You are on page 1of 30





 



The mouth, tonsils and


adenoids

     
    

 "#!  


 $ '& )( +,

 . $ $1 $

Heamatological ( #=
. 0

 //
 C /
["
Agranulocytosis II
/.
Pernicious Anemia 
/
["
B12  \I
Polycythaemia /


Neoplastic
Carcinoma .a

Leukaemia /
 R

   



 

  

"#$ ) '&+-. /' 0



12 4  16 
6   "  /

.

$>@ $
; .6
 B4
C   D

. /
 "I 

CHI

 J 
. (-)' MNH  
/

Overview
    

Autoimmune (E $ #=
Pemphigus
"
Pemphigoid \"
/

 Sore mouth and oral ulceration

Idiopathic F#G ( H


Aphthous ulcers -"

Behcet's syndrome c@


Sarcoidosis /_

Wegener's granulomatosis $`
Lichen planus J#

&

Trauma 

Others  #=
$ 
e` ( C)  [ \
(B6) /I
(B2) [-[I
f
( B3  $
 ) $

.) -   -
Steven-Johnson syndrome
Leukoplakia H#

6 C
 H

Black hairy toungue

$
P/I
:Mechanical ! 
Dentures
Caustic
: Chemical 
Betel nut chewing I$
) QR

Infective (
: Viral !=>
/) Measles I Herpes U

/' -/  - Chickenpox

Handfoot and mouth
: Bacterial !1 ?

" &X
Syphilis WH

Scarlet fever
Candida I
 RI
:Fungal +>
Kaposi's D AIDS A@
Z /  M"[ /'
sarcoma
@$ N#
 XH\  ]/^
.B_
  ` aN XH\ H



FU

T$P
 

G ,
(

 >!  P
(

 (

& (
/& !

 G
"H  (
QE ("#RAH
& ! "#

/ 

 )(-
' M  ?  

 
 
 Sore mouth and oral ulceration
$
f6I
 Z

U

 '
 RC HX
\ hI1 RC
  #1
\
 \ XH
.
"$ 
& \ XH  B e
P
& \ P 1
 W.
]
\6 C . e
P  #
 j
 N
 [" $ i 
 C jN
P 16 / "" 

I#H
f
/
P" .
4 ' 1'"  H


) MP"


 jN'. /' n [  C
P

H
@. \&N
jNH
0
[o   \ p
 \M

D_
 1/

M  [
B4
 [4^ jN
X
\ hI
\ - \  6
@.

 , Ulcers :
 ,  Traumatic ulcer (N

"
 4
 _ CH

 jN \ .    X


\ .B


& -
 \  MII

P/I
 ` $
$ I 6$

p  I
` -Z
' X & $
\ XH
fH

/N 
-C
 @
C6$
 -

/I

.$

), Aphthous ulcers


  H_ C 
" \
D 
Z'  /  /C.
XH\ B4  f
H

 [ / 
.

 
WC I  X2
/"C

/H
$
 `
@/ 
0
\/ P  []$
 6I
 .

M
0 [\ [ />.
] \ " D &\@
`
&  I "H /C . '.HH
[ .6
// $  \/ I
 #D I )
  
/ 
Z  /$\ W $H

 .
 #
-C 
 $
_/

R
[4^ C4
\ hI

C 
 4 
 \.)-
[ P .  
"  \"
I \/$ ' / WIH
 jN'/
 #

\&N.e/
$  ) ' '\-
C(   [/\ M " \" '/
/$ $\ @$  [ )
.


   BI\6
"

 B
C.
@ eI.P
X  C
]

'  /

 C jN 6
^
# 

@ f[
` 
-#
C \XH

H @  cH]. .
X
-  \
 \$
  \/$

.
= R    )(-

Oral cavity cancers


/I ]C.a

H 1
.a _ 
-N )
 


 46 B f
  (%" H   #
 
Z' I / .

 C. [ 6  I
` . 

$1/ 
 . C $>P
\  @ \&1 1 ' P
 -1 X \I
-C

$
.[ >IN
 $
a [ 

 , @ ( Infective ulcers
 I
 U
' iI -"
 I

$ /  -  /\ \ 




 C
[ B
  

R
 @
C
 ) ([H
'. 
C[  I c
[ P 1  [
 X4
 ./


/ \ I
\$ 12
#
/
 U
U[ '#$
"
-

)(-
 QE V# (> P Q$ P  G


@
 )
H -
 ;H1 -

 -X
 - 0$
$
 -N$
(w
 B  . a
H  \XH
[
H
@. I.

+NZ A( XY(W


Blood and dietary disorders
 C
$C 
/ /
P
[  B12 [ xR. 
aN


o[ 0 \ /e

$C  
] M H\ M

" /' . 
C`
1   I
\ ). // ` [ ]$/
)
`-I(  \ \ ).


