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P H A R Y N X
Oleh :Tonny B.Sarbini,dr.,SpTHT.
BAGIAN ILMU KESEHATAN THT-KLFAKULTAS KEDOKTERAN UNPAD
BANDUNG
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DINDING PHARYNX :MUCOSA, MUSCULUS VOLUNTER, DAN APONEUROSIS PHARYNX.
MUCOSA PHARYNX : EPITEL PSEUDO STRATIFIED COLUNNER BERCILIA EPITHEL SQUNOUS STRATIFIED
DINDING PHARYNX DILIPUTI FASCIA BUCCO PHARYNGEAL YANG DIPISAHKAN DARI PREVERTEBRAL OLEH RETROPHARYNGEAL SPACE
P H A R Y N XP H A R Y N XI. ANATOMI
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A. NASOPHARYNX
B. OROPHARYNX
C. LARYNGEAL PHARYNX
PHARYNX.
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*BATAS : ANTERIOR : CHOANAE SUPERIOR : BASIS CRANII
INFERIOR : PALATUM MOLLE.
A. NASOPHARYNX
BERBENTUK KUBOID
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1. TONSIL PHARYNGEAL ( ADENOID )
JARINGAN LYMPHOID PADA ATAP DAN DINDING POSTERIOR NASOPHARYNX.
PADA STADIUM PRENATAL TERDAPAT ANTARA ATAP NASOPHARYNX LARYNX
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VASCULARISASI :
ARTERI : * CAB. PHARYNGEAL
A. CAROTIS EXTERNA
* CAB. PALATINA
A.MAXILLARIS
* CAB. PALATINA
A.FACIALIS
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VENA : PLEXUS PHARYNGEUS V.JUGULARIS INTERNA
SYSTIM LIMPHE :MODUS RETROPHARYNGEAL
MODUS JUGULERPERSYARATAN : CAB. NASOPHARYNX
N. IX. - X
2. BURSA PHARYNGEAL BURSA SISA EMBRYONAL CRANIO PHARYNGEAL PADA BAGIAN DINDING POSTERIOR
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OROPHARYNX BERHUBUNGAN DENGAN CAVUM ORIS MELALUI OROPHARYNX ISTHMUS (FAUCIUM)
SETINGGI VERTEBRA CERVICAL II - III
FAUCIUM :BATAS: SUPERIOR : PALATUM MOLLE LATERAL : PILLAR TONSIL INFERIOR : BASIS LIDAH
PILLAR TONSIL :ANTERIOR : BERISI M.PALATO GLOSSUSPOSTERIOR : BERISI M.PALATO PHARYNGEUS
DIANTARANYA : TONSIL PALATINA
B. OROPHARYNX :
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MASA LYMPHOID DIBASIS LIDAH
TIDAK BERKAPSUL.
DIANTARA FOLLICEL LIMPHOID TERDAPAT
CRYPTA YANG PENDEK, TAK BERCABANG.
DETRIUS YANG TERDIRI DARI :
1. LINGUAL TONSIL :
- EPITHEL YANG MENGALAMI DESQUANASI- LYMPHOCYT YANG MENGALAMI DEGENERASI- BACTERI- SISA MAKANAN
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VASCULARISASI :
CAB. LINGUAL. A.LINGUALIS
SYSTIM LYMPHATIC :NODUS SUPRAHYOID, SUBMAXILLER DAN JUGULER DEEP CERVICAL SUPERIOR.
PERSYARATAN :
SENSORORIS : CAB LINGUAL N.IX CAB SUPERIOR LARYNGEAL N X.
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2. LATERAL BAND ( RETROPILLAR BAND )
TERDIRI DARI ELEMEN LYMPHATIC
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3. CINCIN WALDETER
JARINGAN LYMPHOID YANG MENGELILINGI ISTHMUS OROPHARYNX :
- TONSIL PALATINA : TONSIL- TONSIL PHARYNGEA : ADENOID- TONSIL LINGUAL- LATERAL PHARYNGEAL BAND- BELAKANG PHARYNX DAN SEKITAR ORIFICIUM
TUBA EUSTACHII.
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4. TONSIL PALATINA
JARINGAN LYMPHOID YANG TERBESAR DARI CINCIN WALDEYER.
KAPSEL MELIPUTI 2/3 TONSIL
DEGENERASI TONSIL TERJADI DENGAN BERTAMBAHNYA UMUR.
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* TRABECULA RETICULUM SEBAGAI RANGKA.
