Adenoids and tonsils Flashcards by Unknown Unknown

Adenoids grows till

7 years of age

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Blood supply of adenoids

Maxillary artery
Ascending palatine
Ascending pharyngeal

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Epithelial lining of adenoids

Ciliated columnar
Pseudostratified

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Lymphoid drainage

Retropharyngeal -> Jugulodigastric lymph nodes

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Clinical features

Nasal obstruction causing adenoid facies (mouth open, high arched palate, anterior crowding of teeth, absent nasolabial creases, pinched nose, absent alar prominence)
ET obstruction (serous otitis media, recurrent infections) causing dull look
Rhinolalia clausa
Failure to thrive
Sleep apnea(> 5 times/hour or > 30/7 hours, excessive snoring, increased daytime sleepiness)
Cor Pulmonale

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Adenoids history

Snoring
Noisy breathing
Mouth breathing
Voice change
School performance

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Management for acute cases

Medical management:
Anti-histamines
Antibiotics
Nasal decongestants
Nasal steroid spray

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Chronic cases

Evaluation:
1.Grading adenoids size by nasal endoscopy
2.Lateral X ray
3. Surgical management : Adenoidectomy + Myringotomy with gromet insertion +/- Tonsillectomy

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Indications for adenoidectomy

Recurrent sinusitis (due to nasal obstruction)
Chronic SOM/Recurrent ASOM (due to ET obstruction)
Sleep apnea
Failure to thrive

Adenoid hypertrophy causing snoring, mouth breathing, sleep apnea syndrome or speech abnormalities

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Rose position

Extension at atlantooccipital joint and cervicothoracic joints

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Rose position is used in which surgeries

Adenoidectomy
Tonsillectomy
Tracheostomy

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Methods of Adenoidectomy

Cold methods: Curettage, Microdebrider
Hot methods: Coblation, Diathermy

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Complications

Hemorrhage
ET injury leading to chronic middle ear infections
Unmasking of velopharyngeal insufficiency (nasal regurgitation of fluid and food, rhinolalia clausa)
Grisel syndrome
Nasopharyngeal stenosis
Recurrence

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Contraindications of Adenoidectomy

Acute infection
Bleeding diathesis
Velopharyngeal insufficiency (cleft palate)

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Grisel syndrome

post surgical inflammatory edema -> Paraspinal muscle spasm -> Non traumatic atlantoaxial subluxation -> torticollis/wry neck

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Grisel syndrome management

Anti inflammatory drugs
Immobilization of neck
Rarely neurosurgical intervention

Adenoidectomy procedure

Boyles davis mouth gag
laryngeal mirror
St. Claire Thompson Adenoid curette with guard is introduced into the nasopharynx till its free edge touches the posterior border of nasal septum and is then pressed backwards to engage with adenoids
With gentle sweeping movement, adenoids are shaved off. Lateral masses are removed with small curettes. Small tags of lymphoid tissues are removed with punch forceps
Nasal packing

Tonsillar bed structures

Capsule
Loose alveolar tissue containing paratonsillar vein
Pharyngobasilar fascia
Superior constrictor muscle
Buccopharyngeal fascia
Glossopharyngeal nerve
Facial artery
Submandibular salivary gland
Medial pterygoid muscle
Angle of Mandible

Blood supply of tonsil

Maxillary artery -> descending palatine artery
Ascending pharyngeal artery -> Tonsillar branches
Facial artery -> Tonsillar branch
Lingual artery -> dorsal lingual branches

Most common cause of hemorrhage following tonsillectomy

due rupture of paratonsillar vein

Most common organism causing acute tonsillitis

group A beta hemolytic streptococcus

Symptoms of acute tonsillitis

Sore throat
Fever
Dysphagia/odynophagia
Otalgia
Upper deep cervical lymph node enlargement
Constitutional symptoms: headache, malaise, general body ache, constipation

Types of tonsillitis

Acute catarrhal
Follicular
Membranous
Parenchymatous

Scarlet fever clinical features

Sandpaper rash
Tonsillitis
Strawberry tongue

Local complications of acute tonsillits

Acute otitis media Peritonsillar abscess Parapharyngeal abscess Retropharyngeal abscess Submandibular abscess

Systemic complications of acute tonsillitis

Rheumatic fever Glomerulonephritis Cor pulmonale Subacute bacterial endocarditis Lemierre's syndrome

Lemierre's syndrome

Spread of infection to parapharyngeal space -> Septic thrombophlebitis of internal jugular vein -> Severe neck pain and high grade fever

Differential diagnosis of membrane over tonsil

AL VITAMIN D

Causative organisms of vincent's angina and definition

Borrelia vincenti Fusarium fusiformis Acute necrotizing ulcerative gingivitis

Infectious mononucleosis: causative organism, clinical findings and investigations

Epstein barr virus Sore throat Hepatomegaly Spleenomegaly Paul bunnel test/ monospot test Peripheral smear

Indications of tonsillectomy

Absolute indications Relative indications

Absolute indications

Infective: Recurrent infections Peritonsillar abscess Chronic tonsillitis Non infective: Tonsillitis causing sleep apnea Unilateral asymmetrical enlargement of tonsils

Relative indications

Carriers of streptococcus and diphtheria To approach structures in tonsillar bed(Eagles syndrome, Glossopharyngeal neuralgia) Tonsilolith

Contraindications of tonsillectomy

Acute infections Bleeding diathesis Velopharyngeal insufficiency Polio epidemics (Virus in lymphoid tissue -> enters blood vessels and nerves leading to paralytic polio)

Methods of tonsillectomy

Cold methods: Dissection and snare method Microdebrider Hot methods: Coblation Cautery

Tonsilitis procedure

1. Boyles davis mouth gag 2. Dennis browne Tonsil holding forceps 3. incision is made between anterior tonsillar pillar and tonsil 4. Dissection of tonsil 5. Eves tonsillar snare at inferior pedicle 6. Bleeding points are tied with silk

Complications of tonsillectomy

Immediate: Primary hemorrhage Reactionary hemorrhage Injury to tonsilar pillars, uvula, tongue, superior constrictor muscle Injury to teeth Aspiration of blood Surgical emphysema Delayed: Secondary hemorrhage Infection Lung complications Scarring of soft palate and pillars Hypertrophy of lingual tonsil