(B3) $ $
(B2) [-[I

0
 )
Scurvy (BfI
)$
\ \ [  .C
C I /' 0

/ R
/ ["
/

B$ - I
-N " [
.
 \,# [# >!  
White Patches in The Mouth
 [#  ]#)(-

)Oral thrush (Candida


 /..
 
RI
/$\ I
a6
D [ \6
"  / [
 ) /
\$ ;C4

)^/
 ( . 
0 /
   XH\ B4
 X4 /$\ 0$

@./N
1NI
_/.
] \ XH
 #".   aN
" Patch C"  
RC B

 ` X    



 [N
H aN _/$\  /
  /\ .   jN
@   )-CH
/ R

#
 [
C4 \/

 $ jN
 0  1

&H
 j
@> 
#.

 )(-
  [#  QE ]# T$P  FU

)+ Leukoplakia)(-

  JH#
.N W
]   " B J# ` ]$
P
  [N
H ./N 


JH#; [ " aN

' /[ j
 B$ \ B n
.@$
C
 [ I
N  C
0 C4
& 
 1/
 $ p
) ... $
.w
 N .
 [ >IN h
%
P 
-1 >INH W1
$ .   B
 >
aN
/
f
 0
H
[ H
[
 [
 0$
 fH[ H
 0
HC
1
 0$
.1

 G '" =
Black hairy tongue

)(-
)R QE?^ A! ' (

$ ] 1 $
-#


 & I$ >INH
H
f  I
-#
RI 

XH\ CI/I /' . \ % /$

P  .a \  x$//



.\&N
$ 
 1 
-#
C
) ]
(@$    "B
R \ XH
[

H /
\ X4 /$^/ [ I
` II
  .Epstein Barr

 e
W

 C I
 $[n
B
 . 1/ . [ /_HH
/

[ #N J#
H '  / 
'  $ R  XH\ /C

H
@> 
H 
 $[n
`
[ B I .
RI  .
@
C
 ;]$ J#
H 
   )/
]$).(-

Key points
,   Oral ulceration

)(-
 G '" =

     




   $ " .


   ( 
$ 
+,*) ) 1 /  0(.
= $; ": 7896  4 
  >+ ?0 + ?A  )B
1C@6.
+ E  K$J GH F* GH
" N  ?0G .
:  ,
?  VHU 0 R " 1
 + )0/ X/
1C
.

(Z( ,&
 

Congenital masses  Lumps and swellings in the mouth
B $
[ 2  \ 
 /

\_ 6"  HN
6
H


Haemangiomas

] . ) Cystic hygromas 

.( f

/' P
/C /$\ P
[ 2]
/' W$
 D
 [ X
Z
.  /
[
\_ 2& [ . /
 /$\ 
@pP
@  C

. #

Overview
   
Lump and swellings in the mouth

Congenital (Z( ,&


Haemangioma  /

\_ 6
Cystic hygroma 
 H



Acquired (#G
Ranula \/R

aN
 IP

Mucus retention cyst
Torus platinus  $
] C
/

(- ! )$P! b" AP


Torus Palatines
Osteoma H \ \] I\ 
H M'[ aN
   H
0$
[

/I @
. M# " /'
. .a [ /I $ $6
 \I  P pP P
.$6
 /  B C

Neoplastic 
: (G  -
/C ) iHN

 f CH
/D

(Pleomorphic adenoma 6
: (`#&  -
Squamous cell -N
0_ a

carcinoma
a
 f fIN
 CH
/D

Adenoid cystic

/D

carcinoma
Sarcomas
 
Lymphomas  H

Dental !$= a'$


Abscess )N

Cyst $



(-)
!$P! b" AP

 G (= # Z& (R


Mucus retention cyst

D
@H
aN
 `$

/D
 aN / /.

 e
/D #
 PI

] \ XH   / 
J# H WH 
N .
 ]   [ )


 ).(-

-C Pp
@  c>/
\ 
Z ` jN./

_ \ XH_ _ n[ C
H .
. XH\6

-C 6 \@. f
@

) Marsupialization ;1
J

( H
B

?  
Oral cavity tumours

 6
 H
fIN

'   ] / [ H
 .
/D
CH

D [
   6 $  HN
6 f

/D \/ /6 

 H

 iHN
a
/D


hIN` .
o[ 0

 H '  /


H .


6 f\ [
@
 

  $_ 
-N.
        
 Squamous cell carcinomas
 )(-

)(-
 (G  QE (= #' ( ( G

[ Ranula (EA
X$C
\/R[ 
/R
D
 \I \  I   [

  c
H # '$

/D  c
 0
/D  c
H.

 > @
 I/ D@ 

CI
.
'  /

X@ [ H` I


6 "C
 ]

 \ XH   [ I

\ ] [ ;$ 1
C/C

 1/
 '
C 
ZI

aH /' .] \[ XH " f

H# 6
H# 6
.leuko- or erythroplakia
  6f
\ [ ^ 

@I.