* FOLLICEL GERMINATIVUM YANG MEMBENTUK
LYMPHOCYT.
• JAR.INTER FOLLICULER
KAPSUL TONSIL : FASCIA
TONSIL TERDIRI DARI : (MICROSCOPIS.
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CRYPTA TONSIL : 10-20 CRYPTA TUBULER
PADA POLE ATAS : CRYPTA MAGMA
BATAS FOSA TONSILER :
- ANT. LAT. : PILLAR ANTERIOR- POST-NED : PILLAR POSTERIOR- LATERAL : N.CONSTRICTOR PHARYNGEUS SUPERIOR
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VASCULARISASI
POLE BAWAH :
* CAB.TONSILER A.LINGUALIS ANTERIOR DORSALIS* CAB. TONSILER A.PALATINA ASCENDEN POSTERIOR* CAB. TONSILER A.FASIALIS DIANTARA KEDUANYA
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POLE ATAS :- CAB. TONSILER A.PHARYNGEAL ASCENDER- CAB. TONSILER A. PALATINA DESCENDER
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PEMBULUH DARAH & SARAF PADA TONSIL
17
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SCHEMA PHARYNX DANLARYNX POTONGAN SEGITIGA
18
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A. SPACE SEPANJANG LEHER :
1. SUPERFICIAL SPACE 2. DEEP SPACE :
* RETRO PHARYNGEUS* PRE VERTEBRA* VISCERAL VASCULAR
B. SUPRAHYOID SPACE : 1. PHARYNGO MAXILLER
2. SUBMANDIBULAR :* SUBLINGUAL* SUBMAXILLER
SPACE PADA LEHER :
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3. SPACE OF BODY OF THE MANDIBLE4. MASTICATOR5. TEMPORAL6. PAROTID7. PERITONSILER
C. INFRAHYOID SPACE :
1. ANTERIOR VISCERAL * VENA TONSIL PLEXUS SEKITAR KAPSEL PLEXUS PHARYNXEUS
* VENA DARI PALATUM MOLLE : V.PARATONSILLER BLEEDING PADA TONSILLECTOMY
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NERVE :
* POLE ATAS TONSIL : CAB.DESCENDEN N. PALATINA (GANGGLION SPENO PALATINA)
* POLE BAWAH TONSIL : CAB. TONSILLER (N. IX)
SYSTIM LIMPHATIC :
DRAINASE : DEEP CERVICAL SUPERIOR POSTERIOR ANGULUS MANDIBULALYMPHONODULI SUB. MAXILLER DAN CERVICALIS SUPERFICIAL
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5. PROCESSUS STYLOID :
30 MM. MENGARAH KELUAR TIDAK MENCAPAI FOSSA TONSILER.BILA UJUNG PROCESSUS STYLOID FOSSA TONSILLER SEHINGGA PAIN
C. LARYNGEAL PHARYNX (HYPOPHARYNX): BAGIAN FARING SETINGGI EPIGLOTIS BAGIAN BAWAH CARTILAGO CRICOIDEA.
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* BAGIAN JALAN NAFAS * VENTILASI TUBA EUSTACHII* DRAINAGE HIDUNG / TUBA* RESONANSI
ORO-LARYNX PHARYNX :
* RESPIRASI TRACT DAN DRAINAGE DARI NASOPHARYNX* DIGESTIVE TRACT* RESONANSI
II.PHYSIOLOGI PHARYNX
NASOPHARYNX :
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JARINGAN LYMPHOID DIPHARYNX BERFUNGSI SEBAGAI MEKANISME IMUNITAS
RETRO PHARYNGEAL NODE :
