Tonsilitis & Peritonsillar

Abscess
PBL 7
 Muscles of mastication
MUSCLES OIGIN INSERTION INNERVATION ACTION
Masseter superficial part: ramus of the
maxillary process of mandible
the zygomatic
bone
deep part:
zygomatic arch of
the temporal bone Mandibular nerve closing the mouth
(V3)
Temporalis temporal fossa coronoid process Retract mandible
of the mandible
Medial Pterygoid maxilla & LP plate
of sphenoid
Neck of mandible
Lateral Pterygoid Sup head: greater protract the
wing of sphenoid mandible;
Inf head: LP plate Side to side jaw
of sphenoid movement
 Other organisms cause sore throat
(Pharyngitis)
 Streptococcus
 Mycoplasma pneumoniae
 Chlamydia pneumoniae
 Neisseria gonorrhoeae
 Corynebacterium diphtheriae
 most commonly with a viral upper respiratory infection (URI)
 Haemophilus influenza – adult (beta lactamase)
*throat extends from the nasal passages above and behind the mouth to the esophagus (tube
that carries food to the stomach) in the neck
*complication: lead to tonsillitis, if longstanding infection ensuing quinsy, which affects CT of
tonsil
*Sore throat related to viral URI usually resolves without medication.
*Bacterial pharyngitis is treated with antibiotics
TRISMUS

1. Limited jaw mobility

2. Inflammation and pain
3. Disuse Atrophy and/or Joint
degeneration
Flow of Clinical Events

1. Acute bacterial pharyngitis

 Group A beta-hemolytic streptococci (GABHS): The classic clinical picture includes a
fever, temperature of greater than 101.5°F; tonsillopharyngeal erythema and exudate;
swollen, tender anterior cervical adenopathy; headache; emesis in children; palatal
petechiae; midwinter to early spring season; and absent cough or rhinorrhea.

Center criteria for GAS pharyngitis include the following:

 Fever (1 point)
 Anterior cervical lymphadenopathy (1 point)
 Tonsillar exudate (1 point) - lockjaw
 Absence of cough (1 point)
2. Tonsilitis (inflammation of the tonsils)
 Fever
 Sore throat
 Foul breath
 Dysphagia (difficulty swallowing)
 Odynophagia (painful swallowing)
 Tender cervical lymph nodes

3. Peritonsillar abscess
 Severe throat pain
 Fever
 Drooling
 Foul breath
 Trismus (difficulty opening the mouth) – complication: The fascial spaces of the neck are interconnected. Once
inflammation exceeds the limits of the peritonsillar space, involvement of the masticator space (with increasing
degrees of trismus) occurs.
 Altered voice quality (the hot-potato voice)
TONSILITIS

 Pathogenesis (acute bacterial tonsillitis)

S. pyogenes could be identified both in the mucous layer
covering the tonsils and attached to the surface epithelial cells.
Long chains of coccus-shaped bacteria could be seen
encroaching on the epithelial cell borders. S. pyogenes can
apparently penetrate the mucous barrier, attach to the epithelial
cells, spread from cell to cell and possibly penetrate into the
outermost layer of the epithelial cells. These events in turn
provoke cytokine production and/or complement activation,
which induce inflammatory reaction in the tonsillar tissue.
TONSILITIS

 Other etiology:
1. Recurrent tonsillitis (polymicrobial) - Staphylococcus aureus, and
Haemophilus influenzae are the most common bacteria isolated in
recurrent tonsillitis, and Bacteroides fragilis is the most common anaerobic
bacterium isolated in recurrent tonsillitis.
2. Chronic tonsillitis (polymicrobial) - beta-hemolytic streptococcal species, S
aureus, H influenzae, and Bacteroides species
TONSILITIS

