Throat

Pharynx:
12-24 cm long from the base of the skull to the lower border of cricoid cartilage.
Width is 3.5cm at the base and 1.5 cm at the cricopharyngeal junction
Routes of communication:
Nasal cavity-posterior nasal aperture {choana}
Mouth – oropharyngeal isthmus
Middle ear – eustachian tube
Larynx and tracheobronchial tree – glottis
Oesophageal – upper oesophageal sphincter {cricopharynx}
Boundaries:
Superior: base of the skull
Inferior: 6th cervical or lower border of cricoid cartilage
Posterior: prevertebral facia
Anterior: oral, nasal larynx
Structure of pharyngeal wall:
Mucous membrane
Pharyngeal aponeurosis
Muscular layer: external and internal
Pharyngeal spaces:
Retropharyngeal space
Parapharyngeal spcace
Parts of the pharynx:
Nasopharynx
Oropharynx
Hypopharynx or laryngopharynx
Function:
Swallowing
Protection from inspiratory
Respiratory and food passage
 Speech: resonance
Waldeyar’s ring – immunity {lympgoid tissue in upper part of the pharynx
[nasopharynx and oropharynx] include: pharyngeal tonsils, tubal tonsils and
palatine tonsils
Test of sensation
Mucociliary clearance
Eustachian tube ventilation

a. Diseases of the pharynx:

a. Herpangina: hand foot mouth disease:
Caused by coxsackie A virus
Ss: small vesicles with erythematous- ulcer – spread to anterior
pillar and posterior pharynx, high grade fever, fatigue and
anorexia
Diagnose: history and examination
Treatment: self limitung, oral hygiene, analgesics, hydration and
bed rest
b. Scarlet fever:
2nd to endotoxin by beta hemolaytics type A strep.
Ss: red tonils and pharynx, strawberry tongue, perioral skin
erythema, dysphagia, malaisae, severe cervical lymphadenopathy.
Diagnose: history and examination, culture, sensitivity
Treatment: antibiotics, IV and oral hygiene
c. Infectious mononucleosis:
Caused by EBV
Ss: fever, malaise, large swollen, dirty gray tonsils, sore throat,
dysphagia, odynophagia, ass. Hepatosplenomegaly.
Diagnose: history, monospot test, viral culture
Treatment: secure airway, hydration, analgesics, oral hygiene
Adenoids:
Nasopharyngeal tonsils
Composed of lymphoid tissue, situated at posterior wall of
nasopharynx, enlarge at early childhood and regress at puberty
 Blood supply: ascending pharyneal artery and ascending palatine
artery
Venous: pharyngeal vein
Lymphatic: upper jugular nodes
d. Adenoiditis and adenoid hypertrophy:
Cause: recurrent rhinitis, sinusitis, and chronic tonsillitis, allergy
from URT
Clinical:
adenoiditis: sore throat, purulent rhinorrhea, halitosis,
postnasal drip, nasal obstruction with snoring and fever
Adenoid hypertrophy: nasal obstruction, discharge,
hyponasal speech, snoring, chronic mouth breathing,
eustachian tube obstruction [otitis media, CSOM].
Diagnose: examination of the nose and oropharyngeal with mirror
or endoscopy, x ray: size and extent
Treatment:
Adenoiditis: antibiotic penicillin, bed rest hydration,
analgesia, nasal corticoisteroid and +/- adenoctomy
Adenoid hypertrophy: adenoidectomy
Indications:
Absolute: hyperplasia and nasal obstruction
with orofacial abnormalities
Relative: recurrent adenoditis, otitis media,
chronic sinusitis
Tonsils
Palatine tonsils are 2 in number
Lymphoid tissue, situated in the lateral wall of the oropharynx between
the anterior and posterior pillars
Increase in size between 1-3 years, peak between 3-7 years and
involute after puberty
Relations:
Medial: covered by keratinizing stratified sq. Epithelium
Lateral: fibrous capsule attached to palatoglossus and
palatopharyngeus muscles
Upper pole: extend into soft palate
 Lower pole: attached to the tongue
Bed tonsil: superior constructor muscles and styloglossus
muscles
Blood supply:
Tonsilar branch of
Ascending pharyngeal artery
Ascending palatine artery
Dorsal lingual artery
Desceding palatine
Venous: paratonilar vein
Lymphatic: upper deep cervical
Nerve supply: CN V and IX
e. Acute tonsilitis:
Inflammation of tonsils
Common in children
Cause: group A beta strep. Moraxella, H. influenza
Less common: staph. E.coli, diphtheria. Syphilis and viral
{EBV}
Ss: sore throat, dysphagia, ear pain, fatigability and headache
Examination: red swollen tonsils and yellow spot of purulent,
hyperemia of facial pillars cervical lymphadenopathy of
jugulodigastric lymph node
Diagnose: history and examination, throat culture and CBC
Treatment: bed rest, oral hygiene, analgestics {aspirin and
paracetamol}, antibiotics: pencillin for 7-10 days or erythromycin
Complications:
Airway obstruction
Chronic tonsillitis
Peritonsilar abscess
Parapharyngeal abscess
Acute otitis media
Rheumatic fever
 Acute glomerulonephritis
f. Chronic tonsillitis:
complication of acute tonsillitis or subclinical infections of
tonsils or infection spread from sinuses and dental
Pathogen: polymicrobial
Ss: malaise, recurrent sore thoat, enlarged tonsils, halitosis,
cervical lymphadenopathy
Diagnose: history and examination
Treatment: long term antibiotics and tonsillectomy
Indications tonsillectomy:
Absolute:
Recurrent tonillitis
Peritonilar causing febrile
seizure
Grade 4 tonsils
Suspicion of malignancy
Relative:
Tonsilar stone
Chronic tonsillitis with halitosis
Diphtheria carriers
Recurrent otitis media
Oropharyngeal or dental
disorder
Contraindications:
Hb<10g
Acute tonsillitis
Children under 3 years
Bleeding disorder
Epidemic polio
g. Acute pharyngitis:
Common occur due to:
 Viral [rhinovirus], bacteria [strep.A beta], fungal
[candida]
Viral is the commonest cause
Mild in viral and severe in bacteria
Ss: sore throat, odynophagia, malaise, fever, erythema,
cervical lymphadenopathy
Diagnose: history and examination, throat culture
Treatment: supportive care [ bed rest analgetics, hydration],
mouth wash, antibiotics for bacteria [pencillin]
h. Chronic pharyngitis:
Chronic inflammatory condition
Characterized by hypertrophy of the pharyngeal layers
Cause: persistent infection of dental or sinuses, GERD,
vocal abuse, allergy, granulamatous disease, chronic mouth
breathing, irritants [dust]
Ss: cough, pain in throat, voice fatigue, dry throat,
thickening of pharyngeal wall and pharyngeal crusting
Diagnose: history and examination, culture and biopsy
Treatment: tx underlying cause, voice rest, warm saline
gargle and analgetics