PADA DINDING POSTERIOR DAN LATERAL PHARYNX SETINGGI TL. ATLAS DRAINASE :
* MUCOSA HUDING, SINUS PARANASAL, NASOPHARYNX, TUBA EUSTACHII DAN
TELINGA DALAM
* EFFEREN LYMPH NODE JUGULER INTERNA
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III. IMUNOLOGI :
* IMUNITAS PERMULAAN KEHIDUPAN* TONSIL DAN ADENOID MEMBESAR SAMPAI ADOLECEN KEMUDIAN MENGECIL SECARA
GRADUAL
* TONSIL MEMBENTUK :- IMMUNOGLOBULIN A & E
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IV. MICRO BIOLOGI :
* STAPHYLLO COCCUS (ISOLASI PERTAMAKALI)
* STREPTO COCCUS HEMOLYTICUS JARANG PADA INFANT SEHAT . SEDANG PADA DEWASA SEHAT MERUPAKAN BAGIAN FLORA MULUT
* PERUBAHAN FLORA MULUT : - DEFICIENCY MAKANAN - PEMAKAIAN ANTI BIOTIKA
FLORA COLLIFORM LEBIH MENONJOL
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* FARING * LARING* TELINGA TENGAH * TRAKEAE T I O L O G I :
1. VIRUS : INFLUENZA PARA INFLUENZA RESPIRASI SYNCITIAL VIRUS
2. BAKTERI : STREPTOCOCCUS PNEUMONI
PYOGENES STAPHYLOCOCCUS AUREUS HEMOPHYLLUS INFLUENZA
INFLAMASI UPPER RESPIRASI TRACT
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* INFEKSI PRIMER : TONSIL FARING* KORELASI REKURENSI INFEKSI BESAR* TONSIL HIPER PLASIA : DINI 10-12 THN* FARINGITIS AKUTA DISERTAI RHINITIS
COMMON COLD* PENYEBARAN : DROPLET INFECTION* PERTAHANAN :
* SPECIFIK ANTI BODY MUKOSILIER BLANKET
* MUKOPROTEIN ANTI VIRAL NON SPECIFIK
* GERAKAN SILIA
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* PEMERIKSAAN :
- MUKOSA NASOFARING DILIPUTI MUKOPUS - JARINGAN LIMFOID IKUT PERADANGAN
* SELF LIMITED ( 3 - 4 H)
* KOMPLIKASI :
SINUSITIS LARINGITIS
OTITIS MEDIA TRAKEA BRONKITIS
PNEUMONIA
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INFLAMASI PHARYNX :
A. AKUT :
1. FARINGITIS AKUTA NONSPESIFIK ETIOLOGI : * VIRUS
* STREP HAENOLYTICUS * STREP NON HAENOLYTICUS * PNEUMOCOCCUS * HAENOPHILUS INFLUENZA
SERING PADA CUACA DINGIN, DAYA TAHAN MENURUN, EPIDEMI ATAU PRODRONAL LAINNYA
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GEJALA :
RINGAN : - NYERI TENGGOROK / MENELAN - NYERI TELINGA - SUBFEBRIL - KE G.B. LEHER >>KOMPLIKASI : REUMATIC FEVER &
NEPHRITISBERAT : - FEBRIS TINGGI, RINGOR, TOXENIA
KOMPLISAKI : LARYNGITIS LUDQIG'S ANGINA
TERAPI : - BEDREST - ANTIBIOTIKA - INSISI PD ABSES
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PREDISPOSISI :- FARINGITIS REKURENS- OBSTRUKSI / RADANG HIDUNG- ALKOHOL, MEROKOK BERLEBIHAN- RADANG GUSI & GIGI
J E N I S :
A. CATARRHAL OEDEMA, HYPREAMISB. HYPERTROFIK GRANUALE, LATERAL PHARYNGEAL BANDS MENEBALC. FOLLIKULER KISTA KECIL KUNINGD. ATROFIK KERING
