Pharynx. By Dr. Nourizadeh Assistant professor of E.N.T. Anatomy. The pharynx is a musculomembranous tube that extends from the base of the skull to the level of the sixth cervical vertebra. The pharynx forms from the elongation and growth of the primitive foregut . . Anatomy.
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Assistant professor of E.N.T
Mucous membrane of oral pharynx
Mucous membrane of laryngeal pharynx
The primary follicles are formed during embryonic development and differentiate into secondary follicles after birth.
The lymphatic tissue in the tonsillar ring is also termed the mucosa-associated lymphatic tissue (MALT) of the upper respiratory tract.
In performing the head and neck examination, it is crucial to palpate the oral cavity and oropharynx, as tumors , can be palpable with only subtle surface abnormalities.
Rib cage and abdominal effort
Asymptomatic patients with a positive rapid test should not be placed on antibiotics. Conversely, a culture should be taken in cases where there is clinical suspicion of streptococcal tonsillitis but the rapid test is negative.
Antibiotics are indicated, however, in cases where the offending organism is group A hemolytic streptococcus.
Another treatment option would be a first-generation cephalosporin. it is generally accepted that if the community failure rate with penicillin is less than 10%, penicillin should be the first-line treatment.
Two main forms are distinguished based on their clinical presentation:
Discharge from the hospital is contingent upon test results: three smears taken at 1-week intervals must all be negative.
The treatment for diphtheria is generally considered an emergency, and antitoxins should be given within the first 48 hours of onset to be effective.
Miliary tuberculosis: involvement of the oral mucosa can result from hematogenous spread, appearing as multiple pinhead-size papules, some hemorrhagic, that form on the oral mucosa.
In mononucleosis, the white blood cell count is elevated to 10,000 to 15,000 with 50% or more lymphocytes, which are atypical in structure.
The agents of choice for pain relief are acetaminophen or ibuprofen. Aspirin products should not be used, as they could cause bleeding problems if tonsillectomy is required.
Rarely, hospital admission is required due to tonsillar hypertrophy and airway obstruction. In these cases monitoring for potential airway obstruction is appropriate, and corticosteroids may be of use.
Patients generally complain of extreme unilateral soreness of the throat with odynophagia, drooling, and trismus. Otalgia on the side of the infection is not uncommon.
A more sensitive evaluation is through a computed tomography scan of the retropharynx. A ring-enhanced lesion in this area is suggestive of an abscess. The presence of air within the lesion confirms that an abscess is present.
Cortisone should also be administered in patients with significant dyspnea.
Trismus may also be present due to inflammation and edema around the pterygoid musculature. If only the posterior compartment is involved, there may be no trismus, but rather swelling of the lateral pharyngeal wall and perhaps of the posterior tonsillar pillar. This condition is best diagnosed by CT scan.
The foreign material should be removed as soon as possible due to the risk of superinfection.
Pharyngeal squamous cell carcinomas are strongly associated mouth tobacco and alcohol use.
In the rare early tumor, therapy can be planned that preserves the larynx.
The pharyngeal mucosa appears red and “grainy” due to the hyperplasia of lymphatic tissue on the posterior pharyngeal wall.
Small, firm, immobile tonsils with associated peritonsillar redness. Occasionally a purulent liquid can be expressed from the crypts. Tonsillar smears are found to contain group A β-hemolytic streptococci.
General treatment measures consist of:
The result of the Müller maneuver can be helpful in selecting patients for a surgical procedure on the soft palate.