HYPERPLASIA OF THE FAUCIAL TONSIL'S (SCO Plate 43).
Occurrence.—Enlarged faucial tonsils are rare in nursing infants. They develop usually about the second year, but even this age may be so large that considerable trouble may be produced.
Symptorns.—Enlarged tonsils may be easily recognized when the throat is inspected, as they project as either round or oval shaped tumors. They often cause the faucial pillars to be widely separated. Deposits in the crypts are frequent. Slight enlargements of the tonsils may not produce any symptoms, but when larger and associated with adenoids they always do. The voice has a muffled sou»d, and where the pharynx is much filled up, a pharyngeal stridor is present.
diagnosis is made by examining the throat.
Treatment. —A moderate enlargement causing no symptoms will not require treatment. When the tonsils are subject to recurring inflam matory attacks, they should be removed. The galvano-catitery snare is often used for this purpose. although the ordinary tonsillotomes (Mackenzie, Babinsky, Matthew, Fahnenstock), which encircle the tonsil with a ring knife, are handier. The lower portion of the tonsil should also be removed. IImmorrhage is usually slight although secondary hfemorrhages occur. If the ordinary styptics, adrenalin, gelatin, hot water, fail, pressure with the finger, or with the compressor of Mikulies or Springer, will control the bleeding.
A membrane forms over this cut surface which may be mistaken for diphtheria. It must be borne in mind however, that true diphtheria may occur in the wound.
Growths of the Tonsils and Pharynx Benign and malignant tumors may occur in the nasopharynx during childhood. Dermoid cysts, lipomata, fibromata and fibro sarcomata have been reported. Lymphosarcoma of the tonsil has also been observed.
Retropharyngeal Lymphadenitis. Retropharynycal Abscess processes leading to abscess formation in the retropharyngeal and lateral pharyngeal glands may °CCM'. This may be brought about by infection from ulcers or from a "diffuse infectious catarrh?". Syphilis, measles, scarlet fever, rhinitis, and retronasal angina are important etiological factors.
A true idiopathic retropharyngeal lymphaclenitis does not exist. Streptococci are almost always found on bacteriological examina tion, but influenza bacilli and other bacteria are also found.
Occurrence. usually occurs during the first year of life. Out of BOkay's 467 cases, 20(; occurred in the first year, and 7S in the second. It is believed that later in life these glands become obliterated. Like
catarrhal conditions, this disease occurs in winter and spring.
Pathological first there is a simple swelling of the gland, but later on a periglandular infiltration develops. Abscess formation is common.
in swallowing is one of the first symptoms. There is an excessive collection of mucus above the obstruction. Hoarse ness is often present, and the child breathes with open mouth and with a pharyngeal stridor. The head is held rigidly and to one side. The gland may be felt with the finger, usually laterally behind the pillars of the fauces. Later the gland which is at first movable, becomes im movable, and finally fluctuates. The tumor may at times be readily inspected. Sometimes attacks of suffocation develop. Deep seated swelling may simulate laryngeal croup.
Course.--Some cases subside gradually, others go on to abscess formation, which opens spontaneously or is incised. An involvement of the neighboring, glands is common. The purulent process may ex tend from one gland to another, so that there will be a large collection of pus in the throat. This sometimes burrows in the region of the parotid gland or into the mediastinurn.
Tile spontaneous opening of an abscess niay cause death by a septic aspiration pneumonia. Cases of pytemia have also occurred.
The prognosis is favorable when the condition is recognized early and promptly treated.
Diagnosis. —The condition is often overlooked by beginners. The pharyngeal stridor, the position of the head, the hoarseness, the ratt ling of mucus in the throat arc typical diagnostic signs. Examination with the finger will settle all doubt.
treatment of the tumor before fluctuation, is like that of any angina. A prompt incision should be made with the finger as a guide; the knife blade being covered to within a short distance of the point, or with the knife of Schmitz or Carstans. This should be done with the child in the upright position, but as soon as it is made the head should be lowered to prevent the aspiration of pus. Recovery, except in the cases in which large collections of pus have formed, is rapid. In such cases the external incision may be advisable [ Schmidt, Oppenheimer, Burckhardtt Occasionally tuberculous swelling of the retropharyngeal glands, or abscess of other glands occur. Such con ditions run a chronic course. Operative interference should be delayed as long as possible, and other methods of treatment, such as injections of iodoform may first be tried.