1. FARINGITIS KRONIS NONSPESIFIK.
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GEJALA : NYERI TENGGOTROKAN, SERING MENDEHAM, KADANG-KADANG MENGOROKTERAPI : - MENGATASI PENYEBAB
- ANTIBIOTIKA - KANTERISASI GRANULAE
KELAINAN TONSIL ( KLINIS )
1. INFEKSI - AKUT :* TONSILITIS STREPTOKOKUS* TONSILITIS DIPHTERI* PERITONSILLER ABSES* INFEKSI MONONUCLEOSUS* VENCENT'S ANGINA* KHRONIS* TUBERKULOSA
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2. NEOPLASMA :* SQUAMOUS SEL KARSINOMA* KARSINOMA KEL.LIUR :
- ADENOID KISTIK- MUKO EPIDERMOID
* LIMFOMA
3. KELAINAN DARAH :* AGRANULOSITOSIS* LEUKEMI
4 MISCELLANOUS :* APTHOUS ULCERASI* BECHET'S SINDROM
PEM.PENUNJANG :* DARAH * SEROLOGI* FOTO THOTRAK * BIOPSI
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TONSILITIS AKUTA :
ETIOLOGI :* STREPTOCOCCUS, HAEMOLITICUS* BAKTERI LAIN* VIRUSTIPE-TIPENYA ANTARA LAIN :A. TONSLITIS AKUTA FOLIKULARISB. PARENCHY MATOSA TONSIL HYPERAEMIS, OEDEMATOUS
GEJALA :* NYERI TENGGOROK / MENELAN* FEBRIS, MALAISE, CEPHALGIA* NYERI TELINGA* PEMBESARAN KE.K.B.LEHER
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KOMPLIKASI :
* ABSES PERITONSILER , PARAFARINGEAL* RETRO FARINGEAL* OEDEMA LARYNGS* REUMATISAN* HEPRITIS AKUTA* OTITIS MEDIA AKUTA* SEPTIKAEMIA* TONSILITIS KRONIS
TERAPI ;BEDREST, ANTIBIOTIKA, ANALGETIKA / ANTIPIRETIKA
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DIPHTERI :* PADA NEGARA BERKEMBANG ( MORTALITAS 10 % )* PENYEBARAN TERGANTUNG : VIRULENSI, DAYA TAHAN* MENGENAI : NASAL - LARING - FARING* ETIOLOGI : CORYNE BACTERIUM * DIPHTERI : ( GRAM (+) ; EXOTOXIN )* PENYEBARAN : DROPLET MELALUI NASAL* MASA INKUBASI : 2 - 6 HARI* GEJALA : - MALAISE, SAKIT KEPALA, SUBFEBRIL - DIPHTERI NASL : "MUCOPURULENT HEMORRHAGIC DISCHARGE OBSTRUKSI NASAL - DIPHTERI OROFARING : - SAKIT TENGGOROK; PSEUDE MEMBRAN ; LYMPH NODE JUGULO DIGASTRIK >>
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DIPHTERI LARING :
SESAK NAFAS
STRIDOR INSPIRATOIR
EXOTOXIN : TOXAEMIA
- JANTUNG :MYIOCARDITIS KONDUKSI GGN.ARRITHMIA SIRKULASI
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* NERVE :
PALATUM MOLLE DIAPHRAGMA PARALYSE OTOT MATA
* DARAH : TROMBOCYTOPENI
* TERAPI : - ADS 20.000 - 120.000- PENICILLIN- TRAKEOTOMI
* PENCEGAHAN : IMUNISASI TOXOID
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* USIA DEWASA DENGAN KEBERSIHAN MULUT DAYA TAHAN TUBUH (-) MICRO ORGANISME :
* SPIROCHAETA* BACILLUS FUSIFORM ( ANAEROB )* BORELLA VINCETI
* GEJALA : * SAKIT TENGGOROK
* BAU MULUT* DISFAGI* GUSI : LUKA, PERDARAHAN, DAN
MEMBRAN NEKROTIKP. DIAGNOSTIK :- ULCERASI FARING DENGAN MEMBRAN ABU - KUNING MUDAH DILEPAS- KGB SUBMANDIBULER >>
VINCENT'S ANGINA - TRENCH MOUTHFARINGITIS GANGGRENOSA
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THERAPI :
- GURGLE- PENICILLINE- METRONIDAZOLE
PERITONSILAR ABSCES ( QUINSY )
- PUS ACCUMULATION BETWEEN CAPSUL UPPER POLE TONSIL - FASCIA M. SUPERIOR
CONSTRICTOR PHARINGEUS.
- COMPLICATION OF FOLLICULAR TONSILITIS
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GEJALA :
* RIWAYAT TONSILITIS YANG SERING * SAKIT TENGGOROK* DEMAM* PERUBAHAN SUARA OK :
BENGKAK OROFARINGACCUMULATION SALIVA
PEM. FISIK :
* TRISMUS* CELLULITIS* OROFARING ASIMETRIS* LYMPH. NODE >>* GANGGUAN PERNAFASAN
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THERAPY :* OPERATIF :
- ASPIRASI- INSISI DAERAH FLUKTUASI DIDEPAN
PILAR ANTARA SETINGGI BATAS ATAS MEDIAL TONSIL
- PENISILLINE- IRRIGASI SALINE- T-E : 6 MINGGU RECCURENS
KOMPLIKASI :- JARANG- OEDEM GLOTTIS- PERITONSILLITIS KRONIKA- ABSES KISTE TONSIL- THROMBOSIS VENA- PARA FARINGAL ABSES
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ACCUMULATION PUS PADA SPACE YANG DIBATASI :
LATERAL : M. PTERIGOIDMEDIAL : KEL. PAROTISPOSTERIOR : HUB RONGGA RETROFARINGSUPERIOR : BASIS KRANIIINFERIOR : FASCIA KEL. SUBMANDIBULLERPROC. STILOID MEMBAGI DUA BAG. ANTERIOR ( BATAS MEDIAL : FOSSA TONSILLATERAL : M. PTERIGOID INTERNUSI S I : Q. CAROTIS INTERNA
N. CARNIAL IX; X; XI; XIIV. JUGULARIS INT. OTOT STYLOIDK.G.B.
INFEKSI PRIMER : TONSIL + GIGI
PARAFARINGAEAL ABSES.
