Pedi-TA-020619-slides

Pedi-TA-020619-slides - The Tonsils and Adenoids in...

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The Tonsils and Adenoids in The Tonsils and Adenoids in Pediatric Patients Pediatric Patients Gordon Shields, MD Ronald Deskin, MD June 19, 2002 UTMB
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Introduction Introduction 1994 140,000 U.S. children under the age of 15 had adenoidectomies and 286,000 had adenotonsillectomies This is down from a peak of over 1 million in the 1970’s These are the most common major surgical procedures in children.
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History History Celsus first described tonsillectomy in 30 A.D. Paul of Aegina wrote his description in 625 A.D. 1867 Wilhelm Meyer reports removal of “adenoid vegetations” through the nose with a ring knife. 1917 Samuel J. Crowe published his report on 1000 tonsillectomies, used Crowe-Davis mouth gag Part of Waldeyer’s ring after the German anatomist who described them
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Embryology Embryology Adenoids begin forming in 3 rd month of fetal development Glandular primordia on posterior pharynx are infiltrated by lymphocytes. Covered by pseudostratified ciliated epithelium Fully formed by 7 month
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Palatine tonsils begin development in 3 rd month of fetal development From ventral second pharyngeal pouches 8-10 buds of epithelium grow into pharyngeal walls, form crypts Lymphocytes infiltrate Branching of crypts occurs last trimester
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Anatomy of the adenoids Anatomy of the adenoids Single pyramidal mass of tissue based on posterior-superior nasopharynx Surface folded without true crypts Blood supply – ascending palatine branch of facial artery, ascending pharyngeal artery, pharyngeal branch of internal maxillary artery Innervation – glossopharyngeal and vagus No afferent lymphatics, efferents drain to retropharyngeal and upper deep cervical nodes
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Anatomy of the Tonsils Anatomy of the Tonsils Paired, sit in tonsillar sinus Limited anteriorly by palatoglossal arch, posteriorly by palatopharyngeal arch, laterally by superior pharyngeal constrictor Enclosed in a fibrous capsule Blood supply from tonsillar and ascending palatine branches of facial artery, ascending pharyngeal artery, dorsal lingual branch of the lingual artery and the palatine branch of maxillary artery
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10-30 crypts Innervation from sphenopalatine ganglion via lesser palatine and glossopharyngeal nerves No afferent lymphatics, efferents drain to upper deep cervical lymph nodes
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Immunology and Function Immunology and Function Part of secondary immune system No afferent lymphatics Exposed to ingested or inspired antigens passed through the epithelial layer Immunologic structure is divided into 4 compartments: reticular crypt epithelium, extra follicular area, mantle zone of the lymphoid follicle, and the germinal center of the lymphoid follicle
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Membrane cells and antigen presenting cells are involved in transport of antigen from the surface to the lymphoid follicle Antigen is presented to T-helper cells T-helper cells induce B cells in germinal center to produce antibody Secretory IgA is primary antibody produced Involved in local immunity
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This note was uploaded on 12/28/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Pedi-TA-020619-slides - The Tonsils and Adenoids in...

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