomy surgery.
Rhinoscleroma is a chronic granulomatous disease caused by Klebsiella rhinoscleromatis bacteria. It primarily affects the nose and can spread to the throat and larynx. The disease progresses through three stages - an initial atrophic stage with crusting, followed by a granulomatous nodular stage with non-ulcerative nodules, and finally a cicatrizing stage with scarring and distortion of normal anatomy. Diagnosis involves culture, serological tests, and biopsy showing characteristic Mikulicz cells and Russell bodies. Treatment involves long-term high-dose antibiotics like streptomycin and tetracycline for 4-6 weeks. Local injections of carbolic acid or radiation therapy
1) The document discusses the surgical approach and procedure for cortical mastoidectomy. Key steps include raising skin and periosteal flaps, drilling along anatomical landmarks like the sigmoid sinus and facial nerve to identify structures, and widening the aditus and performing a posterior tympanotomy to access the mesotympanum.
2) Post-operative care involves drain removal within 48 hours and dry dressing of the ear. Potential complications discussed are persistent deafness, facial nerve injury, CSF leak, hemorrhage and infection.
3) The patient is advised restricted activity for 3 weeks followed by a gradual return to normal activity over 4 weeks, and to keep the operation site dry.
Chronic tonsillitis refers to chronic inflammation of the palatine tonsils. It is characterized by (1) complaints reported by the patient such as recurring sore throats, (2) disruption of the tonsils' drainage function, and (3) morphological changes seen on histological examination. Compensated chronic tonsillitis presents with no complaints but local signs of inflammation, while decompensated chronic tonsillitis results in frequent sore throats, abscesses, and possible complications affecting other organs. Adenoid hypertrophy involves enlargement of the lymphoid tissue in the nasopharynx and can partially or fully block the nasal cavity, leading to various respiratory, ear, facial, dental, sleep
1. Vasomotor rhinitis is a non-allergic form of rhinitis characterized by symptoms like nasal obstruction, rhinorrhea, and sneezing without an allergic cause.
2. It occurs due to an imbalance between the sympathetic and parasympathetic nervous systems leading to hyperreactivity of the nasal mucosa.
3. Treatment includes avoidance of triggers, oral antihistamines, topical steroids, and addressing any psychological factors. Surgery may help if medical treatment fails.
This patient presented with conductive hearing loss and tinnitus in the left ear. Examination showed normal appearing ear drums with normal mobility. The audiogram showed a characteristic Carhart's notch, indicating the probable diagnosis of otosclerosis. Otosclerosis causes stapes fixation leading to conductive hearing loss and is identified by the notch on bone conduction testing.
1. Peritonsillar abscess (Quinsy) is most commonly caused by Streptococcus pyogenes, S. aureus, and anaerobes and presents with high fever, severe throat pain, difficulty swallowing, and muffled speech.
2. Parapharyngeal abscess occurs in the space lateral to the pharynx and can be caused by infections from the pharynx, teeth, or ear spreading to other spaces. Clinical features include bulging in the throat, cranial nerve palsies, and swelling of the parotid region.
3. Retropharyngeal abscess most often affects children and is caused by lymph node suppuration, while in adults it is
1) Otitis media with effusion (OME), also known as glue ear, is a chronic accumulation of fluid in the middle ear behind an intact but retracted eardrum that can cause hearing loss.
2) It commonly affects young children, with the highest prevalence between ages 2-5 years old. Risk factors include age, male gender, family history, and exposure to smoke.
3) The fluid is caused by eustachian tube dysfunction preventing drainage and ventilation of the middle ear, which can be due to infections, allergies, or adenoid hypertrophy among other factors.
1. A 10-year-old boy presents with high fever, sore throat, and difficulty swallowing for 4 days. His tonsils are inflamed and enlarged with white membranes.
2. Differential diagnoses include membranous tonsillitis, diphtheria, infectious mononucleosis, leukemia, and peritonsillar abscess.
3. Membranous tonsillitis is caused by pyogenic organisms forming an exudative membrane over the tonsils. Diphtheria and infectious mononucleosis can also present with white membranes over the tonsils.
The document discusses the anatomy, functions, and types of acute and chronic tonsillitis. It describes the location and structures of the palatine tonsils. Acute tonsillitis is usually caused by bacterial or viral infections and causes sore throat, fever, and difficulty swallowing. It can be superficial, follicular, membranous, or parenchymatous. Chronic tonsillitis is a complication of repeated acute infections and can be follicular, parenchymatous, or fibroid. Symptoms include recurrent sore throats and tonsil enlargement may require tonsillectomy.
This document discusses diseases of the external ear. It begins by describing the anatomy of the external ear canal. It then categorizes conditions affecting the external ear into congenital, inflammatory, reactive, traumatic, and tumors. Under congenital conditions it discusses preauricular sinus, congenital ear swellings, fistulas and anomalies. It provides details on preauricular sinus including embryology, clinical features, management and associated syndromes. It also discusses other congenital conditions such as ear swellings, fistulas and atresia. The document further describes inflammatory conditions including erysipelas, perichondritis and malignant otitis externa. It also covers reactive, traumatic, and neoplastic conditions of the external
RETROPHARYNGEAL ABSCESS
Retropharyngeal abscess ia an infection of the retropharyngeal space
Retropharyngeal space is a potential space posterior to the pharynx and the cervical oesophagus
Often presents late, most times in airway obstruction
It is life threatening,adequate care and management is needed
Mortality and morbidity often follows delayed or missed diagnosis
This document discusses chronic rhinosinusitis (CRS). It defines CRS and outlines its main subtypes and symptoms. It describes the histopathology and pathomechanisms involved, as well as common comorbidities. Diagnosis involves nasal endoscopy, CT scans, and allergy testing. Treatment includes topical corticosteroids, antibiotics, antifungals, and surgery for refractory cases.
This document contains 11 multiple choice questions regarding the OSCE examination for Ear, Nose and Throat. Each question provides images, descriptions of patient presentations, and asks for diagnoses, management plans, or other clinical information. The answers to each question are also provided.