H
 .
 
   _ B
 CH

 C. [  C6 &.
BHI
 C_ [ .
$
a
/"CH
H
"I
' /   ]  M
 \XH
  [ H
.n$C

 )(-
= R >! 

"\ \&1 1
 1


 i"[ W)
 jN


&` n\ "
0


'-\ M
^. . ^) P@ [
C
  [D
HC  c
/N
C 16
@ \&1  W$
' c"

 )o  ]$  Full pan -


. endoscopy

 ]$
   ]$ 
#n

 $
 R
HC   6



/ M /' 
 _/ hI1

/ M .> hI1 _/ . $@
" x
C
   $

/ M [
H.
1
-C 
 @
C
\C

N)
) 
-N 1
 (
^ [4
X
 @
C
@
@
 H/ H
En bloc B 

x$
"
#
 .
@
Z
HN j".
@ CR
^\#  )
  '/ ^ .

"/
$" [ I
@
 

@H
 / XH\ /C f
_J


_ J

@/H
HRC


\/
IC Radial forearm flap
$&) 1Z
IC B


HRC
@/H
 
R
[ ]C

 0
. H

 @
C
_
  ["[ i

 @
C
\U
#H.
[ 6
D
 D[" _". B

/"CH
H  
WN
"I$

 [ $ i"[ %6
" /
[o ^.  )/.

Key points
= R H  
Features of oral cavity cancers

C 
Z I
 1/
.
\ B   M
  
" H .
Z
' / 

  C..
$
  $'6
H
X
/"C

' I
".I

-C
.aH
 I
D
#C  66 [ I
.

@
& CHI
nH
[

4
 I6\ $
 ` I6 .
/C
WH"

 1/
 f
ID
 f pI
  C
 p

- ) CI @ 0
 1/

@ )
 ). ;.6; H1 '
(-) .

!" @ #
Infective pharyngitis
 CHI

 P C /' $]C


CH @ \
. I
 I$

.M
/ [
  [C
 
 C

&.H.P]_ . Influenza &.H.6
Rhinoviruses .6 Parainfluenza,
  $
Adenoviruses /D

Herpes simplex iI


U
[
.\ ' Zoster viruses "#$

P Z  >) 1 \  0
$
/H


  /"C
  CHI

Beta-heamolytic
streptococcus
/
Pneumococcus
_
. Haemophilus influenza 
&$

$I
-
' \  6  C

Syphilis WH

Gonorrhoea
.Tuberculosis /

I
 RI
 #  ^
/
/
 HH' (
-
)
/ 

e
H
 N6
. f /\ ^$
j". X4 /

: CHI
 B H [ .

 
  

 Sore throat and tonsillitis





Overview
"!  #
Sore throat and tonsillitis
Trauma !N 
NH
C
:Chemical _
pI

Alcohol

Cigarettes 1/

p
/C
WH"

Gastro-oesophageal reflux
Infections !@

CHI


Viral pharyngitis
 >@
 H


Bacterial tonsillitis
Quinsy$ 1  H
  1
Glandular fever /D
X

Candida I
 RI
:-

;.6; H1 J"
- \ x$
 .^
Purulent postnasal drip 

Tumours 
SCC -N
 _  .a

Lymphoma  H

nH

 6 C_
 I6; $ 
 
..^ 4
X
 CHI

j
 4

" 0
 C
.


E (g
=) !  !

 . !g"A

)(-
= #  "#! e

- "#  P D(E$


Non specific acute pharyngitis
I

 ) C
/D
(.6
@> ) C
/"C



/H (   &.H.6 
 I6
[ X
a6 $ > H

_
"$C  IC
N
I

CHI
 ' /


CHI  6 ^ \[/.
I


&$
[/
 X
" & ` .


-
 - :
 '  :fG# f_ B/ [M

 
CHI /"\  N4 
j
/@." .// 
 aN' /[n

B  \ XH
 0$
H
" XH\ #
D
aN

  _ B`
I MII

  ' H
@> .HH' Ma-1
 ' 'A :A /$\ I
` /a6

/I [ _@[ M\ M4//
B\ \  \ ]
. \ j
  [
H
XH\ ' .
D
 aN
 '/
  `  MI
/ ' /[ n

P  ) M\[/.
)
 X
" &( a-1 
$
 c._ \ I' C
 : $
/
 
@$H 1 \/$
a6 /$1P / x1 - \


  / [ /
 [
/I
1 [  N4
/"C
H
'I
 `  B \ $
 N$
[ x$
CHI
H Z 
X
" \" &$ 
 

D .
& \6 \  - /C

/I

"
 /' C4

/C  B B
_
.

