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Full text of "Diseases Of The Nose Throat And Ear"

CHAPTER 24
MISCELLANEOUS PHARYNGEAL DISORDERS

CONGENITAL ABNORMALITIES

Congenital abnormalities of the uvula and palate are the most common
anomalies found. Bifid uvula is perhaps the most frequent disorder. The
uvula may be split at its tip or may be cleft in its whole length. A further
extension of this is the submucous cleft of the palate, and the ultimate
deformity is a complete cleft of the palate. A bifid uvula is of no significance,
except that it should warn the surgeon of the possibility of a coexisting
submucosal cleft of the palate. This results in insufficient closure of the
nasopharynx during phonation with hyperrhinophonia. Should removal
of adenoids be required in a child with a bifid uvula it would be wise to
test the efficiency of the soft palate in closing the nasopharynx. If the
palate is insufficient, a modified adenoid removal should be performed
(p. 134).

Congenital abnormalities of the palatine arches are rarely seen and are
usually associated with abnormalities or absence of one or both tonsils. When
the tonsil is congenitally absent the space between the palatine pillars contains
a few nodules of lymphoid tissue. A congenital perforation of the palato-
glossal arch may be found, but is of no significance. A congenitally short soft
palate is sometimes found without any cleft. Such children have an increased
distance between the ear and the point of the chin, and show nasal escape on
speech due to lack of closure of the nasopharynx. This must be discovered
before any operation on the adenoids is contemplated, because this merely
aggravates the difficulty in phonation. Some form of plastic closure of the
nasopharynx may be required.                                                              ^

CYSTS OF THE PHARYNX

Thyroglossal cyst arises from the thyroglossal duct which extends from the
foramen caecum on the dorsum of the tongue to the thyroid gland. A cyst
may occur anywhere along this duct, but is most common in the neck, where
it forms a midline swelling. It rarely presents as a. fistula in the midline at the
level of the cricoid cartilage, and from the fistula a leakage of mucus may
occur. The treatment is surgical excision.

Branchial cyst arises from persistence of the first or second branchial arch.
It is usually found in childhood as a swelling postero-inferior to the angle of
the mandible, partially covered by the sternomastoid muscle. It is removed
surgically. A branchial fistula is rare and opens by a slit-like aperture either
below the angle of the mandible or on the anterior border of the sterno-
mastoid muscle, often near its lower end. It has a long track reaching up

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