Chronic tonsillitis has several causes including complications from acute sinusitis or subclinical infections of the tonsils or sinuses. It most commonly affects children and young adults. There are three main types: chronic follicular tonsillitis where the tonsillar crypts are full of infected material; chronic parenchymatous tonsillitis with enlarged lymphoid tissue; and chronic fibroid tonsillitis where the tonsils are small but infected. Clinical features include recurrent sore throats, throat irritation, bad breath, and difficulty swallowing. Examination may show enlarged or small tonsils with pus or debris. Complications can include peritonsillar abscess, tonsilloliths, or intratonsillar
This document provides an overview of adenotonsillar diseases, including the anatomy and functions of the tonsils and adenoids. It discusses acute infections like tonsillitis, peritonsillar abscesses, and infectious mononucleosis. Chronic diseases covered include chronic tonsillitis, tonsillar hypertrophy, and adenoid hypertrophy. The document also reviews surgical indications and techniques for tonsillectomy and adenoidectomy.
Nasal polyps can be either antrochoanal polyps, typically seen in children, or ethmoid polyps, more common in adults. Antrochoanal polyps originate in the maxillary sinus and extend backwards towards the nasopharynx, while ethmoid polyps originate in the ethmoid sinuses and grow forwards, often bilaterally. Treatment involves surgical removal of antrochoanal polyps and may require postoperative antibiotics to prevent recurrence, whereas ethmoid polyps are usually first treated medically with steroids and antihistamines and only require surgery if medical treatment fails or for large polyps.
Diseases of middle ear;csom(safe&unsafe)&cholesteatoma dr.davis thoma...ophthalmgmcri
This document discusses chronic suppurative otitis media (CSOM), including the types, symptoms, signs, investigations, and treatment options. It describes CSOM as a long-standing middle ear infection characterized by continuous or intermittent ear discharge through a perforated eardrum. The two main types are tubotympanic disease, confined to the anterior middle ear, and atticoantral disease, involving the posterior middle ear and associated with bone erosion and possible cholesteatoma formation. Treatment involves medical management with antibiotics and surgery such as myringoplasty, tympanoplasty, and mastoidectomy depending on the severity and extent of disease.
This document describes the indications, techniques, and postoperative care for septoplasty surgery. It indicates that septoplasty is performed to correct a deviated nasal septum causing obstruction or other issues. The key steps described are making an incision, raising mucoperichondrial flaps, removing deviated cartilage and bone, and re-approximating the flaps. Potential complications are also outlined.
palatine tonsil, its anatomy, diseases and their managementVaibhav Lahane
The document provides information on the anatomy, physiology, and diseases of the palatine tonsils. It discusses the embryology, blood supply, innervation, and lymphatic drainage of the tonsils. Common diseases covered include acute and chronic tonsillitis, peritonsillar abscess, and tonsilloliths. The tonsils play an important role in the immune system as part of Waldeyer's ring.
Acute mastoiditis is an inflammation of the mucosal lining of the mastoid air cells caused by bacteria or viruses. It presents with earache, fever, and ear discharge. On examination, the mastoid area is tender and the posterior meatal wall may be sagging. Complications can include abscesses, meningitis, or thrombophlebitis if left untreated. Treatment involves antibiotics and sometimes myringotomy or cortical mastoidectomy surgery.
Rhinoscleroma is a chronic granulomatous disease caused by Klebsiella rhinoscleromatis bacteria. It primarily affects the nose and can spread to the throat and larynx. The disease progresses through three stages - an initial atrophic stage with crusting, followed by a granulomatous nodular stage with non-ulcerative nodules, and finally a cicatrizing stage with scarring and distortion of normal anatomy. Diagnosis involves culture, serological tests, and biopsy showing characteristic Mikulicz cells and Russell bodies. Treatment involves long-term high-dose antibiotics like streptomycin and tetracycline for 4-6 weeks. Local injections of carbolic acid or radiation therapy
1) The document discusses the surgical approach and procedure for cortical mastoidectomy. Key steps include raising skin and periosteal flaps, drilling along anatomical landmarks like the sigmoid sinus and facial nerve to identify structures, and widening the aditus and performing a posterior tympanotomy to access the mesotympanum.
2) Post-operative care involves drain removal within 48 hours and dry dressing of the ear. Potential complications discussed are persistent deafness, facial nerve injury, CSF leak, hemorrhage and infection.
3) The patient is advised restricted activity for 3 weeks followed by a gradual return to normal activity over 4 weeks, and to keep the operation site dry.
Chronic tonsillitis refers to chronic inflammation of the palatine tonsils. It is characterized by (1) complaints reported by the patient such as recurring sore throats, (2) disruption of the tonsils' drainage function, and (3) morphological changes seen on histological examination. Compensated chronic tonsillitis presents with no complaints but local signs of inflammation, while decompensated chronic tonsillitis results in frequent sore throats, abscesses, and possible complications affecting other organs. Adenoid hypertrophy involves enlargement of the lymphoid tissue in the nasopharynx and can partially or fully block the nasal cavity, leading to various respiratory, ear, facial, dental, sleep
1. Vasomotor rhinitis is a non-allergic form of rhinitis characterized by symptoms like nasal obstruction, rhinorrhea, and sneezing without an allergic cause.
2. It occurs due to an imbalance between the sympathetic and parasympathetic nervous systems leading to hyperreactivity of the nasal mucosa.
3. Treatment includes avoidance of triggers, oral antihistamines, topical steroids, and addressing any psychological factors. Surgery may help if medical treatment fails.
This patient presented with conductive hearing loss and tinnitus in the left ear. Examination showed normal appearing ear drums with normal mobility. The audiogram showed a characteristic Carhart's notch, indicating the probable diagnosis of otosclerosis. Otosclerosis causes stapes fixation leading to conductive hearing loss and is identified by the notch on bone conduction testing.
1. Peritonsillar abscess (Quinsy) is most commonly caused by Streptococcus pyogenes, S. aureus, and anaerobes and presents with high fever, severe throat pain, difficulty swallowing, and muffled speech.
2. Parapharyngeal abscess occurs in the space lateral to the pharynx and can be caused by infections from the pharynx, teeth, or ear spreading to other spaces. Clinical features include bulging in the throat, cranial nerve palsies, and swelling of the parotid region.
3. Retropharyngeal abscess most often affects children and is caused by lymph node suppuration, while in adults it is
1) Otitis media with effusion (OME), also known as glue ear, is a chronic accumulation of fluid in the middle ear behind an intact but retracted eardrum that can cause hearing loss.
2) It commonly affects young children, with the highest prevalence between ages 2-5 years old. Risk factors include age, male gender, family history, and exposure to smoke.
