Download Free Medical Anatomy of Tonsil and Acute Tonsillitis-Differential Diagnosis And Management PowerPoint Presentation

Anatomy of Tonsil and Acute Tonsillitis-Differential Diagnosis And Management PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Ear, Nose, and Throat Facts, which is titled "Anatomy Of Tonsil & Acute Tonsillitis – Differential Diagnosis And Management", to know about the anatomy of tonsil and acute tonsillitis, and differential diagnosis and management.

Tags : Ear, Nose, Throat Facts, Anatomy, Tonsil, Acute Tonsillitis, Differential Diagnosis, Management

Published on : Jul 10, 2021 | Views : 3230 | Downloads : 6

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Dr.Nayana V G Anatomy Of Tonsil & Acute Tonsillitis – Differential Diagnosis And Management
Slide 2-

ppt slide no 2 content not found
Slide 3-

Embryology Tonsillar fossa and Palatine tonsils - Dorsal wing of the 1st pharyngeal pouch & Ventral wing of the 2nd pouch – 8 weeks; Tonsillar pillars - 2nd/3rd arches Crypts - 3-6 months. Capsule - 5th month. Germinal centers after birth
Slide 4-

ANATOMY Tonsils are aggregates of lymphoid tissues Forms part of WALDEYER’S ring Inner ring – palatine tonsil, lingual tonsil, tubal tonsil and adenoid Outer ring – RPLN, JDLN, submandibular and submental LN
Slide 5-

TONSIL - ANATOMY Palatine tonsils forms the lateral boundary of the inner ring of waldeyer lymphoid mass Lateral wall of oropharynx b/w palatoglossal & palatopharyneal arch
Slide 6-

MEDIAL SURFACE Non keratinising stratified squamous epithelium Dips into tonsils to form CRYPTS 12-15 crypts Largest – CRYPTA MAGNA or INTRATONSILLAR CLEFT Represent opening of second pharyngeal pouch
Slide 7-

LATERAL SURFACE Covered by capsule Extension of Pharyngobasilar fascia Capsule extends to tonsil tissue - septa b/w capsule & bed of tonsil –loose areolar tissue Plane of tonsillectomy Site of pus collection –peritonsilar abscess
Slide 8-

ppt slide no 8 content not found
Slide 9-

UPPER POLE Extends into soft palate Semilunar fold-plica semilunaris extend b/w ant. & post. Pillar Potential space –Supra tonsillar fossa LOWER POLE Attached to tongue Plica triangularis-triangular vestigial fold of mucous memb cover anteroinf part Space-Ant. Tonsillar space
Slide 10-

TONSIL BED
Slide 11-

TONSIL – ARTERIAL SUPPLY
Slide 12-

VENOUS DRIANAGE Paratonsillar vein Common facial vein & pharyngeal plexus IJV
Slide 13-

LYMPHATIC DRAINAGE No afferent lypmhatic supply Jugulodiastric node below angle of mandible NERVE SUPPLY Lesser palatine br of sphenopalatine ganglion Glossopharyneal Nerve.
Slide 14-

Histology
Slide 15-

DEVELOPMENT EPITHELIUM DEVELOPS –VENTRAL PART OF SECOND PHARYNGEAL POUCH LYMPHOCYTES –MESODERMAL ORIGIN
Slide 16-

LINGUAL TONSIL Base of tongue 30-100 lymphoid follicles ARTERIAL – lingual branches of ECA VENOUS – lingual veins - IJV LYMPHATICS – superior cervical or jugular nodes NERVE - glossopharyngeal
Slide 17-

ppt slide no 17 content not found
Slide 18-

NORMAL FLORA - GABHS - Hemophilus - Staph. aureus - Alpha hemolytic streptococci - Moraxella - Mycoplasma - Chlamydia - Anaerobes - Respiratory viruses
Slide 19-

DISORDERS Infection / inflammation Hypertrophy - U/L or B/L Tumors - benign / malignant
Slide 20-