B
 na$1 
HX

  $1


 Q .
 / [ /
.
'&Diagnosis h
XH\ /C
 .R '

P
@>  )   ( a

 ) - (  h 
P \/$
a6 $ [ I
` II
\  /$[\  n \^[ $
`

 I
/D \  /$[B n
\ P  # [
I
` I


C . Enterovirus



C ' /H" /

&_/

 h/

/"C
"
  
P
CHI
 


C.
" Treatment (H

" Treatment (H

" \ XH

 $ R[1




 XH\ /C

 `P


#

- "#  P  !W 'Y


 $ > G Vincent's angina

- "#  >A !W P


Acute diphtherial pharyngitis


  Z
" X [ /

H [ C H I
` /
X

CHI 
 0$
. fH
MII
C
 
&D IH
D

I
H
 Spirillum $
0
)> 1 
/"C
-_

C 
Z
I
/ 
N$

 $

fH
" 
D
P.
 /
 [@_  \M4
 
6
/ [ /
 nH_



 CH  C
[/
)\
[ ' (H/> Mf  IH

.J"H \ a6 -C$


\ M4
 nH
C

 C46 /"C
 
Z  N4

H B6 B P X f


)  B $ ` I. B
)
 ^'
IN.P

 /  //
HI2 $ 
// .R `60^ ]H  
 ab9$H K919 ;U

'&Diagnosis h
/C
 XH\ jN\6
"


 j@  \


CHI
_D16  :

[/

CHI
H
"

 R
/
 6
.fIN

  >/6  $  9 )09


C/ $/1 X1C@  h9 " GH
F $$* ?B
6.
N=GH @ $
H,  j@6 ]  /
"
$ +*$/1 XH
6 1
 $U.
'&Diagnosis h
XH\ /C
"
 4
j

 ]$
D @
 /

 )o

IN  /C1

1#
 na$
 [
I
 \
[ H  /C
&
[ .H[
i
 \ @[ 0
H \$ /
\/ \$
 /4 jN
[/ [o 
@ \ XH/C

jN

[/ @ " 
/
/
 c6  "
- /C @$ [o
  ' [
@ < /H 
I1P @.
R)ZComplications
' /Z  
P
: X
/ @$H
`6 $1P.


@$
_
"I.

 \ HR
".H
H \ I I  1 $

 ) 0$Z
 11

_ Ca6 ;.6>$


(BHI
[
P
Z /' 1
H

IC
c ` X [ H
\-R
CHI.

].

" Treatment (H
\&
 \# e

R
P/ ]. @.
IN

[/H 

 I \#
  H$I
,-,/  
/
-  \# ^ 

 XH\ W
/" H$I / QH
Q
 " \\) XH.
 ( Prevention
#\o
"H
@ Ba6 @ \#


R
aU
   B

.

- "# :!##P


Granular pharyngitis
HD  /C /p
H h
 NR )6
DHI
) \/) XH

CHI .H
 

C /C P [

CHI B@   


P

.
" Treatment (H
``   

 H
 B

H C4 H# . %

 / R
B I#
R
 /C

&
 W


@/.

- jPHerpes simplexfG#
f
/ ] \ XH  -
D hIH P  @$ #
"  
 a.
'  /
-  /C
 a XH\ /
 ) (-
CHI


H
H  XH\ X
D

@$H
aN.
) 0
$
 U
Herpes zoster '#$

 ] \ XH  - \I' XH



  XH\ 0$
I
` C

 B
C 
 I`
I/

@( .

)(-
 >!  QPAY(

)(-
 jP fG# 

 E Symptoms

 /  /@ C^ 
 iHN

CHI [ n B [2  \"/



n$C 
  # P 

CHIH [
 \/$  
 U
// B C
 
B$[ BHI
#
\
C# B
C `&
) 
6
BH C
CH.
 X\ [2 \" @
C P

\. C
PD

# @$I
@$ %-
- A $ & ) !HQP
AY( ( Glandular fever
iHNf B

H
 
.  C
@
 I

.#I] 
CHI 
 NR
 `  _ XH\ $.

H ) ' .  R (


) (- /
X
fH[ MII
  "$
/ 
CH /
- M.R   f^ 
-.$
 
  //  X
) /"\  N4' [#
 I
B 
Z ' M P C'/
 NR
# [ ;.
P '/
/
 /I' ] /\ \I
)/ ". -( " /H


' ] /\ _


 $C  
"H
Z
 \/ ]. [. M
'&Diagnosis h
IN \ XH
` 
 [-
&


I
.  D
 /
$ %-j

H   I ` . CIa


 jN
cf6 e
/

 
) \ .Paul bunnell P 
@ /C P ^ ./C
[
 jN
 XH\  II1
.Monospot/  /4 [
   
jN.

