Ntho ya Peritonsillar (Quinsy): Lentswe la Matapole a a Bolelo, Go Fapoga ga Uvular, Trismus, Go Elela, le Go Goga ka Nalete kgatlhanong le go Anama ga Parapharyngeal¶

Fa mometso o o botlhoko o fetoga go nna maswe thata ka letlhakore le lengwe, o patilwe ke lentswe le le sa utlwaleng sentle la "matapole a a bolelo" (go utlwala e kete motho o bua ka matapole a a bolelo a a fisang mo molomong wa gagwe), go sa kgone go bula molomo ka tlwaelo (trismus kgotsa go tswalela motlhagare mo go tseneletseng), pa e e botlhoko thata go kometsa mathe go botlhoko thata, mme magalapa a a boleta a a rurugileng a a kgoromeletsang uvula e e lepeletseng go kgabaganya mola o o fa gare go ya kwa letlhakoreng le le fapaaneng (le le itekanetseng), tlhatlhobo ke ntho ya peritonsillar (PTA), e e itsiweng mo hisitoring jaaka quinsy. Eya ka bonako kwa lephateng la maemo a tshoganyetso la bookelo le le nang le bokgoni jwa go ara ka ditsebe (ENT), kgotsa leletsa nomoro ya maemo a tshoganyetso ya lefelo la lona (911 kwa United States le Canada, 112 go ralala Yunione ya Yuropa, 999 kwa United Kingdom; bona nomoro ya rona ya dinomoro tsa tshoganyetso) ka yone nako eo fa motho a tsholola mamina, a sokola go hema kgotsa a sa kgone go kometsa. Fa o ntse o baakanyetsa go tsamaisiwa, farologanya ntho ya peritonsillar e e mo letlhakoreng le le lengwe le go ruruga ga fa fatshe ga molomo go go mo matlhakoreng a mabedi o dirisa Kaedi ya tsela ya mowa ya angina ya ga Ludwig, bapisa ditshwaetsego tsa mometso wa kwa morago mo kaedi ya ntho e e kwa morago ga molomo le bolwetse jwa bogareng, mme o lebelele matshwao a go tlhaselwa ke ditshika tsa mogala wa rona Kaedi ya bolwetse jwa ga Lemierre.

Ntho ya peritonsillar ke tshwaetsego e le nngwe e e tlwaelegileng thata ya sebaka se se kwa teng sa molala mo baneng, mo basheng, le mo bagolong ba ba botlana. E bopega fa tshwaetsego ya dibakateria (ka tlwaelo e leng motswako wa ditshedinyana tse dintsi tsa Setlhopha sa A sa beta-hemolytic Streptococcus pyogenes, *Setlhopha sa Streptococcus anginosus, le ditshenekegi tse di tsenang mo molomong tse di jaaka Fusobabacterium le Prevotella) di thuba ditlhale tse di tswang mo leganong ( Dikgeleswa tse dinnye tsa mathe tsa ga Weber kwa poleng e e kwa godimo ya tonsil) mme di kokoana jaaka kgetsana e e gagametseng ya mamina mo teng ga sebaka se se ka nnang teng fa gare ga capsule ya tonsil ka fa gare le mosifa o o kwa godimo wa pharyngeal constrictor ka fa thoko. Ka gonne mesifa e e kwa godimo ya pharyngeal e e pitlaganyang ke yone fela lebota le le sesane le le kgaoganyang ntho ya peritonsillar le sebaka sa parapharyngeal le kgapetla ya carotid (mo tshika ya ka fa teng ya carotid gantsi e nnang fela ka disentimetara di le 1.0 go ya go di le 2.5 ka fa morago go ya kwa morago le ka fa thoko ga kanton le go kgoreletsa tsela e e kwa godimo ya mowa, go thubega ka go itiragalela fela go tsena mo mafatlheng fa motho a robetse (go baka nyumonia e e bolayang ya go hema), kgotsa go gogolega ka fa thoko go baka ntho ya parapharyngeal, bolwetse jwa Lemierre, kgotsa go tswa madi mo tshikeng ya carotid go go bakang masetlapelo. Fa go sena go bopega mamina a a tlhamaletseng mo teng ga sebaka seno, dibolayamegare tse di nowang ka molomo di le tsosi ga di kake tsa alafa ntho ya peritonsillar; phokotso e e tlhomameng e tlhoka tshoganyetso go tlhotlhora ka nale kgotsa go sega le go ntsha metsi mmogo le dibolayamegare tse di tsenngwang mo ditshikaneng le di-corticosteroid.

