Tonsils and Adenoids

Anatomy: Pharynx: - nasopharynx

- Oropharynx

- Laryngopharynx .

Anatomy

Definition: - Ovoid lymphoid tissue with fibrous capsule laterally over the superior constrictor muscles. Its surface is covered with stratified squamous epithiluim & crypts. It has a medulla & cortex like all other lymphoid tissues. It is

part of the Walderyers ring .

Blood Supply: From upper & lower poles . - Tonsilar branch of facial artery from the ext. carotid.- Descending palatine -------- > internal maxillary artery.- Ascending palatine -------- facial artery - Ascending pharyngeal ---- external carotid.

- Dorsalis linulae ------- lingual - Paratonsillar vein -----> jugular vien.

Functions:

• - Concerned with immune

mechanism.

• - 1st line of defense. The lymphoid tissues produce lymphocytes.

• - T-cells produce plasma cells & help in antibody formation.

Pathology:

• Inflammatory : Bacterial (strept. & other pyogenic organisms ,viral, fungal . It can be specific or none-specific. Also can be acute or chronic .

• Neoplastic : benign or malignant.

Ca Tonsil Lt

Acute tonsillitis

• Acute follicular tonsillitis

• Acute parynchymatous T.

• Membranous Tonsillitis

Clinical Features:

• Usually at 3-7 years age but it can occur at any age with equal sex distribution. Commoner in overcrowded areas (barracks, hostels, camps, schools...i.e infectious)

Symptoms• -- Pyrexia

• -- Pain on swallowing

• -- Malaise

• -- Constipation

• -- Earache.• -- sore throat

Signs:

• - Increase in size.

• - Follicles, membranes or congestion.

• - enlarged tender, Jugulo-diagastric glands.

• - Fetor (halitosis).

Differential Diagnosis:

• -Scarlet fever (strep.)• -Diphtheria• -Vincent's angina (B. Vincenti, fusiform

bacilli & spirochaetes ) • -agranulocytosis – marked reduction in

neutrophils ulcerations & false memb. • -Glandular fever (viral marked increase in

monocytes & lymphocytes=mononuclear cells).

• - leukemia (blood picture & sternal puncture).

Investigations:

• TWBC + Differential.

• Hb%

• Swab C/ S

• ESR

• ASO Titer

Treatment:

• -Bed rest

• -Fluids

• -Soft diet

• -Analgesics

• -Antibiotics: Penicillins,cephalosporins

Complications and Sequelae:

• Peritonsillar abscess

• Retropharyngeal abscess

• Para pharyngeal abscess

• Rheumatic fever

• Glumerulo-nephritis

• chr. tonsillitis.

Chronic Tonsillitis

• -Follicular

• -Parenchymatous• = Hypertrophy

• =Atrophic

Clinical Features:

• -Rec. infection• -sore throat• -congested pillars• -irritating cough

• -Increase in size.

Diff. Diag: .

• Physiological.

• Pharyngitis

• Malignancy

Treatment:

• - Conservative Medical

Treatment.

• - Surgical : i.e Tonsillectomy.

Indications for tonsillectomy:

• - Rec. infections (> 4x per year).

• - sleep apnoea syndrome .

• - peritonsillar abscess.

• - Carrier state (strep., Diphtheria bacilli).

• - Others: Access, malign. Susp

Complications:

• Haemorrhage (primary, reactionary, secondary ).

• Nasal regurg.

• Septicaemia.

• Operative complications.

ADENOIDS

• Def. : hypertrophy of the nasopharyngeal

tonsil sufficient to produce symptoms.

Commonest between the age of 3 – 7 years.

Pathology:

• - Simple inflammatory:

Infection or allergy

• - Tuberculosis: Rare .

Clinical Features:

Symptoms & Signs : • Nasal obstruction: - snoring , mouth breathing , nasal

tone , difficult suckling in infants.• Adenoid facies: narrow pinched nose, open mouth, high

arched palate, crowded upper incisors teeth, receding chin & idiotic look.

• Flat or pigeon chest due to repeated respiratory infections. • Nasal discharge : mucopurulent . • E.T. obstruction: recurrent attacks of secretory or

suppuritive otitis media.• Obstructive sleep apnea syndrome: cor pulmonale & right

sided heart failure . • Nocturnal enuresis , hypoxemia & apathy.

Diagnosis:

• - Clinical .

• - Posterior rhinoscopy

• - X- ray.

Treatment:

• Medical : nasal decongestants .

• Surgical : adenoidectomy.

Complications:

• Palatal scaring , Nasal speech (rhinolalia operta),

• Nasal regurgitations.

• - Remnants ? Recurrence.