applied anatomy and diseases of tonsil

palatine tonsil

1. APPLIED ANATOMY AND DISEASES OF TONSILS BRINDYA. S Roll no:31

2. APPLIED ANATOMY Ovoid mass of lymphoid tissue situated in lateral wall of oropharynx between anterior & posterior pillars . Extends upwards into the soft palate, downwards into base of tongue, anteriorly into the palatoglossal aech It has two surfaces Medial surface Latera l surface It has two poles Upper pole Lower pole

3. Surfaces Medial surface: Covered by nonkeratinised stratified squamous epithelium which dips into the substance in the form of crypts primary& secondary crypts Crypta magna or intratonsillar cleft Crypts may be filled with cheesy material containing ep cells, bacteria & food debris. Lateral surface: Well defined fibrous capsule Tonsillar bed is separated from fibrous capsule by loose areolar tissue-plane of tonsillectomy & site of collection of pus in peritonsillar abscess

4. P oles Upper pole : Extends into soft palate.Its medial surface is covered by semilunar fold Lower pole: A ttached to tongue.Tonsil is separated from tongue by tonsillolingual sulcus which may be the seat of carcinoma

5. Relations

6. Blood supply and V enous drainage Venous drainage is into paratonsilar vein which joins the common fascial vein and pharyngeal venous plexus

7. Lymphatic drainage : jugulodigastric / tonsillar node Nerve supply : lesser palatine branches of sphenopalatine ganglion and glossopharyngeal nerve Functions: Providing local immunity Providing a surveillance mechanism so that entire body is prepared for defence

8. CLINICAL CORRELATION Paritonsillar space is the plane along which tonsil is removed during tonsillectomy. The paratonsillar vein that passes through this space is often a source of postoperative bleeding. In chronic tonsillitis , pus accumulate in the peritonsillar space leading to the formation of peritonsillar abscess. The arteries in lateral relation to tonsil are in danger of injury while removing a tonsil that is adherent to its bed. Injury or compression of glossopharyngeal nerve due to tonsillectomy result in complete loss of sensation on posterior one third of tongue.

9. ACUTE TONSILLITIS Acute infection of tonsils involving surface epithelium,crypts and lymphoid tissue 4 types 1.Acute catarrhal or superficial tonsillitis : here tonsillitis is a part of generalised pharyngitis and is mostly seen in viral infections 2.Acute follicular tonsillitis : infection spread into crypts which become filled with purulent material presenting at the opening of crypts as yellowish spots

10. 3.Acute parenchymatous tonsillitis : tonsil substance is affected.Tonsil is uniformly enlarged and red 4.Acute membraneous tonsillitis : follows acute follicular tonsillitis.Exudation from the crypts coalesces to form a membrane on the surface of tonsil Aetiology Mainly a disease of childhood but also seen in adults Occur primarily as bacterial infection -Haemolytic streptococcus ,staphylococci,pneumococci, H.influenzae secondarily as a result of viral infection

11. Symptoms: Sore throat Difficulty in swallowing Fever Ear ache Constitutional symptoms-headache, bodyache , malaise, constipation Signs: Breath is foetid Hyperaemia of pillars, soft palate & uvula

12. Tonsils are red and swollen with yellowish spots-a/c follicular A whitish membrane on medial surface -a/c membraneous Tonsils may be enlarged & congested so much so that they meet in the midline –a/c parenchymal Jugulodigastric lymph nodes are enlarged and tender

13. T reatment: Patient is put to bed & encouraged to take plenty of fluids Analgesics-Aspirin or Paracetamol Antimicrobial therapy- Penicillin,Erythromycin Complications : 1.Chronic tonsillitis 5.Acute otitis media 2.Peritonsillar abscess 6.Rheumatic fever 3.Parapharyngeal abscess 7.a/c glomerulonephritis 4.Cervical abscess 8.subacute bact endocarditis

14. Differential diagnosis of membrane over the tonsil Membraneous tonsillitis Diphtheria Vincent angina Infectious mononucleosis Agranulocytosis Leukemia Aphthous ulcer malignancy tonsil Traumatic ulcer Candidal infection of tonsil

15. FAUCIAL DIPHTHERIA Aetiology: Acute infection caused by C.diphtheria Spreads by droplet infection Clinical features: Children are more affected A greyish white membrane forms over the tonsils and spreads to the soft palate and posterior pharyngeal wall Jugulodigastric node enlarged and tender-bull neck appearance

16. Complications : Myocarditis,cardiac arrhythmias,acute circulatory failure caused by exotoxin Neurological complications-paralysis of soft palate,diaphragm & ocular muscles Airway obstruction Treatment : Antitoxin Antibiotics-Benzyl penicillin 600mg 6hrly for 7days & Erythromycin 500mg 6hrly orally for Penicillin sensitive individuals

17. CHRONIC TONSILLITIS Aetiology : Subclinical infections of tonsils without an acute attack Mostly affect children & young adults Types : Chronic follicular tonsillitis – Crypts are full of infected cheesy material Chronic parenchymatous tonsillitis – Hyperplasia of lymphoid tissue.Tonsils are very much enlarged &may interfere with speech , deglutition , respiration Chronic fibroid tonsillitis – Tonsils are small but infected with h/o repeated sore throats.

18. Clinical features : Recurrent attacks of sore throat Chronic irritation in throat with cough Bad taste in mouth & foul breath (halitosis) Thick speech , difficulty in swallowing Examination Varying degree of enlargement .Sometimes meet in midline – c/c parenchymatous Yellowish beads of pus – c/c follicular Flushing of anterior pillar Enlargement of jugulodigastric lymph nodes

19. Treatment Conservative treatment – general health , diet , treatment of coexistent infection of teeth , nose & sinus Tonsillectomy Complications Peritonsillar abscess Parapharyngeal abscess Intratonsillar abscess Tonsilloliths – inorganic salts of Ca & Mg deposited leading to formation of stone Tonsillar cyst

20. DISEASES OF LINGUAL TONSILS Acute lingual tonsillitis – a/c infection of lingual tonsil give rise to u/l dysphagia & feeling of lump in the throat.Lingual tonsil enlarged , studded with follicles. Cervical lymph nodes may be enlarged Treatment – Antibiotics Hypertrophy of lingual tonsils – discomfort on swallowing , feeling of lump in the throat, dry cough, thick voice . Lingual tonsils enlarged , associated with dialated veins Treatment – Conservative , excision of lingual tonsil

21. Abscess of lingual tonsil Symptoms – u/l dysphagia , pain in the tongue , excessive salivation , some degree of trismus . Jugulodigastric nodes enlarged & tender. Treatment – antibiotics , analgesics , proper hydration and incision & drainage of abscess.

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