Dira se jaanong¶

1. Eya kwa lephateng la tshoganyetso la bookelo ka bonako (kgotsa leletsa 911 / 112 / 999 fa e le gore o tshologa mamina, o tlhaela mowa, kgotsa o dira medumo e e kwa godimo ya stridor). O se ka wa ya kwa tleliniking ya khemisi ya mabenkele kgotsa wa leta malatsi go bona peelanonako ya tlhokomelo ya motheo, mme o se ka wa tsaya gore amoxicillin e tla rekwa ka molomo kgotsa e bopilwe ntho. Ntho ya peritonsillar e tlhoka go ntsha metsi ka tshoganyetso ka kalafi, go tsenngwa metsi mo ditshikaneng, go tsenngwa di-steroid mo ditshikaneng le dibolayamegare tse di sa direng mowa.
2. Boloka motho a ntse a tlhamaletse a sekametse go le gonnye kwa pele mme o mo neye kopi kgotsa taulo go kgwa mathe. Le ka motlha o se ke wa pateletsa molwetse yo o tshololang mathe kgotsa yo o buang ka lentswe le lekima la "matapole a a bolelo" go rapama ka mokwatla wa gagwe, se se letlang gore palate e e rurugileng e e boleta le tonsil e nne le kotsi ya go ntsha mowa kwa morago kgatlhanong le mathe go thubega ga mamina go go itiragaletseng fela.
3. Dira "Two-Finger Trismus Check" mme o lebe uvula ka lebone la founo (ntle le go tsenya sepe mo teng ga molomo). Kopa motho go bula molomo wa gagwe ka bophara jo a ka bo kgonang ka phuthologo:
4. Ka tlwaelo, ngwana yo o godileng kgotsa yo mogolwane a ka kgona go tsenya bonolo menwana e meraro e e kgobokaneng (dimilimitara di le 35 go ya go di le 50) ka tsepamo fa gare ga meno a bone a a kwa godimo le a a kwa tlase a kwa pele. Fa di kgona go bula molomo fela bophara jwa monwana o le mongwe kgotsa di le pedi (< dimilimitara di le 20 go ya go di le 25) ka ntlha ya go tlhotlhorega go go botlhoko mo letlhakoreng la motlhagare, trismus e teng (e e supang gore thurugo e tenisitse mosifa wa pterygoid o o bapileng le one).
5. Phatsimisa lebone mo molomong kwantle ga go dirisa leswana kgotsa sediriswa se se gatelelang leleme: mo nthong ya peritonsillar, palate e e boleta e e fa godimo ga tonsil e tlhotlhorega go ya kwa tlase le kwa pele jaaka balunu e khibidu e e gagametseng, e kgoromeletsa tonsil kwa tlase/mo teng le go kgoromeletsa **uvula e e lemotshegang kwa thoko (**yealthde) go ya kwa letlhakoreng le lengwe.
6. O SE KE wa leka go thunya, go tlhotlhora, go tlhaba, kgotsa go tlhotlhora tonsil e e rurugileng kwa gae ka swab ya letseta, monwana, nale, kgotsa di-tweezers. Ka fa morago ga ntlha e e kafa thoko ya tonsil go na le tshika ya ka fa teng ya carotid. Go tlhotlhora kgotsa go tobetsa ka bofofu mo selong se se tlhotlhoregang sa peritonsillar kwa gae go ka kgaoganya tshika ya ka fa teng ya carotid (go baka go tswa madi go go bolayang mo metsotswaneng) kgotsa ga thuba morwalela wa mamina a a bokima a a tlhamaletseng go ya kwa tlase mo phaepeng ya phefo.
7. Boloka molwetse Nothing by Mouth (NPO) fela fa o leba kwa bookelong. Le fa molwetse a nyorilwe thata ka ntlha ya malatsi a go sa metse sentle le letshoroma, o se ka wa mo letla go ja kgotsa go nwa mo tseleng go ya kwa lephateng la tshoganyetso. Go ntsha metsi ka nale, go sega le go ntsha metsi ka fa tlase ga go bolaya bogatsu ga selegae/kwa setlhogong, kgotsa go ntsha metsi mo phaposing ya karo go tlhoka mpa e e senang sepe gore molwetse a se ka a kgwa le go ntsha mowa ka nako ya go dirisa mometso.
8. Ela tlhoko difolaga tse dikhibidu tsa gore tshwaetsego e thubile go tswa mo sebakeng sa tonsillar go tsena mo molaleng o o kwa teng (Parapharyngeal Spread). Fa go ruruga, bohibidu, kgotsa bonolo jo bo feteletseng bo atologela kwa tlase ga angle ya motlhagare go ya kwa tlase mo letlhakoreng la molala (go bapa le mesifa ya sternocleidomastoid ya sternocleidomastoid), kgotsa mesifa ya chiffrigor ya sternocleidomastoid), kgotsa kgotsa botlhoko jwa sehuba, tsibosa ngaka ya maemo a tshoganyetso ka bonako gore e laele CT scan ya molala e e tokafaditsweng ka pharologanyo pele o leka thulaganyo epe ya go dirisa nale.

Setlhare sa tshwetso sa kalafi sa mometso o o botlhoko thata wa letlhakore le le lengwe, trismus, le go fapoga ga uvular¶

Dirisa tšhate eno ya kelelo ya kalafi ya tshoganyetso go farologanya bolwetse jo bo bonolo jwa go ntsha madi, bolwetse jwa sele jwa mo mpeng (phlegmon), ntho e e tlhamaletseng ya mo mpeng (quinsy), le go anama ga sebaka se se tseneletseng sa parapharyngeal/carotid.

flowchart TD
    Start["Mometso o o Botlhoko o o Masisi (O o Maswe thata mo Letlhakoreng le le LENGWE),<br/>Letshoroma, Odynophagia, kgotsa Botlhoko jwa Tsebe jo bo Rometsweng"] --> Exam["Tlhatlhoba Tsela ya Mowa le go Dira Tlhatlhobo ya Molomo/Molala ya Dintlha di le 3:<br/>1. Lentswe le le sa utlwaleng la 'Matapole a a Bolelo' kgotsa go Elela<br/>2. Trismus (Go Bulega ga Dino tse di Segang < 25 mm)<br/>3. Magalapa a a Bonolo a Letlhakore le le Lengwe + Uvula e Kgorometswe kwa Letlhakoreng le le Fapaaneng"]

    Exam --> AirwayCheck{"A go na le go tlhotlhorega, go hema thata,<br/>Cyanosis, kgotsa go sa kgone go rapama o le sephaphathi?"}

    AirwayCheck -->|"EE: GO THIBEGA GO TLHAGELANG TSELA YA MOWA"| EmergentAirway["KHOTU YA TSELA YA MOWA YA PHAPOSI YA GO DIRA KA BONAKO:<br/>1. Boloka Boutu jwa Molwetse bo Tlhamame (Didikirii di le 90)<br/>2. Go Kopanya Thuto ya go Bolaya Botlhoko + ENT ya go Tsenya Difaeba tsa Ditsebe mo Tsogang kgotsa Bekapo ya Tsoga ya Tracheostomy<br/>3. Naya Stat IV Deksamethasone 10 mg + Dibolayamegare tsa IV<br/>4. Dira karo ya go ntsha metsi mo KGOTSA Fa Tsela ya Mowa e Sireleditswe"]