3) The fluid is caused by eustachian tube dysfunction preventing drainage and ventilation of the middle ear, which can be due to infections, allergies, or adenoid hypertrophy among other factors.
1. A 10-year-old boy presents with high fever, sore throat, and difficulty swallowing for 4 days. His tonsils are inflamed and enlarged with white membranes.
2. Differential diagnoses include membranous tonsillitis, diphtheria, infectious mononucleosis, leukemia, and peritonsillar abscess.
3. Membranous tonsillitis is caused by pyogenic organisms forming an exudative membrane over the tonsils. Diphtheria and infectious mononucleosis can also present with white membranes over the tonsils.
The document discusses the anatomy, functions, and types of acute and chronic tonsillitis. It describes the location and structures of the palatine tonsils. Acute tonsillitis is usually caused by bacterial or viral infections and causes sore throat, fever, and difficulty swallowing. It can be superficial, follicular, membranous, or parenchymatous. Chronic tonsillitis is a complication of repeated acute infections and can be follicular, parenchymatous, or fibroid. Symptoms include recurrent sore throats and tonsil enlargement may require tonsillectomy.
This document discusses common neck swellings, including their anatomy, clinical presentations, investigations, and management. The main points are:
1. Neck lumps in children are rarely malignant, while adults with lateral neck lumps should be investigated to exclude cancer.
2. The neck is divided into anterior and posterior triangles bounded by muscles and bones. Lymph nodes are grouped into levels.
3. Common neck swellings include infected lymph nodes, cysts, tumors, and abscesses. Investigations include physical exam, imaging like CT/MRI, and biopsy. Management depends on diagnosis and may include antibiotics, surgery, or other treatments.
The document discusses acute tonsillitis, describing the anatomy and function of the palatine tonsils, symptoms and signs of acute tonsillitis, typical causative agents, treatment involving analgesics and antibiotics, potential complications, and differential diagnoses for membranous tonsils. It provides details on the tonsils' location in the throat, lymphatic drainage, classifications of tonsillitis, and comparisons to conditions like diphtheria and infectious mononucleosis.
1. The document discusses the anatomy, etiology, symptoms, signs, treatment, and complications of tonsillitis. It describes the palatine tonsils as two oval masses of lymphoid tissue located in the lateral walls of the oropharynx.
2. Common causes of tonsillitis include streptococcus, staphylococci, pneumococci, and H. influenzae bacteria. Symptoms include sore throat, difficulty swallowing, fever, earache, and general body aches. Treatment involves rest, analgesics, and 7-10 days of antimicrobial therapy.
3. Complications of tonsillitis include peritonsillar abscess, rheumatic fever, acute glo
This document provides information about tonsillar diseases, including the anatomy and functions of the tonsils. It describes different types of acute and chronic tonsillitis, their causes, symptoms, and treatments. Acute tonsillitis can be classified as catarrhal, follicular, membranous, or parenchymal, and is usually caused by viruses or bacteria. Chronic tonsillitis may be follicular, parenchymal, or fibroid in type. Conditions like peritonsillar abscess and tonsilloliths are also discussed. Management approaches include antibiotics, analgesics, and surgery such as tonsillectomy. Unilateral tonsillar enlargement can be due to infection, tumors, or other extrapharyngeal causes
The tonsils are lymphoid tissue located in Waldeyer's ring in the pharynx. They help defend against pathogens and produce antibodies. Tonsillitis can be acute, caused by viruses or streptococcus bacteria, or chronic with recurrent infections. Chronic tonsillitis presents with bad breath, sore throat, and debris in crypts. Large tonsils and adenoids can obstruct the airway and cause sleep issues. Tonsillectomy and/or adenoidectomy may be recommended for recurrent infections, airway obstruction, or chronic tonsillitis resistant to other treatments. Complications can include abscesses.
This document discusses diseases of the tonsils and adenoids. It describes the anatomy and functions of the tonsils and adenoids. The tonsils and adenoids are part of the lymphatic system and help fight infections in children. Common diseases that can affect the tonsils include acute and chronic tonsillitis. Acute tonsillitis causes symptoms like sore throat and fever. Complications may include peritonsillar abscesses if not treated. Adenoids are located in the nasopharynx and can cause nasal obstruction if enlarged. Adenoidectomy is the surgical removal of enlarged adenoids.
The palatine tonsils are dense lymphoid tissue located in the lateral wall of the oropharynx and represent the largest accumulation of lymphoid tissue in Waldeyer's ring. The tonsils occupy the tonsillar fossa between the diverging palatoglossal and palatopharyngeal arches. They receive blood supply from branches of the maxillary, facial, and lingual arteries and drain into the internal jugular vein. Tonsillitis is inflammation of the tonsils most commonly caused by bacterial or viral infection, causing sore throat, fever, and difficulty swallowing. Treatment involves pain relief, antibiotics, and potentially tonsillectomy for recurrent cases. Tonsillect
This document provides an overview of lymph nodes and lymphomas. It discusses the anatomy, histology, embryology and functions of lymph nodes. It also examines various pathological conditions of lymph nodes including infections, reactive hyperplasias and lymphomas. The document summarizes different classification systems for lymphomas and describes some of the major lymphoid neoplasms that can involve lymph nodes, such as mantle cell lymphoma. Clinical features and techniques like fine needle aspiration cytology for evaluating lymphomas are also outlined.
This document provides an overview of common neck swellings, including their classification, clinical features, investigations, and treatments. It discusses ubiquitous neck swellings such as sebaceous cysts and lipomas. It also covers midline neck swellings like lymph nodes and thyroid swellings, as well as lateral neck swellings including branchial cleft cysts, laryngoceles, and carotid body tumors. For each condition, the document describes location, symptoms, diagnostic tests, and surgical management approaches.
Tonsillitis is an inflammation or infection of the tonsils caused by bacteria or viruses. The tonsils are located in the throat and are part of the immune system, fighting infections that enter the body through the mouth or nose. Symptoms include a sore throat, difficulty swallowing, and fever. Diagnosis involves examination for swollen tonsils and testing of throat secretions. Treatment focuses on relieving symptoms with medication and antibiotics if bacterial infection is detected. Complications can include abscesses, though tonsil removal may be required for repeated cases. Prevention involves good hygiene and avoiding contact with other sick individuals.
