Diseases of the Oropharynx → Crypts w/ cheesy material

By Ma. Clarissa Fortuna MD

Anatomy of Waldeyer’s ring
Acute Pharyngitis → Components:
→ Etiology: Steptococcus, Pneumococcus, Influenza  Palatine/ faucial tonsil
bacillus  Pharyngeal tonsil / adenoids
→ S/S:  Lymphoid tissue of Rossenmuller’s fossa
 dryness, throat itchiness, body malaise, and  Linguals
headache, hoarseness, dysphagia
 Edema, hyperemia of the posterior pharyngeal wall Indications for Tonsillectomy
♣ Serous  mucoid exudate → Absolute:
 Cor Pulmonale
♣ Yellowish  grayish plugs in follicles or plaques
 Pharyngeal/ Peritonsillar abscess
in lateral pharyngeal wall  Hypertrophy with dysphagia
→ Diagnosis: Clinical & throat culture and sensitivity
 Biopsy for suspected malignancy
→ Tx: antibiotic coverage, warm saline gargle/hydration
→ Relative
 Documented recurrent bouts (3x/yr)
→ Pictures of hyperemic posterior pharyngeal wall:
 Hyperplasia with obstruction
 Symptoms: (again) sore throat, fever, dysphagia,
cervical lymphadenopathy  IM
 Signs: inflammation, edema  RHD associated w/ chronic tonsillitis
 Tx: antibiotic coverage, gargle
CONTRAindications for Tonsillectomy
→ Systemic infection
Acute Tonsillitis
→ Fever of unknown origin
→ Etiology: β- hemolytic streptococcus, Pneumococcus, → Blood Dyscrasia
Staphylococcus, H. influenza → Enlarged tonsils without obstructive symptoms
→ Pathologic Process:
 Inflammation  exudative  cellulitis  peri- Tonsillectomy pictures
tonsillar abscess  tissue necrosis
Indications for Adenoidectomy
Peritonsillar Abscess (Quincy) → Obstructive adenoids (OSA)
→ Etiology: late course of tonsillitis → Chronic adenoid disease with Middle Ear effusion
→ Bacteriology: C & S of abscess = Streptococcus, → Recurrent acute suppurative OM
Staphylococcus aureus → Suspicion of nasopharyngeal malignancy
→ Pathology: marked swelling in supratonsillar fossa
→ Symptoms: Marked dysphagia, salivation & trismus Retropharyngeal Abscess
→ Tx: drainage → Etiology: secondary to acute pharyngitis
→ Symptoms: fever (preceded by URTI), stridor, dysphagia
Vincent’s Angina → Signs: pus between posterior pharyngeal walll and
→ Etiology: fusiform bacilli and spirochetes prevertebral fascia
→ Clinical Manifestations: fever & cervical → Dx: Lateral x ray
lymphadenopathy → Tx: antibiotics, I & D (incision and drainage)
→ Dx: Fontana stain → Complications: asphyxia and hemorrhage

Diptheria Pharyngomaxillary or Parapharyngeal Abscess

→ Etiology: Corynebacterium diptheriae → Trismus, swelling near angle of mandible
→ Culture at Mc Conckey Agar → Lateral pharyngeal wall pushed medially
→ S/S: sore throat, dysphagia, dark membrane in both → Tx: Incision and drainage
tonsils
→ Tx: antitoxin; penicillin or erythromycin Ludwig’s Angina
→ Complications: airway obstruction, cardiac failure → Etiology: dental infection, suppurative cervical
lymphadenopathy, cellulitis in the suprahyoid space,
Infectious Mononucleosis tongue pushed upward
→ “Kissing disease” → Space between floor of tongue to hyoid bone
→ Etiology: EBV, CMV → Tx: Incision and drainage
→ S/S: fever lymphnode enlargement, maculopapular rash,
jaundice LESSA
→ Dx: lymphocytosis, Mono spot test CHRABI
→ Tx: symptomatic
 Antibiotics if with coexisting β-hemolytic
streptococcus
 Steroids to decrease inflammation

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