    AirwayCheck -->|"NNYAA: Tsela ya Mowa e a Tsepama Fa o Ntse o Tlhamame"| DeepSpread{"A Matshwao a go Anamela ga Parapharyngeal e e Tseneletseng kgotsa<br/>Carotid Sheath a teng?<br/>(Go ruruga ga Molala o o kwa Ntle ka fa Tlase ga Angle ya Motlhagare,<br/>Bonolo jwa SCM ya Kwa Pele, Bogale, Torticollis,<br/>kgotsa Pono ya Molomo e e Thibelang Trismus e e Masisi)"}

    DeepSpread -->|"EE: Go belaelwa gore o na le ntho ya mo molomong<br/>kgotsa Bolwetse jwa ga Lemierre"| ContrastCT["CT YA MOLALE E E TOKAFADITSWENG KE PHAPANO YA STAT:<br/>1. Dimmapa Lefelo le le Tota la Ntho e e Amanang le<br/> Mothapo wa Carotid wa ka fa Gare le Mothapo wa Jugular wa ka fa Gare<br/>2. Simolola go dirisa Ampisilini-Sulbakitamo 3 g q6h (kgotsa Seftriaxone + Metronidazole) + Vancomycin + Deksamethasone ya IV 3. Go Tlhatswa Metsi mo Phaposing ya Karo ya ENT (Go Tsena mo Letlhakoreng kgotsa Kwa Ntle)"]

    DeepSpread -->|"NNYAA: Go tlhotlhorega ga Palate e e Bonolo e e Kgaogantsweng ya Tlwaelo ya Letlhakore le le Lengwe<br/>Supratonsillar"| Ultrasound["ULTRASOUND YA MO MONOMO / YA MO LETLHALO<br/>(E Farologanya Phlegmon kgatlhanong le Kgetsana ya Pus e e Ntshiwang<br/>le go Supa Kelelo ya Doppler ya Tshika ya Carotid)"]

    Ultrasound -->|"Pokello ya Seeledi sa Hypoechoic<br/>(Ntho ya Boammaaruri ya Peritonsillar)"| Drainage["GO TSHOLA METSI A TSHOGANYETSO + PHALOSO YA KALAFI:<br/>1. Seokobatsi sa go bolaya bogatsu sa mo leinong/sa selegae + Go tsenya metsi mo mmeleng +<br/> Dexamethasone ya mo mmeleng 10 mg Selekanyo se le sengwe<br/>2. Go Goga ka Nalete (Nalete ya 18G e e nang le Sethibela-Boteng<br/> <= 1.0 go ya go 1.5 cm kwa Poleng e e kwa Godimo) KGOTSA<br/> Go Sega ga Scalpel e e Sireleditsweng le go Gontsha Metsi<br/>3. IV/Ampisilini-Sulbaketamo e e Nowang ka Molomo kgotsa Amokisisilini-Klavulanate"]

    Ultrasound -->|"Edema e e Thata Fela, Ga go na Pus<br/>(Bolwetse jwa Disele jwa Peritonsilla)"| Cellulitis["BOLWETSE JWA DISELE TSA PERITONSILLA (PHLEGMON):<br/>1. O se ka wa Sega (Ga go ise go nne le mamina a a tshwanetseng go ntsha)<br/>2. Fana ka IV Metsi, IV Deksamethasone 10 mg,<br/> le IV Ampisilini-Sulbaktam / Seftriaxone + Metronidazole<br/>3. Ela tlhoko Diura di le 12 go ya go di le 24 tsa Tharabololo kgatlhanong le Go Nna Seedi"]

Thulaganyo ya mmele le thuto ya malwetse: Sebaka sa peritonsillar, dikgeleswa tsa ga Weber, le kotsi ya tshika ya ka fa teng ya carotid¶

Go tlhaloganya melelwane e e tlhomameng ya mmele wa bolao jwa tonsillar go tlhalosa letshwao lengwe le lengwe la kalafi la quinsy le go senola gore ke eng fa go tlhotlhora ka nale go tshwanetse ga latela matshwao a a gagametseng a jometeri go tila tshika ya ka fa gare ya carotid.