Fissural cysts arise along lines of fusion between embryonic processes. Nasopalatine duct cysts are the most common non-odontogenic cyst, arising from epithelial remnants of the nasopalatine duct. Median palatal cysts occur in the midline of the hard palate from entrapped epithelium. Dermoid and epidermoid cysts contain skin elements and arise from implantation of epithelium during embryonic development. These cysts are examined clinically and radiographically and often surgically removed.
Tonsillitis is an inflammation or infection of the tonsils, which are lymph glands located in the throat that help fight bacteria and viruses. Common causes are streptococcus bacteria and various viruses. Symptoms include sore throat, difficulty swallowing, and fever. Diagnosis involves examination of swollen tonsils and testing of throat secretions. Complications can include abscesses, but tonsillitis is usually treated with antibiotics, acetaminophen, and ibuprofen. Repeated cases may require tonsil removal. Prevention involves avoiding sick people and practicing good hand hygiene.
This document discusses tumors of the larynx, including benign and malignant tumors. It provides details on various benign tumors such as papillomas, paragangliomas, schwannomas, and hemangiomas. It then focuses on malignant tumors, specifically squamous cell carcinoma which is the most common. Details are given on risk factors, pathology, staging, symptoms, workup and various treatment options for laryngeal cancer such as cordectomy, laryngectomy, and chemoradiotherapy.
This document discusses cervical lymph nodes and lymphadenitis. It covers causes of cervical lymphadenitis including infectious, neoplastic, and tuberculous etiologies. It describes acute and chronic cervical lymphadenitis. Tuberculous cervical lymphadenitis is discussed in depth, covering pathology, clinical manifestations, diagnosis, and treatment. Levels of cervical lymph nodes and patterns of neck metastasis are also outlined.
This document discusses cervical lymph nodes and lymphadenitis. It covers causes of cervical lymphadenitis including infectious, neoplastic, and tuberculous etiologies. It describes acute and chronic cervical lymphadenitis. Tuberculous cervical lymphadenitis is discussed in depth, covering pathology, clinical manifestations, diagnosis, and treatment. The levels and patterns of cervical lymph node metastasis are outlined.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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2. OVERVIEW
• Introduction
• Histology of palatine Tonsils
• Functions and Immunology of Palatine Tonsils
• Acute Tonsillitis
• Chronic Tonsillitis
• Tonsillectomy
• Various Tonsillectomy Methods
• Complications of Tonsillectomy
3. INTRODUCTION
• The palatine tonsils are dense compact
bodies of lymphoid tissue that are
located in the lateral wall of the
oropharynx.
• The palatine tonsil represent the largest
accumulation of lymphoid tissue in
Waldeyer's ring.
4. UNIQUENESS OF TONSIL
• Unlike spleen and Lymph node – not
fully encapsulated
• Don’t have afferent lymphatics
• Lymphoepithelial organs
• Presence of crypts
5. TONSILS
• Non keratinised stratified squamous epithelium
• Crypts – 295 cm2
• 4 lymphoid compartments
• Crypt epithelium
• Extrafollicular areas
• Mantle zone of lymphoid follicle
• Germinal centre of lymphoid follicle
6.
7. PHYSIOLOGY AND IMMUNOLOGY
• Tonsil acts as a sentinel to guard against foreign introducers by two
• mechanism;
• Providing local immunity
• Providing surveillance mechanism
• Tonsils- predominantly B-cell organs;
• B cells - 50% to 65%
• T cells - 40%,
• Mature plasma cells – 3 %.
• Conversely, 70% of the lymphocytes in peripheral blood are T cells.
8. • Tonsils are particularly designed for direct transport of
foreign material from the exterior to the lymphoid
cells.
• Intra tonsillar defense mechanisms eliminate weak
antigenic signals.
• Low antigen doses effect the differentiation of
lymphocytes to plasma cells, whereas high antigen
doses produce B-cell proliferation.
• The tonsil produces antibodies (IgG, IgA, IgM )locally, as well as B cell which migrate to other sites
around the pharynx and peri glandular lymphoid tissues to produce antibodies.
9. DISEASED STATE
Inflammation of the reticular crypt epithelium results in shedding of
immunologically active cells
Decreasing antigen transport function with subsequent replacement
by stratified squamous epithelium.
Reduced activation of the local B-cell system
Decreased antibody production
Overall reduction in density of the B-cell and germinal centers in
extrafollicular areas.
10. • The size of the tonsil varies according to the age,
individuality, and pathologic status.
• Actual size of the tonsil is bigger than the one
that appears from its surface .
• At the fifth or sixth year of life, the tonsils rapidly
increase in size, reaching their maximum size at
puberty.
• At puberty, the tonsils measure 20-25 mm in
vertical and 10-15 mm in transverse diameters
11. ANATOMY OF PALATINE TONSILS
• Palatine tonsils are two in number and ovoid
in shape.
• Situated in Tonsillar fossa in lateral wall of
oropharynx.
• Tonsillar fossa - composed of three muscles.
• Palatoglossus muscle - anterior pillar.
• Palatopharyngeal muscle - posterior pillar
• Superior constrictor muscle – laterally – forms
larger part of the tonsillar bed.
12. • Tonsil has -
• Two surfaces- a medial and a lateral
• Two poles - an upper and a lower.
• Medial Surface
• Covered by non-keratinising stratified squamous
epithelium
• Epithelium dips in tonsil stroma to form crypts
• 12-15 crypts
• Crypta magna –a/k/a intratonsillar cleft, represents the
ventral part of second pharyngeal pouch.
• From the main crypts arise the secondary crypts.
13. UPPER POLE
• Extends into soft palate.
• Supratonsillar fossa – potential space
enclosed in a semilunar fold, extending
• between anterior and posterior pillars.
• Weber's glands are tubular mucous glands
located at superior pole of the tonsil. The
glands send a common duct to the tonsil and
secrete saliva on to the surface of the tonsillar
crypts.
14. LOWER POLE
• Attached to the tongue.
• A triangular fold of mucous
membrane extends from
anterior pillar to the
anteroinferior part of tonsil.
• Anterior tonsillar space – Space
enclosed by Triangular fold of
mucous membrane.
