Tonsillitis case
- 1. PROBLEM BASED LEARNING E.N.T SAROSH UL HASSAN
- 2. CASE SCENERIO• A 10year old boy comes to OPD with high grade fever, sore throat and dysphagia to solids for past 4 days. • Mother informs that he had multiple similar episodes in the past 2 years, always alleviated by taking antibiotics. • On examination tonsils were inflamed, hypertrophied with whitish membrane. Child looks toxic though.
- 5. ANATOMY OF PALATINE TONSILS • Palatine Tonsil is an ovoid mass of lymphoid tissue situated in the lateral wall of oropharynx between anterior and posterior pillars • It has Two surfaces – Medial and Lateral, and Two poles – Upper and Lower
- 6. MEDIAL SURFACE • Medial Surface is covered by nonkeratinizing stratified squamous epithellium which dips into the substance of tonsils in the form of crypts • One of the crypts, situated near the upper part of tonsils is very large and deep and is called CRYPT OF MAGNA
- 7. LATERAL SURFACE • It is covered by the fibrous capsule of the tonsil • The tonsillar bed is separated from the capsule by loose areolar tissue • This makes it is easy to dissect the tonsil from its bed during tonsillectomy • It is the site of collection of pus in peritonsillar abscess (quinsy)
- 8. POLES OF TONSILS • UPPER POLE – It extends into the soft palate – There is a semilunar fold of mucous membrane which covers the medial part of the upper pole • LOWER POLE – It is attached to the tongue – The lower pole is separated from the tongue by the tonsillolingual sulcus • This sulcus may harbour carcinoma
- 9. BLOOD SUPPLY
- 10. VENOUS AND LYMPHATIC DRAINAGE Enlarged non tender jugulodigastric lymph node is a sign of chronic tonsillitis
- 11. Nerve supply - Lesser palatine branch of sphenopalatine ganglion - Glossopharyngeal nerve
- 12. FUNCTIONS OF TONSIL • It has a protective function in that it prevents entry of pathogens through the nasal and oral route • The crypts on the surface of the tonsil serve to increase the surface area and increase the efficiency of protection against pathogens • It forms a part of Waldeyer’s lymphatic ring
- 13. COMING BACK TO THE DIFFERENTIAL DIAGNOSIS……
- 16. CATARRHAL TONSILLITIS MEMBRANOUS TONSILLITISPARENCHYMATOUS TONSILLITIS FOLLICULAR TONSILLITIS
- 17. MEMBRANE OVER TONSILS MEMBRANOUS TONSILLITIS DIPTHERIA VINCENT ANGINA INFECTIOUS MONONUCLEOSIS AGRANULOCYTOSIS LEUKEMIA APHTHOUS ULCERS MALIGNANCY TONSILS TRAUMATIC ULCERS CANDIDAL INFECTION OF TONSIL
- 18. MEMBRANOUS TONSILLITIS • Occur due to pyogenic organisms • An exudative membrane forms over the medial surface of the tonsils • Features of acute tonsillitis
- 19. DIPTHERIA • Acute infection caused by Corynebacterium Diptheriae • Formation of false membrane which extends beyond the tonsils on to the soft palate and posterior pharyngeal wall. • Dirty gray in color, firmly attached to mucosa. • Cause bleeding when membrane is removed • Diphtheria is slower in onset with less local discomfort
- 20. VINCENT ANGINA • Insidious in onset with less fever and less discomfort in throat • Gray membrane forms usually over one tonsils can be easily removed revealing an irregular ulcer on the tonsil. • Throat swab will show both organisms typical of this disease, that are: • Fusiform Bacilli • Spirochetes
- 21. INFECTIOUS MONONUCLEOSIS • Also called as glandular fever, caused by epstein barr virus. • Both tonsils are enlarged, congested and covered with mombrane. • Lymph Node enlarged in the posterior triangle of neck along with speenomegaly • Blood smear show more than 50% lymphocytes, out of which 10% are atypical. • White cell count is normal in first week but rises in the second week
- 22. LEUKEMIA • In children, 75% of leukemias are acute lymphoblastic and 25% acute myelogenous or chronic • Peripheral blood shows TLC>100,000/CU MM. • It may be normal or less than normal. AGRANULOCYTOSIS • Ulcerative necrotic lesions not only on the tonsils but also in the oropharynx. • Patient is severely ill. • In acute form, total leucocytic count is dec. to <2000/cu mm APHTHOUS ULCERS • They may involve any part of oral cavity or oropharynx • Very painfull • It is solitary & may involve the tonsil and pillars • May be small or large MALIGNANCY TONSILS • Oral or pharyngeal tumors are the excessive growth of cells in these regions. • They may be benign or malignant. • Most oral/pharyngeal tumors are malignant
- 24. QUINSY • Also called as peritonsillar abscess. • It the collection of pus in the peritonsillar space. FEATURES: • Dysphagia • High grade fever • Muffled and thick speech also called HOT POTATO VOICE • Trismus • Swollen soft palate • Uvula swollen and edematous.