Diseases of Pharynx.pptx

larynx

1. Diseases of Pharynx TEKLEWEINI ABRHA (MD)

2. Pharynx Conical fibromuscular tube Lined with skeletal muscle Runs from skull base to C 6 vertebrae Connects nasal cavity & mouth to esophagus & larynx Common passage for food and air Divided into 3 regions Nasopharynx ( epipharynx ) Oropharynx ( mesopharynx ) Laryngopharynx ( hypopharynx )

3. Nasopharynx Lined by Ciliated pseudostratified columnar epithelium Found Posterior to Nasal Cavity, inferior to Sphenoid bone & superior to Soft Palate It has pharyngeal tonsils (adenoids) & tubal tonsils Function As a conduit of air Through Eustachian tube - ventilates middle ear cavity Prevents regurgitation A resonating chamber A draining cannel for mucus secretion

4. Oropharynx Lined with thick, protruding stratified squamous epithelium due to great friction Location Posterior to Oral Cavity Runs from Soft Palate to Epiglottis Palatine tonsils & lingual tonsils are found in this part. Function – for passage of air & food Helps in pharyngeal phase of swallowing Vocal tract Helps in appreciation of taste

5. Laryngopharynx Stratified squamous epithelium Location - Posterior to Larynx Continuous with esophagus (digestive system) & larynx (respiratory system) Subdivided in to 3 regions – piriform sinus ,posterior cricoid region & posterior pharyngeal wall Function Common pathway for air & food For vocal resonance Help in deglutition

6. Tonsils Simple lymphoid organs MALT: mucosa-associated lymphoid tissue Form ring around opening of pharynx 4 groups Palatine (pair) Lingual Pharyngeal Tubal (pair)

7. Disease of the nasopharynx Congenital- transsphenoidal meningoencephalocele Glioma , dermoid cyst Inflammatory – Adenoiditis –viral ,bacteria Tumours Benign-juvenile nasopharyngeal angiofibroma is the most common Malignant -90% are SCC ..

8. Adenoiditis viral ,bacterial Acute ,chronic ,recurrent E tiology –recurrent rhinitis ,sinusitis , tonsilitis ,allergy Clinical features Nasal obstruction ,nasal discharge Rhinitis/sinusitis Hyponasal voice Recurrent otitis media, chronic suppurative otitis media(CSOM) Obstructive sleep apnea(OSA) Post nasal drip and cough Pulmonary HTN , corpulmonale if long standing

9. Adenoiditis… Diagnosis –rigid or flexible endoscopy Lateral neck X-ray Treatment- treat predisposing factors like rhinitis, sinusitis or tonsillitis - Decongestant nasal drops ,antihistamine Indications for surgery ( adenoidectomy ) OSA, corpulmonale Chronic nasopharyngitis CSOM Recurrent AOM Suspect malignancy Chronic sinusitis

10. Disease of the oropharynx Congenital Inflammatory - tonsilitis Tumors Benign malignant

11. Acute Tonsillitis Etiology Group A beta- hemolytic streptococcus and Group G streptococcus S. pneumoniae , S. aureus , H. influenzae , M. catarrhalis Epstein-Barr virus (EBV) 4 types Acute caterrhal tonsilitis Acute follicular tonsilitis Acute parenchymatous tonsilitis  acute membraneous tonsilitis

12. Acute Tonsillitis… Clinical Features symptoms sore throat dysphagia, odynophagia, trismus malaise, fever otalgia (referred pain to the ear) signs tender cervical lymphadenopathy especially submandibular, jugulodigastric lymph nodes tonsils enlarged, inflammation ± exudates strawberry tongue palatal petechiae (infectious mononucleosis)   

13. Acute Tonsillitis Investigations CBC swab for C&S Treatment Supportive (bed rest, soft diet, ample fluid intake ) gargle with warm saline solution analgesics and antipyretics antibiotics for 7-10 days only after appropriate swab for C&S 1st line - penicillin or amoxicillin (erythromycin if penicillin allergic). 2 nd line – Augmentin if no response to the above A bxs will avoid serious sequela and to provide earlier symptomatic relief

14. Acute Tonsillitis Complications Chronic tonsilitis with recurent acute attack AOM D eep neck space infection A bscess: peritonsillar , intratonsillar ,retropharyngeal, or parapharangeal S epsis R heumatic fever Glomerulonephritis Subacute bacterial endocarditis

