Emran Al-Herz Yaqob Al-Abbad

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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 It extends superiorly up to the skull base, .gland 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

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

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

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

Treatment In Otolaryngology, Head and Neck Surgery, 2/e 2007 (CMDT Otolaryngology ,HN Surgery, 2/e 2007)

http://www.bcm.edu/oto/grand/102292.html http://www.dochazenfield.com/Tonsillectomy.

htm

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