tonsil
ent revision notes for neet pg preparation
waldeyer ring
tonsillar bed
blood supply of tonsil
histology
tonsillitis
stylocarotid syndrome
irwin moores sign
indications of tonsillectomy
recurrent tonsillitis
6. Bed of tonsil is formed by
• Loose areolar tissue
• Pharyngobasilar fascia
• superior constrictor
• Buccopharyngeal fascia
• Styloglossus
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7. Loose areolar tissue in bed of tonsil
• Plane of dissection during tonsillectomy
• Site of collection of pus in peritonsillar abscess
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12. • The medial surface of palatine tonsils is
covered by non keratinizing stratified
squamous epithelium which dips into
the substance of tonsil in the form of
crypts. One of these crypts is very large
and deep and is called crypta magna or
intratonsillar cleft.
• Ventral part of 2nd pharyngeal pouchTONY SCARIA 2010 KMC
23. Lymphatic drainage of tonsil
• upper deep cervical nodes particularly the jugulodigastric (tonsillar)
node situated below the angle of mandible
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24. • Tonsils reach maximum size
• From birth to 3 years after that from 7 years to 12 years afer that it undergoes
atrophy
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26. Acute tonsillitis
1. Acute catarrhal or Superficial tonsillitis – seen in viral infection
2. Acute follicular tonsillitis – Purulent material seen in crypts as
yellowish spots
3. Acute parenchymatous - tonsillar substance is affected causing
uniform enlargement and redness
4. Acute membrane tonsillitis – exudation coalesce to form membrane
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27. a/c tonsillitis
• Grp A beta haemolytic streptococci mc organism
• Signs
• Enlarged jugulodigastric nodes
• i
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29. D/D of Membrane over the tonsils:
1. Membranous tonsillitis
2. Diphtheria: membrane is dirty Grey, removal causes bleeding
3. Vincent’s angina
4. Infectious mononucleosis
5. Agranulocytosis
6. Leukemia
7. Aphthous ulcer
8. Malignancy tonsil
9. Traumatic ulcer
10. Candidiasis
All except vincents anginaforms a
white membrane
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30. • IRWIN MOORE'S SIGN——– positive squeeze test in chronic tonsillitis
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31. Indications for tonsillectomy
Absolute indication
• Huge hypertrophic tonsil
causing Obstructive sleep
apnea or oropharyngeal
obstruction
• 2nd episode of quinsy
• Suspected malignancy
tonsils for biopsy
Relative C/I
• Recurrent tonsillitis
• Tonsillitis causing febrile
seizure
• IgA nephropathy
As a part of other surgery
• Uvulopalatopharyngoplasty
• An approach to IX CN &
styloid process
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32. Recurrent tonsillitis
• > 7 culture proven episodes of a/c tonsillitis in 1 year
• >5 episodes per year in 2 years
• >3 episodes per year in 3 years
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33. Absolute C/I for tonsillectomy
• Epidemic of poliomyelitis
• Polio virus gets concentrated in lymphoid tissue
• a/c tonsillar infection
• Recent URTI
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34. Methods of tonsillectomy
• Dissection & snaring method of choice
• Harmonic scalpel
• Dissection & snaring
• Diathermy
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36. After tonsillectomy patient lies in tonsil
position to Px aspiration of clots
Pillow under thorax
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37. Tonsillectomy complications
• Haemorrhage most common complication
Primary
haemorrhage
• During surgery
• d/t recent
infection
• Bleeding
diathesis
• Poor technique
Reactionary
haemorrhage
• With in 7-24 hours
• Increase in BP
• Slipping of
ligatures
• Postoperative
retching
Secondary
haemorrhage
• After 7 days
• d/t infection
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