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GEJALA : - DEMAM - SAKIT TENGGOROK TELINGA - KAKU LEHER - ODINOFAGIPEM.FISIK : - BENGKAK & INDURASI LEHER SUPERIOR - TRISMUS ( BILA BAGIAN ANTERIOR )PEM.PENUNJANG : - LAB. LEUKOSITOSIS - FOTO LEHER : BENGKAK DD LEHERTHERAPI : - INSISI " COLLAR " - A.B.KOMPLIKASI : - THROMBOSIS V. JUGULER INT. - RUPTUR A. CAROTIS
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PROSES SUPURATIVA K/G.B. RONGGA PHARYNX ANTARA FASCIA BUCCOFARINGEAL DAN PREVERTEBRAL SETINGGI C 2-3
* ANAK USIA < 3 TAHUN
* DEWASA PADA :LUKA PENETRASI FARINGPAROTITIS TENGAHPROSES SPESIFIK ( POTT'S )
* GEJALA :KEPALA HIPER EXTENSIODINOFAGIKEPALA KAKUTRISMUS ( - )
RETROPHARYNX ABSES
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* PEM. FISIKBULGING KEMERAHANFEBRISCERVICAL ADENITISFLUXTUASI
* PEM. PENUNJANGFOTO LEHER LAB. LEUKOSITOSISI
* THERAPIDRAINAGEANTI BIOTIKA
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TERDIRI DARI :SUBLINGUAL ABSESSUBMAXILLAE/ : INFEKSI : - DEMAM - K.G.B.
- TRSIMUS - DROOLINGPEM.FISIK :1. PEMBENGKAKAN DASAR MULUT MENDORONG LIDAH KEATAS & KEBLK ( INF.SUBLINGUAL )2. PEMBENGKAKAN & KONS. KERAS SUB. MAXILLARIS ( INF. SUBMANDIBULER )1-2. ANGINA LUDWIG : CELLUITIS GANGRENOSA PENGERASAN JAR. THERAPI :
- MENJAMIN KELANCARAN UDARA- ANTIBIOTIKA- OPERATIVE : DEKOMPRESI
SUB MANDIBULER ABSES :
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ETIOLOGI : VIRUS EPSTEIN BARR ( DARAH, SALIVIA, KGB. )
MASA INKUBASI : 5 - 7 MINGGU
GEJALA : * SAKIT KEPALA* LEMAH* FEBRIS* SAKIT TENGGOROK* KGB. >>
P. DIAGNOSTIK :* TONSIL HIPERMIS DENGAN EXUDAT PD. KRIPTA MEMBRAN KOTOR* SPLENOMEGALI ( 50 % )* JAUNDICE ( 1 % )* HEPATO MEGALI ( 10 % )* SKIN RASH
INFECTIOUS MONONUCLEOSUS
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LABORATORIUM :
* LEUKOSITOSIS ( SEL MONONUKLEAR )
* LIVER FUNTION TEST ABNORMAL
* TEST SEROLOGI HETEROPHIL ANTI BODI ( PAUL BUNNEL )
THERAPI :
* SIMPTOMATIS
* ANTIBIOTIKA
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* PADA INFANT : THRUST* E/ : CANDIDA ALBICANS ( 15 - 25 % )
MUKOSA ( NORMAL )SPROFIT PATOGEN :- DAYA TAHAN MENURUN- AB YANG LAMA- PENYINARAN LAMA
* GEJALA : A.SIMPTOMATIKSAKIT TENGGOROK, MENELAN
* PEM. KLINIS :- TONSIL, BUKAL DAN GINGGIVA- EXUDAT MUKOID ULKUS
ERITHEMATOUS- KGB >> (-)- LABORATORIUM ; MYCELLIUM (GRAM )- THERAPI : MYSTATIN 100.000 M.
