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Anatomy of Tonsil and Acute Tonsillitis

Anatomy of Tonsil and Acute Tonsillitis

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Anatomy of Tonsil and Acute Tonsillitis

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  1. Anatomy of Tonsil and Acute Tonsillitis Dr. Mubeena

  2. Anatomy of tonsil

  3. Palatine (Faucial tonsil) • 2 • Lymphoid tissue • Location

  4. Palatine tonsil • Medial surface- non keratinising stratified squamous epithelium • Crypts – Crypta magna • Lateral surface – fibrous capsule • Loose areolar tissue

  5. Palatine tonsil • Upper pole – semilunar fold – supratonsillar fossa • Lower pole – attached to tongue • Tonsillolingual sulcus

  6. Relations of tonsillar bed

  7. Relations of tonsillar bed 1. Tonsillar capsule 2. Peritonsillar space with paratonsillar vein 3. Pharyngo-basilar fascia, Superior constrictor 4. Bucco-pharyngeal fascia 5. Styloid process, muscles, glossopharyngeal nv. 6. Facial artery 7. Medial pterygoid, submandibular salivary gland 8. Mandible

  8. Arterial supply of tonsil

  9. Anatomy of tonsil • Venous drainage:Para tonsillar vein -> common facial vein  pharyngeal venous plexus • Lymphatic drainage:jugulo-digastric • Nerve supply:Glossopharyngeal nerve & Lesser palatine nerve

  10. Adenoid Tonsil 1. Ciliated columnar 1. Non-keratinizing epithelium squamous epithelium 2. No capsule 2. Partly encapsulated 3. Has furrows 3. Has crypts 4. Peak growth: 6 yr 4. Peak growth: 8 yr 5. Growth stops: 12 yr 5. Growth stops: 15 yr 6. Disappears: 20 yr 6. Partial regression:18 yr

  11. FUNCTIONS OF TONSILS • 1. LOCAL IMMUNITY • Epithelium • M cells, antigen processing cells  antigen brought in contact with subepithelial lymphoid follicles  B cell stimulation  Plasma cells  antibodies

  12. 2. Surveillance mechanism • Identifies intruder • Prepares the entire body for defense mechanism

  13. ACUTE TONSILLITIS

  14. Types of acute tonsillitis 1. Superficial / catarrhal: part of generalized pharyngitis 2. Follicular:crypts filled with pus, visible as yellow-white dots 3. Membranous: multiple follicles join to form a yellow-white membrane 4. Parenchymatous:infection of lymphoid parenchyma  tonsil enlargement

  15. Superficial Tonsillitis

  16. Follicular Tonsillitis

  17. Membranous Tonsillitis

  18. Parenchymatous tonsillitis

  19. Aetiology • Children • Haemolytic streptococcus • Others – Staphylococci, pneumococci, H influenzae

  20. Symptoms • Sore throat • Dysphagia • Fever • Earache • Constitutional symptoms

  21. Signs of tonsillitis 1. Congested tonsil & tonsillar pillars 2. Enlarged tonsil (except chronic fibrotic type) • Follicles over surface of tonsil • White patch/membrane over tonsil 4. Jugulo-digastric lymph node enlarged. Tender jugulo-digastric node seen in acute tonsillitis.

  22. Tonsillar enlargement Grade 1 = tonsil within tonsillar fossa Grade 2= tonsil come outside tonsillar fossa Grade 3 = Significant tonsillar hypertrophy but not touching in midline Grade 4= Kissing tonsils

  23. Grade 1 enlargement

  24. Grade 2 enlargement

  25. Grade 3 enlargement

  26. Grade 4 enlargement

  27. Complications of acute tonsillitis Local 1. Recurrent tonsillitis 2. Intra-tonsillar abscess 3. Peri-tonsillar abscess (Quinsy) 4. Parapharyngeal abscess 5. Retropharyngeal abscess

  28. Complications of acute tonsillitis Systemic Focal 1. Rheumatic fever 1. Otitis media 2. Endocarditis (SABE) 2. Cervical abscess 3. Glomerulonephritis due to lymph node 4. Urticaria, erythema enlargement 5. Septicemia

  29. Treatment of tonsillitis • Bed rest + plenty of fluids • Systemic antibiotic: Cefadroxil, Cefuroxime • Antihistamine – Decongestant tablet • Analgesics • Antiseptic gargle • Treatment of focus of infection

  30. Membrane over the tonsil tonsil  Membranous tonsillitis  Faucial diphtheria  Infectious mononucleosis  Candidiasis (throat swab  Candida albicans)  Vincent's angina (fusiform bacilli, spirochaete)

  31. Membrane over the tonsil • Aphthous ulcer (red margin, yellow centre) Agranulocytosis (peripheral blood smear) • Leukemia (peripheral blood smear)  Neoplasm (excision biopsy)  Traumatic ulcer (history of trauma)

  32. Membranous tonsillitis

  33. Post - Tonsillectomy scab

  34. Vicent’s angina • Insidious onset • Membrane on one side • Fusiform bacilli, spirochaetes

  35. Infectious Mononucleosis • Young adults • Posterior triangle lymph nodes and splenomegaly • >50 % lymphocytes – 10% atypical • Paul Bunnet test

  36. Oral Candidiasis

  37. Keratosis pharyngis

  38. Faucial Diphtheria

  39. Faucial diphtheria • Corynebacterium diphtheriae • Droplet infection • Incubation period – 2- 6 days

  40. More in children • Greyish white membrane in oropharynx – bleeds on removal • Jugulodigasric node enlargement – bull neck appearance • Toxaemic

  41. Complications • Due to exotoxins • Myocarditis, arrhythmias, acute circulatory failure • Paralysis of soft palate, diaphragm, ocular muscles • Larynx – airway obstruction

  42. Treatment of faucial diphtheria • Isolation + bed rest • I.V. benzyl penicillin 600 mg q6h 3. Diphtheritic anti - toxininfusion in saline • 20,000 – 40,000 U:  48 hrs duration, tonsillar • 40,000 – 80,000 U: nasopharynx / larynx • 80,000 – 120,000 U:  48 hrs, neck edema 4. Emergency tracheostomy required for stridor

  43. Keratosis pharyngis • Benign self – limiting condition • Etiology: smoking, alcohol, vitamin A deficit • O/E:yellowish, horn-like outgrowths from mucosa of tonsil. Cannot be wiped off. • H.P.E.:Absence of inflammation; hyper-trophy & hyperkeratinization of epithelium.

  44. Keratosis pharyngis Treatment:Reassurance. Tonsillectomy in severe cases.

  45. Diagnosis of membrane over tonsil • History • Physical examination • Total and differential count • Blood smear • Throat swab • Bone marrow aspiration • Paul Bunnet test, biopsy of the lesion

  46. Unilateral tonsillar enlargement Tonsillar causes: 1. Tonsillar malignancy 2. Peri-tonsillar abscess 3. Intra-tonsillar abscess 4. Tonsillolith 5. Tonsillar cyst 6. Tonsillar artery aneurysm 7. Vincent's angina

  47. Unilateral tonsillar enlargement Extra-tonsillar causes:  Parapharyngeal abscess  Parapharyngeal tumours  Tumours of deep parotid lobe  Internal carotid art. aneurysm  Cervical lymphadenopathy

  48. Thank You