HA ch.16

Cleft Palate

A congenital defect, the failure of fusion of the maxillary processes. Wide variation occurs in the extent of cleft formation, from upper lip only, palate only, uvula only, to cleft of the nostril and the hard and soft palates.

Acute Tonsillitis and Pharyngitis

Bright red throat; swollen tonsils; white or yellow exudate on tonsils and pharynx; swollen uvula; and enlarged, tender anterior cervical and tonsillar nodes. Accompanied by severe sore throat, painful swallowing, fever >101° F of sudden onset. Bacterial infections may have absence of cough. With severe symptoms (listed above) or sore throat lasting >3-5 days, consider streptococcal infection and confirm with rapid antigen testing or throat culture. Treat positive tests with antibiotics. Untreated GAS pharyngitis may produce peritonsillar abscess, lymphadenitis, or acute rheumatic fever (although this is now rare in the United States).

Oral Kaposi Sarcoma

Bruiselike, dark red or violet, confluent macule, usually on the hard palate, may be on soft palate or gingival margin. Oral lesions may be among the earliest lesions to develop with AIDS.

Bifid Uvula

The uvula looks partly severed and may indicate a submucous cleft palate, which feels like a notch at the junction of the hard and soft palates. This may affect speech development because it prevents necessary air trapping. The incidence is more common in American Indians.

Peritonsillar Abscess

Untreated acute pharyngitis may cause suppurative complications, peritonsillar abscess, or suppurative thrombophlebitis. Thrombophlebitis is Lemierre syndrome caused by the gram-negative Fusobacterium necrophorum. This microbe occurs as often as streptococcal pharyngitis in adolescents and young adults. In this age-group, the two major red flags with this pharyngitis are worsening symptoms or neck swelling.4,25