ACUTE TONSILLITIS PRE DISPOSING FACTORS Fatigue Extremes of climate Pre-existing URTI Metabolic or immune disorder
Slide 21-

EPIDEMIOLOGY Affects both sexes All age groups are affected; increased in children Autumn and winter Rare in infants and age more then 50 years
Slide 22-

CLASSIFICATION a/c catarrhal a/c follicular a/c membranous a/c parenchymatous
Slide 23-

A/c CATARRHAL A/c superficial / congestive Initiated by viral infection As a part of pharyngitis Mainly local symptoms
Slide 24-

A/c FOLLICULAR Suppurative Follow superficial tonsillitis/reactivation of subclinical infections Inflammation of mouth of crypts Presents with both local and systemic symptoms
Slide 25-

ppt slide no 25 content not found
Slide 26-

A/C MEMBRANOUS Stage ahead of follicular Exudates at the crypts coalesce to form a membrane Local and constitutional symptoms
Slide 27-

A/C PARENCHYMATOUS Tonsillar substance is affected Uniformly enlarged and congested More obstructive symptoms
Slide 28-

AETIOLOGY GABHS Staphylococci Pneumococci Hemophilus Anaerobic Secondary to viral infection
Slide 29-

FEATURES Fever with chills and rigor Sorethroat Odynophagia Dysphagia Voice changes Pain neck Cervical lymphadenopathy Earache Abdominal pain
Slide 30-

OROPHARYNX
Slide 31-

Grading the Size of Tonsils BRODSKY;MOORE;STANIEVICH Grading system: 0 – tonsils in fossa +1 – tonsils less than 25% +2 – tonsils less than 50% +3 – tonsils less than 75% +4 – tonsils greater than 75%
Slide 32-

MANAGEMENT Blood routine - leucocytosis; ESR X-ray nasopharynx - adenoids X-ray PNS - associated sinusitis PTA and impedance Throat swab for C and S - posterior pharynx and tonsillar areas Rapid antigen testing (RAT) for GABHS
Slide 33-

MEDICAL Supportive - hydration; bed rest; warm saline gargles; analgesics; antibiotics ANTIBIOTICS - shorten duration of illness Decrease complications Penicillin – DOC Erythromycin; tetracycline Beta lactamase –amoxycillin-clavulanate Anaerobes –metronidazole Dexamethasone –single dose for pain
Slide 34-

COMPLICATIONS LOCAL Quinsy Intratonsillar abscess Parapharyngeal abscess Retropharyngael abscess Suppurative jugulodigastric lymphadenitis Lemierre’s syndrome SYSTEMIC a/c glomerulonephritis SABE Exacerbation of psoriasis Acute rheumatic fever
Slide 35-

1.QUINSY Collection of pus between tonsillar capsule and bed Follows recurrent tonsillitis/inadequately treated c/c tonsillitis Theories- 1] pus tracking into the supratonsillar fossa 2] infection of peritonsillar salivary gland-Webers gland
Slide 36-

Diagnosis - physical examination USG and CT. S Staphylococcus aureus is the most common organism. Clinical presentation: Dysphagia, odynophagia Inability to swallow with drooling. Muffled voice(hot potato voice) Trismus
Slide 37-

SIGNS Uvula is deviated away from the abscess Tonsil pillars and soft palate congested u/l peritonsillar bulge Cervical LNE Torticollis; Signs of dehydration
Slide 38-

MANAGEMENT Routine investigations Supportive measures Parenteral antibiotics Early cellulitis can be managed conservatively If frank abscess ;incision and drainage
Slide 39-

INCISION AND DRAINAGE Point of aspiration is point of maximum bulge above the upper pole of tonsil or just lateral to the point of junction of anterior pillar and a line through base of uvula If pus is present; a stab incision and dilatation; pus for C and S Usually recovery by 4-5 days
Slide 40-

ppt slide no 40 content not found
Slide 41-

ppt slide no 41 content not found
Slide 42-

ppt slide no 42 content not found
Slide 43-

TONSILLECTOMY Classic teaching - 4-6 weeks after quinsy(interval tonsillectomy) Some argue for an abscess /hot tonsillectomy esp. in following situations: - if antibiotics are not sufficient enough - those with recurrent tonsillitis / abscesses - avoidance of loss to follow up - for rapid relief of symptoms
Slide 44-