 JI
R ) &1 ` X

" Treatment (H
P)
\. @
C /
/
X#C


'H ^.
.f

 $ R[1
 #

  \#
&  /$C

 \ XH
 @
C ) nR

# n
_  N4 @.
H
B
 

/ \ " P. \I
' P /) B
 R /C PI

 \  \" \ H


^. a I M + [
"$
 / a-1P .

)(-
 $ k

- h, ##P
Agranulocytosis

$
&  c
 0 \ I
` x$
x1 
 $
/"C
RN
.Streptococcus viridians.C


 X^
C B Drolling
&4 Trismus' // /. [

# n
_  I&.P
HN

H j
 /@. .  ' [ @.

.)(-

iIf MII
$ I "$  C6

 \ XH "H
&$I 1
/ 6
/ H

)
H  6  ( 6

R
U
fIN
 "$H
#If$
 1 [ .N. [ \/


I1
II )f

$ ( 
$ f
).
]
 
CHI 
/) 6
X
[" /@$ B
  

 '/
 MI $ X#D
D
 ) \XH

H
CHI (
 \  BH;C4
\ 
 \   B p 

' // &.
j"$
.

" Treatment (H

'&Diagnosis h

iN6
-CH 

/
. $.6  /$\ ' /@.) n
) . 
# n
_ / '/

XH\ /C
"
 4
j

 /C

I&

. "$

$- Ludwig's angina k

" Treatment (H
" \ XH"
/
[ I
&C

 B$^.
.f \#
 ".

/ \# [  B12' / @H


X
. ".

-(   P ) ( (^$
)( " ( "((#U
Angioneurotic oedema









 h
H 
 0$  //
/"C
 C e@  I6
N R[1
iDR
NH
#If

"
f ACEI $@.U
I

@ C e`6 .
 
 C ) - P
[
CHI  
[ D
.

 j /  R // \XH

H 
 0$'@$H
/ /.


/"\  N4.

 .' . B

 X  // \ /$a6.
^ .

  C. [ 6.
[  N4
H.
\ /$a6   \6
I 

 X
IN[  C
P
//
]
C \ .P

 /
C
[ #CH
n[ j".
@
I.

" Treatment (H
)(-
  1 H!

  R
 
&
 -1 X -.

   H!  P
Acute follicular tonsillitis

  )(-
Tonsillitis
 jN

H \ P#N
 .M
"
)
 @.


H 
 J -

 :

 .nH
 C
 
.BHI
 \ C .
 _ [  .Halitosis

 _ B H h )6
H

I  [ \ XH
'  #C
 ]$
 i"$' H /e


"  #C RC B 
`    \ XH J#
H.
\ MII )>
/"C


/H 

_
 /

&$/' .
  >. 
P [ ./



 X
 .
/D
). /
$
(@N
$
 
H #D  ' $ 
R )
/"\  N4 B (-
C .' / NR
#
./I


H
 [ nf
 6 \[/.P
 X
" & )h

M. JI
CHI " $" .
 ` n
H ' &
@ /H
[ \  ] \[/.P
@/H

#"$
 (.
") >!    P
[
P
N    iI

 [
 i  B
C 4
_ [  [
P
6 f/ [R   f
H$I
^f   [
P
//
 h 
 ` ' \ XH1

_
[ [ [  M
JC
/

_ B\#  /.

 X#
 -@>
/ -


H
& .
$  f  I

CHI

H
 . ) $' /
):(XH\6 C

 X
" &.

[/ ' ' //>. M
$1 [. .
[" /
II.
. /
$
. @N
    !G$
Peritonsillar abscess or quinsy
) (-

IC Ba-1P ^


P ..

H `
 I 
N [ ).
. / h $^.
X
x$

H ) [DH ( >  
N
 @ ' B ]  B4
H

@/
@CHIH
I.
@ .

) R    P
a-1

H .  e6

' // 1) \ /$a6 \


a n.
" J
[ X
n$C
[/  N
 X 
H
1  -$1 ) .
CHI-
1 ;H1
CHI a-1P
16 
@$ -
>


]  /C B
@
-


H
 -
 6

 )(-
  r Z :!G$ q \>A$ p H
 H D F U

1 J - R   $: H








  @.
N 
H B[/$

H ..6
 B[/$
H .
@ ` .
.
\   

 f


H
) iI
 /nH
 /
   - X)
\ \  //(
 
 -
CH _


.
 

R&
6 \/$
[ J
  \ @. >  -.

P .
-RC
@$ 1

HRC
@$  N4 B .6
[ 
Z
/"C
' ) [ I^..

