Emran Al-Herz 2041100005 Yaqob Al-Abbad 2041100020

The microbiology of the oral cavity is very

complex. The total count of anaerobic

bacteria is estimated to be 1.1 x 108/ ml.

Anaerobes outnumber aerobes by 2:1 in saliva.

Bacterial interference between organisms is

responsible for helping maintain equilibrium.

The use of antibiotics can substantially alter

the bacterial balance.

Recurrent peritonsillar abscess is four times more likely to occur in patients with a previous history of recurrent tonsillitis and unlikely to occur in patients over 40 years old.

Most peritonsillar abscesses can be treated by aspiration and antibiotics, with interval tonsillectomy reserved for those patients under 40 years of age with a history of previous tonsillitis or peritonsillar abscess.

It consists of loose areolar tissue lateral to the pharynx and is bounded medially by the

fascia of the pharynx and laterally by the pterygoids and the sheath of the parotid

gland.It extends superiorly up to the skull base, but is limited inferiorly at the hyoid bone by the sheath of the submandibular gland and its attachments to the stylohyoid and the

posterior belly of the digastric. Posteriorly, the space is bounded by the

connective tissue around the internal carotid and internal jugular veins.

In a report by Bredenkamp (1990) of 26 pediatric patients treated for acute nontraumatic torticollis, three were found to have acute tonsillitis and three had retropharyngeal abscess or cellulitis.

Torticollis, or wryneck, is a contracture of the neck causing the head to be drawn and rotated so the chin points to the contralateral side. It is a common sign in the pediatric population with nearly 80 different etiologies.

Inflammatory torticollis is characterized by local irritation and spasm of the sternocleidomastoid muscle with compensatory neck rotation.

In a similar fashion inflamed, retropharyngeal nodes may cause edema and irritation of the longus colli and the scalenes leading to compensatory hyperextension of the neck.

Radiographically this leads to loss of the normal cervical lordosis.

The initial management of acute torticollis is

cervical spine immobilization until Cspine

films exclude the possibility of fracture or

rotary subluxation.

Acute rheumatic fever usually occurs 18 days after an infection caused by group A β-hemolytic Streptococcus, when the throat culture is no longer positive.

Streptococcal infection results in production of cross-reactive antibodies, leading to damage of the heart tissues with subsequent endocarditis, myocarditis, or pericarditis.

Once heart tissue damage occurs, little can be done to reverse the β-hemolytic Streptococcus, when the throat culture is no longer positive.

Streptococcal infection results in production of cross-reactive antibodies, leading to damage of the heart tissues with subsequent endocarditis, myocarditis, or pericarditis.

Once heart tissue damage occurs, little can be done to reverse the process.

Patients should be placed on a penicillin prophylaxis or undergo tonsillectomy to eliminate the reservoir of streptococcal infection; preventing rheumatic fever requires eradicating the Streptococcus from the pharynx in addition to resolving the episode of pharyngitis.

Poststreptococcal glomerulonephritis typically occurs as:

an acute nephritic syndrome about 10 days after a pharyngotonsillar infection (12–25% incidence)

or as skin infections with a nephrogenic strain caused by group A β-hemolytic Streptococcus (10% incidence), depending on the genetic host susceptibility factors.

The pathogenic mechanism of the disease

involves injury to the glomerulus by deposition

of the immune complexes as well as circulating

autoantibodies of the streptococcal antigen.

Antibiotic treatment has not been shown to

affect the incidence of the disease.

The proposed cause is a cross-reactivity of antistreptococcal antibodies with basal ganglia neurons.

The exacerbations of the disease can be monitored by measuring antistreptolysin-O titers.

Treatment with either antibiotics or a tonsillectomy has been correlated with a decrease in OCD symptoms.

Current Medical Diagnosis And Current Medical Diagnosis And Treatment In Otolaryngology, Head and Treatment In Otolaryngology, Head and Neck Surgery, 2/e 2007Neck Surgery, 2/e 2007

(CMDT Otolaryngology ,HN Surgery, 2/e (CMDT Otolaryngology ,HN Surgery, 2/e 2007)2007)

http://www.bcm.edu/oto/grand/102292.htmlhttp://www.bcm.edu/oto/grand/102292.html

http://www.dochazenfield.com/http://www.dochazenfield.com/Tonsillectomy.htmTonsillectomy.htm