Tonsil anatomy and acute tonsil

Acute Tonsil

1. TONSIL E.N.T TUTORIAL REPRESENTATION BY :- SAURABH RANJAN BATCH:-(15-16)

2. ANATOMY OF PALATINE TONSIL Palatine tonsile are 2 in number. Tonsils are large lymphoid tissue. S ituated in the lateral wall of the oropharynx between the anterior and posterior pillars . They form lateral part of the Waldeyer's ring .

3. Tonsil has two surfaces 1.Medial 2.Lateral Two poles 1.upper 2.lower two developmental folds 1 . plica triangulris 2.plica semilumris one cleft Intratonsillar cleft

4. Medial surface It is covered by non- keratinising startified squamous epithelium Opening of 12-15 crypts usually plugged with Epithelial cell B acteria Food Debris

5. Lateral surface It present well defined fibrous capsule. It is also the site for collection of pus in peritonsillar abscess. Fibre of palatoglossus and palatopharyngeus muscle are attached to the capsule of the tonsil.

6. Upper pole It extends into soft palate Its medial surface is covered by a semilunar fold , extending b/w anterior and posterior pillars and enclosing a potential space called supratonsillar fossa

7. Lower pole It is attached to the tongue. A triangular fold of mucous membrane extend from anterior pillar to the anterioinferior part of tonsil and encloses a space called anterior tonsillar space.

8. Bed of the tonsil It is formed by the superior constrictor and styloglossus muscle The glossopharyngael nerve and styloid process , if enlarged , may lie in relation to the lower part of tonsillar fossa Outside the superior constrictor , tonsil is related to the facial artery, submandibular salivary gland, posterior belly of digastric muscle medial pterygoid muscle and the angle of mandible

9. Blood Supply of tonsil Tonsillar branch of facial artery.It is the main branch Ascending pharyngeal artery from external carotid Ascending palatine branch of facial artery Dorsal lingual branches of lingual artery Descending palatine branch of maxillary artery

10. Venous drainage Veins from the tonsils drain into paratonsillar vein It joins the common facial vein and pharyngeal venous plexus

11. Lymphatic drainage Lymphatics from the tonsil pierce the superior constrictor and drain into upper deep cervical nodes particularly the jugulodigastric node situated below the angle of mandible.

12. Nerve supply Lesser paltine branches of sphenopalatine ganglion(CN V) Glossopharyngeal nerve provide sensory nerve supply

13. Function of tonsils Lymphoid masses of waldeyer’s ring, palatine tonsil have a protective role It act as sentinels at the portal of air and food passage The crypts in tonsils increase the surface area for contact with foreign substances

14. Acute tonsillitis Mainly a disease of childhood but is also seen in adults Acute infections of tonsil are classified as 1. Acute catarrhal or superficial tonsillitis - mostly seen in viral infection. 2. Acute follicular tonsillitis- infection spread into the crypts and it filled with purulent material, presenting at the opening of crypts as yellowish pots

15. 3. Acute parenchymatous tonsillitis – tonsil is uniformly enlarged and red. 4. Acute membranous tonsillitis- it is a stage when exudation from the crypts coalesces to form a mambrane on the surface of tonsil

16. aetiology Haemolytic streptococcus is the most common infecting organism Others like….. staphylococci Pneumocci H. influenzae

17. symptoms Sore throat Difficulty in swallowing Fever it vary from 38◦ to 40◦ C Earche Constitutional symptoms :- headache General body ache Malaise constipation

18. signs Breath is foetid and tongue is coasted. Hyperaemia of pillars, soft palate and uvula Tonsil are red and swollen with yellowish spots of purulent material presenting at the opening of crypts Jugulodigastric lymph node are enlarged and tender

19. Treatment Patient is put to bed and encouraged to take plenty of fluids Analgesic (aspirin , paracetamol ) are given according to the age of the patient to relieve local pain and down the fever. Anti microbial therapy- infection are due to streptococcus , and penicillin is the drug of choice patients allergic to pencillin can be treated with erythomycin . Antibiotics should be continued for 7-10 days

20. complications Chronic tonsillitis with recurrent acute attacks Peritonsillar abscess Parapharyngeal abscess Cervical abscess Acute otitis media Rheumatic fever Acute glomerulonephritis Subacute bacterial endocarditis due to streptococcus viridian infection.

21. T hankuuuuuuuuuuu Thanku