15. ACUTE TONSILLITIS
• Acute inflammation of the
faucial tonsils which may
involve the mucosa, crypts,
follicles and or tonsillar
parenchyma
• Children and also frequently in
adults
16. Aetiology
• Most commonly – Primary infection of the Tonsil
Or
• Occurs secondary to the infection of the Upper Respiratory tract
following Viral Infection
23. ACUTE CATARRHAL OR SUPERFICIAL TONSILLITIS
• Viral etiology
• Tonsils are inflamed as a result of
generalised infection of
oropharyngeal mucosa
• Difficult to differentiate from
general pharyngitis
24. ACUTE FOLLICULAR TONSILLITIS
• Severe form, Adults
• Caused by Bacterial Organism – Strep.
haemolyticus, H. influenza
• Inflammation spreads from surface
mucosa into crypts esp. crypta magna
• And also from Crypt to surrounding
follicles
• White yellowish spots on inflamed
tonsils
25. ACUTE MEMBRANOUS TONSILLITIS
• Follicular tonsillitis -
Follicles(exudates) from crypts
unite(coalesce) to form
yellowish white
patch(membrane) over tonsil
• DD – Membrane Over the
Tonsils
26. ACUTE PARENCHYMAL TONSILLITIS
• Characterised by uniform Enlargement of Tonsils
Tonsillar parenchyma is loosely arranged with
inadequate septa
Viral infection – Low immune status
Allows for secondary bacterial infection
Invade the crypts and rapidly spread to
parenchyma
29. SIGNS
• Breath is foetid and tongue is coasted
• Hyperemia of pillars, soft palate and
uvula
• Tonsils – red swollen with yellowish
spots of purulent material / whitish
membrane / enlarged tonsils, congested
meet at midline
• Tender Jugulodigastric Lymph Node
30. LYMPHATIC OF TONSILS
• Upper deep cervical lymph nodes,
especially the jugulodigastric or tonsillar
node.
• JD lymph nodes belong to
Anterosuperior group of Level II LN
• Bounded by;
• IJV
• Facial Vein
• Posterior belly of Digastric
• Other areas draining into JD LN –
• Submandibular gland
• oropharynx
37. SPECIFIC ANTIMICROBIAL THERAPY
• Parenteral
• 1. Benzathine Penicillin (ATD)
Adult – 1.2 Million Units IM one Dose
Children – 25,000 Units /kg IM to max of 1.2 Million units One Dose
• 2.INJ Amoxycillin + Clavulanate
Adult – 1.2 gm 8th hrly
Children – 40mg/kg/day every 8th hrly
38. OTHERS PARENTERAL
• INJ CEFTRIAXONE + CLINDAMYCIN
• INJ CEFUROXIME + CLINDAMYCIN
CEFTRIAXONE CLINDAMYCIN
ADULT 1 gm 12 Hrly or 2gm OD 600 mg/ day 6th hrly
CHILDREN 50-75 mg/kg daily in single
or 12th hrly dose
10-20 mg/kg/day 6th hrly
CEFUROXIME CLINDAMYCIN
ADULT 750MG-1/5 GM 8TH hrly 600 mg/ day 6th hrly
CHILDREN 50-75 mg/kg daily 8th hrly 10-20 mg/kg/day 6th hrly
39. ORAL ANTIBIOTICS
Antibiotics Adult Children
Amoxycillin 500 mg tds 30-40 mg/kg/ day every 8th hrly
Amox + Clavulanate 1 gm bd 40 mg/kg/day every 8th hrly
Erythromycin 250 or 500 mg TID 30-60mg/kg/day
40.
41.
42. MENDL’S PAINT
• CONSTITUENTS
• 1. Iodine – 1.25 gm - Antiseptic
• 2. Potassium Iodide – 2.5 Gm -
• 3. Distilled Water – 2.5 ml - Solvent
• 4. Peppermint Oil – 0.6 ml –
Flavouring Agent
• 5. Glycerin – 10 ml
• Apply over twice daily for 3 days
43. DD for Membrane over the Tonsil
• “ALL VITAMIN D”
• A – Agranulocytosis
• L – Leukemia
• V – Vincent Angina
• I – Infectious Mononucleosis
• T – Trauma
• A- Aphthous Ulcer
• M- Moniliasis
• I – Infection of Throat
• N – Neoplasia
• D- Diphtheria
44. OTHER CAUSES
• Viral:
• IMN, Herpes simplex, HIV
• Bacterial:
• Membranous tonsillitis
• Faucial diphtheria
• Vincent’s angina
• Keratosis of the tonsil
• Secondary syphilis
• Tuberculous tonsillitis
• Others:
• Aphthous ulcers
48. ETIOPATHOGENESIS
• M/C Agent – Beta-hemolytic streptococcus
• Children and Young Adults
• Repeated attacks of acute tonsillitis
• Inadequately resolved acute tonsillitis
• Subclinical infections of tonsils without an acute attack
• Chronic infection in sinuses, oral cavity and teeth.
50. CHRONIC FOLLICULAR TONSILLITIS
• Tonsillar crypts are full of infected cheesy material
• Adults
• Due to repeated attacks of acute tonsillitis
• Recurrent acute inflammations - Inadequate clearance of exudates
• Pressure over tonsillar substance extrudes more debris.
• Tonsils may be enlarged to variable extent.
51. CHRONIC PARENCHYMATOUS TONSILLITIS
Following repeated attacks of Acute Tonsillitis
Lymphoid follicles in the tonsillar parenchyma –
Hypertrophy
Uniform enlargement of the tonsil
Causing food and air way obstruction
52. Patients also have adenoid hypertrophy
Causing snoring and sleep apnoea
• Interfere with speech, deglutition and respiration
53. CHRONIC FIBROTIC TONSILLITIS
• Repeated inflammations atrophy during healing process
• More Fibrotic tissue than the normal parenchyma
• Diagnosis
• Anterior pillars are congested
• Tonsillar size??
