Download pharyngitis: to treat or not to treat

ANATOMY OF PHARYNX
BRIG MIRZA KHIZER HAMEED
PHARYNX
• Muscular tube lying behind
•
•
the nose, oral cavity & larynx
Extends from the base of the
skull to level of the 6th
cervical vertebra, where it is
continuous with the
esophagus
The anterior wall is deficient
and shows (from above
downward):
 Posterior nasal apertures
 Opening of the oral cavity
 Laryngeal inlet
PHARYNX
Site
Seen from behind
Midline of the neck
Behind
: to
From skull
base
The Nose
esophagus
The of
Mouth
In front
upper 6
The vertebra
larynx
Cervical
PHARYNX
Shape
Irregular
Fibromuscular tube
lined by mucous
membrane
Length: 15 cm
PHARYNX
Structure
The wall is formed of
4 layers
1-Mucous membrane
2- Pharyngeal aponeurosis
3-Muscle layer
4-Bucco-pharyngeal fascia
Formed
ofsquamous
3of
muscles,
superior
inferior
constrictor
A thin
coat
connective
tissuemiddle
Loose
connective
tissue
which
contains
lymphoid
tissue
that aggregates
Stratified
epithelium
except and
the
nasopharynx,
it is
muscles
in some
areas forming tonsils
(Waldayer’s
pseudo-stratified
with goblet
cellsring)
PHARYNX
Compartments
• Pharynx is divided into three
compartments:
 Nasopharynx:
 Superior part, communicates
with the nasal cavity through
posterior nasal apertures
 Oropharynx:
 Middle part, communicates
with the oral cavity through
the oropharyngeal isthmus
 Hypopharynx:
 Inferior part, communicates
with the larynx through the
laryngeal inlet
PHARYNX
Compartments
Seen from behind
• Nasopharynx
• Oropharynx
• Hypopharynx
PHARYNX
Compartments
Seen from lateral
• Nasopharynx
• Oropharynx
• Hypopharynx
Nasopharynx
-Behind the nasal cavity
-Extends from skull base
superiorly to the soft
palate inferiorly
-Communicates inferiorly
with the oropharynx
through the velopharyngeal sphincter
-The nasopharyngeal tonsil
lies in the roof
-The pharyngeal opening of
ET lies in the lateral wall
Oropharynx
Behind the oral cavity (in
front of 2nd&3rd Cervical
vertebra)
From the soft palate superiorly to
tip of epiglottis inferiorly
Communicates:
Anteriorly with the oral cavity
Superiorly with the
nasopharynx
Inferiorly with the
hypopharynx
The palatine tonsils lie laterally
between the anterior and
posterior pillars
The tonsils lie between the
Two pillars
PALATINE TONSILS
• Paired masses of
lymphoid tissue
• Located in the palatine
fossa/sinus, in the
lateral wall of the
oropharynx
• Reaches its maximum
size during early
childhood, but after
puberty diminishes in
size
PALATINE TONSILS
• Lateral surface: covered by a
•
fibrous capsule
Medial surface:
• Projects into the cavity of
oropharynx
• Covered by mucous
membrane
• Shows multiple
depressions, the tonsillar
crypts and one deep
intratonsillar cleft
Hypopharynx
Behind the Larynx (in front of
3rd to 6th Cervical vertebra)
From the tip of epiglottis
superiorly to the lower border
of cricoid cartilage inferiorly
Communicates:
- Anteriorly with the Larynx
- Superiorly with the oropharynx
- Inferiorly with the esophagus
Hypopharynx
Seen from
behind
The hypopharynx does not only
lie behind the larynx BUT also
Projects laterally on each side of
the larynx
So it is formed of :
- Postcricoid region ( behind
the larynx)
- Posterior pharyngeal wall
- Two pyriform fossae (on
each side of the larynx
Cross section
Waldeyer’s ring
• It is a lymphoid tissue ring located
•
in the pharynx
Consists of:
 Adenoids (pharyngeal tonsils)
 Tubal tonsil
 Palatine tonsil
 Lingual tonsil
 Lateral pharyngeal bands
 Lymphoid follicles in post.
