Tonsillitis & Tonsillectomy PDF

Dr. Luqman A. Mustafa M.B.Ch.B, FKBMS (ORL-HNS) UOD/SCHOOL OF MEDICINE 2022-2023 Waldyers ring Tonsillitis Definition: Is an inflammation of the tonsils. Types: Acute tonsillitis Chronic tonsillitis Acute tonsillitis Classification: Acute catarrhal or superficial tonsillitis: is a...

Dr. Luqman A. Mustafa M.B.Ch.B, FKBMS (ORL-HNS) UOD/SCHOOL OF MEDICINE 2022-2023 Waldyers ring Tonsillitis Definition: Is an inflammation of the tonsils. Types: Acute tonsillitis Chronic tonsillitis Acute tonsillitis Classification: Acute catarrhal or superficial tonsillitis: is a part of generalized pharyngitis and seen in viral infections Acute parenchymatous tonsillitis: The tonsils are uniformly enlarged and red Acute follicular tonsillitis: In which tonsillar crypts become filled with purulent materials Acute membranous tonsillitis: The exudates in the crypts coalesces to form membrane on the surface Acute catarhal tonselitis Acute Parenchymatous Tonselitis Acute Folliculer Tonselitis Acute Membranous Tonselitis Etiology: — Affects school-age children but adults can also be affected. It is rare in infants (< 1 year age) and persons above 50 years. Causative organisms: — Group A beta hemolytic streptococci — Haemophilus influenzae — Streptococcus pneumoniae — Staphylococci — Tuberculosis (in immunocompromised) — Viruses: adenovirus, Epstein-Bar virus and herpes simplex virus Symptoms: — sore throat — difficulty in swallowing + pain — fever (can be accompanied by rigors and chills) — ear ache — headache — generalized body fatigue Signs: — breath is foetid and tongue is coated — hyperaemia of the pillars, soft palate and uvula — enlarged and congestive tonsils with swollen uvula (acute parenchymatous tonsillitis) — red and swollen tonsils with yellowish spots in the crypts (follicular tonsillitis) — whitish membrane on the medial surface of the tonsils (membranous tonsillitis) — enlarged and tender jugulodigastric lymph nodes Differential diagnosis: — Diphtheria — Infectious mononucleosis — malignancy (lymphoma, leukemia) Treatment: — Bed rest + plenty of fluids — Analgesia — Antimicrobial Chronic tonsillitis Types: — chronic follicular tonsillitis — chronic parenchymatous tonsillitis — chronic fibroid tonsillitis Tonsils are small but infected, with history of repeated sore throats. Etiology: — may be a complication of acute tonsillitis — subclinical infection of tonsils without acute attack — chronic infection of sinuses or teeth may be a predisposing factor Clinical features: — recurrent attacks of acute tonsillitis — chronic irritation in throat and cough — bad taste in mouth and foul breath (halitosis) Treatment: — Conservative treatment: attention to diet, general health and treatment of coexisting infections of teeth, sinuses and nose. — Tonsillectomy Tonsillectomy Definition : — Tonsillectomy is defined as the surgical excision of the palatine tonsils.  we sualisdo Poliolyelin Indication Adenoidectomy I. Absolute v 1- Enlarged tonsils that cause obstructive sleep apnea specially in pediatric patients v2- peritonsillar abscess (quinsy) (the risk of recurrence after the 2nd PTA is high) 3- Tonsils requiring biopsy to define tissue pathology (Biopsy tonsillectomy) II- Relative indications vRecurrent genuine attack of acute tonsillitis How many? More than 6–7 episodes in one year, 5 episodes per year for two years, or 3 episodes per year for three years. 00 Genuine : mean real attack with sever sore throat, pyrexia often dysphagia and generalized systemic upset.  a vAs part of uvulopalatopharyngoplasty (U3P)in treatment of snoring and OSA in adult patients vAs an approach to other procedures such as Ø glossopharyngeal neuralgia ØEagle’s syndrome (elongation of styloid process). v Chronic Tonsillitis v Pediatric septic tonsils  Paediatric septic tonsil — 2 of 3 — Congestion of the anterior faucial pillar — Pus expressed from tonsillar crypts either spontaneously or by squeezing by spatula. — Persistent jugulodiagastric lymph node enlargement without other obvious causes. Techniques Dissection techniques include: — cold dissection techniques — diathermy or electrocautery dissection which uses an electrically heated instrument to cut or coagulate tissues; — radio frequency/electrosurgery tonsillectomy in which the instrument itself does not become hot but rather produces a current flow that generates heat within the tissue; — harmonic scalpel (ultrasound) tonsillectomy; — laser dissection tonsillectomy: CO2 laser, potassium titanyl phosphate (KTP) and Nd-YAG laser tonsillectomy. Nondissection techniques include: guillotine tonsillectomy; intracapsular partial tonsillectomy. guillotine intracapsular partial tonsillectomy Dissection technique — Anesthesia: GA — Endotracheal tube. — Position :supine with neck ext. — Mostly dissection method. — Incise mucosa of anterior pillar. — Dissect between capsule and sup. constrictor. — Haemostasis(most important step) by either ligation, electro cautery or both Contraindication 1.Bleeding disorders v Hx of bleeding tendency v Family history 2. Recent infection v Potential risk of bleeding v Operate when fever subside. v Operate when tonsil not obviously acutely infected. v Risk of pulmonary complication. 3. Oral contraceptives v Risk of DVT 4. During epidemic of any infectious illness (poliomyelitis) because Ts exposed nerves ending through which the virus may spread and cause bulbar palsy.  Postoperative care v I — Early detection of bleeding Pulse rate Tonsil has 5 sources of blood supply! So there is too much risk of bleeding v Excessive swallowing v Vomiting of blood — Analgesia v Be careful with aspirin v Better paracetamol Postoperative care(cont.) — Diet vDay zero: ice diet. vAfter that usual diet. — The patient , can be discharged at the day of surgery or not??  Complications — Perioperative 1. Bleeding (primary) Ø Recent infection Ø Previous quinsy. 2. Trauma Ø Teeth Ø Soft palate and uvula Ø TMJ Ø Post. Pharyngeal wall — Immediate post operative 1. Bleeding(reactionary) Ø Up to 24hr Ø Dangerous because patient still unconcious and can result in shock. Ø Due to slipped ligture Ø Increase in BP post op Ø Allways take it seriously. 2. Complication of anesthesia. Ø Asphexia — Intermediate complication. 1. Bleeding(secondary) Ø More han 24hr Ø Mostly due to infection Ø In most cases respond to AB and blood transfusion. 2. Haematoma and edema of uvula. 3. infection Bleeding → clot 4. Pulmonary complications 5. SBE(due to transient bactremia) Subacute bacterial endocarditis 6. Pain and otalgia. Change in voice of removal pinars if Permont There may be primary — Late postoperative complication 1. Scarring. 2. Reminant and reinfection ANY QUESTION ?