H  / '
C N /

  P"
D
aN

"
 ' / C M#D


".
 c
N) P .o[ @
C

 hIH \ nfI$ [ . 6I


6 ^ [N
" J 

H 
.0$
") Treatment
 _/I  H
DH 

1
H$I h ) ^.
B
 $ R[1

D`
#
 .
[   cH
N) [) x
C
 Q
" J
N)   #
;
  0 aH) )(-
 h@
  n #". f "
  Vb/;
B " =$1 N9
 K 9
9 b F:U
 l( )UB+  " =$1 N9 F
 l " $;
U(
+
U  F ";6(1 ?  R
81n b b69 K910H
.G

  ? vG$F
 T$P
 
 e#
 H

e  "A
E& f $q

 ("#R

# D FHP
 ' #
  H 

) (- =! &  !G$ b  q  H

= #+ = Ug 
Indications for tonsillectomy
" PI#
I. X :"H#
- #+=Z (,+

f ) >IN
 0 
 /

@( .
 @& \ ) H\ f 1

 B$ ) N
H
CHI
0$
)Uvulopharyngopalatoplasty (uppp

 -  ';
 W$/.P >$

$ \ /$a6 Obstructive sleep


apnoea syndrome
)(OSAS
)
 NR
//
 [
H (
- #+=Z (#G$











H

  ) 

@  f 
/
$
$/  f 
$

/ 
 $  
$

/ $ 
(


H
& .
  1  $ ) n
 (
-1P
 Febrile convulsion


/"C
H
' I
XH\ /$C

 @
C
  H@ 


  .
@  
 IH
.
@  
>
H

 [" B c
  [

H .

 @ "  
 \ XH/ f
" p
 \/
a /$M


  

i"[ $
 $[ B n-1  .

@
H  > ' XH\ H


[ 
P  
H D

@
  W.
H
I .
[


/. M ';  W$>$

$ OSAS $@ p


H

I  H 

X/ .
[ = #+ = Ug 
Contarindications for tonsillectomy





[  NR
H [" i
  Z
X
\.
P/C
&$H  I  
.1 
\$ f

[/ P@ p


H >$
/ 6 p
[/ N [/
Ha6.
". 
.0$

(E= Ug 

Tonsillectomy
 /  B
HC
@

@ [ .
@
C
@  wH
H
'
&$ 
 fN
 iX"I

 [
/
X 
H' I'

&$ / \  X#D

H
 /Cp
H R "I# .


 ' XH\ #1 jN /.

 . )(-

Key points
 "#   = Ug


Sore throat, tonsillitis and


tonsillectomy

 )(-
 b$ !"#+  P ( )  Q
" A= Ug 


&$   B-1 #1 ef
 /Cp
H
 ' /   I
-1
\ 6
/C Xp
H
 X
&$ P  Reactionary
haemorhage  @. .
#

@ ' `  . \/


)

[D
HC .

&$
.f Secondary haemorhage
/ \  - /C  /C
@
@.
P . $C 'I

X#C  
 /`
I 
^"
&$ .   H#^'

@ .
 /C
C
@ 
 
  CIa /"C \ H
/C QR
p
H 
 B

\ B$ XH\ /
P  /C
C

@ .

@ CI \  Z 
P

CHI
& .

 X
/D ) /
$

/ (@N ]  



P
H @
 [  0
\/ 

H \XH

R
.


H
  . ';

 W$/.P >$
$ OSAS
 BI# Pp
H \/$
a6.
 B-1 Pp
H 

&$ .

&$  - /C  /Cp

H  @.
 
@.
@ @ B
  /Cp

H \ XH6
  
.CIa


    " !

b  $

%  ' &  

"
X . . )(-

The adenoid, snoring, and


sleep apnoea

- ( Nasal

 $ The adenoid
!  $ )(-

 \I \ @
x. B a P
 [ ] 0H
[ ;H1 ;.6

@/
CHIH
HN .6 P) /P
 ./
 . H\ nH#.
 NR e
 $ /@  $
P
 \ X$ [ /I /C 
R
/
N h ]Ca6  \ /C
.$

 N4
 $ Z /.P ;.6
@.` C$H
'- Z
W$H

  [ 6 - @. ;.


\/  ;.6
BHI
 CI#
 
[ D
 @./. ;.6
 /.P Z 

 X
 $
 X
/D  h] ".
[ [ ;.6 [ e6$ h
I
$f  NR
JI[ fH@$
 D ] /' M. [ 
/
[#I$ JI
  -\ #C I

 W$
/_
  Z
.M[) X
/
 
 $ [ M.oZ
X

 (P> \N 
=

 $ : 
?e #E $ 


)(-
 \N $

- .' ;.  N4
 $
Z
/$\ NHa6 ["B c
[  N4
H [Z .o
nR

# n
 $
HC 

 / $
';
 W$^/. >$
$ OSAS

$     [ ./C
-( Otological
 N4
 $
 ' /Z

.

#4P
Eustachian tube / eZ

P 6
 X#
) H^[ (
6
D )
. Glue ear ("/
j".
/ B - 6
#
@ $ @ .\/ 

 N4 \ H
 $ /. .

