Chapter 17: Diseases of the Nasopharynx and Oropharynx Flashcards
Regions of pharynx
- Nasopharynx
- Oropharynx
- Laryngopharynx/hypopharynx
Respiratory portion of the pharynx
Immobile except for the lower soft palate
Nasopharynx
Extends from the inferior border of the soft palate to the lingual surface of the epiglottis
Includes the palatine tonsils with their pillars and the lingual tonsils located on the base of the tongue
Oropharynx
Represents the region of the separation of the upper airway from the upper digestive pathway
Laryngopharynx/hypopharynx
Posterior wall extending toward the vault of the nasopharynx
Adenoid tissue
Recessus pharyngeus
Rosennüller’s fossa
Reflection of pharyngeal mucosa over the rounded protrusions of the cartilaginous portion of the ET projects as a thumblike intrusion into the lateral wall of the nasopharynx just above the attachment of the soft palate
Torus tubarius
Posterior choanae of the nasal cavity
Nasopharynx
Close proximity and can be involved by extension of nasopharyngeal disease
Cranial foramina (jugular foramina)
Important vascular structures in the immediate in the nasopharynx
- Inferior petrosal sinus
- Internal jugular vein
- Meningeal branches from the occipital and ascending pharyngeal arteries
- Hypoglossal foramen
Is in the proximity to the lateral portion of the roof of the nasophatynx
- Petrous portion of the temporal bone
2. Foramen lacerum
Ostium of the sphenoid sinuses
Nasopharynx
Permits direct visualization of the nasopharynx and torus tubarius
Nasopharyngoscope
Circumferential ring of lymphoid tissue
Waldeyer’s ring
Other parts of the ring
- Lymphoid tissue
- Palatine/faucial tonsils
- Lingual tonsils
- Lymphoid follicles on the posterior pharyngeal wall
Has its lymphoid structures arranged in folds
Adenoid/pharyngeal tonsils
Has its lymphoid arrangement around cryptlike formations
Palatine tonsils
- Becomes diseased frequently than any of the other components of the ring
- More tortuous in the upper pole of the tonsils
- Become plugged with food particles, mucus, desquamated epithelial cells, leukocytes and bacteria
- Excellent place for the growth of pathogenic bacteria
Palatine tonsils
Have small crypts that are not particularly tortuous or branched
Lingual tonsils
Serves as a divider between the oropharynx and the hypopharynx
Epiglottis
- Includes the pyriform sinuses, posterior pharyngeal wall and post cricoid cartilage
- Funnel-shaped
Hypopharynx
Results from the embryologic failure of the bucconasal membrane to rupture prior to birth
Congenital choanal atresia
Results in the persistence of a bony plate (90%) or membrane (10%) obstructing the posterior nares
Congenital choanal atresia
Congenital choanal atresia
Unilateral: asymptomatic
Bilateral: emergency
Diagnostic for congenital choanal atresia
Inability to pass a soft catheter through the nose into the pharynx
Emergency treatment for congenital choanal atresia
Inserting a plastic oral airway into the infant’s mouth
Alternative treatment for congenital choanal atresia
Tape a rubber baby bottle nipple (McGoven nipple) with a large opening on the tip into position in the infant’s mouth (permitting both breathing and feeding)
Blindly perforating the bony plate or membrane is prohibited because of the…
Narrow nasopharynx
Atresia plate can be approached surgically by…
- Transnasal
- Transeptal
- Transpalatal (more definitive)
- Is a form of postnasal discharge that is produced by mucoid drainage from a pocket (pharyngeal bursa) in the uppermost part of the posterior pharyngeal wall
- Unusual cause of postnasal drainage
- Corrected by excision
Nasopharyngeal bursitis
Symptoms of nasopharyngeal tumor
- Posterior epistaxis
- Postnasal discharge
- Nasal obstruction
- Hearing loss
- Late sign: paralysis of CN 3, 6, 9, 10, 11