COMPLICATIONS Rupture of abscess during surgery Intra tonsillar abscess Parapharyngeal abscess Edema of larynx Septicemia - endocarditis ;nephritis If aspiration has taken place; pneumonitis/lung abscess Internal jugular vein thrombosis Necrotising fascitis Perichondritis of thyroid cartilage Spontaneous hemorrhage from carotid or IJV
Slide 45-

2.Parapharyngeal abscess If pus tracks through the superior constrictor and localises between superior constrictor and deep cervical fascia Trismus Tender neck swelling Airway compromise CT with contrast - inv. of choice First conservative; not responding; external drainage
Slide 46-

3.Retropharyngeal abscess Pus between posterior pharyngeal wall and prevertebral fascia Usually children below 5 yrs-following suppuration of lymph nodes Dysphagia ; dyspnoea; croupy cough; torticollis O/e bulge in the posterior pharyngeal wall X ray STN –widening of prevertebral shadow I and D ; antibiotics; tracheostomy
Slide 47-

4.LEMIERRE’S SYNDROME Septic thrombophlebitis of IJV A fusiform bacillus Severe neck pain; septicemia Also secondary to tympanomastoid infection Imaging - thrombus in neck veins Antibiotics (beta-lactam with metronidazole or amoxycillin-clavulanate) and anticoagulation
Slide 48-

5.SPONTANEOUS HAEMORRHAGE Occasionally spontaneous haemorrhage from inflamed tonsils may take place which is a rare but serious condition. Also occurs in response to minor trauma in inflamed tonsil. Respond to cautery under LA Tonsillectomy
Slide 49-

SYSTEMIC COMPLICATIONS a/c rheumatic fever } immune a/c PSGN } complex Exacerbation of psoriasis (guttate variety) Scarlet fever SABE
Slide 50-

SUBACUTE TONSILLITIS Patients never free of low grade discomfort in the throat Enlarged inflamed tonsils Punctuated with acute episodes which may be mild or severe
Slide 51-

RECURRENT TONSILLITIS H.influenza and Staph.aureus 7 or more episodes of a/c tonsillitis in one year 5 episodes for 2 consecutive years 3 episodes for 3 consecutive years
Slide 52-

CHRONIC TONSILLITIS Persistent inflammation of tonsils as a result of recurrent a/c or subclinical infections Usually adults; gram positive organisms Predisposing - c/c infection in sinuses /teeth c/f -recurrent sore throats; cervical LNE; halitosis; thick speech; increased episodes of URTI
Slide 53-

D/D OF ADENOTONSILLAR INFLAMMATION / INFECTION
Slide 54-

INFECTIOUS MONONUCLEOSIS Caused by EBV Young adult Dirty grey membrane over tonsils not responding to antibiotics, sore throat, dysphagia and odynophagia Other manifestations include liver damage, generalised LNE, skin rash, splenomegaly
Slide 55-

Upper airway obstruction can occur due to severely enlarged tonsils which can be life threatening Petechiae at the junction of hard & soft palate Method of transmission – Oral contact
Slide 56-

Diagnosis DC– 50% lymphocytosis with 10% atypical lymphocytes Monospot & Paul Bunnell test Management: Symptomatic Recovery takes weeks Antibiotics for 2o bacterial infection Ampicillin should be avoided If severe respiratory obstruction – high dose steroid therapy If not relieved – either an adenotonsillectomy or a tracheostomy
Slide 57-

DIPHTHERIA Exudative pharyngotonsillitis Suspected in a very toxic child Dirty grey membrane over tonsils extending to pillars, palate and posterior pharyngeal wall
Slide 58-

DIPHTHERIA Lethal exotoxins Removal of membrane causes bleeding. Firm leathery membrane Bull neck due to LNE – even in mild cases Condition of the patient deteriorates secondary to airway obstruction
Slide 59-

