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History Stations
Published in Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar, ENT OSCEs, 2023
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar
The palatine tonsils form part of Waldeyer's ring of lymphoid tissue in the pharynx along with the adenoid pad, lingual tonsils and mucosa-associated lymphoid tissue (MALT). They sit within the tonsillar fossa, bordered anteriorly by the palatoglossal arch (anterior pillar) and posteriorly by the palatopharyngeal arch (posterior pillar). Acute tonsillitis involves inflammation of the palatine tonsillar tissue and is extremely common, especially in the paediatric population; and contributes to missed days of school and work every year. There are other causes of ‘sore throats’ that are worth bearing in mind including viral upper respiratory tract infections, pharyngitis, and in the adult population, Candida, gastro-oesophageal reflux and malignancy.
Anatomy of the head and neck
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
The soft palate is the muscular posterior part, attached to the posterior border of the hard palate and extending as a posteroinferiorly curved free margin that terminates in the uvula. It is strengthened by a palatine aponeurosis formed by the expanded tendon of the tensor veli palatini and is attached to the posterior margin of the hard palate. Laterally, it is continuous with the wall of the pharynx and joined to the pharynx and tongue by the palatopharyngeal and palatoglossal arches. The masses of lymphoid tissue forming the palatine tonsil lie within the tonsillar fossa, bounded by the palatoglossal and palatopharyngeal arches and the tongue.
History Stations
Published in Joseph Manjaly, Peter Kullar, Alison Carter, Richard Fox, ENT OSCEs: A Guide to Passing the DO-HNS and MRCS (ENT) OSCE, 2019
Joseph Manjaly, Peter Kullar, Alison Carter, Richard Fox
The palatine tonsils form part of Waldeyer’s ring of lymphoid tissue in the pharynx along with the adenoid pad, lingual tonsils and mucosa-associated lymphoid tissue (MALT). They sit within the tonsillar fossa, bordered anteriorly by the palatoglossal arch (anterior pillar) and posteriorly by the palatopharyngeal arch (posterior pillar). Acute tonsillitis involves inflammation of the palatine tonsillar tissue and is extremely common in the United Kingdom, especially in the paediatric population; and contributes to missed days of school and work every year. There are other causes of ‘sore throats’ that are worth bearing in mind including viral upper respiratory tract infections, pharyngitis, and in the adult population, Candida, gastro-oesophageal reflux and malignancy. The history is vital for both diagnosis and importantly establishing frequency of episodes and the impact on the child in context, e.g. looming GCSEs. In the exam setting it is important to remember the potential ‘hidden agenda’ that could be held by the parents, in this case arranging a tonsillectomy for their child. Acute tonsillitis can be viral or bacterial in origin, with group A beta-haemolytic streptococcus being the most common organism. Glandular fever, secondary to Epstein–Barr virus, can present similarly to acute bacterial tonsillitis, with a typically longer history of symptoms. There are other viral causes including adenovirus and respiratory syncytial virus which may be complicated by superadded bacterial infection.
Comparison between landmark and ultrasound-guided percutaneous peristyloid glossopharyngeal nerve block for post-tonsillectomy pain relief in children: a randomized controlled clinical trial
Published in Egyptian Journal of Anaesthesia, 2022
Abdelrhman Alshawadfy, Ahmed A. Ellilly, Ahmed M. Elewa, Wesam F. Alyeddin
To reduce pain after tonsillectomy surgery, the use of corticosteroids, alterations to anesthesia and surgical technique, and local anesthetic agents have been combined with general anesthetic to lessen post-tonsillectomy discomfort. However, the outcomes are ambiguous and debatable [3,4]. A systematic review by Grainger and Saravanappa [5] determined that local anesthetic procedures were efficient in reducing postoperative analgesic usage, and raised satisfaction following tonsillectomy [3,6]. Local anesthetics decreased the central nervous system sensitization and blocked the peripheral nociceptor transmission after tissue damage. The local anesthetic drugs are applied either by topical application into the tonsillar fossa or via infiltration either before or after tonsillectomy [7]. Where, the glossopharyngeal nerve (GPN) supplies the tonsillar and peritonsillar regions especially, the sensory fibers. Thereby, GPN block reduced postoperative discomfort during tonsillectomy and analgesic use [8].
Bilateral second branchial cleft fistulae coexisting with bilateral pre-auricular fistulae: A rare case report
Published in Acta Oto-Laryngologica Case Reports, 2020
Hongli Gong, Chunping Wu, Liang Zhou, Lei Tao
This patient underwent definitive surgery excision under general anesthesia in a supine position, and the neck extended. A transverse incision was made with two elliptical incisions around each of the two external openings (Figure 3). Methylene blue was injected to trace and dissect the tract from the surrounding structures; the blue dye did not stain the surrounding tissues. We traced the tube starting from the external openings, ascending to the area adjacent to the internal and external carotid arteries, and passing the glossopharyngeal (IX) and hypoglossal (XII) nerves. Finally, the fistula tract opened into the tonsillar fossa. We excised the whole fistula tract completely from the external opening to the tonsillar fossa, and the fossa suture was ligated. The procedure was repeated similarly on the other side. Postoperative histopathological examination of the specimen confirmed the presence of the tract lined with columnar epithelium (Figure 4). The postoperative course was uneventful, and the patient was discharged on the third postoperative day. There were no complications or recurrence after 6 months of follow-up.
Tonsillotomy versus tonsillectomy in adults suffering from tonsil-related afflictions: a systematic review
Published in Acta Oto-Laryngologica, 2018
Justin E. R. E. Wong Chung, Peter Paul G. van Benthem, Henk M. Blom
Different methods for tonsillectomy and tonsillotomy have been described. The literature comprises reports on the use of CO2-laser, coblation, shaver (microdebrider), diode-laser, and radiofrequency. All these methods can be used for extra-capsular tonsillectomy as well as for intra-capsular tonsillotomy. However, regardless of the method used, tonsillotomy will result in less pain and lower post-operative bleeding rates. At present, conclusive evidence supporting the supremacy of any surgical technique is lacking. Two recent Cochrane reviews on tonsillectomy could not find a difference in morbidity between cold knife dissection and diathermy tonsillectomy, nor could they find a difference in post-operative pain or in the speed and safety of recovery between coblation and other tonsillectomy interventions. Magdy et al. could not find a difference in tonsillar fossa healing when comparing coblation, dissection and laser-assisted tonsillectomy, but monopolar cautery did show a slower healing process after 7 and 15 d [17]. Coblation was associated with less thermal damage to surrounding tissue, which was presumed to be the result of the relatively low temperatures needed for sustaining the necessary plasma field. Currently, there is no sufficient evidence in favour of any method for tonsillectomy or tonsillotomy, and the choice of a surgical method is, at present, only based on the surgeon’s preference and the availability of equipment.