1. Melelwane ya popego ya mmele ya sebaka sa peritonsillar le dikgeleswa tsa ga Weber¶

Tonsil ya palatine e nna e tlhomilwe mo teng ga lefelo le le kwa tlase la khutlotharo mo leboteng le le fa thoko la oropharynx le le bidiwang tonsillar fossa, le le foreimilweng kwa pele ke pilara ya tonsil ya kwa pele (mosifa wa palatoglossus) mme kwa morago ke pilara ya tonsil ya kwa morago (mesifa ya palatopharynge). - Sebaka sa Peritonsillar: Go dikologa letlhakore le le kwa teng la tonsil ke sebaka se se sa gagamalang sa kgonagalo ya areolar se se lekanyeditsweng ke: - Ka fa gare: khapsule e e thata ya tlhale ya tonsil ya palatine. - Ka fa thoko: Mesifa e e kwa godimo ya go pitlagana ga molomo (o o kgaoganyang sebaka sa peritonsillar le sebaka sa parapharyngeal). - Kwa pele: Pilara ya tonsilla e e kwa pele (mosifa wa palatoglossus). - Ka morago: Pilara ya ditonsi ya kwa morago (mosifa wa palatopharyngeus). - Mekgwa e mebedi ya go bopega ga ntho (Go Tswelela Pele ga Tonsillitis kgatlhanong le Sialadenitis ya Kgeleswa ya ga Weber): 1. Katoloso ya Tonsilla e e Tlhamaletseng: Bolwetse jo bo botlhoko jwa dibakateria bo thuba capsule ya tonsilla e e nang le ditlhale mo karolong ya yone e e tshesane thata ya kwa godimo, bo tswelela pele ka kgato ya diura di le 24 go ya go di le 48 tsa selulitis ya peritonsillar (phlegmon), mme bo nna seedi go nna periton-off e e nang le lebota. 2. Go Thibega ga Kgeleswa ya Weber (Go Tlhalosa Goreng PTA e ka Diragala Kwantle ga Bolwetse jo bo Masisi jwa Tonsillitis Pele Kgotsa Le Morago ga go Kgaolwa ga Tonsille ka Bontlhabongwe): E tsentswe mo magaleng a a boleta ka tlhamalalo fa godimo ga pole e e kwa godimo (pole e e kwa godimo) ya tonsil ke setlhopha sa mathe a a kwa tlase a le 20 go ya go 25. dikgeleswa, tse diphaephe tsa tsone tse dinnye di tshologelang mo dikhuting tse di kwa godimo tsa tonsillar go ntsha matlakala. Fa thurugo kgotsa mabadi a thiba ditšhika tsa dikgeleswa tsa ga Weber, tshwaetsego e e rurugileng mo teng ga dikgeleswa e bopa ntho ka tlhamalalo mo palate e e boleta ya supratonsillar (e leng se se tlhalosang lebaka la go bo diperesente di le 90 tsa diso tsa peritonsillar di nna kwa superior pole kwa godimo ga tonsil lohind go na le go nna kwa godimo ga tonsil).

+-------------------------------------------------------------------------+
|     ANATOMY OF A PERITONSILLAR ABSCESS & INTERNAL CAROTID PROXIMITY     |
+-------------------------------------------------------------------------+
|  VIEW LOOKING INTO THE OPEN MOUTH (EXAMPLE: LEFT PERITONSILLAR ABSCESS) |
|                                                                         |
|   * Soft Palate & Anterior Pillar on Affected Side:                     |
|     - Swollen, erythematous, bulging DOWNWARD and FORWARD               |
|     - Effaces (flattens out) the normal fold of the anterior pillar     |
|   * Palatine Tonsil on Affected Side:                                   |
|     - Pushed DOWNWARD, MEDIALLY (toward midline), and FORWARD           |
|   * Uvula (Midline Marker):                                             |
|     - Pushed across the midline AWAY from the abscess toward the        |
|       HEALTHY (opposite) tonsil                                         |
+-------------------------------------------------------------------------+
|  WHAT LIES DIRECTLY LATERAL & POSTERIOR TO THE ABSCESS (THE DANGER):    |
|   * Thin Superior Pharyngeal Constrictor Muscle (only 2-3 mm thick)     |
|   * Lateral to that muscle = PARAPHARYNGEAL SPACE & CAROTID SHEATH      |
|   * INTERNAL CAROTID ARTERY + Ascending Pharyngeal/Facial Arteries      |
|     sit just 1.0 to 2.5 cm posterolateral to the inferior/middle tonsil |
|   * Medial Pterygoid Muscle (chewing muscle) sits immediately lateral   |
|     to the superior constrictor -> Irritation causes SEVERE TRISMUS     |
+-------------------------------------------------------------------------+

2. Goreng Aruscess ya Peritonsillar e baka matshwao a le 4 a a tlwaelegileng a kalafi¶

1. Trismus e e masisi (E teng mo peditharong ya balwetse, mme e le #1 e e farologanyang tonsillitis e e bonolo): Ka bonako fela kwa ntle ga mesifa e e kwa godimo ya pharyngeal constrictor go na le mesifa ya pterygoid e e fa gare (ya ka fa gare), nngwe ya mesifa e e maatla ya go ja e e tswalang motlhagare. Fa pus le di-cytokine tsa thurugo di kokoana mo sebakeng sa peritonsillar, thurugo e e bapileng e tena mesifa ya pterygoid e e fa gare go nna go ruruga ga mesifa ya reflex e e bogale. Go leka go bula molomo go otlolla ditlhale tsa mesifa e e rurugileng, go baka botlhoko jo bo botlhoko jo bo lotlelang motlhagare gore o se ka wa bulega ka dimilimitara tse di kwa tlase ga di le 15 go ya go di le 25. (Perela ya kalafi: Tonsillitis e e sa raraanang e e bogale ya megare kgotsa ya strep GA E KE e baka trismus e e masisi; fa molwetse yo o nang le mometso o o botlhoko a sa kgone go bula molomo wa gagwe ka bophara, belaela gore go na le ntho ya peritonsillar kgotsa ya parapharyngeal ka bonako).
2. Lentswe le le thibetsweng la "Matapole a a Bolelo" (Rhinolalia Clausa): Go bua sentle, magala a a boleta (velum) a tshwanetse go tsholetsa le go ama lebota la pharyngeal le le kwa morago go tswala leroba la nko ka tshwanelo. Fa kokoanyo e kgolo ya mamina e atolosa magala a a boleta a a leng letlhakore le le lengwe mme e dira gore mesifa ya palatoglossus le levator veli palatini e se ka ya tsamaya, molwetse ga a kgone go tsholetsa magala a gagwe a a boleta mme a sa itemoge o tshwara mokwatla wa mometso wa gagwe ka thata go fokotsa botlhoko, a dira gore go nne le modumo o o boleta o o sa utlwaleng sentle.
3. Go Fapoga ga Uvular le go Suta ga Tonsil e e Kwa Tlase: Ka gonne ntho e nna mo teng ga magala a a boleta a supratonsillar kwa godimo le ka fa thoko ga capsule ya tonsil, bolo e e atologa ya pus e kgoromeletsa **tonsil ka boyone kwa tlase le go ya kwa bogareng jwa palate, uvula ka fa thoko go ya kwa letlhakoreng le le fapaaneng, le le itekanetseng.
4. Botlhoko jwa Tsebe jo bo Rometsweng mo Letlhakoreng le lengwe (Otalgia via Jacobson's Nerve): Le fa moropa wa tsebe le tsebe e e fa gare di tlwaelegile ka diperesente di le 100 fa go dirwa otoscopy, balwetse ba ngongorega thata ka botlhoko jo bo bogale, jo bo tlhabang mo letlhakoreng le le tshwanang le la ntho. Seno se diragala ka gonne mothapo wa glossopharyngeal (mothapo wa tlhogo IX) o tlamela ka ditlhale tsa maikutlo mo fossa/pharynx ya tonsillar le mo lerobeng la tsebe e e fa gare ka kala ya one ya tympani (mothapo wa ga Jacobson); boboko bo tlhalosa ka tsela e e sa siamang go otlolla ga capsule e e tseneletseng ya tonsillar jaaka botlhoko jo bo tswang kwa tengteng mo teng ga tsebe.

