Document 6587628

The Nasopharyngeal Tonsil
• It is a mass of sub-epithelial
lymphoid tissue present at
the junction between the
roof & posterior wall of the
nasopharynx
• The free surface has 6 folds
• It has no capsule
• It is covered by pseudoThe palatine tonsil has a capsule
stratified
columner
on its lateral surface
epithelium
which separate the lateral wall
from
bed
• It drains
tothe
the
The
palatine
tonsil
Retropharyngeal
lymph
is covered
by stratified
nodes
Upper
Deep
columner
epithelium
Cervical Lymph Nodes
The palatine tonsil drains to
The Jagulodigastric lymph nodes
below the angle of the mandible
Adenoid
Definition
Age
Causes of enlargement
• Hypertrophy of the
nasopharyngeal onsil
sufficiently to produce
symtoms
2 -12 years
• Physiological enlargement : at 3-7 years
• Pathological: recurrent upper respiratory
tract infection
Symptoms
- Bilateral Nasal
Obstruction
-
Mouth Breathing
Snoring & OSA
Speech hyponasality
Difficult suckling
Rhinolalia clausa
(speech hyponasality)
‫ينطق الميم مثل الباء‬
• Bilateral Nasal
discharge
- Mucoid or mucopurulent
discharge WHY? Due to
blockage of the choanae
‫األنف تفرز‬of
‫ أن‬the
‫هل تعلم‬nasal
- Excoriation
‫لتر&ونصف من‬upper
‫حوالي لتر الي‬
vestibule
lip
-
‫السائل المخاطي يوميا‬
‫ماذ يحدث في حالة االنسداد الخلفي لألنف‬
‫تتحول للنزول‬
‫كل هذه الكمية‬
Post‫من‬nasal
discharge
‫لألنف‬frequent
‫الفتحة االمامية‬nocturnal
causing
cough
Signs
• Posterior Rhinoscopy  difficult
• Digital palpation not pleasant
• Endoscopic examination the best
Investigations
• Lateral soft tisue X ray
of the nasopharynx
It is not the size of the
nasopharyngeal tonsil which is
important but the size of the
mass in relation to the
nasopharyngeal space
Complications
1- OSAS:
- During Sleep:
- During day time
2- Descending infection
3- ِAdenoid Facies
Restless sleep,
Night mare, ‫كوابيس‬
Nocturnal eneuresis
‫تبول الارادي‬
Morning headache
Impaired concentration
Excessive day-time sleepiness
Recurrent OM
Pharyngitis, Laryngitis, bronchitis
Idiot look
Pinched nostril
Short upper lip
Prominent incisor
High arched palate
‫• الطفل طول الليل نايم فاتح فمه وبيشخر وكل شويه تنفسه يتوقف ويصحي‬
‫يأخد نفسه وينام تاني‬
‫• وبالنهار دايما نايم علي نفسه وتركيزه قليل‬
‫• وعنده تبول الارادي‬
Treatment
Adenoidectomy operation
Acute tonillitis
Acue inflammation of the palatine tonsils
Age:
Any age but common
in children
Etiology :
-
Beta hemolyic streptococci
Streptococcus pneumonia
Hemophylus influenza
Mode of transmission
droplet infection
Symptoms
Rapid onset of
- Fever, Headache, Anorrhexia, Malaise
- Severe sore throat ± referred otagia
- Halitosis
Signs
General :
High Fever with flushed face
Pharyngeal
Acute follicular tonsillitis
Acute membranous tonsillitis
Acute parynchymatous tonsillitis
Cervical
Enlarged tender jugulo-digastric
lymph nodes
The
yellowofspots
may
The crypts
the tonsils
Marked
hyperemia
and
Coalease
to formexudate
a
are full of purulent
enlargement
of
the
tonsils
Giving yellow
spots on the
Yellow
membrane
tonsils
Acute follicular T.
Acute membranous T
Acute parynchymatous T
Complications
Local:
-
Peritonsillar abscess
Parapharyngeal abscess
Retropharyngeal abscess
Systemic
-
Rheumatic fever (carditis
and arthritis)
Acute glomerulonephritis
Quinzy
Treatment
Antibiotics: 10 dayes
Rest
Ample fluid intake
Cold compresses
Analgesic Antipyretics
Gargles
Chronic Tonsillitis
Chronic inflammation of the palatine tonsils
Etiology :
Repeated attacks of acute tonsillitis
Symptoms: one or more of the following
- History of repeated attacks of AT
- Irritation in the throat
- Foetor oris
If hypertrophic
- Difficult swallowing
- Obsrtuctive sleep apnea
Signs:
Pharyngeal
- Asymmetry of the size of
the tonsils
- Hypertrophy of the tonsils
- The crypts ooze pus on
pressure by tongue
depressor
- Hyperaemia of the anterior
pillars
Cervical
Persistent enlargement of
jagulodigastric lymph
nodes
Treatment of Chronic Tonsillitis
Surgical By
Tonsillectomy operation