Adenoids,acute and chronic tonsillitis

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1. ACUTE AND CHRONIC ADENOTONSILLITIS ANAKHA RAJENDRAN ROLL NO-23

2. ADENOIDS NASOPHARYNGEAL TONSIL OR ADENOIDS IS A SUBEPITHELIAL COLLECTION OF LYMPHOID TISSUE AT THE JUNCTION OF ROOF AND POSTERIOR WALL OF NX

3. ANATOMY PINK GLOBULAR MASS COMPOSED OF VERTICAL RIDGES SEPERATED BY DEEP CLEFTS COVERING EPITHELIUM: PDEUDOSTRATIFIED CILIATED COLUMNAR STRATIFIED SQUAMOUS TRANSITIONAL NO CRYPTS NO CAPSULE

4. PRESENT AT BIRTH PHYSIOLOGICAL ENLARGEMENT UPTO 6 YRS AND TENDS TO ATROPHY AT PUBERTY AND COMPLETELY DISAPPEARS BY 20 YRS BLOOD SUPPLY:ASCENDING PALATINE ASCENDING PHARYNGEAL ASCENDING CERVICAL BRANCH PHARYNGEAL BRANCH OF 3 RD MAXILLARY ARTERY LYMPHATICS:UPPER JUGULAR OR RETRO/PARAPHARYNGEAL NS:CN IX AND X .REFERRED PAIN TO EAR

5. ETIOLOGY PHYSIOLOGICAL HYPERTROPHY UPTO 10 YRS RECURRENT SINUSITIS,RHINITIS,C/C TONSILLITIS ALLERGY OF URT

6. CLINICAL FEATURES NASAL SYMPTOMS - NASAL OBSTRUCTION LEADS TO MOUTH BREATHING AND SNORING.FEEDING PROBLEMS IN CHILD IS ALSO PRESENT NASAL DISCHARGE-DUE TO CHOANAL OBSTRUCTION SO SECRETIONS CANT DRAIN INTO NX AND DUE TO ASSTD RHINITIS.THE CHILD HAS A WET BUBBLY NOSE SINUSITIS-PERSISTENCE OF NASAL DISCHARGE AND INFECTION EPISTAXIS VOICE CHANGE-TONELESS AND LOSES NASAL QUALITY DUE TO NASAL OBSTRUCTION

7. AURAL SYMPTOMS TUBAL OBSTRUCTION-RETRACTED TM AND CONDUCTIVE HEARING LOSS RECURRENT AOM-SPREAD OF INFECTION VIA ET CSOM SOM-ADENOIDS ARE AN IMPORTANT CAUSE FOR SOM IN CHILDREN

8. GENERAL SYMPTOMS ADENOID FACIES PULMONARY HTN AND COR PULMONALE APROSEXIA

9. DD THORNWALDTS DISEASE HIGH ARCHED PALATE

10. DIAGNOSIS EXAMINATION OF POST NASAL SPACE-ADENOID MASS SEEN WITH A MIRROR NASOPHARYNGOSCOPE SOFT TISSUE LATERAL RADIOGRAPH OF NX-SIZE AND EXTENT

11. TREATMENT NOT MARKED SYMPTOMS-DECONGESTANTS,BREATHING EXERCISES,ANTIHISTAMINICS FOR ALLERGY ASSTD MARKED SYMPTOMS-ADENOIDECTOMY

12. ADENOIDECTOMY INDICATIONS ADENOID HYPERTROPHY CAUSING SNORING,MOUTH BREATHING,SLEEP APNOEA SYNDROME,SPEECH ABNORMALITIES LIKE RHINOLALIA CLAUSA RECURRENT RHINOSINUSITIS C/C OTITIS MEDIA WITH EFFUSION,RECURRENT EAR DISCHARGE IN BENIGN CSOM ASSTD WIT ADENOID HYPERPLASIA DENTAL MALOCCLUSION

13. C/I -CLEFT PALATE HEMORRHAGIC DIATHESIS A/C INFECTION OF URT GA GIVEN

14. STEPS -BOYLE DAVIS MOUTH GAG INSERTED ADENOID CURETTE WITH GUARD INTRODUCED INTO NX AND ADENOIDS SHAVED OFF BY GENTLE SWEEPING MOVEMENTS HAEMOSTASIS ACHIEVED BY PACKING THE AREA,IF PERSISTENT BLEEDING ELECTOCOAGULATION DONE,IF IT STILL NOT CONTROLLED A POST NASAL PACK IS LEFT FOR 24 HRS

15. ENOSCOPIC ADENOIDECTOMY These days adenoids can be removed more precisely by using a debrider under endoscopic control

