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Disorders related to tonsils
- 1. Disorders related to Tonsils and Adenoids
- 2. Tonsils
- 5. blood supply
- 6. venous drainage • Veins from the tonsils drain into paratonsillar vein which joins the common facial vein and pharyngeal venous plexus.
- 7. lymphatics • Lymphatics from the tonsil pierce the superior constrictor and drain into upper deep cervical nodes particularly the jugulodigastric (tonsillar) node situated below the angle of mandible.
- 8. Nerve supply • Lesser palatine branches of sphenopalatine ganglion (CN V) and glossopharyngeal nerve provide sensory nerve supply.
- 9. TONSILLITIS • It is the inflammation of the tonsils due to infection of the tonsils . • It can be : acute tonsillitis chronic tonsillitis
- 11. Classification : • 1. Acute catarrhal or superficial tonsillitis :Here tonsillitis is a part of generalized pharyngitis and is mostly seen in viral infections. • 2. Acute follicular tonsillitis : Infection spreads into the crypts which become filled with purulent material, presenting at the openings of crypts as yellowish spots .
- 12. • 3. Acute parenchymatous tonsillitis: Here tonsil substance is affected. Tonsil is uniformly enlarged and red. • 4. Acute membranous tonsillitis: It is a stage ahead of acute follicular tonsillitis when exudation from the crypts coalesces to form a membrane on the surface of tonsil.
- 13. Aetiology : • Acute tonsillitis often affects school-going children, but also affects adults. It is rare in infants and in persons who are above 50 years of age. • Haemolytic streptococcus is the most commonly infecting organism. Other causes of infection may be staphylococci, pneumococci or H. influenzae. These bacteria may primarily infect the tonsil or may be secondary to a viral infection.
- 14. Symptoms : • Sore throat • Difficulty in swallowing • Fever • Earache • constitutional symptoms [ general body ache , malaise , headache , constipation]
- 15. Signs: • Often the breath is foetid and tongue is coasted. • There is hyperaemia of pillars, soft palate and uvula. • Tonsils are red and swollen with yellowish spots of purulent material presenting at the opening of crypts (acute follicular tonsillitis). • Whitish membrane on the medial surface of tonsil which can be easily wiped away with a swab (acute membranous tonsillitis) .
- 16. • The tonsils may be enlarged and congested so much so that they almost meet in the midline along with some oedema of the uvula and soft palate (acute parenchymatous tonsillitis). • The jugulodigastric lymph nodes are enlarged and tender.
- 19. Management: • Put to bed and encouraged plenty of fluids . • analgesics , to relieve pain and fever . • Antimicrobials , penicillin to streptococcus for 7-10 days and in case of allergy to penicillin , erythromycin is advised .
- 20. Complications : • chronic tonsillitis • peritonsillar abscess • parapharyngeal abscess • cervical abscess • rheumatic fever • acute glomerulonephritis • acute otitis media
- 21. D/D of membrane over tonsil: • Diphtheria • Vincent Angina • Infectious mononucleosis • Malignancy of tonsil • Traumatic Ulcer • Aphthous ulcer • Agrannulocytosis
- 23. Aetiology: • 1. It may be a complication of acute tonsillitis. Pathologically, microabscesses walled off by fibrous tissue have been seen in the lymphoid follicles of the tonsils. • 2. Subclinical infections of tonsils without an acute attack. • 3. Mostly affects children and young adults. Rarely occurs after 50 years. • 4. Chronic infection in sinuses or teeth may be a predisposing factor.
- 24. Types : • 1. Chronic Follicular Tonsillitis. Here tonsillar crypts are full of infected cheesy material which shows on the surface as yellowish spots. • 2. Chronic Parenchymatous Tonsillitis. There is hyperplasia of lymphoid tissue. Tonsils are very much enlarged and may interfere with speech, deglutition and respiration. Attacks of sleep apnoea may occur. Long-standing cases develop features of cor pulmonale. • 3. Chronic Fibroid Tonsillitis. Tonsils are small but infected, with history of repeated sore throats.
- 26. C/F: • 1. Recurrent attacks of sore throat or acute tonsillitis. • 2. Chronic irritation in throat with cough. • 3. Bad taste in mouth and foul breath (halitosis) due to pus in crypts. • 4. Thick speech, difficulty in swallowing and choking spells at night (when tonsils are large and obstructive).
- 27. Treatment : • 1. Conservative treatment consists of attention to general health, diet, treatment of coexistent infection of teeth, nose and sinuses. • 2. Tonsillectomy is indicated when tonsils interfere with speech, deglutition and respiration or cause recurrent attacks .
- 28. TONSILLECTOMY
- 29. INDICATIONS : • Absolute : recurrent throat infections Peritonsillar abscess Tonsillitis causing febrile seizures Airway obstruction , dysphagia odynophagia Relative : diphtheria carriers streptococcal carriers chronic tonsillitis with halitosis patient with valvular heart disease and recurrent tonsillitis
- 30. Position : • Rose’s position, i.e. patient lies supine with head extended by placing a pillow under the shoulders. A rubber ring is placed under the head to stabilize it
- 31. Techinques : • • Cold methods • Dissection and snare (most common) • Guillotine method • Intracapsular (capsule preserving) tonsillectomy with debrider • Harmonic scalpel (ultrasound) • Plasma-mediated ablation or dissection technique (coblation) • Cryosurgical technique • • Hot methods • Electrocautery • Laser tonsillectomy or tonsillotomy (CO2 or KTP) • Radiofrequency
- 32. Complications : • IMMEDIATE - primary hemmorhage reactionary hemmorhage injury to tonsillar pillars , uvula facial edema surgical emphysema aspiration of blood
- 33. • DELAYED - secondary hemmorhage infection scarring of soft palate , pillars tonsillar remnants
- 34. Adenoids
- 35. Anatomy : • These are the nasopharyngeal tonsils . • Situated b/w roof and posterior wall of nasopharynx . • Has 3 types of epithelium - transitional stratified squamous pseudostratified ciliated columnar
- 36. • Blood supply. Adenoids receive their blood supply from: • 1. Ascending palatine branch of facial. • 2. Ascending pharyngeal branch of external carotid. • 3. Pharyngeal branch of the third part of maxillary artery. • 4. Ascending cervical branch of inferior thyroid artery of thyrocervical trunk. • Lymphatics from the adenoid drain into upper jugular nodes directly or indirectly via retropharyngeal and parapharyngeal nodes. • Nerve supply is through CN IX and X. They carry sensation. Referred pain to ear due to adenoiditis is also mediated through them.
- 37. Aetiology : • Physiological enlargement in childhood . • Certain children have a tendency to generalized lymphoid hyperplasia in which adenoids also take part. • Recurrent attacks of rhinitis, sinusitis or chronic tonsillitismay cause chronic adenoid infection and hyperplasia. • Allergy of the upper respiratory tract may also contribute to the enlargement of adenoids.
- 38. C/F: Nasal symptoms - discharge obstruction Sinusitis Voice change Aural symptoms - Tubal obstruction CSOM Recurrent ASOM General Symptoms - Adenoid faces pulmonary hypertension lack of concentration
- 41. Treatment: • When symptoms are not marked, breathing exercises, decongestant nasal drops and antihistaminics for any co-existent nasal allergy can cure the condition without resort to surgery. • When symptoms are marked, adenoidectomy is done.
- 42. THANK YOU