 ' /Z

H_ 1
6
.X#
 A (,
 = Q+ P


AG q
=) !

 
 6
 X#
"

 . Acute otitis media


- ;.6
HN"
CH 
f\6  $H

P 'Z /

P ;.6
@

/"C

H [
#4-
[4^ n$C

 $
_  I^.
$
X

#
 ) $ I
W$

/ /.
CHI ) .6
1 .
'&Diagnosis h
P 
  N4 jN 0
 $
\6
  .XH\6
[ j
CHI 
 .6 C
) ]C /$\ ea6  [j

CHI ]$
 .6
H
.
[
P IC
 jN@ 
)CHIH
# I. [ C4) .6

iI
 (. )(-


 jN
Z /
@ W^CI

CHIH c .6


/N
C.
" Treatment (H

 @
C
[]:

P Y
) )(($

& q
. $ $1 $

 )(-
 $



 $ ^ ..
& ' /"

C
@>
X6
 \ X#
a . n 

 / .

" \ @
C XH
P #\o


$ I C
"#
.6
" ` RI
N
/ '
' XH\ /\ /
 XH\ HD/. ;.6
@ @
C

@
[n



 )/ 
D

 $

 [ $

"$
\ H  / [
. @
C

 )(-
 " $ (E > b[{  +{
 "# !W  !  &N (H(  $

c$

 Z
X/. ;.
j". B - & X#
 
 6
 X#



@ [ @H
X
 @
C
@
@;
 $.

 @
C
@ Surgical treatment
(E H q $ Adenoidectomy

@ \@ H;


 $   \X

CHIH c .6


/N
C IC

&$  aN
@;
 '/
/ >$
@; /C 
`&  H#)
CHIH .6
 X
&$ 
&$ P 
. Reactionary haemorhage

/
&$  1 @.
 
 X
&$
.f

 $
Secondary haemorhage\ 
/  -  HC
M
p
H . x
C e



 

' I\#

p
 $  '

p
H '@ / B.

U
 X#  #
. 0

 0$ C ^`-
CHI
.6[ \ MH
CHI
  
$ '  e
 - 0$".
- $
 $ o
 f 0$

  e

 @ @$
) @;
 $H 6  "H# $
#1 / ' [ 
0$
Palatal incompetence
 Z
/P e/
_
C#
X;.6
#4
- )
- (;.6
[ .6
Rhinolalia-aperta
)
. Hypernasality ($N

'& $  q . $ $1
$
Snoring and sleep apnoea
\ 
 N
$ /.P
$ ';
 W$>$
$ OSASh
OSAS X4 ]CN

 W  X4
/
N OSAS
]C
 X4
 . \ XH
/

# $ ';


 W$>$
$  

/
 $

 $ .

" Definitions q
'& Snoring
  &\ x] >$
$ @.
&
x$
1 [
CHI f

 0$'\/
H ./ \ XH/.
)&_ [
# n
 $
HC >$
$
-R\ ;C4 IC 
 0$'\/

H
@/
@CHIH
I. >$
$
f6I
_ NH
C 4\ IC
> [
  /.P #".
W$
>$
$.
$  q . $ $1 $
Sleep apnoea syndrome
 / > XH\ . >-;' '6

/
W$ &> \ /-1 .
\
$.
$  q . $ $1 $ ZAG
)Obstructive sleep apnoea(OSAS

$  @./.
#
$

HC @.
0/I )
/
 )/
/
 [ 




# n
/
II

;'H/I  I.& 6@ 


/
N.P \  /$ N.P
#"$H

)  C
 W C$
& ["+
."\ . 1 B
&
 ' H
"
P 0  _ '  #
 


X
" H
_.
$  q . $ $1 $  e
Central sleep apnoea
 ' \ /.P 

 [ I&
 M#4 [

 ]$
"
IC

[ W$H

HI [
"-I
_
#
Z
[ j". X
 MI$
 $$
 Ia
IC  ;' $

/ W$  )/
/
)\ W/.P(.
|   q . $ $1 $
Sleep apnoea index
 \/ [
'; 
\ .
E )E $  q . $ $1
$
Signs and symptoms of OSAS
\ 
 
D
/ M [

 N4 n$\ B  [ 

  IC
/I . f6I

 . % I$ NH
4 $@
) [ j  B1   eI.P
/.P
#
 $
HC )(-

\ I \ /$a6  N4

H
 $ 6I 16 

I
I .6
 6

.
 ;.6 N4

H D@
 0
.... H
. w

 N
C 6 `
 I
  M$
 0 
[4 .
';
I
W$
& B
#C

/ 16 /
  JI
 _@ 
B [ a6 ...
w >
1
  "\ $C
$.