• Jugulo-digastric lymphadenopathy is the diagnostic feature for
diagnosis in these patients
54. Symptoms
• Recurrent Attacks of Sore Throat – 3 to 4 times /
year
• Cough – due to chronic irritation
• Hawking sensation or frequent clearing actions of
throat
• Dysphagia
• Halitosis
• Bad taste in mouth – due to pus in crypts
• Thick speech
• Acute excerbations
55. FOUR CARDINAL SIGNS
• Persistent Congestion of anterior pillar
• Ervin-Moore sign – Positive
• Enlarged non-tender Jugulodigastric nodes
• Tonsils - Varying Degree of Enlargement
56. CAUSES FOR U/L TONSILLAR ENLARGEMENT
• Inflammatory
• Acute
• Peri tonsillitis
• Peritonsillar abscess
• Intra tonsillar abscess
• Parapharyngeal abscess
• Chronic
• Tuberculosis of tonsil
• Granulomatous conditions
57. • Trauma
• Surgical trauma
• Hematoma
• Foreign body in the tonsil
• Tumour and tumour like conditions
• Papilloma
• Fibroma
• Tonsillolith
• Tonsillar cyst
• Parapharyngeal Tumours
• Aneurysms of ICA
• NHL
• Kaposi Sarcoma
• Squamous cell carcinoma
60. INVESTIGATIONS
• CBC
• Coagulation profile
• Blood grouping/typing
• ASO titers
• Throat swab for C/S
• Renal and Cardia functions if Rheumatic disease is suspected
• X ray nasopharynx lateral view
61. TREATMENT
• Conservative
1. General health (nutrition, hygiene)
2. Co-existing septic focus in Head/Neck: caries tooth, recurrent
rhinitis/sinusitis, nasopharyngitis, allergic rhinitis
3. Treatment of acute episodes
• Surgical
Tonsillectomy
62. LATERAL SURFACE
• Presents a well-defined fibrous capsule.
• The tonsillar capsule is a specialized
portion of the Pharyngobasilar fascia
• TONSILAR BED
• 1. Loose areolar tissue with Paratonsillar vein
• 2. Pharyngobasilar fascia
• 3. Superior constrictor muscle
• 4. Buccopharyngeal fascia
• 5. Styloglossus
• 6. Glossopharyngeal nerve
• 7. facial artery
• 8. Medial pterygoid muscle
• 9. Angle of mandible
• 10. Submandibular salivary gland
63. IMPORTANCE OF TONSILAR BED
• Capsule - Because of the septa, tonsil is not easily separated from its capsule.
• Loose areolar tissue - One can easily dissect the tonsil by separating the capsule from
the muscle through this loose connective tissue.
• Glossopharyngeal nerve –
• This nerve can be easily injured if the tonsillar bed is violated
• Commonly affected temporarily by edema after tonsillectomy, which produces both a
transitory loss of taste over the posterior third of the tongue and referred otalgia.
• Can be addressed surgically through tonsillar bed for its neuralgia.
• Styloid process -
• Can be addressed surgically through tonsillar bed for Eagle syndrome.
64. ARTERIAL SUPPLY OF TONSILS
• The arterial blood supply of the tonsil enters
primarily at the lower pole, with branches also at
the upper pole.
• At the lower pole:
• Tonsillar branch of the facial artery
• Tonsillar branch of the dorsal lingual artery
Anteriorly
• Ascending palatine artery (a branch of the facial
artery) posteriorly
• At the upper pole:
• Ascending pharyngeal artery enters posteriorly
• Lesser palatine artery enters on the anterior
surface.
65. NERVE SUPPLY
• Tonsillar branches of the
glossopharyngeal nerve about
the lower pole of the tonsil
• Descending branches of the
lesser palatine nerves, which
course through the
pterygopalatine ganglion.
66. TONSILLECTOMY - ABSOLUTE INDICATIONS
1. Recurrent infections of throat. This is the most common indication.
Recurrent infections are further defined as:
• (a) Seven or more episodes in 1 year, or
• (b) Five episodes per year for 2 years, or
• (c) Three episodes per year for 3 years, or
• (d) Two weeks or more of lost school or work in 1 year.
67. 2. Peritonsillar abscess. In children, tonsillectomy is done 4–6 weeks after
abscess has been treated. In adults, second attack of peritonsillar abscess
forms the absolute indication.
3. Tonsillitis which causes febrile seizures.
4. Hypertrophy of tonsils causing
• (a) airway obstruction (sleep apnoea),
• (b) difficulty in deglutition and
• (c) interference with speech.
5. Suspicion of malignancy. A unilaterally enlarged tonsil may be a lymphoma
in children and an epidermoid carcinoma in adults.
68. RELATIVE INDICATIONS
1. Diphtheria carriers, who do not respond to antibiotics.
2. Streptococcal carriers, who may be the source of infection to others.
3. Chronic tonsillitis with bad taste or halitosis which is unresponsive to
medical treatment.
4. Recurrent streptococcal tonsillitis in a patient with valvular heart
disease.
69. Tonsillectomy in non-inflammatory conditions
/ normal tonsils / as a part of other surgeries
1. Styloid process resection in elongated styloid process
2. Resection of ossified stylohyoid ligament
3. Glossopharyngeal neurectomy
4. As a part of Uvulo-palato-pharyngo-plasty (UPPP)
71. • Documentation :
• Each episode and its qualifying features had been substantiated by
contemporaneous notation in a clinical record
Or
• If not fully documented, subsequent observance by the clinicians of 2
episode of throat infection with patterns of frequency and clinical
features consistent with the initial history
72. CONTRAINDICATIONS
• 1. Haemoglobin Less than 10 gm%
• 2. Presence of Acute infection – Acute Tonsillitis, Upper Respiratory
Tract Infection (2-3 Weeks)
• 3. Children less than 3 years of age
• More than average amount of Blood Loss – Haemodynamic instability
• Compensatory hypertrophy of other lymphoid tissues
• Peak Action of Defence Function
• 4. Bleeding disorders – Leukaemia, Purpuras, Aplastic Anaemia,
Haemophilia
• 5. uncontrolled Diabetes, Heart diseases, Hypertension
73. BLOOD LOSS ESTIMATION (15 Kg)
CLASS I CLASS II CLASS III CLASS IV
Blood Loss (%) Upto 15% 15 – 30% 30 – 40% >40%
80 ml / kg =
80 x 15 = 1200
ml
Blood Loss (ml) 180 ml 180-360 360-480 >480
Pulse Rate <100 100-120 120-140 >140
Systolic Blood
Pressure
Normal Normal Decreased Decreased
Children – BLOOD LOSS – 80 ml/ kg
Adults – BLOOD LOSS – 65-75 ml / kg
74. Pre –Op Workup
• Careful History and Clinical Examination
• Bleeding Disorders, Previous surgeries
• Investigations
• HB, TC,DC, Platelet
• BT,CT, PT,APTT
• Blood Grouping
• Urine Routine Examination
• HIV, HbSAg
• Chest X ray
• X Ray Nasopharynx
• Down Syndrome child – Neck Xray – c1 c2 subluxation
75. • Poliomyelitis Epidemic – 6 weeks delay
• Overt or submucous cleft palate
• Medications to be stopped:
• Aspirin – 2 weeks Before
• NASAIDS- 2 days before
• Preoperative Consideration
• Consent : Loose tooth- Consent for Removal is advised
• Patient kept NPO for 8 hours before surgery
• Prophylactic IV Antibiotics
76. • Anaesthesia
• General Anaesthesia with endotracheal Intubation
Position:
Rose Position: Patient lies supine with head extended by placing a
pillow under the shoulder. A Rubber ring is placed under the head to
stabilise it.