 Causes: similar to pharyngitis

1. Viral:
- Herpes simplex virus
Epstein-Barr virus (EBV)
Cytomegalovirus
Other herpes viruses
Adenovirus
Measles virus

 Complication: usually PTA following acute cases

PTA

 Pathogenesis
The nidus of accumulation is located between the
capsule of the palatine tonsils and the constrictor muscles
of the pharynx. The anterior and posterior pillars, torus
tubarius (superior), and pyriform sinus (inferior) form the
boundaries of this potential peritonsillar space. Because
this area is composed of loose connective tissue, severe
infection may rapidly lead to formation of purulent
material. Progressive inflammation and suppuration may
extend to directly involve the soft palate, the lateral wall
of the pharynx, and, occasionally, the base of the
tongue.
Nice to know. . .

 soft diet
 a diet that is soft in texture, low in residue, easily digested, and well tolerated. It
provides the essential nutrients in the form of liquids and semisolid foods, such
as milk; fruit juices; eggs; cheese; custards; tapioca and puddings;
 strained soups and vegetables; rice; ground beef and lamb; fowl; fish;
mashed, boiled, or baked potatoes; wheat, corn, or rice cereals; and breads.
 Omitted are raw fruits and vegetables, coarse breads and cereals, rich
desserts, strong spices, all fried foods, veal, pork, nuts, and raisins.
 It is commonly recommended for people who have GI disturbances or acute
infections and those unable to tolerate a normal diet
 SWOLLEN TONSILS
DUE TO BACTERIAL
SWOLLEN UVULA INFECTION WITH
WHITE SPOTS
SWOLLEN SOFT
PALATE
 DISEASE Acute bacterial Acute Bacterial tonsillitis Peritonsillar abscess
DIAGNOSTIC/LAB TESTS pharyngitis

Lab studies • Throat culture • Throat cultures (GABHS FBC, electrolyte level
• Rapid antigen infection) measurement, and
detection tests • Monospot serum test, blood cultures;
FBC, and serum monospot test
electrolyte level (heterophile
• Rapid antigen antibodies); throat
detection test (RADT) swab and culture

Imaging studies N/A • CT scan (extend to • Plain

deep neck) radiography(cance
l retropharyngeal
abscess)
• CT scan
• Ultrasound

Diagnostic procedures Needle aspiration

RAPID ANTIGEN
DETECTION TEST (RADT)
 DISEASE MEDICAL CARE SURGICAL CARE
Acute bacterial Antibiotic therapy (Oral rare cases, pharyngitis
pharyngitis penicillin V; Amoxicillin – spreads to adjacent
1st line due to narrow structures and forms
spectrum) both abscesses. In these
efficaciuos cases, a drainage
procedure.

Acute bacterial tonsillitis • Corticosteroids (Fever) • Tonsillectomy

• oral penicillin for 10 (individuals who have
days or Intramuscular experienced more

TREATMENT
benzathine penicillin than 6 episodes of
G streptococcal
pharyngitis)

Peritonsillar abscess • Antipyretics and • Needle aspiration (as

analgesics a diagnostic and as a
• Antibiotic therapy therapeutic modality)
(after culture) – IV • Incision and drainage
penicillin & Oral
antibiotics
DIFFERENTIAL DIAGNOSES

 BACTERIAL PHARYNGITIS
Acute retroviral syndrome

Epstein-Barr Virus (EBV) Infectious Mononucleosis (Mono)

Peritonsillar Abscess

Viral Pharyngitis
 TONSILITIS & PTA
Gastroesophageal Reflux Disease

Ophthalmologic Manifestations of Leukemias

Lymphomas of the Head and Neck

Malignant Nasopharyngeal Tumors

Dental infection

Malignant Tonsil Tumor Surgery

RISK FACTORS OF TONSILLITIS & PTA

 5-15 years of age

 Teenagers and young adults (MALE)
 Smoking
 history of recurrent tonsillitis or extraperitonsillar spread
PREVENTION AND AWARENESS OF
TONSILLITIS & PTA
 Proper hygiene care – oral
 Avoid smoking
 Adequate hydration
 Soft diet
EPIDEMIOLOGY OF TONSILLITIS & PTA