Diffuse pharyngeal cellulitis (Senator's disease): causes, symptoms, diagnosis, treatment

Diffuse phlegmon pharynx (Senator's disease) is a disease that occurs extremely rarely. Characterized by a sudden violent onset with severe dysphagia, diffuse hyperemia, edema and inflammatory infiltration of all the walls of the pharynx. With this form of phlegmon pharynx, there is no distinctly limited abscess. The presence of anaerobes gives the inflammatory process the character of the diffusely developing gangrene of all layers of the pharynx. It is described as a complication of measles and scarlet fever in malignant course, and also as a pharyngeal manifestation of noma. Diffuse phlegmon pharynx in the vast majority of cases, despite the use of the most modern treatment, leads to death.

Periamigdalite of the lingual tonsil is a disease that occurs infrequently, which can be caused by inflammation of any solitary lymphadenoidia tissue of the pharynx or injury from the foreign body of the lingual tonsil. Sometimes this form of inflammation occurs after diathermocoagulation of the lingual tonsil produced during its hypertrophy. Often, the cause of periamigdalitis of the lingual tonsil may be hypertrophy of the lingual tonsil, which contacts the swallowed dense food objects and is gradually traumatized by them.

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

Then the inflammatory process extends to the submucosa, resulting in the development of the periamigdalitis of the lingual tonsil, in which the infection spreads over the entire lingual-epiglottial space. In the vast majority of cases, the inflammatory process is limited to one of the half lingual tonsils, which is due to the presence of the middle lingual-epiglottis ligament, which prevents the spread of infection to the entire parenchyma of the amygdala. Above the sublingual-epiglottis membrane prevents the spread of infection in the thyroglossal-epiglottis space; lateral lingual-epiglottis 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 spread only posteriorly, in the direction of the epiglottis and the threshold of the larynx. This creates a certain danger to the respiratory function of the larynx, since its edema, and sometimes the inflammation of the lymphoid tissue contained in it, especially the larynx rich in the ventricles and the folds of the vestibule, can lead to rapid obstruction of the respiratory cricle and asphyxiation.

Symptoms and clinical course of diffuse phlegmon pharynx. Usually, periamigdalitis of the lingual tonsil occurs 2-3 days after the beginning of banal angina or simultaneously with it. There are pains when swallowing, sticking out the tongue, dysphagia and dysarthria, the feeling of having a foreign body in the lower part of the pharynx. The pathognomonic symptom for the periamigdalitis of the lingual tonsil is spontaneous pulsating pain in the area of the PC, which is sharply increased when pressure is applied to it. Often these pains radiate into the ear. The ingestion of saliva and liquid food is gradually hampered and at the height of the disease becomes almost impossible. With the spread of edema on the epiglottis and vestibular folds, there are signs of obstruction of the larynx and suffocation. Body temperature reaches 39 ° C, in the blood - moderate signs of an inflammatory reaction.

With pharyngoscopy, signs of a primary pharynx disease that could cause periamigdalitis of the lingual tonsil can be determined. Pressing with a spatula on the root of the tongue causes unbearable pain - another pathognomonic sign of the disease under consideration. In the area of the lingual tonsil, a sharply hyperemic swelling is defined, somewhat offset from the midline, which partially or completely conceals the epiglottis from examination. In some cases, the infiltrate overlaps the lateral edge of the tongue, going beyond it. In rare cases, there is a bilateral lesion of the lingual tonsil, in which there are two symmetrically located infiltrates separated by a medial lingual-epiglottis ligament. Near-regional regional lymph nodes are enlarged and painful on palpation.

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