ANATOMI TENGGOROKAN

DAN PENERAPAN KLINISNYA

dr. Adi Arianto, M. Biomed

Sagital section
 Anatomy of hypopharynx
(hypopharyngoscopy-laryngoscopy)
EXAMINATION of the THROAT
(bacteriological)
EXAMINATION of the THROAT
(palpation)
 PHISIOLOGY of the THROAT
Breathing
Swallowing
Separating (channelization)
Speech (articulation)
 SWALLOWING
Normal mechanism - 3 stages
1st Stage - Oral (Voluntary) - tongue pushed against palate,
forcing food into pharynx, triggering reflex stages
2nd Stage - Pharyngeal involuntary lasts 1-2 seconds Food in
pharynx stimulates receptors with afferents in V and IX leading to
the medulla. Reflex efferent signals travel via V, IX, X, and XII to:
Elevate soft palate to seal off nasopharynx
Move palatopharyngeal walls medially
Close glottis and depress epiglottis
Larynx moves superiorly, and anteriorly under base of tongue to shield
larynx and widen hypopharynx
Relax cricopharyngeus
Close superior constrictor as bolus passes into esophagus
3rd Stage - Esophageal (Involuntary)
Liquids usually fall by gravity
Peristaltic waves push solids. Innervated by vagi and myenteric
plexus.
 Examination Scheme

External: Lips
Oral vestibule
Teeth and gums Put Tongue Depressor &
examine:
Hard & soft palate
Tonsils
Palatal mobility
Ant. & post. Pillars
Tongue dorsal, ventral
surfaces, Tongue Posterior 1/3
Floor of mouth Post. Pharyngeal wall
Tongue mobility & its mobility
Examination
Tongue Depressors
Taste Sensation &
Electrogustometry
 INFLAMMATORY DISORDERS OF
THE PHARYNX
Inflammatory disorders of the pharynx most
commonly present as throat or neck pain.
Disphagia, odynophagia, and airway obstruction
are other frequent complaints. The pharynx is a
dynamic conduit for inspired air and ingested
matter, responsible for diverting each into the
trachea or esophagus, respectively. This process
may be impaired by anything which obstructs or
restricts the mobility of the pharynx. The following
outline is directed toward a systematic approach to
the evaluation of the patient with sore throat,
odynophagia or disphagia.
 EVALUATION
Key historical considerations
Age of patient
Onset and duration
History of recent trauma (including possible foreign
body)
Inflammatory symptoms - fever, pain, malaise,
malodorous breath
Status of nasal airway: congestion, obstruction,
rhinorrhea, purulent discharge, allergic history, snoring
Reflux symptoms such as heartburn or water brash
Associated ear pain
Disphagia or odynophagia
Dyspnea or stridor
Other associated symptoms
Recent exposure to infectious discharge
Cancer risk factors: smoking history, ETOH abuse
Key considerations of physical examination
for patients with throat pain:
Ears - The patient's ears need to be examined for primary ear
pathology, as acute otitis media and serous otitis media are often
preceded by pharyngitis and nasal congestion. Conversely many
patients with pharyngeal inflammation or tumor will have referred ear
pain in which case otoscopy will be normal.
Nose - The nose should be examined for any evidence of obstruction,
purulence, or excessive secretions. Mouth breathing leads to drying of
pharyngeal mucosa; this is a very common cause of chronic sore
throat. Excessive secretion may cause the patient to clear his throat
frequently, which traumatizes the larynx; and infected drainage from
sinusitis may cause irritation in the pharynx.
Pharynx - Examination of the throat for asymmetry, injection,
erythema, exudate, swelling, or pooling of secretions. Also, careful
inspection and palpation of any ulcerations, lesions, mucosal or
submucosal masses.
Neck - Careful palpation and inspection of the neck for
lymphadenopathy, swelling, tenderness, induration or fluctuance.
Large, firm, non-tender masses suggest neoplasia, while multiple small
nodes are often seen in chronic recurrent infections.
 Acute Viral or Bacterial Pharyngitis
Pharyngitis is caused by a variety of microorganisms. Most
cases are viral and include the virus causing the common
cold, flu (influenza virus), adenovirus, mononucleosis, HIV
among various others. Bacterial causes include
Group A streptococcus which causes strep throat (15% of
cases), in addition to Corynebacterium, Arcanobacterium,
Neisseria gonorrhoeae, Chlamydia pneumoniae and
others. In up to 30% of cases, no organism is identified.
Most cases of pharyngitis occur during the colder months
-- during respiratory disease season. Spread among
household members is common. The medical importance
of recognizing strep throat as a cause of pharyngitis stems
from the need to prevent its complications which can
include acute rheumatic fever, kidney dysfunction and
severe disease such as bacteremia and rarely
streptococcal toxic shock syndrome.
 Symptoms
sore throat
additional symptoms are dependent on the underlying
microorganisms
step throat may be accompanied by fever, headache,
swollen lymph nodes in the neck
viral pharyngitis may be associated with runny nose
(rhinorrhea) and postnasal discharge
severe cases of pharyngitis may be accompanied by
difficulty swallowing and rarely difficulty breathing
Signs and tests A physical exam with attention to the
pharynx to assess whether drainage/coating
(exudates) are present, as well as skin, eyes, neck
lymph nodes is frequently done.
 Oropharyngoscopy
Swollen,
erythematous
mucosa of the
oropharynx and
hypopharynx,
often with
edema of the
uvula and soft
palate.
Swollen cyanotic
lymphatic
follicles on the
posterior wall
Mucous or
purulent
discharges on
the posterior
 Complications
complications of strep throat:
rheumatic fever,
glomerulonephritis (kidney inflammation),
chorea,
bacteremia (bloodstream infection) and rarely
streptococcal shock syndrome
in some severe forms of pharyngitis (e.g.,
severe mononucleosis-pharyngitis)
airway obstruction may occur
peritonsillar abscess, retropharyngeal abscess
 Acute Tonsillitis
The most common organism is beta
hemolytic streptococcus, but viral organisms
can also cause exudative tonsillitis. Other
causative organisms include staphylococcus
aureus, streptococcus viridans, and various
hemophilus species.
 General Symptoms
Rapid onset of throat pain with pain on
swallowing associated with
Fever, often 38-39 C
Malaise
fatigue
Chill
Pain in extremities, muscles and joints
The Tonsils
Catharal and Follicular Tonsilitis

The tonsils are

red, enlarged
and painfulness
with an exudate or
studded with white
follicles.
Tender, firm
cervical
adenopathy is
often present.
Tonsillectomy
Tonsillectomy
Secondary
infection
Adenoidal facies
 Adenotomy

Adenoid grades
 Tonsils
Effect of tongue depressor on size
Tonsillar hypertrophy
 Asymmetrical tonsils
Large kissing tonsils
Acute tonsillitis
In mononucleosis the tonsils are hyperaemic and pus
accumulates in the tonsillar crypts. The debris in the
crypts coalesces to form a purulent membrane. The
clinical picture resembles of that in streptococcal
tonsillitis
 Right peritonsillar abscess; the
peritonsillar space, the soft palate and
the uvula are swollen. The uvula is
displaced to the contralateral side
Peritonsillar Abscess Quinzy
Tonsil cysts
 Tonsil Tumours

Carcinoma
Papilloma
Pharyngitis

Chronic Pharyngitis
TERIMA KASIH