- Serous otitis media
- Uncommon tumor occurs exclusively in adolescent boys
- Symptoms: epistaxis, nasal obstruction
- Can invade the surrounding vital structures with eventual invasion of the base of the skull
Juvenile nasopharyngeal angiofibroma
Treatment modalities for juvenile nasopharyngeal angiofibroma
- Radiation ( for residual disease or when surgery is not possible)
- Surgery (preferred treatment when feasible)
- Hormonal therapy
Evaluation of juvenile nasopharyngeal angiofibroma
- CT scan
2. Arteriography
Highly vascular tumors obtain their blood supply from
- Ascending pharyngeal artery or
- Internal maxillary artery
Additional: branch of the internal carotid artery (tumor transcends into the anterior or middle cranial fossa)
Diagnosis of juvenile nasopharyngeal angiofibroma
- History
- Exam
- CT
- Arteriogram
- Biopsy (not necessary and is hazardous)
Most common presenting sign of nasopharyngeal carcinoma
Posterior high cervical lymph node
Virus that is associated with nasopharyngeal carcinoma
Epstein-Barr virus
An accumulation of lymphoid tissue along the posterior wall of the nasopharynx above the level of the soft palate
Adenoids
Adenoids
Hypertrophy: childhood (normal), greatest size in the preschool and early school-age years
Spontaneous resolution: 18-20 years
Related to ET obstruction and resultant serous otitis media as well as recurrent and repeated episodes of acute otitis media
Adenoid hypertrophy
Can interfere with nasal breathing if theres obstruction
Adenoid hypertrophy
May lead to some changes in dental structure and malocclusion
Adenoid hypertrophy
Can interfere with the normal respiratory process—>cor pulmonale or sleep apnea-type syndromes
Adenoid hypertrophy
Indications for adenoidectomy
- Chronic upper airway obstruction with resultant sleep disturbances, cor pulmonale or sleep apnea syndrome
- Chronic purulent nasopharyngitis despite adequate medical management
- Chronic adenoiditis or adenoid hypertrophy associated with production and persistence of middle ear effusion
- Recurrent acute suppurative otitis media that has not responded to medical management with prophylactic antibiotics
- Certain cases of chronic suppurative otitis media in children with associated adenoid hypertrophy
- Suspicion of nasopharyngeal malignancy
Most common and preferred treatment for chronic serous otitis media that is refractory to medical management with antibiotics and other forms of conservative treatment
Insertion of ventilation tubes through the TM (may remain in place only 6-12 months)
Serves as a flag to warn of possible submucous palatal cleft
Bifid uvula
Oropharyngeal disorder can be divided into those that cause…
- Acute sore throat
2. Chronic sore throat
Common organisms found in acute pharyngitis
- Streptococci
- Pneumococci
- Influenza bacillus
Stages of acute pharyngitis
Hyperemia—>edema—>increased secretion
Exudate at first is serous but becomes thicker or mucoid—>become dry and may adhere to the pharyngeal wall
Signs and symptoms of acute pharyngitis
- Dryness or scratchiness of the throat
- Malaise
- Headache
- Fever
- Exudate in the pharynx
- Hoarseness
- Dysphagia
- Cervical adenopathy and tenderness
- Pharyngeal wall is reddened
Acute suppurative bacterial tonsilitis is most often caused by
Beta-hemolytic Streptococcus group A Others: Pneumococci Staphylococci Hemophilus influenzae
General inflammation and swelling of the tonsil tissue with an accumulation of leukocytes, dead epithelial cells and pathogenic bacteria in the crypts
Acute suppurative bacterial tonsilitis
Pathologic phases: acute suppurative bacterial tonsilitis
- Simple inflammation of the tonsil area
- Formation of exudates
- Cellulitis of the tonsil and its surrounding area
- Formation of a peritonsillar abscess
- Tissue necrosis