• 1. Food and air inlet.
• 2. Play an important role in speech through vocal resonance and articulation.• 3.The protective function of Waldeyer's ring.
• 4. Deglutition: it's divided into 3 stages:
• a. Oral stage (voluntary).
• b. Pharyngeal stage (involuntary).
• c. Oesophageal stage (involuntary).
Physiology of the Pharynx
1- Sore throat (pain)
a. Inflammatory.b. Neoplastic.
c. Neurological: IX neuralgia.
d. Blood dyscrasia: agranulocytosis and leukaemia.
2- Dysphagia: is difficulty in swallowing whereas odynophagia is painful swallowing.
Dysphagia: Intraluminal, Luminal Extraluminal
3- Difficulty in breathing like stridor in Ludwig's angina.
4- Difficulty in speech: Paralysis of the soft palate(hypernasalily).
5- Neck mass Cervical lymphadenopathy
Symptoms of Pharyngeal Diseases
Examination
Nasopharynx: Postnasal mirror and tongue depressor (posterior rhinoscopy), Rigid and Flexible endoscopes.Oropharynx: Tongue depressor; Palpation may be needed for the tongue.
Hypopharynx: Laryngeal mirror to examine the larynx too. It can be done thoroughly with the use of Endoscope.
Neck examination: for cervical LN.
Other areas : Ears are examined for secretory otitis media in cases of nasopharyngeal tumours.
Investigations of pharyngeal diseases
Radiography:Plain films like lateral X-Ray of the skull, Adenoids, and Bone erosion , cancer.
Contrast films: barium swallow : pharyngeal pouch, esophageal web and hypopharyngeal mass.
CT scan
MRI scan.
Laboratory investigations:
CBC, ESR, serum iron and iron binding capacity, monospot test, serology for toxoplasma, brucella, CMV and HIV.
Biopsy for suspected lesions in the pharynx may be needed.
• Is an inflammation of the whole lining of the oral cavity.
• It could be:
• -Viral infection: Herpes simplex
• -Bacterial: Gingivitis.
• -Fungal: candidiasis (thrush).
• -Spirochaetes: Vincent's angina.
• -Miscellaneous: Aphthus, Behcets syndrome, pemphigus and pemphigoid.
Stomatitis
Recurrent oral ulceration of unknown aetiology:
viral, psychogenic, endocrinal and autoimmune.Clinical picture
This ulcer is typically quite sensitive and painful, has a central necrotic base with a surrounding red circumference.
Two types:
The minor form, more common, 3-6 mm in size and multiple and heal within 7-10 days without leaving a scar.
The major form, 1-2 cm in size, less common, long lasting and heal with a scar.
Aphthus Ulcer
Treatment
Is symptomatic:-Oral antiseptic: like chlorhexidine gurgle.
-Topical application of local analgesic like xylocaine.
-Topical steroids e.g. Kenalog in orabase.
It is a gingivitis producing ulceration and necrotic membrane.
It is called "Trench Mouth"Aetiology
Infection : Spirochaete, Borrelia vincenti & an Anaerobic organism , Bacillus fusiformis.
Occurs in debilitated patients who have poor dental hygiene.
Fever, sore throat , tender LN.
Acute necrotizing gingivitis (Vincent's angina)
On examination
The lesions originate around the interdental papillae and gums and may spread to involve the tonsil and oropharyx. The ulcers are painful, associated with foeter (fishy odor), and covered by a slough.Diagnosis
Swab for gram stain and culture.Treatment
-Oral hygiene by mouth wash.
- Antibiotics like benzyl penicillin + metronidazole.
Acute cellulitis of the floor of the mouth and submandibular space secondary to soft tissue infection.
Infection within a closed fascial space, tension rises rapidly and laryngeal oedema may occur.
Aetiology
Root abscess of the lower premolar and molar teeth (80%).The most usual organisms are strepto. viridans and E. coli.
-Tonsillar infection.
-Submandibular sialadenitis
Ludwig's Angina
Clinical picture
The patient is ill, toxic > 38 oC with odynophagia and salivation.
On examination
Indurated and usually non-fluctuant swelling below the angle of the jaw.
The floor of the mouth becomes very oedematous with the tongue pushed upwards.
• Potential complications
• -Airway compromise due to laryngeal oedema.• -Spread into the parapharyngeal and retropharyngeal spaces.
• -Septicaemia.
• -Aspiration pneumonia.