77. Advantages of Rose Position
• Larynx lie at a higher level than the oral cavity – No risk of aspiration
• Excellent exposure
• Both the hands of the surgeons are free
• Hyperextension should be avoided
• Makes cervical vertebral bodies prominent – Damage to ligaments or
cartilages of Vertebral spine or Bodies – Grisel’s Syndrome
• Grisel’s Syndrome – Atlanto axial subluxation
80. STEPS OF SURGERY
• 1. Patient is placed in Rose’s Position
• 2. Check for any loose teeth and if any
use gauze for protection of teeth
81. • 3. Boyle Davis Mouth gag is engaged to
open the mouth & retract the tongue.
• Tongue blade – should be able to retract the
base of tongue
• Shouldn’t Injure Post. Pharyngeal Wall
• The split Blade hold the ET Tube and the
tongue in midline
• The Gag is suspended with Draffin’s bipod
and with Magauren plate
82. • 4. Throat packed with Wet roller gauze
• Prevent Aspiration
• Avoid Dry Gauze
• 5. Tonsil is caught at the upper pole by Dennis
Browne tonsil holding forceps & pulled medially
• Tonsil is grasped and moved back & froth to identify the
border b/w Tonsil and Anterior Tonsillar Pillar
• 6. Incision is made at the mucosa b/w anterior pillar
and tonsil at the upper pole with Waugh’s forceps
and carried till the base of the anterior pillars.
83. • 7. Tonsil is held medially by tonsil holding forceps and blunt
dissection with Mollison tonsillar dissector
• Separates the upper pole of the tonsil with the capsule from the
loose areolar tissue and from Ant and Post. Pillars.
• Plane of Dissection
• Easy dissection
• White glistening colour
• Minimal Bleeding
• With Medical traction, tonsil is separated with its capsule
from the loose areolar tissue.
84. • While dissecting –
• Dissect away from the tonsil with mollison tonsillar dissector
• Tonsil should be bluntly dissected from peritonsillar tissue
• Scar Adhesions – Sharply dissection
• The dissection is continued to lower pole
• 8. Eve’s Tonsillar snare is passed around the pedicle and
snared off. Tonsils gets separated
85. • 9. Tonsillar Fossa is packed with gauze soaked with
Hydrogen Peroxide for few minutes to stop oozing
• In case or prominent bleeding points, they caught
ligated
• 11. The bleeding Vessel is grasped with the tip of
the long slender Birkett’s straight First artery
forceps.
• Followed by Negus curved second artery forceps
under the tip of the first artery and straight forceps
is removed.
86. • 12. 2-0 Linen or Silk is placed under the curved clamp using
a Negus knot pusher.
• 13. Tonsillar fossa – Packed with Gauze soaked in H2O2
• 14. Repat the same procedure on Other side
• 15. After Haemostasis is achieved, Post nasal space,
pharynx, larynx should be cleared off from blood.
• 16. Release Boyle’s Davis Mouth gag, Check again the lower
pole for any bleed.
• 17. Remove throat pack, total count of swabs should be
checked before and after the procedure.
87. POST OP ADVICE
• NPO till 4 hours / full recovery from anaesthesia
• Head low and Left Lateral Position
• Monitor Vitals
• Inj. DEXAMETHASONE Intraoperative and 6 hours after surgery
• Anti inflammatory, antipyretic, antiemetic, mood elevator
• Inj. ONDANSETRON single dose intraoperatively
• Paracetamol sos
88. POST OP DIET
• First Day : Start with ice cold water followed by ice cream
• Jelly, pudding, yorgut, banana
• Second day to 1 week – Same as first day + milk, honey, smashed rice
with mashed vegetables, grapes
• Second Week – Normal Diet
• Things to be avoided:
• Hot, spicy food, cola and pepsi beverages
• Physical exertion
89. Methods of Tonsillectomy
• Cold Methods
• Dissection and snare
• Guillotine method
• Intracapsular (capsule
preserving) tonsillectomy
• Harmonic scalpel
• Plasma-mediated ablation
technique
• Cryosurgical technique
• Hot Methods
• Electrocautery
• Laser tonsillectomy (CO2 or
KTP)
• Coblation tonsillectomy
• Radio frequency
90. DIATHERMY / ELECTROCAUTERY TONSILLECTOMY
• One of the most common technique
• Electrocautery tip – standard electrocautery tip –
20 W, Micro dissection needle – 6 W
• Technique –
• Anterior Pillar
• Dissection from superior to inferior
• Haemostasis – packing/cautery / absorbable ties
91. MICRODEBRIDER TONSILLECTOMY
• Microdebrider
• Intracapsular method
• Powered rotatory shaving device with
continuous suction
• Partial tonsillectomy is completed with 90 to
95% tonsils
• Capsule is preserved.
92. COBALATION TONSILLECTOMY
• Means “cold” and “removal”
• Controlled ablation
• Unique method of rapid and controlled
removal of tissues at lower temperature
• extra and intracapsular tonsillectomy
• Uses radio frequency in bipolar mode
with a conductive solution (saline)
• This field created high energy particles
like ionized vapour layers OH, H, Na free
radicals and electron.
93. • Enough to break the tissues molecular bonds, creating
ablative path.
• The heat generated varies from 40 - 80 degrees
centigrade, much lower than that of electro cautery.
• Results in volumetric removal of target tissue with
minimal damage to surrounding tissue.
• The major advantage of this procedure is reduced
bleeding and reduced post operative pain.
94. LASER TONSILLECTOMY
• Laser tonsillectomy. It is indicated in coagulation disorders.
• CO2 laser – 10.6 Micrometre
• M/C applied in oral and laryngeal practice.
• Laser output – continuous or pulsed laser. Laser operates with a continuous
output for longer or less than 0.1 sec
• Laser in living tissue – Photoablation, Photochemical, photomechanical and
Photothermal reaction.
• Tissue effect can be cutting, coagulation or vaporisation.
