Diseases of the OropharynxBy Ma. Clarissa Fortuna MD

Acute Pharyngitis → Etiology: Steptococcus, Pneumococcus, Influenza

bacillus→ S/S:

dryness, throat itchiness, body malaise, and headache, hoarseness, dysphagia

Edema, hyperemia of the posterior pharyngeal wall Serous mucoid exudate Yellowish grayish plugs in follicles or

plaques in lateral pharyngeal wall→ Diagnosis: Clinical & throat culture and sensitivity→ Tx: antibiotic coverage, warm saline

gargle/hydration

→ Pictures of hyperemic posterior pharyngeal wall: Symptoms: (again) sore throat, fever,

dysphagia, cervical lymphadenopathy Signs: inflammation, edema Tx: antibiotic coverage, gargle

Acute Tonsillitis→ Etiology: - hemolytic streptococcus,

Pneumococcus, Staphylococcus, H. influenza→ Pathologic Process:

Inflammation exudative cellulitis peri-tonsillar abscess tissue necrosis

Peritonsillar Abscess (Quincy)→ Etiology: late course of tonsillitis → Bacteriology: C & S of abscess = Streptococcus,

Staphylococcus aureus→ Pathology: marked swelling in supratonsillar fossa→ Symptoms: Marked dysphagia, salivation &

trismus → Tx: drainage

Vincent’s Angina→ Etiology: fusiform bacilli and spirochetes→ Clinical Manifestations: fever & cervical

lymphadenopathy → Dx: Fontana stain

Diptheria → Etiology: Corynebacterium diptheriae→ Culture at Mc Conckey Agar→ S/S: sore throat, dysphagia, dark membrane in

both tonsils → Tx: antitoxin; penicillin or erythromycin → Complications: airway obstruction, cardiac failure

Infectious Mononucleosis → “Kissing disease”→ Etiology: EBV, CMV→ S/S: fever lymphnode enlargement,

maculopapular rash, jaundice→ Dx: lymphocytosis, Mono spot test→ Tx: symptomatic

Antibiotics if with coexisting -hemolytic streptococcus

Steroids to decrease inflammation

Chronic tonsillitis → Tonsils are enlarged, w/ hypertrophy, scarring

→ Crypts w/ cheesy material

Anatomy of Waldeyer’s ring→ Components:

Palatine/ faucial tonsil Pharyngeal tonsil / adenoids Lymphoid tissue of Rossenmuller’s fossa Linguals

Indications for Tonsillectomy→ Absolute:

Cor Pulmonale Pharyngeal/ Peritonsillar abscess Hypertrophy with dysphagia Biopsy for suspected malignancy

→ Relative Documented recurrent bouts (3x/yr) Hyperplasia with obstruction IM RHD associated w/ chronic tonsillitis

CONTRAindications for Tonsillectomy→ Systemic infection→ Fever of unknown origin→ Blood Dyscrasia→ Enlarged tonsils without obstructive symptoms

Tonsillectomy pictures

Indications for Adenoidectomy → Obstructive adenoids (OSA)→ Chronic adenoid disease with Middle Ear effusion→ Recurrent acute suppurative OM → Suspicion of nasopharyngeal malignancy

Retropharyngeal Abscess→ Etiology: secondary to acute pharyngitis→ Symptoms: fever (preceded by URTI), stridor,

dysphagia→ Signs: pus between posterior pharyngeal walll and

prevertebral fascia→ Dx: Lateral x ray→ Tx: antibiotics, I & D (incision and drainage)→ Complications: asphyxia and hemorrhage

Pharyngomaxillary or Parapharyngeal Abscess→ Trismus, swelling near angle of mandible → Lateral pharyngeal wall pushed medially → Tx: Incision and drainage

Ludwig’s Angina→ Etiology: dental infection, suppurative cervical

lymphadenopathy, cellulitis in the suprahyoid space, tongue pushed upward

→ Space between floor of tongue to hyoid bone → Tx: Incision and drainage

LESSACHRABI

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