Oropharynx Flashcards
What are the types of Acute tonsillitis?
Acute catarrhal/superficial tonsillitis
Acute follicular tonsillitis
Acute membranous tonsillitis
Acute parenchymatous tonsillitis
Acute tonsillitis is common in _____________ and is caused by ___________
school going children
hemolytic streptococcus
What are the symptoms of tonsillitis?
Sore throat
Ear ache
Difficulty in swallowing
Fever, malaise
What are the signs of tonsillitis?
Bad breath
Coasted tongue
Follicles
Hyperemia of the tonsils
A membrane that can be easily wiped
Tonsils that meet each other (parenchymatous)
Enlarged JD nodes
What is the treatment for tonsillitis
Fluids
Aspirin or paracetamol
Penicillin or erythromycin for 7-10 days
What are the complications of tonsillitis?
Chronic tonsillitis
Peritonsillar abscess
Parapharyngeal abscess
Cervical abscess
Rheumatic fever
Acute glomerulonephritis
Subacute bacterial endocarditis
Acute otitis media
Distinguishing features of Diphtheria
Slow onset
Membrane is dirty grey in color
Extends onto tonsils, soft palate
Removing it leaves a bleeding surface
Urine shows albumin
Distinguishing features of vincent angina
Removing the membrane will reveal irregular ulcers on tonsil
Distinguishing features of IMN
Young adults
Splenomegaly
Failure of the antibiotic treatment
Lymphocytes on CBC
Paul Bunnell test (mono test)
What is the Paul Bunnell test done for?
Infectious mononucleosis
What do we find in the Paul Bunnell test?
High titre of heterophil antibody
D/Ds of acute tonsillitis
Diphtheria
Vincent Angina
IMN
Agranulocytosis
Leukemia
Aphthous ulcer
Malignant tonsils
Traumatic ulcer
Candida
What are the types of chronic tonsillitis?
Chronic follicular
Chronic parenchymatous
Chronic fibroid
WHat type of chronic tonsillitis is associated with sleep apnea and risk of cor pulmonale?
Chronic parenchymatous
WHat type of chronic tonsillitis is associated with recurrent sore throat?
CHronic fibroid tonsillitis
Important sign of chronic tonsillits
Flushing of Anterior pillars
What are the indications of tonsillectomy
Speech
Deglutition
Respiration
Recurrent attacks
What are the complications of chronic tonsillitis?
Peritonsillar abscess
Parapharyngeal abscess
Intratonsillar abscess
Tonsilloliths
Tonsillar cyst
Other systematic infections
What is ludwig Angina
Infection of the submandibular space
Explain the anatomy of the submandibular space
Above the mylohyoid, we got the sublingual space
Below it, we have submaxillary and submental space
WHat are the causes of ludwigs angina
Dental infection
Submandibular sialadenitis
Injury to oral mucosa
Fractures of mandibule
What afre the bacteria involved in ludwigs angina
Mixed
Streptococci
Staphylococci
Bacteroides
Features of ludwig angina
Odonyphagia
Trismus
Tongue pushed up
Woody hard feel
Laryngeal edema
Complications of LA
SPread of infection
Airway obstruction
Septicemia
Aspiration pneumonia
Treatment of LA
Systemic antibiotics
I/D intraoral if sublingual
I/D external if submaxillary
Tracheostomy
What is peritonsillar abscess
Collection of pus in the space between capsule of tonsils and superior constrictor muscle
What is the cause of peritonsillar abscess
Acute tonsillits
De novo
Features of Peritonsillar abscess
Constitutional symptoms
Odonyphagia is so severe that it causes dehydration
Hot potato voice
Foul breath
Earache
Trismus
Peritonsillar abscess mostly affects ________ and is _________ (unilateral/bilateral)
adults
unilateral
WHat are the signs of peritonsillar abscess
Uvula bulged to opposite site
Torticollis to the side of abscess
Tx of Peritonsillar abscess
Hospitalization
IVF
A/A
I/D
Interval tonsillectomy
Abscess or hot tonsillectomy
Complications of Peritonsillar Abscess
Parapharyngeal abscess
Laryngeal Edema
Septicemia
Pneumonia
Jugular Vein thrombosis
SPontanoeus hemorrhage
Explain retropharyngeal space
The space between bucopharyngeal fascia (covering the pharyngeal constrictors) and prevertebral fascia
Explain prevertebral space
Space between the prevertebral fascia and the vertebral bodies
Acute retropharyngeal abscess is in _____________
Retropharyngeal space
Chronic Retropharyngeal abscess is in _______________
prevertebral space
Etiology of Acute RP Abscess
Secondary infections of surrounding structures in children
Injury in adults
Dx of Acute RP abscess
Stridor
Croupy cough
Torticollis
Dysphagia
Bulge in the posterior pharyngeal abscess
Widening of prevertebral shadow and presence of gas
Chronic RP Abscess is caused by _____________
tuberculosis (on one side of the midline)
caries of the cervical spine (centrally)
Quinsy is AKA as _____________
Peritonsillar Abscess
Explain the parapharyngeal space anatomy
The space lateral to the pharynx. It is divided into Anterior compartment and posterior compartment
What are the important structures that pass through the posterior compartment of parapharyngeal space?