16. POST OP CARE AND COMPLICATIONS IMMEDIATE GENERAL CARE DIET ORAL HYGIENE ANALGESICS AND ANTIBIOTICS COMPLICATIONS HEMORRHAGE INJURY-EUSTACHIAN TUBE,PHARYNGEAL MUSCLES AND VERTEBRA GRISEL SYNDROME VELOPHARYNGEAL INSUFFICIENCY NX STENOSIS AND RECURRENCE

17. ACUTE AND CHRONIC TONSILLITIS

18. TONSILS OVOID MASS OF LYMPHOID TISSUE IN THE LATERAL WALL OF OROPHARYNX BETWEEN ANTERIOR AND POSTERIOR PILLARS TWO IN NO. TWO SURFACES;MEDIAL AND LATERAL TWO POLES;UPPER AND LOWER

19. Medial surface STRATIFIED SQUAMOUS NON KERATINIZING EPITHELIUM IT DIPS INTO SURFACE OF TONSILS FORMING CRYPTS LARGEST IS CRYPTA MAGNA CRYPTS FILLED WITH CHEESY MATERIAL CONSISTING EPITHELIAL CELLS,BACTERIA AND FOOD DEBRIS

20. Lateral surface COVERED BY FIBROUS CAPSULE OF TONSIL BETWEEN CAPSULE AND BED OF TONSIL IS LOOSE AREOLAR TISSUE SO IT IS EASY TO DISSECT THE TONSIL FROM THE BED DURING TONSILLECTOMY IT IS THE SITE OF COLLECTION OF PUS IN QUINSY SOME FIBRES OF PALATOGLOSSUS AND PALATOPHARYNGEUS ARE ATTATCHED TO THE CAPSULE OF TONSIL

21. UPPER POLE extends into the soft palate Extends into soft palate There is a semilunar fold of mucous membrane which covers the medial part of the upper pole It extends from anterior pillar to posterior pillar It encloses a potential space – supratonsillar fossa fo

22. Lower pole ATTATCHED TO TONGUE A TRIANGULAR FOLD OF MUCOUS MEMBRANE EXTENDS FROM ANTERIOR PILLAR TO TONSIL ENCLOSE A SPACE CALLED ANTERIOR TONSILLAR SPACE TONSIL IS SEPERATED FROM TONGUE BY A SULCUS CALLED TONSILLOLINGUAL SULCUS-SITE OF CA

23. Bed of tonsil BED OF TONSIL IS FORMED BY SUPERIOR CONSTRICTOR STYLOGLOSUS

24. STRUCTURES RELATED TO BED OF TONSIL

25. BLOOD SUPPLY

26. VENOUS DRAINAGE;PARATONSILLAR VEIN JOIN COMMON FACIAL VEIN AND PHARYNGEAL VENOUS PLEXUS LYMPHATIC DRAINAGE;UPPER DEEP CERVICAL NODES(JDG) NS;LESSER PALATINE BRANCHES OF SPHENOPALATINE GANGLION AND GLOSSOPHARYNGEAL NERVE PROVIDE SENSORY NERVE SUPPLY

27. ACUTE TONSILLITIS ACUTE INFECTION OF TONSIL INVOLVES;SURFACE EPITHELIUM,CRYPTS,LYMPHOID TISSUE ACUTE CATARRHAL OR SUPERFICIAL ACUTE FOLLICULAR ACUTE MEMBRANOUS ACUTE PARENCHYMATOUS

28. ETIOLOGY AND C/F AFFECTS MAILNLY SCHOOL GOING CHILDREN HEMOLYTIC STREPTOCOCCI SYMPTOMS -SORE THROAT,DIFFICULTY IN SWALLOWING,FEVER,EARACHE,CONSTITUTIONAL SYMPTOMS SIGNS -FOETID BREATH,COATED TONGUE,HYPEREMIA OF PILLARS SOFT PALATE UVULA,TONSILS RED AND SWOLLEN WITH YELLOWIS SPOTS OF PURULENT MATERIAL AT OPENING OF CRYPTS,WHITISH MEMBRANE,MEET IN THE MIDLINE,JUGULODIGASTRIC LYMPH NODES ENLARGED AND TENDER

29. TREATMENT PATIENT IS PUT TO BED AND ENCOURAGED TO TAKE PLENTY OF FLUIDS ANALGESICS ANTIMICROBIALS-PENICILLIN IS THE DOC/ERYTHROMYCIN*7-10 DAYS

30. COMPLICATIONS CHRONIC TONSILLITIS PERITONSILLAR ABSCESS PARAPHARYNGEAL ABSCESS CERVICAL ABSCESS AOM RF ACUTE GLOMERULONEPHRITIS SUBACUTE BACTERIAL ENDOCARDITIS

31. DD FOR MEMBRANE OVER TONSIL MEMBRANOUS TONSILLITIS DIPHTHERIA VINCENT ANGINA IMN AGRANULOCYTOSIS LEUKEMIA APHTHOUS ULCERS MALIGNANCY TRAUMATIC ULCER CANDIDAL INFECTION

