Edema of the palatine arches

  • Sore throat, usually on one side or more pronounced on one side; can give in the ear, teeth.
  • Feeling of a coma in the throat.
  • Difficulty swallowing.
  • An increase in submandibular lymph nodes, sometimes on the one hand.
  • Increase in body temperature, sometimes up to 39-40 ° C.
  • Deterioration of general health is weakness, weakness, headache.
  • Nasal.
  • When forming a cavity with pus (paratonsillar abscess), it becomes impossible to completely open the mouth (trismus of muscles), bad breath.
Depending on the form of the inflammation:
  • edematous paratonzillitis - is relativelyrarely, less than 1/10 cases. The soft palate and palatal arms on one side are edematous, the small tongue is enlarged, the mucous membrane of pale color, shines (vitreous edema); localization of inflammation is difficult to accurately determine due to diffuse edema;
  • infiltrative paratonzillitis - tissues surroundingpalatine tonsil, become bright red, there is a swelling in the site of inflammation (above, below or behind the tonsils), the soft sky is asymmetrical. In most cases, without treatment after 3-5 days, this stage passes into a purulent form - abscessed paratonzillitis, or paratonsillar abscess;
  • abscessed paratonzillitis - purulent formparatonzillita, in the place of inflammation formed a limited abscess (abscess). Externally marked pronounced swelling in the area of ​​the abscess, through the mucous membrane can shine light pus, with pressing the instrument, there is a fluctuation of pus (fluctuation).

Depending on the location:
  • anterior (antero-top) paratonzillitis -most frequent localization. Infection penetrates from the upper pole of the amygdala into a loose surrounding tissue. There is an asymmetry of the soft palate, the amygdala on one side swells to the middle line;
  • posterior paratonsillitis - marked edema of the posterior palatal arch;
  • lower paratonzillitis - inflammation of the tissues belowpalatine tonsil. External signs are not pronounced, there is swelling of the lower part of the anterior palatal arch, there may be soreness of the tongue on the side of the lesion;
  • lateral (external) paratonzillite - occursleast often. Inflammation of loose tissue outside of the palatine tonsil. External manifestations are not bright, there is a slight bulging of the amygdala on the affected side. With the development of a purulent form of paratonsillitis (paratonsillar abscess), a trisus of masticatory muscles develops (the impossibility of completely opening the mouth). There may also be swelling and tenderness of the neck on the side of the lesion.
  • Paratonzillitis (inflammation of the tissue surrounding the palatine tonsils) causes a variety of bacteria, most often streptococci.
  • In most cases, paratonzillitis developsafter an untreated tonsillitis (acute inflammation of the tonsils) - usually a few days after the improvement, reduction of sore throat, associated with angina, the patient again notes the increased pain on one side, the deterioration of the general condition. The provoking factor may be hypothermia.
  • Paratonzillitis may be a complication of severe formschronic tonsillitis (chronic inflammation of the tonsils). As with angina, the infection penetrates the surrounding tissues from the amygdala itself.
  • Perhaps the development of paratonsillitis in people with tonsils removed - in the event that during the operation was left a small area of ​​the tissue of the amygdala.
  • Less commonly, the infection extends to the paratonsillar region from teeth affected by caries (usually the molars of the lower jaw).
  • Contribute to the development of paratonzillitis diseases and conditions, accompanied by a decrease in immunity:
    • various chronic inflammatory diseases (for example, foci of infection in the paranasal sinuses - chronic sinusitis);
    • diabetes mellitus - a chronic disease, accompanied by an increase in blood glucose (sugar);
    • immunodeficiencies - immunity disorders, leading to increased susceptibility of the organism to infections. May be congenital and acquired (eg, AIDS);
    • smoking, alcohol abuse;
    • inadequate nutrition, life in adverse climatic or social conditions.

LookMedBook reminds: the sooner you seek help from a specialist, the more chances to keep health and reduce the risk of complications:

  • Analysis of complaints and anamnesis of the disease:
    • whether the patient notes unilateral sore throat, difficulty swallowing, worsening overall well-being;
    • was there a few days before the real deteriorationepisode of angina (acute inflammation of the palatine tonsils with raids on them, increase in body temperature to 39-40 ° C), exacerbation of chronic tonsillitis (chronic inflammation of tonsils, which is accompanied by pain in the throat when swallowed and for which no temperature rise characteristic above 37.5 ° C), what treatment was performed;
    • to determine the stage of paratonzillitis is importantto find out how many days ago there was a worsening of the condition, there was a sore throat on the one hand: if this period exceeds 3-5 days, most likely, the stage is purulent, that is, the throat is parathonsillar abscess - ulcer.
  • General examination: submandibular lymph nodes are usually enlarged on the side of the lesion. Pay attention to the degree of opening of the mouth.
  • Pharyngoscopy: examination of the throat. It can be difficult because of the trisus of masticatory muscles - the impossibility of completely opening the mouth, which is characteristic of abscessed paratonzillitis (purulent stage). The most typical picture is the asymmetry of the soft palate, the amygdala on one side swells to the middle line, the mucous membrane red, edematous. Less typical options:
    • Isolated edema and redness of the posterior palatal arch;
    • swelling of the lower part of the anterior palatal arch, sometimes of the tongue on the side of the lesion, swelling of the lower pole of the amygdala;
    • diffuse swelling of the soft palate on the one hand, a small tongue sharply enlarged, pale in color, the mucous membrane shines (vitreous edema).
  • Inspection of the larynx - laryngoscopy. Inflammation and edema can spread to the larynx tissue, especially with the development of purulent inflammation behind or below the tonsils.
  • In some cases, additional methods are used to clarify the diagnosis: ultrasound of the soft tissues of the neck, computed tomography (CT) of the neck.
  • It is also possible to consult a therapist.
  • Patients with abscessing (purulent) form of paratonzillitis - paratonzillar abscess - are recommended hospitalization.
  • With edematic or infiltrative formparatonzillita (usually in the first 2-3 days after the onset of the disease, redness is noted, edema of the mucous membrane of the soft palate on the one hand, the amygdala swells to the midline), when the abscess is not yet formed, the treatment is conservative: antibiotics are usually prescribed, more often intramuscularly, rinsing of the throat antiseptics, antihistamines (antiallergic) drugs (they relieve swelling), if necessary - hormonal, analgesic, antipyretic drugs.
  • At the initial stage, the appointment of physiotherapy is also possible.
  • With development of abscess (3-5 days from the beginningdiseases; the abscess swells, pus appears, pus pressure is observed when pressing the instrument with an oscillation of pus), a surgical opening of the abscess (ulcer) is performed at the place of greatest swelling under local anesthesia. The cavity of the abscess is washed with a disinfectant solution for several days, until complete cleansing.
  • In some cases, abscessesillectomy is performed - removal of the abscess simultaneously with the amygdala. The indications for this operation are as follows:
    • lateral (external) location of the abscess, when it is difficult to open it;
    • no changes in the patient's condition or deterioration even after the dissection of the abscess;
    • development of complications - the transition of inflammation to the soft tissues of the neck and chest;
    • signs of decompensation of chronic tonsillitis(the development of complications due to disruption of the work of adaptive mechanisms), namely: repeated paratonsillar abscesses, repeated angina (acute inflammation of the tonsils) for several years.
      The question of simultaneous removal of the second palatine tonsil is decided depending on the situation.
  • At the stage of abating inflammation, physiotherapy is prescribed to accelerate healing.

The risk of complications is greatest in purulent paratonzillitis (paratonsillar abscess).

  • Phlegmon neck - purulent inflammation of the soft tissues of the neck.
  • Mediastinitis is an inflammation of the space in the middle parts of the thoracic cavity bordering on the heart and lungs.
  • Sepsis - the spread of infection through the blood throughout the body.
  • Inflammation of larynx tissue withthe development of acute stenosis of the larynx - narrowing its lumen and obstructing the passage of air into the respiratory tract, which is accompanied by shortness of breath, even to choking.
  • Risk of death.
  • Strengthening immunity:
    • general and local (from the throat) hardening of the body;
    • regular exercise;
    • air and water procedures;
    • ultraviolet irradiation - stay under the sun.
  • Treatment of chronic diseases of the nose (for example, chronic sinusitis - inflammation of the paranasal sinuses) and nasopharynx (for example, adenoids - pathologically enlarged pharyngeal tonsil).
  • Treatment of diseases of the oral cavity (caries), throat (chronic tonsillitis - chronic inflammation of the palatine tonsils).
  • Rational treatment of angina (administration of antibiotics for at least 7 days, dosage and duration of intake should be observed, despite rapid improvement).
  • Correction of immunodeficiency states and diabetes mellitus is a chronic disease accompanied by an increase in blood glucose (sugar) level.
  • Refusal to smoke, alcohol abuse.

Palatine tonsils (they are also often calledglands) - paired organs of the immune system that perform a protective function and are part of the first barrier faced by an infection that enters the body through the respiratory tract. Are located on the lateral walls of the oropharynx, between the anterior and posterior palatine arch - vertical folds extending from the soft palate.

National guidelines on otorhinolaryngology, ed. V.T. Palchon. GEOTAR-Media, 2008
Otorhinolaryngology. Luchikhin LA Ed. Eksmo, 2008