Go farologanya ntho ya mo mpeng le Bolwetse jwa sele jwa mo mpeng, Bolwetse jwa ditonsi, le go anama ga molala o o kwa teng¶

Dirisa lenaane leno la papiso la kalafi go farologanya ntho e e kgonang go ntsha metsi mo kgatong ya yone ya pele ga ntho (peritonsillar cellulitis) le mo ditshwaetsong tse di tseneletseng, tse di ka tsenyang botshelo mo kotsing ya sebaka sa molala:

Lefapha la Maemo a Tshoganyetso la Bookelo le porothokholo ya taolo ya ENT¶

+-------------------------------------------------------------------------+
|     EMERGENCY DEPARTMENT & ENT PROTOCOL FOR PERITONSILLAR ABSCESS       |
+-------------------------------------------------------------------------+
|  STEP 1: IMMEDIATE MEDICAL RESUSCITATION & PAIN/EDEMA CONTROL           |
|  * IV Isotonic Crystalloid Bolus: 1,000 mL Normal Saline or Lactated    |
|    Ringer's (most patients are severely dehydrated from 2-4 days of     |
|    inability to swallow liquids)                                        |
|  * Single-Dose Intravenous Corticosteroid (AAO-HNS / Evidence-Based):   |
|    - Dexamethasone 10 mg IV (Children: 0.3 to 0.6 mg/kg IV, max 10 mg)  |
|    - Meta-analyses show a single dose of IV dexamethasone rapidly       |
|      relieves trismus, reduces pain, speeds time to oral swallowing,    |
|      and decreases hospital length of stay without worsening infection  |
|  * Parenteral Analgesia & Antiemetic: IV Ketorolac (if not going to     |
|    open surgery) or IV Fentanyl + IV Ondansetron                        |
+-------------------------------------------------------------------------+
|  STEP 2: EMPIRIC POLYMICROBIAL ANTIBIOTICS (STREP + ORAL ANAEROBES)     |
|  * Intravenous Regimens:                                                |
|    - FIRST LINE: Ampicillin-Sulbactam (Unasyn) 3 g IV every 6 hours     |
|      (Children: 50 mg/kg/dose of ampicillin component IV q6h)           |
|    - ALTERNATIVE: Ceftriaxone 1 to 2 g IV daily PLUS Metronidazole      |
|      500 mg IV every 8 hours                                            |
|    - SEVERE PENICILLIN ALLERGY: Clindamycin 600 to 900 mg IV every 8h   |
|    - Add Vancomycin if MRSA risk or severe toxicity is present          |
|  * Oral Step-Down (Once Drained and Swallowing Liquids Comfortably):    |
|    - Amoxicillin-Clavulanate (Augmentin) 875/125 mg PO twice daily      |
|      for 10 to 14 days (OR Clindamycin 300-450 mg PO tid-qid)           |
+-------------------------------------------------------------------------+
|  STEP 3: ULTRASOUND LOCALIZATION & SURGICAL DRAINAGE                    |
|  * Point-of-Care Intraoral (Endocavitary) or Submandibular Ultrasound:  |
|    - Confirms liquid abscess vs. phlegmon & locates Internal Carotid    |
|  * Drainage Method 1: Guarded Needle Aspiration (18G needle with plastic|
|    sheath trimmed so ONLY 1.0 to 1.5 cm of needle tip is exposed)       |
|  * Drainage Method 2: Guarded #11 Blade Incision & Drainage + Blunt     |
|     curved Kelly Hemostat spreading in the SUPRATONSILLAR POLE           |
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1. Ke ka ntlha yang fa Ultrasound ya Ntlha ya Tlhokomelo (POCUS) e fetotse tlhokomelo ya Diso tsa Peritonsillar¶

Go ya ka hisitori, dingaka di ne di kgona go farologanya fela peritonsillar cellulitis (phlegmon) le ntho ya peritonsillar ka go tsenya nale ka bofofu mo magaleng a a boleta a a rurugileng ("go tlhotlhora ga nale e e foufetseng ya go tlhatlhoba bolwetse"), e e neng e na le diperesente di le 10 go ya go di le 24 tsa selekanyo sa madi a a sa siamang le - Gompieno, dingaka tsa maemo a tshoganyetso le dingaka tsa ditsebe le ditsebe di baya probe ya ultrasound ya makhubu a a kwa godimo e e kobegileng (e e khurumeditsweng ka kgetsana e e senang megare e e nang le gel) ka bonolo kgatlhanong le magalapa a a boleta a a rurugileng (kgotsa dirisa probe ya mola/e e kobegileng kwa ntle ka fa tlase ga motlhagare fa trismus e gagametse thata). - Melemo e meraro e megolo ya Ultrasound: 1. Ka bonako fela e farologanya peritonsillar cellulitis e e tiileng (e e tlhokang dibolayamegare tsa IV le di-steroid kwantle ga dithupana tsa nale tse di botlhoko) go tswa mo lesoba la ntho ya seedi le le nang le modumo o o kwa tlase/le le sa tshwaneng le le nang le tokafatso ya modumo wa kwa morago. 2. E tobetsa Color Doppler go dira mmapa wa boteng jo bo tlhomameng le tsela ya tshika ya ka fa gare ya carotid (e ka tlwaelo e leng disentimetara di le 1.5 go ya go di le 2.5 kwa morago ga tonsil, mme e ka koba ka tsela e e sokameng gaufi le lebota la pharyngeal mo balwetseng bangwe). 3. E letla go tlhotlhora ga nale go go kaelwang ke ultrasound ka nako ya nnete, go oketsa katlego ya go ntsha metsi ka nako ya ntlha go feta diperesente di le 90 go ya go di le 95.

