Pharynx clinical

Question 1

in which age group are pharyngeal tonsils prominent?

Answer 1

children (adenoids)

undergo atrophy after puberty

Question 2

what can happen in adenoiditis?

Answer 2

inflamed pharyngeal tonsils
can fill nasopharynx (roof of nasopharynx)
obstruct passage of air from nasal cavity –> choanae (where the 3 meatus drain in posterior nasopharynx)

Question 3

what will adenoiditis result in?

Answer 3

mouth breathing

can block eustachian tube - recurrent middle ear infections + glue ear (treat with grommets) –> reduced hearing

Question 4

what does eustachian tube provide a conduit for?

Answer 4

sepsis to travel from the (naso)pharynx to middle ear

accounts for frequency for otitis media complications from URTI (usually viral)

Question 5

what else can adenoiditis cause?

Answer 5

hyponasal speech (decreased resonance)
sleep apnoea (pauses in breathing during sleep)
difficulty in feeding in infants (infants are mouth breathers)

Question 6

what can be done in adenoiditis?

Answer 6

adenoidectomy: curettage (scrap) / diathermy (high-frequency electric current)

Question 7

what are complications of adenoidectomy?

Answer 7

bleeding
infection
eustachian tube stenosis (from scar)

Question 8

what is the pharyngeal fossa?

Answer 8

true diverticulum (lining of diverticulum, takes all lining with it)
posterior herniation of pharyngeal mucosa occuring in Killian's dehiscence (inferior constrictors)

Question 9

which population does pharyngeal fossa tend to occur in? why?

Answer 9

older people (>70 years)
due to weaker area, incoordination of pharyngeal phase of swallowing (pharyngeal peristalsis into oesophagus), crico-pharyngeal spasm
gives halitosis (bad breath)

Question 10

which tonsils tend to be affected in tonsillitis?

Answer 10

palatine tonsils

Question 11

what can be done to treat tonsillitis?

Answer 11

tonsillectomy e.g. electro / laser / radiowave surgery

Question 12

what can tonsillectomy result in? why?

Answer 12

profuse bleeding due to rich blood supply to tonsils (MALT - mucosal lymphoid tissue)
especially: TONSILLAR branch of FACIAL VEIN / external palatine vein

Question 13

which nerve innervates the palatine tonsils?

Answer 13

maxillary of trigeminal nerve via the lesser palatine nerves
and
tonsillar branches of the glossopharyngeal nerve (9)

Question 14

what does the glossopharyngeal nerve run close to? where?

Answer 14

tonsillar artery on lateral wall of pharynx
and
ICA (lateral to tonsils)
(both vulnerable to damage during surgery)

Question 15

when is tonsillectomy performed?

Answer 15

recurrent tonsillitis (>5/year for 2 years)
previous quinsy (peritonsillar abscess)
obstructive sleep apnoea
suspected cancer