95. HARMONIC SCALPEL
• It is an ultra sound coagulator and dissector that uses ultra sonic
vibrations to cut and coagulate tissues.
• The cutting operation is made possible by a sharp knife with a
vibratory frequency of 55.5 KHz over a distance of 89 micro meters.
• Coagulation occurs due to transfer of vibratory energy to tissues. This
breaks hydrogen bonds of proteins in tissues and generates heat
from tissue friction.
97. PLASMA-MEDIATED ABLATION TECHNIQUE
• In this ablation method, protons are energized to break molecular
bonds between tissues.
• It is a cold method and does not cause thermal injury
98. CRYOSURGICAL TECHNIQUE
• Tonsil is frozen by application of cryoprobe and then allowed to thaw. Two
applications, each of 3-4 minutes, are applied.
• Tonsillar tissue will undergo necrosis and later fall off leaving a granulating
surface.
• Bleeding is less due to thrombosis of vessels caused by freezing.
• - 82 degrees centigrade by carbondioxide
• - 196 degrees centigrade by liquid nitrogen
99.
100. RADIOFREQUENCY ABLATION
• Similar to Coblation
• Literature
• Using radiofrequency technique to perform partial tonsillar ablation or tonsil
reduction in children with tonsil hypertrophy.
• Temperature controlled radiofrequency technique operates by heating the target
tissue through an electrode placed submucosally.
• Radiofrequency generator regulates energy flow to form a precise lesion which
gradually reabsorbed by the body.
• Thus shrinking tissue volume while leaving underlying mucosa intact.
108. COMPLICATIONS
• 1. Primary Haemorrhage
• Occurs at the time of operation
• Causes:
• 1. Improper Pre op Preparation
• Acute tonsillitis
• Quinsy
• Bleeding tendency
• 2. Massive fibrosis in tonsillar fossa
• 3. Bad Plane to dissection
• 4. A larger tonsillar branch of facial artery
• 5. Section of Paratonsillar vein
• Rarely – Aberrant internal carotid artery
109. • Management :
• Managed with packing, pressure, electrocautery, slipknot
• External carotid artery ligation – If above methods fails
• Surgical Trauma
• Trauma to lips, tongue, tonsillar pillars, posterior pharyngeal wall
• Burn injury to tongue – due to usage of cautery
• Management:
• Proper Placement of Mouth gag
• Tooth is missing – Chest x Ray - Bronchoscopy
• Aspiration – due to uncuffed ET tube
• Prevented by – Rose Position, Placement of throat packs
• After surgery- surgical sites and nasopharynx is properly irrigated with saline
to remove clots and tissues
110. • Airway Compromise – Occur Intraoperatively
• Malposition / kinking of ET tube
• Inhaled Foreign body like blood clot
• Pulmonary edema
• Treatment – Diuretics, continuous positive airway pressure
• Airway fire – due to diathermy
• Prevented by wet gauze
• Cut the anaesthetic gas immediately and pour saline into oral cavity
111. POST OPERATIVE COMPLICATIONS
• Reactionary haemorrhage – occurs within a period of 24 hours
• Causes
• Clot dislodges
• Vasodilatation of blood vessels
• Post operative blood pressure changes
• Increased venous pressure due to coughing
• Slippage of Ligature
• Failure to ligate all bleeding vessels
112. • C/F – H/O spitting of fresh blood, vomiting of altered blood
• Signs – cold extremities, tachycardia, low BP, excessive swallowing
(earliest sign of haemorrhage), examination of oral cavity and
oropharynx coated with blood and blood clots
• PPW – stained with blood
• Preparation: NPO, Consent for Surgery including consent for ligation
of external carotid artery, inform anaesthetist and OT staff, arrange 1
pint of blood
• Investigations
• Treatment:
• Conscious – Make the patient sit upright and ask to spit the blood to
make the airway clear
• Unconscious – recovery position with head of bed down and lateral
position
113. • 1. Rehydration with crystalloids
• When sufficiently hydrated – shift the patient to OT
• 2. Intubated – properly suctioning and bleeding controlled by proper
suctioning from tonsillar fossa followed by ligating and cauterizing
blood vessels
• 3. Bleeding Not controlled – Sututing of anterior and posterior pillars
with / without packs. Remove pack after 24 hrs.
• Disadvantages of Pack – dislodgement of pack with looseing of sutures
• Severe dysphagia
• Re-anaesthesia to remove the pack
• 4. Ligation of External Carotid Artery – in neck after it gives off its first
branch.
• 5. Bleeding Controlled – Ryle’s tube passed to stomach and gastric
lavage is done until clear fluid is spirated.
114. • Surgical Trauma – Trauma to teeth, Palate, Pillars, Uvula
• Inj Dexa and gargle of ice cold hydrogen peroxide
• Severe Oedema of uvula results in resection of anterior pillars
• Respiratory Obstruction
• Laryngeal Spasm – extubation / irritation of vocal cord
• Failing back of tongue
• Inhaled foreign body as blood clots, secretions, neglected loose gauze,
tonsillar tissue
• Aspirated vomitus – due to poor pre op preparation
• Laryngeal oedema/ spasm – oversized ET tube or poor technique of
intubation
C/F – Inspiratory Stridor, cough, tachycardia, tachpnoea
Auscultation - decreased air entry
decreased oxygen saturation
Bradycardia and cyanosis
115. • Treatment
• Reintubation and administration of oxygen
• Suction of secretions, blood and vomitus and removal of foreign body
• Steroids
• Intermediate Complications
• Secondary haemorrhage
• Infection of tonsillar fossa
• Oedema and necrosis of uvula
• Pulmonary complications – pneumonia, bronchitis
• Subacute bacterial endocarditis
116. SECONDARY HAEMORRHAGE
• Occurs 24 hours to 5-7 days after surgery
• Cause – infection
• Treatment –
• Systemic antibiotics
• Injectable analgesics
• Hydrogen peroxide gargles of each feed
• Blood transfusion if needed
• In case of severe bleed – shift to OT – management as like primary
haemorrhage
Droplets of polio could proliferate within tonsil affects regional nerve sheath brain stem Bulbar Polio
H2O2 dissociates into h2 and nascent oxygen, when it comes in contact with tissues. The nascent oxygen liberated oxidises the slough. H2o2 get under the slough and lift it by effervescent action. Prevents anaerobic infection due to the presence of nascent oxygen. Generates heat and increases vascularity of wound, helps in healing. Mild cauterizing effect.