$

$ "
C$H
/_ >$

 (&N

AG !
 # P
....~

 (&N

 q"#
 !

R T$
  "#
 

 G #
> T Y

 D Q"#
 H$P

> = >!
 H$P

)(-
= #  &' (P)(  q . $ZAG $1 $

$
$ B
C 
 C;C4

&
 [" [ /
` I
@$

/ .[

 1 '] /

 
I#16 @./ '

" H
" H
_.
U,=Z Investigations

"  
   N
 i OSAS@ ) 
$
$" I
 [ / 
$
a
H" \/ C 
I$
 i#N
" H i#N
 / i#N

-RC
_ 
CI.
& 6@ [
/ 
#I

/ @ /[ i 

H

 N  )

 >$
$.
@ 
;.U
]$  P&
[
 N  /.P [ OSAS
\ a n
]$
H
  /C

 /\ M . Ia


/N h
1/
]$ ;.6 j
#

 $
HC   I .
  [C /.P [ 
1) [
C \ a$ n 
H
Mueller manoeuvre
o 01

]$
H
 
;.6

# n
_  h H#

) $ [


 C "

)o [  > M[ nHD


 jnHD
[ ;.6

B n
/. ;.6
  #
]$ .
  /.P.
A '& $
ZAG

q

. $

Management of snoring and OSAS

 \ >-> XH ) i. D




 @
C
/_
 @
C
@(.
- Y f P lifestyle
P
 )/ @ B
 \XH

 ;N
 J@.
0 ]C
\6 .
@ "

_/
$.
-"  (HMedical (#+
 c6 [ / H"
OSAS .

C
Rapid eye C
) movement sleep (REM
 /"C
[ .
$
 / [ OSAS
f .Protriptyline

o[ 0 4
Respiratory W$
  /' stimulants [ [ 
C
-C .

o[ 0 )&
  c
iDR
^@
 Continuos positive
) airway pressure (CPAP \-
[C
OSAS h WIH
 '$
[ W$ /$\ ;.6
$ #C c
" [ /\ iD4
#
$

HC   B$N.P


x$H

1
_ ' /  $


NRH
P /' 0


"$ .
- H ( Surgery
p
H
 $ \ /$a6
;N
 N $ ';
W$
>$
$.
 \ /$
 [C @[ D
I
 H
[
# n
_
Z
 \ P&

 /.P
Z
NH
$ ';
 W$>$
$ > @H

o[ )-C  $ /. [ f -;.6

I
I .6 . I -

\U \@ _/$


@
I
IH

" .
   

 0$
"
 CHI
 
/
 @ _/$\ H ) B$

 0$
CHI
H  UPPP X
) (Uvulopharyngopalatoplasty"
\ XHp
H
H p
)&_
aNH
 [ 
/[ 

 0$) I.
CHI 

$
$N' 
 0$1

_ Ca6 ;.6>$


BHI
).(-

$ \/ a  ' ) \XH



-C
0$
 H\ f N/

&H
 0$
/ 
$
   ;H
 

 0$ JIf
' " & e>$ 
 .
' / 
 I /\' [  N4

H $  fM)-C
C

@ ' / I  H\ c
0

)(-
)" UPPP (E '& $  q . $ $1 $

 H "/
]C

 -
R[6)  e
HC \X4 /$

 0
 H
.Micrognathia "H1 D
&1
` X
-C f 6
C
 h@. $
 nR
Z
\U
   OSAS X 
e

]C /$\ [


 M@ HC
X4
HR 'a1 .

Key points
'& $  q . $ZAG
$1 $ Snoring And OSAS

 N
C
_
$
OSAS

 W /
NM
$ OSAS

 $ >Z ';


 W$>$
$ \XH

@
 $
"   IH.I
 @ 1
"
)
4
\6
HH
.0
 ".
 i.  B


)-C
.
C
 @ \- /. [ f ;.6

I
I .
.
 @ ) I1
$
 /
 jN
.OSAS
  ]$ ;.6>$
$ \[ /
 [C
 N/.P [
OSAS

Case study
) B QHI
C  $

 \ XH
@ .6
H B

 X$Z
\ M
 n  x
C M.
a XH\ D
@ .6

H  o
 $ $' /
/
MC /C X $j

)/
/ M "  \ XH
@.
6
H '
 j .CIa
-  '& h`  Z
- q` #'&h
- ! E &+ >! = R
H  
" , Comments
-a _ 0
-N SCC
-
\&N c R
/N
C 16
n\ "
"\ \&1
 
0
^)  ]$ 
#H n
$

P RCI ) .> _/


. Second primary tumour
[ - e


 C6#1 f 

 @
C
 \C
" `

  W .   /C
$
C  16
 1/ QR
)
I$ Betel nut '
1 

4
$

& . $
 
H# 66
leukoplakia & erythroplakia
[  ' I. .a
-

You might also like