Emran Al-Herz 2041100005

Yaqob Al-Abbad 2041100020

The microbiology of the oral cavity is very
complex. The total count of anaerobic bacteria
is estimated to be 1.1 x 108/ ml.
Anaerobes outnumber aerobes by 2:1 in saliva.
Bacterial interference between organisms is
responsible for helping maintain equilibrium.
The use of antibiotics can substantially alter the
bacterial balance.
Recurrent peritonsillar abscess is four times
more likely to occur in patients with a
previous history of recurrent tonsillitis and
unlikely to occur in patients over 40 years old.

Most peritonsillar abscesses can be treated by

aspiration and antibiotics, with interval
tonsillectomy reserved for those patients
under 40 years of age with a history of
previous tonsillitis or peritonsillar abscess.
 It consists of loose areolar tissue lateral to
the pharynx and is bounded medially by the
fascia of the pharynx and laterally by the
pterygoids and the sheath of the parotid
It extends superiorly up to the skull base,
.gland
but is limited inferiorly at the hyoid bone by
the sheath of the submandibular gland and
its attachments to the stylohyoid and the
posterior belly of the digastric.
Posteriorly, the space is bounded by the
connective tissue around the internal
carotid and internal jugular veins.
In a report by Bredenkamp (1990) of 26
pediatric patients treated for acute
nontraumatic torticollis, three were found to
have acute tonsillitis and three had
retropharyngeal abscess or cellulitis.

Torticollis, or wryneck, is a contracture of the

neck causing the head to be drawn and
rotated so the chin points to the contralateral
side. It is a common sign in the pediatric
population with nearly 80 different etiologies.
Inflammatory torticollis is characterized by
local irritation and spasm of the
sternocleidomastoid muscle with
compensatory neck rotation.

In a similar fashion inflamed, retropharyngeal

nodes may cause edema and irritation of the
longus colli and the scalenes leading to
compensatory hyperextension of the neck.

Radiographically this leads to loss of the

normal cervical lordosis.
The initial management of acute torticollis is

cervical spine immobilization until Cspine films

exclude the possibility of fracture or rotary
subluxation.
Acute rheumatic fever usually occurs 18 days after
an infection caused by group A β-hemolytic
Streptococcus, when the throat culture is no longer
positive.

Streptococcal infection results in production of

cross-reactive antibodies, leading to damage of the
heart tissues with subsequent endocarditis,
myocarditis, or pericarditis.

Once heart tissue damage occurs, little can be done

to reverse the β-hemolytic Streptococcus, when the
Streptococcal infection results in production of
cross-reactive antibodies, leading to damage of
the heart tissues with subsequent endocarditis,
myocarditis, or pericarditis.
Once heart tissue damage occurs, little can be
done to reverse the process.
Patients should be placed on a penicillin
prophylaxis or undergo tonsillectomy to
eliminate the reservoir of streptococcal infection;
preventing rheumatic fever requires eradicating
the Streptococcus from the pharynx in addition
to resolving the episode of pharyngitis.
Poststreptococcal glomerulonephritis
typically occurs as:
 an acute nephritic syndrome about 10
days after a pharyngotonsillar infection
(12–25% incidence)
 or as skin infections with a nephrogenic
strain caused by group A β-hemolytic
Streptococcus (10% incidence),
depending on the genetic host
The pathogenic mechanism of the disease
involves injury to the glomerulus by
deposition of the immune complexes as well
as circulating autoantibodies of the
streptococcal antigen.

Antibiotic treatment has not been shown to

The proposed cause is a cross-reactivity of
antistreptococcal antibodies with basal
ganglia neurons.

The exacerbations of the disease can be

monitored by measuring antistreptolysin-O
titers.

Treatment with either antibiotics or a

tonsillectomy has been correlated with a
decrease in OCD symptoms.
Current Medical Diagnosis And
Treatment In Otolaryngology, Head and
Neck Surgery, 2/e 2007
(CMDT Otolaryngology ,HN Surgery, 2/e
2007)

http://www.bcm.edu/oto/grand/102292.html

http://www.dochazenfield.com/Tonsillectomy.
htm