Treatment
-Early stages (early cellulitis): heavy antibiotics covering aerobes and anaerobes.-Drainage: If the state progress and the swelling increases.
Curved incision 2 cm below the angle of the jaw.
-Endotracheal intubation and
tracheostomy may be required
if laryngeal oedema
supervenes.
Acute pharyngitis
Acute inflammation of the mucous membrane of the pharynx occurring primarily in winter months.Aetiology
Viral in origin( mostly adenovirus and rhinovirus).
20 % are bacterial: mostly Pneumococci, Haemophilus influenza and group A beta-hemolytic streptococci (S. Pyogens).
30 % No pathogen is isolated.
Pharyngitis may be part of the clinical picture of measles, scarlet fever, infectious mononucleosis and typhoid fever.
Pharyngitis
Symptoms-Sore throat, Chills, Pyrexia, Headache and Joint pain.
Sings
-Redness and injection the mucous membrane of the pharynx.
-Hypertrophic and proliferation of lymphoid tissue on the posterior pharyngeal wall with particular aggregates in the lateral pharyngeal bands.
- Oedema of uvula
-Tender and palpable cervical LN.
Treatment
-Symptomatic: bed rest, analgesics and fluid by mouth.-Antibiotics: if bacterial infection is suspected.
Generalized inflammation of the mass of the tonsil, usually accompanied by a degree of inflammation of the pharynx.
Any age group, most frequently found in children.
Aetiology
Bacteria :group A B-haemolytic streptococcus, pneumococcus, staphylococcus& Haemophilus influenzae.
Viruses: rhinovirus, adenovirus &
enterovirus
Acute Tonsillitis
• Symptoms
• Onset: often sudden :• -Sore throat & odynophagia.
• -Constitutional symptoms especially in children.
• -Referred otalgia and abdominal pain due to mesenteric adenitis.
• Examination
• - Furred tongue & halitosis.
• - Tonsils: enlarged red and swollen.
• -The crypts become filled with pus (follicular tonsillitis).
• - A patchy membrane on the surface of the tonsil (membranous tonsillitis).
• -Cervical tender lymphadenopathy jugulodigastric node.
Acute follicular tonsillitis
• Differential Diagnosis• -Scarlet fever: Streptococcal infection erythrogenic toxin.
• Tongue has a strawberry appearance
• Cutaneous punctate erythema.
• -Glandular fever:
• -Agranulocytosis and leukaemia.
• -Acute diphtheria.
• -Vincent's angina.
Scarlet fever
• Complications
• local• a. peritonsillar abscess(quinsy).
• b. Retropharyngeal abscess.
• c. Parapharyngeal abscess.
• d. Acute otitis media.through the Eustachian tube.
• General
• a. Rheumatic fever and glomerulonephritis which follow B- haemolytic streptococcal tonsillitis of Lancet group A.
• b. Subacute bacterial endocarditis.
• c. Septicaemia.
Treatment
1. Bed rest, good oral fluid intake.
2. Antipyretics and analgesics.
3. Antibiotics: Penicillin, Erythromycin in allergy to penicillin.
Lack of response may suggest the presence of B-lactamase producing organism or even an anaerobic one, in which augmentin and/or metronidazole will be the antibiotic of choice.
Peritonsillar Abscess( Quinsy)
Is a collection of pus between the fibrous capsule of the tonsil and the superior constrictor.Usually unilateral, Adult males.
Complication of acute tonsillitis.
Clinical Picture
1. The patient looks ill, feverish with rigor .2. Acute sore throat & referred otalgia, Odynophagia). This makes the saliva dribbles from the month.
3. Trismus: irritation of the pterygoid muscles .
4. Thick and muffled voice often called “hot potato
voice”.
Examination
1. The tonsil is congested and pushed medially with the soft palate bulging downward and forward.
The uvula may be pressed against the opposite tonsil.
2. Red and enlarged anterior tonsillar pillar.
3. Tender and enlarged cervical lymph nodes
.
Treatment
I. Medical : Effective in early peritonsillar cellulitis.II. Surgical : when considerable swelling is present or in case of failure to medical treatment.
1. Incision of the abscess: this is undertaken at the point of maximum swelling of the soft palate. The classical site is at a point where an imaginary line through the base of the uvula is intersected by a perpendicular line from the junction of the anterior tonsillar pillar with the tongue.
The tonsils might be removed 6-8 weeks following quinsy.
2. Abscess tonsillectomy