32. CHRONIC TONSILLITIS COMPLICATION OF ACUTE SUBCLINICAL INFECTION WITHOUT ACUET ATTACK CHONIC INFECTION OF SINUSES OR TEETH-PREDISPOSING MOSTLY AFFECTS CHILDREN AND YOUNG ADULTS TYPES; CHRONIC FOLLICULAR PARENCHYMATOUS FIBROID

33. C/F RECURRENT ATTACKS OF SORE THROAT OR ACUTE TONSILLITIS CHRONIC IRRITATION IN THROAT WITH COUGH BAD TASTE IN MOUTH AND FOUL BREATH(HALLITOSIS)DUE TO PUS IN CRYPTS THICK SPEECH,DIFFICULTY IN SWALLOWING,AND CHOKING SPELLS AT NIGHT(DUE TO LARGE TONSILS CAUSING OBSTRUCTION) O/E ;TONSILS ENLAGED AND MEET IN MIDLINE YELLOWIS SPOTS ON MEDIAL SURFACE OF TONSILS-c/c follicular IRWIN MOORE SIGN- SMALL TONSILS AND PRESSURE ON ANTERIOR PILLAR EXPRESSES CHEESY MATERIAL OR FRANK PUS-c/c fibroid FLUSHING OF ANTERIOR PILLARS-IMP SIGN ENLARGED JDG

34. TREATMENT GENERL HEALTH,DIET,AND COEXISTENT INFECTION OF TEETH NOSE AND SINUSES TREATED TONSILLECTOMY IS DONE WHEN TONSILS INTERFERE WITH SPEECH,DEGLUTITION,RESPIRATION AND RECURRENT ATTACKS

35. COMPLICATIONS PERITONSILLAR ABSCESS PARAPHARYNGEAL ABSCESS INTRATONSILLAR ABSCESS TONSILLOLITHS TONSILLAR CYST RF,AGN,EYE AND SKIN DISORDERS

36. TONSILLECTOMY INDICATIONS- ABSOLUTE RECURRENT THROAT INFECTIONS->7/YR,>5/2YRS,>3/3YRS,2 WEEKS ABSENT QUINSY TONSILLITIS CAUSING FEBRILE SEIZURES HYPERTROPHY-SLEEP APNOEA,DIFF IN DEGLUTITION,SPEECH INTERFERENCE MALIGNANCY-U/L ENLARGED LYMPHOMA OR EPIDERMOID CA RELATIVE -DIPHTHERIA,STREPCARRIERS NOT RESPONDING TO ANTIBIOTICS C/C TONSILLITIS WITH HALLITOSIS “ “ “ RECURRENT STREP TONSILLITIS IN PT WITH VHD PART OF ANOTHER OPERATION -PALATOPHARYNGOPLASTY,GLOSSOPHARYNGEAL NEURECTOMY,REMOVAL OF STYLOID PROCESS

37. CONTRAINDICATIONS HB <10G% ACUTE URTI AND ACUTE TONSILLITIS CHILDREN UNDER 3 YRS CLEFT PALATE BLEEDING DISORDERS EPIDEMIC OF POLIO UNCONTROLLED SYSTEMIC DISEASE AT THE TIME OF MENSES

38. DISSECTION AND SNARE METHOD GA ANAESTHESIA ROSE POSITION STEPS -BOYLE DAVIS MOUTH GAG IS INTRODUCED AND OPENED TONSIL GRASPED WITH TONSIL HOLDING FORCEPS AND PULLED MEDIALLY INCISION MADE IN THE MUCOUS MEMBRANE WHERE IT REFLECTS FROM TONSIL TO ANT PILLAR.IT MAY BE EXTENDED ALONG UPPER POLE TO MUCOUS MEMBRANE BETWEEN TONSIL ND POSTERIOR PILLAR BLUNT CURVED SCISSORS TO DISSECT TONSIL WIRE LOOP OF TONSILLAR SNARE IS THREADED OVER THE TONSIL TO ITS PEDICLE TIGHTENED PEDICLE CUT AND TONSIL IS REMOVED GAUZE IS KEPT IN THE FOSSA AND BLEEDING SITES ARE TIED

39. COMPLICATIONS IMMEDIATE PRIMARY HEMORRHAGE REACTIONARY HEMORRHAGE INJURY TO PILLARS,SOFT PALATE AND UVULA,TEETH ASPIRATION OF BLOOD FACIAL EDEMA SURGICAL EMPHYSEMA OF NECK DELAYED SECONDARY HEMORRHAGE INFECTION LUNG COMPLICATION SCARRING IN SOFT PALATE PILLARS TONSILLAR REMNANTS HYPERTROPHY OF LINGUAL TONSILS

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