MONILIASIS ( CANDIDIASIS )
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1. TONSILLITIS KRONIS : A. TONSILITIS KRONIS HYPERTROPICANS
RECURENS TONSILLITIS AKUT
GEJALA KLINIS : - GANGGUAN BERNAFAS - NYERI TENGGOROK, PILEK & DEMAM YANG BERULANG - ADENOPATI CERVICALIS - HALITOSIS - UPPER RESPIRATORY TRACT INFECTIONS - PERADANGAN TELINGA MAUPUN SINUS & INFEKSI SISTEMIS
B. PERADANGAN KRONIS :
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PEMERIKSAAN KLINIS :
- PEMBESARAN TONSIL DENGAN KRIPTA YANG MELEBAR & DETRITUS
- PILLAR TONSIL INFLAMASI
TERAPI :
- ANTIBIOTIKA, ANALGETIKA, ISTIRAHAT.
- DEFINITIF ADALAH TONSILLECTOMY
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BIASANYA ORANG DEWASA, KHAS ADANYA PUS DIDALAM KRIPTA
GEJALA KLINIS :
- NYERI MENELAN - BATUK - BATUK- NYPERAENIA TONSIL & DEMAM
PEMERIKSAAN KLINIS :
- TONSIL YANG ATROFIS - DETRITUS
TERAPI :- SINTONATIK OBAT-OBATAN- TONSILLEKTOMI
B. TONSILLITIS KRONIS FIBROTIK (ATROFICANS)
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ETIOLOGI :
IRITASI & INFLAMASI NASOPHARYNX PADA RECURENS UPPER RESPIRATORI TRACT INFECTIONS.
GEJALA KLINIS :
- OBSTRUKSI NASALIS, MENGAKIBATKAN PERNAFASAN MELALUI MULUT- PENGELUARAN SEKRET DARI HIDUNG- TIDUR, MULUT TERBUKA & MENGOROK- ADENOID FACIES
2. HYPERTROFI ADENOID ( CHRONIC HYPERPLASTIC ADENOID )
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DIAGNOSA
- NASOPHARYNGOSCOPE ATAU PALPASI
- RO PHOTO NASOPHARYNX LATERAL
TERAPI :
1. OPERATIF
2. MENGATASI ALLERGI DENGAN OBAT-OBATAN / DESENSITASI
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ETIOLOGI :
TERJADI SEKUNDER SETELAH PENYAKIT AKTIF DALAM PARU-PAARU JENIS BOVINE ( DARI SUSU ) DAPAT JUGA MENYEBABKAN INFEKSI PRIMER
PEMERIKSAAN KLINIS :- MUKOSA PHARYNX DAN TONSIL MENGANDUNG ILCERASI YANG MENGANDUNG B.T.A FUBERKEL- ADANYA PEMBENGKAKAN KELENJAR LEHER
DIAGNOSA :- B.T.A. PADA APUS - PA DARI BIOPSI TONSIL
TERAPI :- TONSILLECTOMY - TERAPI SPECIFIK
3. TONSILLOFARINGITIS T.B.C.
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- KELAINAN DARAH : a. AGRANULOCYTOSIS
- JARANG TERJADI- E/ : REAKSI HYPERSENSITIVITAS- GEJALA :
- DEMAM- SAKIT KEPALA- SAKIT MENELAN
- PEMERIKSAAN FISIK ; - ILKUS NEKOROTIK FARING - K.G.B. TAK >>- TERAPI :
- STEROID- ANTIBITIKA
HUBUNGAN PENYAKIT LAIN DENGAN TONSIL
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b. L E U K E M I A
BENTUK : LYMPHOBLASTIK ( ANAK )MYELOBLASTIK ( DEWASA )MONOBLASTIK
GEJALA : DEMAM, ANEMI, PERDARAHAN
PEMERIKSAAN FISIK :ULCERASI & MEMBRAN KOTORGUSI ; KAVUM ORIS ; FARING
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c. AGRA MULOCYTOSIS
- ULCERASI DAN NEKROSIS MEMBRAN MUKOSA PHARYNX & MULUT
- NYERI TENGGOROKAN DAN
- DEMAM TINGGI YANG AKUT
DIAGNOSA :
LEUKOPENIA DENGAN GRANULOCYT YANG SANGAT KURANG.
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• SEBELUMNYA TONSILLEKTOMI DAN ADENOIDEKTOMI DAPAT MENGHINDARI TONSILLITIS STREPTOKOKKUS DAN REUMATIK FEVER.