Carotid artery
Jugular Vein
9, 10, 11 and 12 CN
Sympathetic trunk
Deep cervical nodes
What are the features of Anterior compartment infection of the parapharyngeal space?
prolapse of tonsil and fossa
trismus
swelling behind the angle of the jaw
What are the features of posterior compartment infection of the parapharyngeal space?
Bulge of pharynx behind the posterior pillar
Paralysis of CNs and sympathetic chain
Swelling of the parotid region
Complications of Parapharyngeal abscess
Edema of larynx
Thrombophlebitis
Spread of infection
Mycotic aneurysm of carotid artery
Carotid blow
Pleomorphic adenoma is most commonly found on _____________
hard or soft palate
Mucus cyst is usually seen in _________
vallecula
Common sites of malignant tumors in the oropharynx
Posterior 1/3 or base of the tongue
Tonsils and fossa
Faucial palatine arch
Posterior and lateral pharyngeal wall
Hot potato voice is seen in ___________ and _____________
Peritonsillar abscess
Base of the tongue CA
____________ CA is the most common in oropharynx
Squamous cell carcinoma
What is styalgia?
Pain in tonsillar fossa
Aggravated on swallowing
Dx - Palpation of styloid process and Xray lateral or open mouth
Styalgia is AKA ___________
Eagle Syndrome (elongation of styloid process or calcification of stylohyoid ligament)
Sleep Apnea means ___________
No breathing during sleep
Types of sleep apnea
Obstructive sleep apnea
Central Sleep Apnea
Mixed
Pathophysiology of sleep apnea
Hypoxia - CO2 retention - pulmonary vasoconstriction - CHF, ↓ HR, MI leaft heart failure, cardiac arrhythmias and sudden death
Symptoms of sleep apnea
Sleep fragmentation
Day time sleepiness
Snoring
Gasping and choking
Morning headaches
Memory loss
Impotency
Excessive daytime sleepiness is measured by ______________
Epworth sleepiness scale
The collar size should not exceed ____ cm in males and ____ cm in females
> 42 cm in males
37.5 cm in females
Muller maneuver is used for __________
sleep apnea
Examination of patients with sleep apnea include
BMI
Collar size
Head and neck examination
Muller Maneuver
Systemic examination
Cephalometric radiographs
Polysomnography
Split-night polysomnography
What is the gold standard test for sleep apnea?
Polysomnography
Nonsurgical treatment of sleep apnea
Positional therapy (sleep on his/her side)
Intraoral devices (Mandible advancement device; MAD or Tongue retaining device TRD)
CPAP (continuous positive airway pressure)
Surgical treatment of sleep apnea
Permanent tracheostomy is the gold standard
Tonsillectomy/ Adenoidectomy
Nasal surgery
Oropharyngeal surgery
Advancement genioplasty with hyoid suspension
Tongue base radiofrequency
Maxillomandibular advancement osteotomy
