KANTHAGAT ROG SANKHYA SAMPRAPTI VA GILAYU NIDAN AVAM CHIKITSA

- Deepali Waghmare Final year B.A.M.S.

(2012)

१) आचाय सू ुत अनूसार स तदश क ठरोग- क ठगता तु - रोह यः पंच, ठशालुकं, अ धिज हो, वलयो, बलास, एकवृंदो, वृ दः, शत नी, गलायुः, गल व धीः, गलौघः, वर नो, मांसतानो, वदार चे त. - सु. न. १६/४६

KANTHAGAT ROG SANKHYA SAMPRAPTI

२) आचाय वा भट अनुसार अ टदश ठरोग - गळे वातरो हणी, प रो हणी, कफरो हणी, र तरो हणी, सि नपातरो हणी, शालूक, वृ द, तु डीकेर , गळौघ, वलय, गलायुक, शत नी, गळ व धी, गळाबुद, पवनग गंड, ले मग गंड, मेदोग गंड, वरा या अ टादश रोगा भवि त. - इंद ूट का पान १८३

३) आचाय चरक यांनी क ठगत रोग वेगळे न सांगता संपूण मुखगत ६४ रोगांचे वातज, प ज, कफज व सि नपा तक कार केले आहे. परंतु च.सु. १८- शोथीय अ याय याम ये गल ह नावचा याधी वणन केला आहे.

गलायु

हेतू - म यमा हषवराह प शतामकमूलकं, माषसूपद ध ीरसु ते ुरसफा णतं, अवाक श यां च भजतो वषतो द तधावनं, धूम छदनग डूषानु चतं च सरा यधं. - वा.उ.२१/१,२.

च क सा -अ) आचाय वा भट अनुसार - त व च वृ दशालूक तु डीकेर गलायुषु. - वा.उ. २२/६३१) वेदन - था नक व सावदै हक.२)लेखन - वेदनो र.

३) तसारण - कटु वगातील य यामधे गहृधूम, फला, सधव मसळून तसारण करावे.

४)गंडूष - कटु वगातील यां या वाथ याने गंडूष.५)कवल - वेता, वडगं, दंती, सधव यांनी स ध तैलानी कवल.६)न य - कवल य, अपामाग, न बप , जातीप , यांनी स ध तैलानी न य

ब) आचाय सु ुत अनुसार - गलायू चापी यो या ध तं च श णे साधयेत. सु. च. २२/६६.

TONSILLITIS

Tonsil are nothing but mass of Lymphoid tissue. They can be best presented in Waldeyer’s ring which is scattered throughout the pharynx in its subepithelial layer consisting of -1) Nasopharyngeal tonsil or Adenoids2) Palatine tonsils or simply tonsils3) Lingual tonsil4) Tubal tonsils

NORMAL PALATINE TONSILS

Palatine Tonsils

(A) Acute Palatine Tonsillitis : Aetiology - Following bacteria can infect tonsil primarily or secondary to viral infection.1) Haemolytic Streptococcus2) Staphylococci3) Pneumococci4)Haemophilus influenzae

Treatment -1) Patient is encouraged to rest in bed and have plenty of fluid.2) Analgesic like aspirin or paracetamol.3) Antimicrobial therapy -a)penicillin V Children dose - 125-250 mg orally every 6 hourly for 10 daysAdults dose - 500 mg orally every 6 hourly for 10 days.

b)In case of penicillin allergy or resistance Erythromycin is given. Adult dose - 250-500 mg orally, 6 hourly for 7 to 10 days.Children dose - 60 mg/kg body weight orally QDS for 7 to 10 days.4) Gargle with lukewarm water and salt 4-5 times per day.

(B) Chronic Palatine Tonsillitis :

Aetiology -1)Complication of acute tonsillitis.2)Subclinical infections of tonsils without an acute attack.3)Chronic infection in sinuses or teeth may be a predisposing factor.

Chronic tonsillitis causing Hypertrophy of tonsils.

Treatment -1) Conservative treatment - a) attention to general health b) diet c) treatment of coexistent infection of teeth, nose and sinuses.2) Tonsillectomy.

Tonsillectomy

Indications:(A) Absolute indications -1) Recurrent infection of throat : (a) 7 or more episodes in 1 year OR (b) 5 episodes per year for 2 years OR (c)3 episodes per year for 3 years OR (d) 2 weeks or more lost of school/work in 1 year.

2) Peritonsillar abscess.3) Tonsillitis causing febrile seizures.4) Hypertrophy of tonsils causing - (a) airway obstruction. (b) difficulty in deglutition. (c ) interference with speech.5) Suspicion of Malignancy.

(B) Relative indications - (1) Diphtheria carriers. (2) Staphylococcal carriers. (3) Chronic tonsillitis with halitosis. (4) Recurrent streptococcal tonsillitis in a patient with Valvular Heart disease.

( C) As a part of related surgery - 1) Palatopharyngoplasty for sleep apnoea. 2) Glossopharyngeal neurectomy. 3) Removal of styloid process.

Contraindications :1) Hb less than 10 g %.2) Presence of acute URTI, even in acute tonsillitis.

e.

3) Children under 3 yrs of age.4) Over or submucous cleft palate.5) Bleeding disorder. eg: aplastic anaemia. Haemophilia, purpura. 6) Epidemic of polio.7) Uncontrolled systemic disease. eg: Diabetes, cardiac disease, HTN.8) During menses.

Techniques of tonsillectomy/tonsillotomy:(A) Cold methods -1) Dissection and Snare (most common)2) Guillotine method3) Intracapsular with debrider4) Harmonic scalpel5) Plasma mediated ablation technique6) Cyrosurgical technique.

(B) Hot methods -1) Electrocautery2) Laser tonsillectomy or tonsillotomy 3) Coblation tonsillectomy4) Radiofrequency

Surgical procedure :( Dissection and snare method )- surgery is usually done under G.A. and in Rose’s position.- Boyle-Davis mouth gag is introduced and opened and held in place by Draffin’s bipods.- Tonsil is grasped with tonsil holding forceps and pulled medially- Incision is made in mucous membrane reflecting from tonsil to anterior pillar.

- Blunt curved scissor is used to dissect tonsil from peritonsillar tissue and separate its upper pole.- Now tonsil is held by its upper pole and traction is applied downwards and medially, dissection is continued until lower pole is reached.- Now wire loop of tonsillar snare is threaded over tonsil on to its pedicle, tightened, and pedicle is cut and tonsil is removed.

- A gauze sponge is placed in the fossa and pressure is applied for few minutes- Bleeding points are tied by silk. Same procedure is done on other side.- In post operative care vital signs are monitored with watch on bleeding from nose, mouth or both.- Patient is usually sent home after 24 hrs with oral hygiene and diet instructions if there is no complication.

Complications : (A) Immediate -1) Primary haemorrhage (during surgery)2) Reactionary Haemorrhage (within 24 hrs)3) Injury to tonsillar pillars, uvula, soft palate, tongue or superior constrictor muscle4) Injury to teeth5) Aspiration of blood6) Facial oedema, particularly of eyelids7) Surgical emphysema

(B) Delayed -1) Secondary haemorrhage2) Infection3) Lung complication4) Scarring in soft palate and pillars5) Hypertrophy of lingual tonsils6) Tonsillar remnants- Sometimes lymphoid tissue is left in plica triangularis which later gets hypertrophied therefore should be removed during tonsillectomy.

THANK YOU