2. Mekgwa ya pabalesego ya go Goga Madi ka Nalete le go Sega le go Ntsha Madi (Go Tila Tshika ya Carotid)¶

Fa ngaka ya maemo a tshoganyetso kgotsa mankge wa ENT a ntsha ntho ya peritonsillar mo mosheng kgotsa mogolo yo o dirisanang mmogo: 1. Topical and Submucosal Anesthesia: Molwetse o nna a tlhamaletse a tshwere ntlha ya Yankauer e e gogang mo seatleng sa gagwe (gore ba kgone go goga madi le mamina a a tatso e e maswe ka bonako fela fa a tswa). Legogo le le fa godimo ga go tlhotlhorega ga meno le gasetswa ka 4% ya lidocaine kgotsa benzocaine/cetacaine, mme morago ga moo go tsenelele 1% go ya go 2% ya lidocaine e e nang le epinephrine ya 1:100,000 ka fa tlase ga legogo go dirisiwa naletsana e e boleta ya meno ya selekanyo sa 27. 2. Sethibela Boteng jwa Nalete se se Tlamang (1.0 go ya go 1.5 Disentimetara Bogolo): Pele ga go gokelela nalete ya lerapo la mokwatla kgotsa e telele ya selekanyo sa 18 mo sering ya 10 mL, ngaka e tlosa kepisi ya tshireletso ya polasetiki mo polasetiki mme e kgaole disentimetara di le 1.0 go ya go p5. sekere, a bo a relela kgetsana ya polasetiki gape mo naleteng. Polasetiki eno ya sethibela boteng e dira gore go se kgonege mo mmeleng gore ntlha ya nalete e tsenelele kwa teng go feta 1.0 go ya go 1.5 centimeters mo magaleng a a boleta, e thibela gotlhelele go phunya ka phoso ga tshika ya ka fa teng ya carotid le fa molwetse a ka gotlhola kgotsa a tlhotlhorega kwa pele. 3. Seikaelelo sa Keletso (Pole e e kwa Godimo pele, LE KE E SE KE ya nna kwa tlase): - Ka gonne diperesente di le 90 tsa diso tsa peritonsillar di nna mo poleng e e kwa godimo (supratonsillar) le ka gonne tshika ya ka fa teng ya carotid e nna gaufi thata le dipole tse di kwa tlase le tse di kwa thoko, nalete e tsenngwa ka thata mo sefofaneng sa sagittal (se se tlhamaletseng go tswa kwa pele go ya kwa morago, GA SE KE sa tlhomamisa go ya kwa pele) go fetogafetoga kwa superior pole (kwa marakanelong a mola o o rapaletseng o o thadilweng go ralala motheo wa uvula le mola o o emeng o o thadilweng go bapa le pilara ya tonsillar e e kwa pele). - Fa pole e e kwa godimo e sa ntshe mamina mme ultrasound e bontsha kgetsana ya pole e e fa gare, go dirwa aspiration ya bobedi 1 centimeter kwa tlase go bapa le pilara e e kwa pele; pole e e kwa tlase e a tilwa ka ntlha ya go nna gaufi ga tshika ya carotid. 4. Go Sega le go Ntsha Metsi (I&D) kgatlhanong le Go Goga ka Nalete kgatlhanong le go Kgaola Tonsille ka Nako: - Go tlhotlhora ka nale: E rarabolola diperesente di le 85 go ya go di le 92 tsa diso tse di sa raraanang tsa peritonsillar mo go feteng ga ntlha ka botlhoko jo bonnye le go dutla madi morago ga thulaganyo. - Go Sega le go Ntsha Metsi (I&D): Ka go dirisa legare la scalpel la #11 le le sireleditsweng (le le theipitsweng gore go bonale fela 0.5 go ya go 1.0 cm ya ntlha ya legare), ngaka e dira segao se sennye sa legogo mo godimo ga go tlhotlhorega ga tlhogo e e kwa godimo, morago ga moo e tsenya legare le le tswetsweng le le kobegileng Kelly hemostak upt mafelo, go latelwa ke go tlhotlhora ga letswai/haeterojene perokosaete e e bothitho. I&D e na le seelo se se kwa godimonyana sa kalafi ya motheo (diperesente di le 93 go ya go di le 95) sa diso tse dikgolo kgotsa tse di nang le mafelo a mantsi. - Tonsillectomy ya ka bonako ("Quinsy") kgatlhanong le Tonsillectomy ya Kgaotso: Mo baneng ba ba botlana ba ba sa kgoneng go dirisana le go ntsha metsi mo mmeleng, kgotsa mo balwetseng ba ba nang le diso tsa peritonsillar tse di ipoeletsang (diperesente di le 10 go ya go di le 15 tsa go boela gape) kgotsa go palelwa ke go ntsha metsi ka nale/ka go segwa, tonsillectomy ka fa tlase ga go idibatsa ka kakaretso mo phaposing ya karo kgotsa tonsillectomy ya sekgala e e tlhophilweng dibeke di le 4 go ya go di le 6 moragonyana fa thurugo e e bogale e kokobetse.

