BRIG MIRZA KHIZER HAMEED 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 Midline of the neck From skull base to esophagus Behind : Seen from behind Midline of the neck From skull base to esophagus In front of upper 6 Cervical vertebra Behind : The Nose The Mouth The larynx

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 of 3 muscles, superior middle and inferior constrictor muscles A thin coat of connective tissue Loose connective tissue which contains lymphoid tissue that aggregates in some areas forming tonsils (Waldayer’s ring) Stratified squamous epithelium except the nasopharynx, it is pseudo-stratified with goblet cells

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 Nasopharynx Oropharynx Hypopharynx Seen from behind Nasopharynx Oropharynx Hypopharynx

PHARYNX Compartments Nasopharynx Oropharynx Hypopharynx 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 velo-pharyngeal 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 posterior pillar formed The tonsils lie between the The anterior pillar formed by palatoglossus muscle The posterior pillar formed by palatopharyngeus muscle 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 The hypopharynx does not only 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 Sensory Autonomic Except : Stylopharyngeus IX Tensor palati V Sensory Nasopharynx V Oropharynx IX Laryngopharynx X Autonomic Sympathetic: SCG Parasympathetic: through VII

BRIG MIRZA KHIZER HAMEED 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 Fungal Others Viral 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

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