wall
Waldeyer’s ring
The lymphoid tissue in the
pharyngeal aponeurosis
aggregates in some areas
forming tonsils:
1-one nasopharyngeal tonsil
2- two palatine tonsils
3- two lingual tonsils
Blood supply
From the External Carotid Artery & its branches
1- Tonsillar artery (from Facial Artery)
2- Ascending palatine artery (from Facial Artery)
3- Ascending pharyngeal Artery (from external carotid)
4- Descending palatine artery ( from Maxillary artery)
5- Dorsalis lingulae artery (from Lingual artery)
Lymph Drainage
• Nasopharynx ---►Retropharyngeal
---►Upper Deep Cervical L N
• Oropharynx
---► Upper Deep Cervical L N
• Hypopharynx ---► Upper Deep Cervical L N
Nerve Supply
Motor
X
Except :
Stylopharyngeus
Tensor palati
IX
V
Nasopharynx
Oropharynx
Laryngopharynx
V
IX
X
Sympathetic: SCG
Parasympathetic: through
VII
Sensory
Autonomic
ACUTE PHARYNGITIS
BRIG MIRZA KHIZER HAMEED
Pharyngitis
– Inflammation of the
Pharynx secondary to
an infectious agent
– Most common
infectious agents are
Group A
Streptococcus and
various viral agents
– Often co-exists with
tonsillitis
Etiology
• 30%-65%: idiopathic
• 30%-60%: viral
• 5%-10%: bacterial
• Group A beta-hemolytic: most common
bacterial pathogen
– 15%-36%: pediatric cases
– 5%-10% : adult pharyngitis
– Disease of children
Etiology
Bacterial
• Strep.A
• Corynebacterium
diphteriae
Gonococcus
•
Fungal
• Candida albicans
Others
• Toxoplasmosis
Viral
• Rhinovirus
• Influenza
• Parainfluenza
• EBV
• Cytomegalovirus
• HIV
Clinical manifestations
•
•
•
•
•
Differ in severity
Fever
Sore throat
Headache
GI symptoms
•
•
•
•
•
•
Erythema
Exudates
Enlarged tonsils
Anterior cervical
adenopathy
Prominent lymphoid
follicles on Post. Wall
Edema of Uvula
Suppurative Complications of
Group A Streptococcal Pharyngitis
• Otitis media
• Sinusitis
• Peritonsillar and retropharyngeal
abscesses
• Suppurative cervical adenitis
Nonsuppurative Complications of
Group A Streptococcus
• Acute rheumatic fever
– follows only streptococcal pharyngitis (not
group A strep skin infections)
• Acute glomerulonephritis
– May follow pharyngitis or skin infection
(pyoderma)
– Nephritogenic strains
Course
• Group A strep pharyngitis naturally self-
limiting
• Resolve spontaneously in 3-4 days w/ or
w/o antibiotics
• Rapid test or throat culture: reduces
unnecessary antibiotic use by identifying
those whom antibiotic therapy is justified
Diagnosis
• History
• Throat culture
• Rapid antigen detection test (RADT)
Diagnostic tools
• History:
– Fever
– Tonsillar exudates
– Swollen or tender lymph nodes
– Lack of cough
– unreliable
Diagnostic tools
• Throat culture: gold
standard for dx
– Sensitivity 90%,
specificity 99%
– For adult patients to
confirm clinical
diagnosis
Diagnostic tools
• Rapid antigen detection test (RADT)
– When throat culture is impractical or
inappropriate
• Extensive contact with others
• Work full-time jobs
• Difficult to reach
– Sensitivity 80%-90%, specificity 70%-95%
– Helps selects true positives thus avoiding
unnecessary use of antibiotics
– (+) RADT- start antibiotic therapy
Treatment
• Antibiotic
• Bed rest
• Plenty of fluids
• Analgesics/ Antipyretics
• Warm saline gargles
• Decongestants
Antibiotic therapy
• Penicillin
• Ampicillin, amoxicillin
• Cephalosporins
• Macrolides
Thank You