• KONTROVERSI
2. RHEUMATIC FEVER
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- BERASAL : LENGKUNG BRANCHIAL KE.2- TERLETAK ANTARA @ CAROTIS INT. EXT.- PANJANG 2,5 CM- PROC. STYLOID MENEKAN
* FOSA TONSIL ( POST ) T.E. SAKIT* CAROTIS PERASAAN TIDAK NYAMAN a/r PARIETAL OPHTHAMICA
PEM. FISIK :* PALDASI FOSSA TONSIL* RADIOLOGI
TERAPI :OPERASI PROC. STYLOID YANG BERLEBIH
ELONGATED STYLOID PROCESSUS
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SUMBATAN " CASEOUS" YANG MENGISI KRIPTA TONSIL ( TONSILLITIS KRONIS )
TERAPI :
MENGANGKAT CASEOUS / TONSIL
TONSILLOLITH :
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I. INDIKASI : * INDIKASI ABSOLUT TONSILEKTOMI
1. TONSILLITIS ACUTA YANG BERULANG-ULANG ATAU TONSILLITIS KRONIS 2. POST PERITONSILLAR ABSES 3. ABSTRUKSI MEKANIS SALURAN PERNAFASAN 4. KRIER DIPTHERIA 5. BIOPSI* INDIKASI ABSOLUT ADENOIDEKTOMI
1. OBSTRUKSI TUBA EUSTACHII 2. HYPERTROFI ADENOID MENIMBULKAN OBSTRUKSI SALURAN NAFAS 3. SERANGAN SINUSITIS YANG BERULANG-ULANG
d. OPERASI PENGANGKATAN TONSIL DAN ADENOID
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1. NYERI TENGGOROK BERULANG-ULANG 2. SAIT TELINGA BERULANG-ULANG 3. RHINITIS YANG BERULANG-ULANG ATAU RHINITIS CHRONIKA 4. INFEKSI SALURAN NAFAS BAG.ATAS YANG BER ULANG-ULANG 5. TIDUR NGOROK ATAU BERNAFAS MELALUI MULUT 6. PERTUMBUHAN YANG KURANG BAIK 7. TONSIL YANG BESAR ATAU ADANYA DETRITUS 8. LYMPHADENOPATI LEHER 9. ADENITIS TUBERKULOSIS10. PENYAKIT SISTEMIS
INDIKASI RELATIF ADENOTONSILECTOMI:
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KONTRA INDIKASI ABSOLUT ADENOTONSILLECTOMI
1. PENYAKIT - PENYAKIT DARAH2. PENYAKIT SISTEMIK YANG TIDAK TERKONTROL
KONTRA INDIKASI RELATIF ADEMOTONSILLECTOMI :
1. ADANYA CELAH LANGIT-LANGIT2. ADANYA TONSIL DAN ADENOID3. INFEKSI TONSIL AKUT4. EPIDEMI POLIMYELITIS5. UMUR 3 TAHUN, PERDARAHAN POST OPERATIF SULIT DIATASI
2. KONTRA INDIKASI :
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1. NASOFARING : MASA DI NASOFARING BILA :
- OBSTRUKSI NASAL- RHINORRHEA- EPISTAXIS- PERUBAHAN SUARA- GANGGUAN PENDENGARAN- GANGGUAN SARAF KRANIAL- SAKIT WAJAH- MASA DI LEHER
2. ANGIOFIBROMA :- JARANG- ADOLECEN- P.A. : VASKULER- PATOGENESA : HORMORAL- SIFAT : EROSI - DESTRUKSI
TUMOR - FARING
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- GEJALA : OBSTRUKSI NASAL ( 90 % ) EPSITAXIS ( 80 % ) EXOPHTHALMUS
- PEM. KLINIS : MASA KE ABU-ABUAN / MERAH PIPI / PALATAL
- PEM. PENUNJANG : * FOTO KEPALA - ANGIOGRAFI * C.T. SCAN
- THERAPI : OPERASI
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2. KOANAL POLIP : - MASA LUNAK : GELATINOUS PROLAP - BERASAL MUKOSA SINUS MAXILLA - TERAPI : OPERATIVE
3. TUMOR BENIGNA LAIN
- TERATOMA - ADENOMA - MIXED TUMOR - CHONDROMA
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1. CARSINOMA NASOFARING- FREQ : 2 % KEGANASAN
O : O = 3 : 1- P.A. : 85 % Ca EPIDERMOID- KGB LEHER 50 %- GEJALA : * HIDUNG : RHINORRHOE
