Disease of throat Flashcards
Wall of pharyngeal consist of 5 layers
- Mucosa membrane
- Submucosa
- Pharyngobasilar fascia
- Pharyngeal muscle
- Buccopharyngeal fascia
Pharyngeal muscle inverted by vagus nerve
(CN X)
- Salphingopharyngeus
- Palatopharyngeus
Pharyngeal muscle inverted by glossopharyngeal nerve (CN IX)
Stylopharyngeus
Primary responsible for constricting the pharynx during swallowing (Constrictor muscles)
External Circular layer
Elevate/shorten and widen the pharynx during swallowing and speaking
Internal Longitudinal layer
Blood supply of pharynx
Branches of the External Caroid Artery
1. Ascending pharyngeal
2. Ascending palatine
3. Tonsillar branches of the facial artery
4. Branches of the maxillary and lingual arteries
5. Pharyngeal brances of the inferior thyroid artery
Nasopharynx: Continuous surface that lies inferior to the body of the sphenoid bone and the basilar part of the occipital bone
Roof and posterior wall
Nasopharynx: Found in the mucous membrane of the roof and posterior wall of the nasopharynx
Pharyngeal tonsils
Functions of the nasopharynx
- Airway
- Hearing, middle ear ventilation, maintains air pressure
- Resonance
- Drainage
- Prevent aspiration
Functions of the tonsils and adenoids
- Immunity
- Barrier to infection
- IgA antibody production
Laryngopharynx borders
✓ Posterior: related to the bodies of the C4-C6 vertebrae
✓ Posterior and lateral walls: middle and inferior constrictor muscles
Pharynx deglutiton phase
- Oral → voluntary (1 second)
- Pharyngeal → both (1 second)
- Esophageal → involuntary (8-20 seconds)
Pharyngeal phase reflex actions
- Closure of nasopharyngeal isthmus (soft palate raised against passavants ridge)
- Closure of oropharyngeal isthmus (palatoglossus muscle)
- Closure of laryngeal inlet (contraction of aryepiglottic folds
Esophageal phase definition
• Closure of cricopharyngeal sphincter
• Primary peristalsis of esophagus (contraction of circular muscles)
• Food moves down: relaxation of gastroesophageal sphincter and opens (CN X)
• Food enters the stomach: sphincter closes
• Note: secondary peristalsis due to esophageal distension (Auerbach’s plexus)
Adenoid Hyperplasia/Adenoiditis Etiology
- Physiological enlargement – 3-5 years of age (same children develop generalized lymphoid hyperplasia)
- Recurrent attacks of rhinitis, sinusitis, tonsillitis
- Allergy of the upper respiratory tract
Adenoid facies clinical presentation
- Elongated face with dull expression
- Open mouth
- Prominent and crowded teeth
- Hitched up upper lip
- Pinched in appearance of nose
- High arched palate
Acute Nasopharyngitis Clinical features
- Dryness and burning sensation of the throat above the soft palate
- Pain and discomfort localized to the back of nose with difficulty in swallowing
- In severe infection, there is fever and enlarged cervical lymph nodes
- Exam: congested and swollen mucosa often covered with whitish exudates
Acute Nasopharyngitis Clinical features
- Dryness and burning sensation of the throat above the soft palate
- Pain and discomfort localized to the back of nose with difficulty in swallowing
- In severe infection, there is fever and enlarged cervical lymph nodes
- Exam: congested and swollen mucosa often covered with whitish exudates
Infection of the pharyngeal bursa which is a median recess representing attachment of notochord to endoderm of primitive pharynx
Tornwald’s Disease
Infection of the pharyngeal bursa which is a median recess representing attachment of notochord to endoderm of primitive pharynx
Tornwald’s Disease
Examination apperance of Tornwald’s disease
Cystic and fluctuating swelling of the posterior wall of nasopharynx
Examination apperance of Tornwald’s disease
Cystic and fluctuating swelling of the posterior wall of nasopharynx
Persistent nasal discharge with crusting in nasopharynx
Tornwald’s disease
Gross presentation of nasopharyngeal cancer
Proliferative, ulcerative, infiltrative types
Genome studies in NPC
- HLA A2
- HLA B46
- HLA B17
WHO Classification of NPC
- Keratinizing Squamous cell (25%)
- Non keratinizing squamous carcinoma (12%)
- Undifferentiated carcinomas (60%)
Neurologic findings of patient with NPC
Neurologic (25-40%)
1. Headache
2. Facial pain
3. Xerophtalmia
4. Jugular foramen syndrome
Lingual thorid definition
- Lingual thyroid tissue is associated with an absence of the normal cervical thyroid in 70% of cases
- May enlarge and cause dysphagia, dysphonia, dyspnea, or a sensation of choking
- Hypothyroidism
Characterized by red, swollen tonsils that may or may not have exudates
Tonsillopharyngitis
Characterized by red, swollen tonsils that may or may not have exudates
Tonsillopharyngitis
Tonsillopharyngitis sign and symptoms
- Severe sore throat
- Painful/difficult swallowing
- Headache
- Fever and chills
- Enlarged and tender lymph nodes
- Pain in the tonsil area
- Loss of voice
Physical signs of Quinsy
- Redness and edema in the tonsillar area of the affected side
- Swelling of the jugulodigastric lymph nodes
- The uvula may be displaced towards the unaffected side
Kissing disease, Pfeiffer’s disease and Grandular fever
Infectious Mononucleosis
Caused by EBV which infects the B lymphocytes, transmitted from asymptomatic individuals through saliva or by sharing a drink, or sharing eating utensils and may also be transmitted through the blood
Infectious Mononucleosis
Carcinoma of the Piriform sinus clinical features
- Metastatic neck nodes (1st sign)
- Sticking or pricking sensation in throat
- Referred otalgia
- Odynophagia
- Dysphagia