Mathata a a bolayang fa Ntho ya Peritonsillar e anama ka fa thoko kgotsa kwa tlase¶

Fa ntho ya peritonsillar e tlhokomologilwe kgotsa e sa alafiwe sentle, mamina a thuba mo mesifeng e mesesane e e kwa godimo ya pharyngeal go tsena mo sebakeng sa parapharyngeal, mme seno se tsosa maemo a tshoganyetso a le mane a a ka nnang a bolaya: 1. Go ruruga ga Sebaka sa Parapharyngeal le go Thibana ga Tsela ya Mowa: Go ruruga go atologa ka fa tlase ga angle ya motlhagare go ya kwa tlase mo molaleng o o fa thoko, go kgoromeletsa lebota lotlhe la pharyngeal le le fa thoko le supraglottis go kgabaganya tsela ya mowa. 2. Bolwetse jwa ga Lemierre (Thrombophlebitis e e tswang mo mothapong wa ka fa teng): Fusobacterium necrophorum e e sa tlhokeng mowa e tsena mo kgapetleng ya carotid, e thiba mothapo wa ka fa teng wa mothapo le go tlhapisa mafatlha ka bobedi ka emboli ya makgwafo e e tswang mo mafatlheng (bona Kaedi ya bolwetse jwa ga Lemierre). 3. Pseudoaneurysm ya Mycotic ya Tshika ya Carotid ya ka Fa Gare le go Tula Madi a a Thunyang: Go tswelela go tlhapa lebota la tshika ya ka fa gare ya carotid ka diensaeme tsa dibakateria tse di bolayang go koafatsa bobegakgang jwa tshika, go bopa pseudoaneurysm ya carotid e e tshwaetsegileng. Gantsi go etelwa pele ke tlhagiso e nnye e le 1 kgotsa 2 "sentinel bleeds" (go kgwa mathe a le mmalwa a madi a mahibidu a a phatsimang go tswa mo kgokgotsong kgotsa mo tsebeng), go thubega ka tshoganyetso ga pseudoaneurysm ya carotid go tsena mo pharynx go baka go tswa madi a mantsi, a a bolayang. (Molwetse mongwe le mongwe yo o nang le ntho ya ga jaana kgotsa ya bosheng ya peritonsillar/parapharyngeal yo o kgwang madi a mahibidu a a galotseng mathe o tlhoka go dirwa CT angiogram [CTA] ya tshoganyetso ya molala ka bonako le go tsenngwa ga stent/go tsenngwa ga madi mo methapong kgotsa go bofiwa ka karo). 4. Mediastinitis e e fologang e e bolayang: Pus e latedisa diphatlha tsa parapharyngeal le tsa kwa morago go tsena mo lerobeng la sehuba.

Sekeripiti se se tlhomameng sa tlhaeletsano ya go tlhaola kwa bookelong¶

Fa o goroga kwa lephateng la tshoganyetso la bookelo le molwetse yo o belaetsang gore o na le ntho ya peritonsillar, dirisa mokwalo o o tlhapileng ono fa o tlhaola:

"Ke fano le molwetse wa dingwaga di le [Dingwaga] yo mometso wa gagwe o o botlhoko o ntseng o le maswe thata mo letlhakoreng la [molemeng/mojeng] mo malatsing a a fetileng a [Palo], mme yo jaanong a nang le lentswe le le sa utlwaleng sentle la matapole a a bolelo, botlhoko jo bo tseneletseng mo tsebeng mo letlhakoreng le le lengwe, [go metsa mamina / go sa kgone go metsa metsi a bone fela. monwana o bophara). dexamethasone, ampicillin-sulbactam, le go goga kgotsa go ntsha metsi ka nale e e kaelwang ke modumo wa ultrasound."

Dipotso tse di bodiwang kgapetsakgapetsa¶

Ke ka ntlha yang fa ntho ya peritonsillar e dira gore motlhagare wa gago o tswalele (trismus) mme o dire gore tsebe ya gago e nne botlhoko fa tshwaetsego e le mo kgokgotsong ya gago?¶

Ka bonako fela kwa ntle ga lebota le lesesane la mesifa e e tshotseng tonsil ya gago go na le mesifa ya pterygoid e e fa gare, e leng nngwe ya mesifa e megolo e e tswalang motlhagare e e tlhafunang. Fa mamina a kokoana fa thoko ga tonsil, thurugo e tena mesifa ya pterygoid e e fa gare go nna spasm e e gagametseng, e e botlhoko (trismus) gore o se ka wa kgona go bula molomo wa gago thata; ka nako e e tshwanang, mothapo wa borobongwe wa tlhogo (mothapo wa glossopharyngeal) o o utlwang botlhoko mo tonsil ya gago le one o romela lekala (mothapo wa ga Jacobson) kwa tsebeng ya gago e e fa gare, mme seno se dira gore boboko jwa gago bo utlwe botlhoko jwa tonsil e le botlhoko jo bo bogale jwa tsebe mo letlhakoreng le le tshwanang.

Nka bona jang pharologanyo fa gare ga mometso o o maswe wa strep (tonsillitis) le ntho ya mo mpeng (quinsy)?¶

Mo strep throat e e tlwaelegileng kgotsa tonsillitis ya megare, di-tonsil ka bobedi di bohibidu e bile di rurugile mo matlhakoreng oobedi a mometso, o sa ntse o ka bula molomo wa gago ka bophara (menwana e meraro fa gare ga meno a gago a a kwa pele), mme uvula e nnye e e lepeletseng e lepeletse ka tlhamalalo kwa tlase mo bogareng jo bo siameng jwa mometso wa gago. Mo nthong ya peritonsillar, botlhoko le go ruruga di sutela thata kwa letlhakoreng le lengwe, motlhagare wa gago o a lotlega gore o kgone go bula molomo wa gago ka bothata (trismus), lentswe la gago le utlwala le thibetswe jaaka e kete o tshwere ditapole tse di bolelo mo molomong wa gago, mme magala a a boleta a a rurugileng fa godimo ga tonsil e le nngwe a kgoromeletsa upositadewaek ya gago kwa thoko go ya kwa upositadewaek notice.

