Tonsil

1. ACUTE & CHRONIC
TONSILLITIS
By
Dr. Lakshmi Unnikrishnan

2. APPLIED ANAT. OF PALATINE TONSILS
• No.
• Shape, location
• Actual size bigger (extn- upw, downw,ant)
• 2 surf, 2 poles

3. MED SURF
• Cov by
• 12-15 crypts
• Crypta magna or intratonsillar cleft – repres ventral part of P2
• Sec crypts
• Cheesy mat- epith cells, bact, food debris

4. LAT SURF
• Well def fib capsule
• Loose areolar tiss – b/w capsule & bed
a. Easy dissection
b. Site for collection of pus
• Some fib of palatogl, palatoph att to capsule

5. UPPER POLE
• Ext into soft palate
• Med surf – cov by semilunar fold  ext b/w ant & post pillars
 enclosing a pot space  supratonsillar fossa

6. LOWER POLE
• Att to tongue
• A ular fold of muc memb- ext frm ant pillar  ant.inf. Part of tonsil
 encloses a space ant tonsillar space
• Sep frm tongue by tonsillolingual sulcus ( seat of Ca.)

7. BED OF TONSIL
• Formed by sup constr & styloglossus m
• IX, styloid pr (if enlarged)- lower part of tonsillar fossa
• Facial art, subm saliv gl, post belly of digastric, med pterygoid, < of mandible

8. BL S

9. V. D
• Paratonsillar vein common facial vein & pharyngeal ven pl

10. LD
• Pierce sup constr  upper deep C l.n (JD or tonsillar node)- below < of mandible

11. NS
• Lesser palatine br of sph pal gangl
• IX

12. FUNCT
• Protective role
• Crypts
• Larger in ch
• Removed when seat of dis

13. ACUTE TONSILLITIS

14. CONSITS OF
• Surf epith
• Crypts
• Lymphoid tissue

15. CLASSIF OF AC INF
1. Ac catarrhal / superfic
2. Ac follicular
3. Ac parenchym
4. Ac memb

16. AETIO
• School going ch, adults
• Rare in infants, >50
• B- hemolytic strep- m/c
• Others: staph, pneumo, H.infl
• 1* / 2* to viral

17. SYMPT
• Sore throat
• Diff in swallowing
• Fever
• Earache
• Constitutional sympt

18. SIGNS
• Breath- foetid, tongue- coated
• Hyperaemia of pillars, soft palate,uvula
• Tonsils-red, swollen , yell spots(ac follicular)
• Whitish memb- easily wiped off with swab(ac memb)
• Enl, congested, oedema of uvula, soft palate (ac parenchym)
• JD nodes enl, tender

19. RX
• Fluids, rest
• Analgesics
• Antimicrobial Rx DOC: penicillin (strep)/ erythromycin(7-10d)

20. COMPLICATIONS
• C/c tonsillitis
• Peritonsillar abscess
• Parapharyngeal abscess
• Cervical abscess-d/t suppuration of JD nodes
• Ac. OM
• Rheum fever
• Ac GN itis
• SABE

21. D/D OF MEMB OVER TONSIL
• Memb tonsillitis
• Diphtheria
• Vincent’s angina
• IMN
• Agranulocytosis
• Leukaemia
• Aphthous ulcer
• Malignancy tonsil
• Traumatic ulcer
• Candidal infn of tonsil

22. DX OF ULCEROMEMB LESION OF THROAT
• Hist
• Phy examinn
• TC, DC
• PS
• Throat swab & cult
• Bm aspirn or needle biopsy
• Paul Bunnel / mono spot test
• Biopsy of lesion

23. FAUCIAL DIPHTHERIA

24. AETIO
• Corynebacferium diphtheriae
• Droplet infn
• IP: 2-6 days
• Carriers

25. CL. FEAT
• Ch
• Oropharynx, larynx, nasal cavity
• Greyish white memb over tonsil, soft palate, ppw
• Tenacious, bleeding when removed
• C l.n (JD)- enl, tender. Bull neck app
• Ill, toxaemic, fever<38 deg C

26. COMPLICATN
• Exotoxin- heart, N myocarditis, c arrhythmia , ac circul failure
• Neurogenic- paralysis of soft palate, diaphragm & ocular m
• Larynx- memb a/w obstruction

27. RX
• Antitoxin
• Antibiotics

28. C/C TONSILLITIS

29. AETIO
• Complication of ac
• Subcl infn
• Ch, young adult (rare >50)
• C/c infn- sinuses/teeth- predisp factors

30. TYPES
• C/c follicular
• C/c parenchym
• C/c fibroid

31. CL. FEAT
• Rec attack of sore throat / ac tonsillitis
• C/c irritation in throat with cough
• Bad taste, halitosis
• Thick speech, dysphagia, choking spells at night

32. EXAMINATION
• Enl of tonsil
• Yellowish beads of pus
• Irvin moore sign
• Flushed ant pillars
• Enl JD nodes, non- tender

33. RX
• Conservative Rx
• Tonsillectomy

34. COMPLIC
• Peritonsillar abscess
• Paraph abscess
• Intratonsillar abscess
• Tonsillolith
• Tonsillar cyst
• Focus of infn- RF,ac GN, eye & skin dis

35. DIS OF LINGUAL TONSIL
• Ac lingual tonsillitis
• Hypertrophy
• Abscess