15. Chronic tonsillitis Aetiology As a complication of acute tonsilitis Chronic infection in sinuses or teeth Types Chronic follicular tonsillitis Chronic parenchymatous tonsillitis Chronic fibroid tonsillitis Clinical feature –recurrent attack of sore throat , chronic irritation in throat with cough , bad test in mouth ,foul breath thick speech ,difficulty of swallowing

16. Chronic tonsillitis… On examination Tonsilar enlargment ,yellowish beds of pus Enlargement of jugulodigastric LNs Mx –conservative Mx of co-existing disease eg. Chronic infection in sinuses or teeth Antibiotic – similar to acute tonsilitis but longer duration( 10-14 days) Tonsillectomy what are the indications??????

17. Tonsil Hypertrophy

18. Indications for Tonsillectomy Absolute OSA, cor pulmonale Suspect malignancy Hemorrhagic tonsillitis Severe dysphagia Relative Tonsillar hypertrophy Recurrent tonsillitis Complications of tonsillitis

19. Obstructive sleep apnea syndrome (OSAS) Definitions Apnoea Cessation of airflow at nostrils for 10 seconds or longer Causes of OSAS: Nose Polyps Deviated nasal septum Choanal stenosis

20. Pharynx Adenoidal hypertrophy Nasopharyngeal tumor Large palatine/lingual tonsils Retropharyngeal mass Large tongue Obesity S upraglottic - - laryngomalacia Cerebral palsy

21. Clinical features of OSAS Frequent wakening and disturbed sleep pattern Snoring Sign of partial airway obstruction Apnoeic episodes Daytime somnolence Signs Poor nasal airway Mouth breathing Noisy respiration Grossly hypertrophic tonsils Short, thick neck Obesity Complications of OSAS: Pulmonary hypertension , Corpulmonale , failure to thrive

22. Special investigations Lateral neck X-ray, CXR, ECG Nasal endoscopy Treatment – Mx the cause For eg . Adenotonsillectomy adenotonsillar hypertrophy Chemo-radiotherapy for nasopharyngeal Ca. Advice on weight reduction sleeping on lateral position for obesity

23. Deep neck space infections Neck spaces by far the most complex anatomy Compartmentalization →prevent spread of infection Prevention, spread & treatment based on anatomy Commonly arise from a septic focus of the mandibular teeth, tonsils, parotid gland, deep cervical LNs, middle ear, or PNS Often rapid in onset and may progress to fatal complications.

24. Neck spaces Entire length of the neck Prevertebral space Retropharyngeal space Danger space Visceral vascular space Infrahyoid Pretracheal space Suprahyoid Parapharyngeal space Submandibular space Parotid space Masticator/ buccal space Peritonsillar space Temporal space

25. Causes Adults Odontogenic infections most common Salivary gland infections, FBs, trauma, instrumentation, URTI Pediatrics -Tonsillitis most common cause followed by odontogenic infectios . Bacteriology Mixed infection Usually reflect oropharyngeal flora Streptococci are the most commonly cultured organism

26. Diagnosis Symptoms Signs Pain Fever Swelling Dys/odynophagia Trismus Resp. difficulty Toothache Swelling Dental abnormality. Flactuant mass Oropharyngeal diseases. Trismus

27. Radiology Plain films PA & lateral neck X ray FB, tracheal deviation, subcut air, soft tissue edema Important in the diagnosis of pretracheal & retropharyngeal abscess CXR Pulmonary edema, pnumothorax / pnumomediastinum , hilar LAP Mediastinal widening in mediastinitis Panorex oral view Apices of 2 nd & 3 rd mandibular molars extend below myelohyoid line CT/MRI U/S Guides aspiration & supplement diagnosis, but it is Operator dependent

28. Management Securing the airway is the 1 st priority Humidified air & observation enough for most Intubation/ cricothyrotomy /tracheostomy Fluid resuscitation often indicated Antibiotics Emperic till culture result arrives Immunocompetent ceftriaxone/ cefoxitine

29. - Compromised Clindamycin + ciprofloxacin S. aureus suspected add vancomycin Necrotizing cervical fascitis Ceftriaxone + clindamycin/metronidazole Surgical management Tooth extraction if inciting tooth disease identified Incision & drainage Abscess Impending complications No improvement after 48 hrs of parentral antibiotics