Ke ka ntlha yang fa dibolayamegare tse di nowang ka molomo di sa kgone go alafa ntho ya peritonsillar kwantle ga gore ngaka e e ntshe metsi ka lemao kgotsa ka go sega go le gonnye?¶

Pele ga go nna le ntho (ka nako ya fa e sa ntse e le mo kgatong ya ntlha e e bidiwang peritonsillar cellulitis), madi a sa ntse a elela mo thishung e e rurugileng, ka jalo dibolayamegare le di- steroid tse di tsenngwang mo ditshikaneng di ka e alafa. Le fa go ntse jalo, fa go setse go bopilwe kgetsana e e thibetsweng ka lobota ya mamina a a metsi (ntho), ga go na ditshika tsa madi mo teng ga leroba la mamina tse di ka rwalang dibolayamegare tse di nowang ka molomo, mme mamina a a nang le asiti, a a senang okosejene a dira gore dibolayamegare di le dintsi di se ka tsa dira; go ntsha mamina ka mmele ka nalete e e disitsweng kgotsa ka go sega go le gonnye go imolola kgatelelo ka bonako, go emisa botlhoko le trismus, e bile go dira gore mamina a se ka a thunya mo mafatlheng a gago kgotsa mo molaleng o o kwa teng.

Ke ka ntlha yang fa go kgwa mathe le eleng madi a mannye fela a mahibidu a a phatsimang e le boemo jwa tshoganyetso jwa kalafi fa e le gore o na le ntho ya peritonsillar kgotsa e e tseneletseng mo molaleng kgotsa o sa tswa go nna le yone?¶

Mothapo wa ka fa teng wa carotid (mothapo o mogolo o o rwalang madi go tswa mo pelong ya gago go ya kwa bobokong jwa gago) o tsamaya mo thishung ya molala disentimetara di le 1 go ya go di le 2,5 fela kwa morago le kwa letlhakoreng la tonsil ya gago. Ka sewelo, tshwaetsego e e tseneletseng ya peritonsillar kgotsa ya parapharyngeal e ka gogogela mo leboteng la tshika ya carotid kgotsa mo dikaleng tsa yone, ya dira letshoroma le le bokoa le le bidiwang pseudoaneurysm; go kgwa madi a mannye a mahibidu a a galotseng e ka nna "madi a sentinel" a a tlhagisang gore tshika e tloga e thubega, e e tlhokang gore go dirwe CT angiogram ya molala ka bonako mo phaposing ya maemo a tshoganyetso.

Metswedi e tlhotlhomisitswe¶

• Sekolo sa Amerika sa Otolaryngology-Karo ya Tlhogo le Molala (AAO-HNS, United States): Kaelo ya Tiriso ya Kalafi: Go Kgaolwa ga Tonsille mo Baneng le go Laola Ntho ya Peritonsillar (ditshupo tsa go ntsha ka nale kgatlhanong le go sega le go ntsha metsi kgatlhanong le go ntsha metsi mo teng ga tshika le go ntsha metsi mo teng ga tshika, kalafi ya corticosteroid).
• Mokgatlho wa Malwetse a a Tshelanwang wa Amerika (IDSA, United States): Dikaelo tsa Tiriso tsa go Tlhatlhoba le go Laola Bolwetse jwa Mometso jwa Setlhopha sa A le Mathata a a Rurugang a mo Leganong (setlhogo sa ditshedinyana tse dintsi sa Streptococcus anginosus, setlhopha sa Streptococcus pyocosus, di-anaerobe tsa molomo tse di tlhagisang beta-lactamase Fusobabacterium le Prevotella, le dithulaganyo tsa go dirisa di-ampicil-sulbactam, seftriaxone mmogo le metronidazole, le clindamycin).
• Kholetšhe ya Amerika ya Dingaka tsa Maemo a Tshoganyetso (ACEP, United States): Pholisi ya Tleliniki le Dikaelo tsa Ultrasound ya Ntlha ya Tlhokomelo (POCUS) tsa Ultrasound ya Mo Molomong le ya mo Letlalong mo Nthong ya Letlalo (go farologanya bolwetse jwa sele jo bo sireletsang mo mpeng le jwa ntho ya ka fa teng, le 1.0 go ya go 1.5 cm thekeniki ya go tlhotlheletsa ka nale ya dipole tse di kwa godimo).
• Cochrane Database of Systematic Reviews: Go tlhotlhora ka nalete kgatlhanong le go sega le go ntsha metsi go alafa ntho ya mo mpeng le Di-Corticosteroid jaaka Kalafi e e thusang mo nthong ya mo mpeng (e e bontshang phokotsego e e bonalang ya botlhoko, trismus, le nako ya go metsa mo methapong e e oketsegileng ka go metsa).

Dikaedi tse di tsamaelanang¶

• Angina ya ga Ludwig: selulithi ya fa fatshe ga molomo e e amanang le matlhakore a mabedi le go gagamala ga thamo e e tshwanang le logong
• Ntho ya morago ga molomo mo baneng le mo bagolong, botlhoko jwa go atolosa molala, le mediastinitis
• Bolwetse jwa ga Lemierre: thrombophlebitis e e tswang mo tshikeng ya mo teng ga molaleng morago ga mometso o o botlhoko
• Go dutla madi morago ga go kgaolwa ga ditonsi: letsatsi la bo 5 go ya go la bo 10 go tlhotlhorega ga eschar le go tlhaola ditsela tsa mowa
• Epiglottitis, go tlhotlhorega, go tlhotlhorega, le go thibana go go tseneletseng ga tsela e e kwa godimo ya mowa