Diagnosis Fluorescent antibody studies Gram staining – Klebs-Loffler bacillus Culture TREATMENT Adequate hydration Antibiotics – Pencillin – in high doses-benzyl pn-600mg 6hrly for 7 days/erythromycin Antitoxin – within first 48hrs Airway obstruction - tracheostomy
Slide 60-

VINCENT’S ANGINA Borrelia vincenti and Bacillus fusiformis M.C.in over crowded conditions Fever, headache, sore throat, cervical lymphadenopathy Membrane over the tonsil and on removal  an ulcer remain confined to the surrounding tissue & usually heals in 7-10 days Rx – Penicillin, local hygiene
Slide 61-

SCARLET FEVER Thick membranous tonsillitis with marked erythema of oropharyngeal mucosa Strawberry tongue with prominent lingual papillae and characteristic scarlatine rash Due to endotoxin produced by streptococcus Diagnosis : Bacteria in throat cultures, Immune testing – Dick’s test or Schultz – Charlton blanching phenomenon
Slide 62-

AGRANULOCYTOSIS Ulcerative necrotic lesion over tonsil and oropharynx Patient severly ill. TLC <2000 cu.mm upto 50 cu.mm and PMN <5%
Slide 63-

LEUKEMIA C/F –fatigue,headache,sorethroat,f/o acute tonsillitis,stomatitis,bleeding from mucous membrane Bone marrow- blat cells
Slide 64-

APHTHOUS ULCER Involve any part of oral cavity and oropharynx Tonsil and pillars Solitary,painful Small or large
Slide 65-

MALIGNANCY TONSIL Persisitent sore throat,,difficulty in swallowing,pain in the ear,lump in the neck Biopsy
Slide 66-

TRAUMATIC ULCER Accidental trauma Heals by memebrane formation Within 24 hrs
Slide 67-

OTHER MISCELLANEOUS CONDITIONS Fungal infection – Candida – immunocompromised removal of membrane – raw bleeding surface Leukoplakia Pemphigus Granulomatous diseases like T.B,Syphilis Leishmaniasis Neisseria gonorrhoea – M.C.in homosexual males as a part of gonococcal pharyngitis Crohn’s disease – serpigenous ulcers over tonsil
Slide 68-

DIAGNOSIS OF ULCERO-MEMBRANEOUS LESION OF TONSIL HISTORY Physical Examination TLC and DC (Agranulocytosis,leukemia,IMN) Blood smear(for atypical cells) Bone marrow aspirations and needle biopsy
Slide 69-

Throat swab and culture( pyogenic bacteria,vincents angina ad candidal infections) Special tests: paul bunnel / monospot test(IMN) Biopsy of lesion(malignancy)
Slide 70-

MISCELLANEOUS CONDITIONS OF TONSILS Tangier disease – A yellow orange hypertrophy of the tonsil, a consequence of -lipoprotein deficiency Hyperkeratosis of the tonsils (Keratosis Pharyngeus) White projection on the lymphoid tissues of the pharynx as well as on the tonsils and adenoids Young adults and debilitated Initially thought to be due to Leptothrix buccalis (fungus) or due to some metabolic disturbances
Slide 71-

CLINICAL FEATURES Vague symptoms – FB sensation, recurrent cough O/E: White minute projections from tonsillar crypts or other pharyngeal lymphoid tissues Rx: Primarily supportive Removal by curette or Electrocoagulation
Slide 72-

3)TONSILLOLITHS (Calculi) More frequently in adults Repeated episodes of inflammation -> fibrosis at the openings of the tonsillar crypts ->Bacterial and epithelial debris, then accumulate within these crypts -> retention cyst forms ->Calcification later occurs.
Slide 73-

Certain calculi form from keratohyaline accumulation in the crypts with 2o deposits of salts C/F: Non specific c/c sorethroat and otalgia, foreign body sensation throat. O/E: Stones in the tonsil Rx: Supportive, local excision, tonsillectomy
Slide 74-

THANK YOU