Tonsillitis, Tonsillectomy, and Adenoidectomy幻灯片.pptVIP

Tonsillitis, Tonsillectomy, and Adenoidectomy Mary Talley Dorn, M.D. Norman R. Friedman, M.D. History Celsus 50 A.D. Caque of Rheims Philip Syng Wilhelm Meyer 1867 Samuel Crowe Embryology 8 weeks: Tonsillar fossa and palatine tonsils develop from the dorsal wing of the 1st pharyngeal pouch and the ventral wing of the 2nd pouch; tonsillar pillars originate from 2nd/3rd arches Crypts 3-6 months; capsule 5th month; germinal centers after birth 16 weeks: Adenoids develop as a subepithelial infiltration of lymphocytes Anatomy Tonsils Plica triangularis Gerlach’s tonsil Adenoids Fossa of Rosenmüller Passavant’s ridge Blood Supply Tonsils Ascending and descending palatine arteries Tonsillar artery 1% aberrant ICA just deep to superior constrictor Adenoids Ascending pharyngeal, sphenopalatine arteries Histology Tonsils Specialized squamous Extrafollicular Mantle zone Germinal center Adenoids Ciliated pseudostratified columnar Stratified squamous Transitional Common Diseases of the Tonsils and Adenoids Acute adenoiditis/tonsillitis Recurrent/chronic adenoiditis/tonsillitis Obstructive hyperplasia Malignancy Acute Adenotonsillitis Etiology 5-30% bacterial; of these 39% are beta-lactamase-producing (BLPO) Anaerobic BLPO GABHS most important pathogen because of potential sequelae Throat culture Treatment Microbiology of Adenotonsillitis Most common organisms cultured from patients with chronic tonsillar disease (recurrent/chronic infection, hyperplasia): Streptococcus pyogenes (Group A beta-hemolytic streptococcus) H.influenza S. aureus Streptococcus pneumoniae Tonsil weight is directly proportional to bacterial load. Acute Adenotonsillitis Differential diagnosis Infectious mononucleosisMalignancy: lymphoma, leukemia, carcinomaDiptheriaScarlet feverAgranulocytosis Medical Management PCN is first line, even if throat culture is negative for GABHS For acute UAO: NP airway, steroids, IV abx, and immediate tonsillectomy for poor response Recurrent tonsillitis: PCN inje