OBSTRUKSI NASAL EPISTAXIS POST
* TELINGA : GANGGUAN PENDENGARAN * MATA : GANGGUAN N. V-VI
OPHTHAL MOPLEGIDIPLOPIACORNEA REFLEX MENURUN
* JUGULER FORAMEN : IX X XII TRUNSUS SIMFATIKUS
B. MASA MALIGNA :
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- LEHER : METASTASE 60 - 80 %
- PEM. FISIK : NP COPY - DIREK- INDIREK
- PEM. PENUNJANG :
RADIOLOGI : BASIS KRANNII
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MASA DI ORO-HIPOFARING BILA :
- SAKIT TENGGOROK
- ODINOFAGI
- DISFAGI
- PERUBAHAN SUARA
- OTALGIA
- RASA MENGGANJAL DI TENGGOROK
ORO - HIPOFARING
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a. MASA BENIGNA :
1. KISTE RETENSI MUKUS BERASAL KEL. SALIVATORIUS RESPIRASI DUSTRESS PADA ANAK
2. LIPOMA : MASA BUAH ARBEIN DI PALATUM. UVULA : FOSSA TONSIL THERAPI : EXSISI
3. THIROID ABBERAN : - PD BASIS LIDAH : FOR CAECUM - O.K. KEGAGALAN UNLAGE THIROID TURUN KE BAWAH
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b. MASA GANAS OROFARING :
- GEJALA : ORONOFAGI OTALGIA
MASA PD LEHER ( 50 % )
- USIA : 50 - 80 TAHUN
- ANAMNESA HUBUNGAN DENGAN ALKOHOL TEMBAKAU
- PEM. FISIK : LESI ULCERASI / EXOPHYTIK
- THERAPI : RADIASI OPERASI CHEMOTHERAPI
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c. MASA GANAS HYPOFARING :
- TERMASUK SINUS PIRIFORMIS DAN DD FARING POST : 95 % Ca EPIDERMPOID - METASTASE : SIST. LIMFATIK
50 % KGB LEHER >> - PEM. FISIK : LESI ULCERASI / EXOPHYTIK - PEM. PENUNJANG :
* TOMOGRAM* BUBUR BARIUM* C.T. SCAN* LARYNGOGRAM
- THERAPI :* OPERASI* CHEMOTHERAPY* IRRADIASI* KOMBINASI
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SINDR . : - CLEFT PALATE- MICROGNATHIA- GLOSSOPTOSIS
DISERTAI DENGAN : TULI ; KATARANG ; SPINA BIFIKA OCULTA DAN JANTUNG
1) " PIERE ROBIN SIDROM "1 : 30.000 KELAHIRAN
2) BURSA THORNWALD'S KISTE NASOFARING " MIDLINE PERSISTEM EMBRIONIC ANTARA NOTO CHORD - ATAP FARING
KELAINAN KONGENITAL FARING
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GEJALA : KISTE MENGALAMI PERADANGAN :
* OKLUSI* POST NASAL DISCHARGE* SAKIT KEPALA* RASA KECAP* KRUSTA NASO F.* GANGGUAN T. EUSTACHII
PEM FISIK : KISTE PADA DD POST NASOFARING
THERAPI : - MARSUPILISASI - ANTIBIOTIKA
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3). CHOANAL TRESIA
KEGAGALAN MEMBRAN BUCCO - PHARYNGEAL PD PERTUMBUHAN EM. BRIONIC (7-8 MG) BERSIFAT :
- UNILAT (KA >KI) / BILATERAL
- TERDIRI TL/MEMBRAN (TL + 90 % )
- KOMPLIT / INKOMPLIT
- KEMUNGKINAN TERDENSI FAMILIER
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GEJALA :* ATR. BILAT BAYI DISPNOE/CYANOSIS YANG HILANG BILA MENANGIS / BERNAFAS VIA MULUT
* KESULITAN WAKTU MAKAN : MUKA CYANOSIS DAN ASPIRASI
* " NASAL DISCHARGE " KENTAL
PEM. FISIK :* TEST KATHETER VIA LUBANG HIDUNG* PEM. RO RADIO CPAG MELALUI HIDUNG DAN CT SCAN ( BASIS - KARNII )
THERAPI : OPERASI
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