Diffuse phlegmon of the pharynx (Senator's disease): causes, symptoms, diagnosis, treatment

Diffuse phlegmon of the pharynx (Senator's disease) is a disease that occurs extremely rarely. It is characterized by a sudden violent onset with pronounced dysphagia, diffuse hyperemia, edema and inflammatory infiltrate of all the walls of the pharynx. With this form of phlegmon of the pharynx, a clearly limited abscess does not occur. The presence of anaerobes gives the inflammatory process the character of a diffusely developing gangrene of all layers of the pharynx. It is described as a complication of measles and scarlet fever in their malignant course, as well as a pharyngeal manifestation of noma. Diffuse phlegmon of the pharynx in the overwhelming majority of cases, despite the use of the most modern treatment, leads to death.

Periamygdalitis of the lingual tonsil is a rare disease, the cause of which may be inflammation of any solitary lymphadenoid tissue of the pharynx or trauma to the lingual tonsil by a foreign body. Sometimes this form of inflammation occurs after diathermocoagulation of the lingual tonsil, performed in case of its hypertrophy. Often the cause of perimygdalitis of the lingual tonsil may be hypertrophy of the lingual tonsil, which comes into contact with swallowed dense food objects and is gradually injured by them.

Pathological anatomy. The first stage of the disease is characterized by catarrhal inflammation of the mucous membrane of the lingual tonsil, against the background of which individual suppurating follicles appear.

The inflammatory process then spreads to the submucosal layer, resulting in periamygdalitis of the lingual tonsil, in which the infection spreads to the entire glosso-epiglottic space. In the vast majority of cases, the inflammatory process is limited to one of the halves of the lingual tonsil, which is due to the presence of the median glosso-epiglottic ligament, which prevents the spread of infection to the entire parenchyma of the tonsil. Above, the hyoid-epiglottic membrane prevents the spread of infection to the thyrohyoid-epiglottic space; the lateral glosso-epiglottic fold prevents the penetration of infection in the lateral direction. Thus, the topographic-anatomical conditions of the lingual tonsil are such that the infection can only spread posteriorly, in the direction of the epiglottis and the vestibule of the larynx. This creates a certain danger for the respiratory function of the larynx, since its swelling, and sometimes inflammation of the lymphoid tissue contained in it, especially rich in the ventricles of the larynx and the folds of the vestibule, can lead to rapid obstruction of the respiratory slit and asphyxia.

Symptoms and clinical course of diffuse phlegmon of the pharynx. Usually, perimygdalitis of the lingual tonsil occurs 2-3 days after the onset of a common sore throat or simultaneously with it. There is pain when swallowing, sticking out the tongue, dysphagia and dysarthria, a feeling of a foreign body in the lower part of the pharynx. The pathognomonic symptom for perimygdalitis of the lingual tonsil is spontaneous pulsating pain in the PC area, which sharply increases when pressing on it. Often these pains radiate to the ear. Swallowing saliva and liquid food gradually becomes difficult and at the height of the disease becomes almost impossible. When the edema spreads to the epiglottis and vestibular folds, signs of laryngeal obstruction and suffocation occur. Body temperature reaches 39 ° C, in the blood - moderate signs of an inflammatory reaction.

Pharyngoscopy may reveal signs of a primary pharyngeal disease that caused periamigdalitis of the lingual tonsil. Pressing the root of the tongue with a spatula causes unbearable pain, another pathognomonic sign of the disease in question. In the area of the lingual tonsil, a sharply hyperemic swelling is determined, slightly shifted to the side from the midline, which partially or completely hides the epiglottis from examination. In some cases, the infiltrate overlaps the lateral edge of the tongue, extending beyond it. In rare cases, bilateral damage to the lingual tonsil occurs, in which two symmetrically located infiltrates are observed, separated by the medial lingual-epiglottic ligament. The parajugular regional lymph nodes are enlarged and painful on palpation.

[ 1 ]