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Palatine tonsil
 

Palatine tonsil

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Palatine tonsil structure blood supply clinical importance

Palatine tonsil structure blood supply clinical importance

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    Palatine tonsil Palatine tonsil Presentation Transcript

    • LYMPHOID TISSUE 1. Primary – Thymus - Bone marrow 2. Secondary - lymph nodes, lymphoid follicles in tonsils, Peyer's patches, spleen, adenoids, skin, etc. 3. Tertiary - Distributed groups of lymphocytes Generate lymphocytes from Immature progenitor cells
    • Secondary or peripheral lymphoid organs maintain mature naive lymphocytes and initiate an adaptive immune response Theses are the sites of lymphocyte activation by antigen Activation leads to clonal expansion and affinity maturation Mature Lymphocytes recirculate between the blood and the peripheral lymphoid organs until they encounter their specific antigen GALT Gut associated lymphoid tissue MALT mucosa-associated lymphatic tissue; lymphoid tissue associated with the mucosa of the female reproductive tract, respiratory tract, etc SALT Skin associated - dermis of the skin
    • Precursor cells in the bone marrow produce lymphocytes. B-lymphocytes (B-cells) mature in the bone marrow. T-lymphocytes (T-cells) mature in the thymus gland. The ducts of the lymphatic system provide transportation for proteins, fats, and other substances in a medium called lymph. Lymph "Means clear water and it is basically the fluid and protein that has been squeezed out of the blood (i.e. blood plasma). "Unlike the cardiovascular system, the lymphatic system is not closed and has no central pump." "Lymph movement occurs despite low pressure due to peristalsis – smooth muscle and skeletal activity (everyday activity and motion of the body).
    • Nasopharynx Oropharynx Laryngopharynx Oesophagus Cricoid Fold by Levator palatini Salpingopharyngeal fold
    • Tensor veli palatini Levator veli palatini
    • The palatine tonsil is an ovoid mass of lymphoid tissue located in the oropharynx between the anterior and posterior pillars It has a 2 surfaces – medial and lateral and 2 poles – upper and lower
    • Medial surface It is lined by stratified squamous non keratinising epithelium which dips into the crypts The crypts are 12-15 in number Secondary crypts arise from the primary crypts and extend into the substance of the tonsil On of the crypts located in the upper part are larger than the rest – crypta magna It represents the ventral part of second pharyngeal pouch The crypts serve to increase the surface area of the tonsil The crypts may be filled witth cheesy material – epithelial debris, food particles and bacteria
    • Lateral surface It is covered by the fibrous capsule of the tonsil The tonsillar bed is separated from the capsule by loose areolar tissue This makes it is easy to dissect the tonsil from its bed during tonsillectomy It is the site of collection of pus in peritonsillar abscess (quinsy) Some fibers of palatoglossus and palatopharyngeus gets attached to capsule of tonsil
    • Bed of tonsil It is formed by the 2 muscles Superior constrictor Styloglossus
    • Tensor veli palitini Lavator veli palitini
    • Palatopharyngeus
    • Structures related to bed of tonsil The tonsil is separated from its bed by loose areolar tissue. The structures forming the bed of the tonsil are: Superior constrictor muscle Styloglossus muscle The structures related to the bed of the tonsil are: styloid process (if enlarged) glossopharyngeal nerve facial artery submandibular salivary gland posterior belly of digastric medial pterygoid muscle angle of mandible
    • PS: Palatine / External palatine / Paratonsillar vein
    • Upper pole It extends into the soft palate There is a semilunar fold of mucous membrane which covers the medial part of the upper pole It extends from anterior pillar to posterior pillar It encloses a potential space – supratonsillar fossa
    • Lower pole It is attached to the tongue A triangular fold of mucous membrane extends from the anterior tonsillar pillar to the lower pole It encloses a space – anterior tonsillar space The lower pole is separated from the tongue by the tonsillo-lingual sulcus This sulcus may harbour carcinoma
    • Blood supply The tonsil is supplied by branches of external carotid artery The tonsil is supplied by 5 arteries: Tonsillar branch of facial artery (main supply) Ascending palatine branch of facial artery Ascending pharyngeal branch of external carotid artery Dorsal linguae branch of lingual artery Descending palatine branch of maxillary artery
    • Blood supply from medial surface
    • Venous drainage Blood from the tonsil drains into the paratonsillar vein which in turn drains into the common facial vein and pharyngeal venous plexus
    • Lymphatic drainage Lymphatics from the tonsil pierce the superior constrictor and drain into the upper cervical lymph nodes especially jugulodigastric (tonsillar) lymph node Enlarged non tender jugulodigastric lymph node is a sign of chronic tonsillitis
    • Facial vein Omohyoid muscle Supraclavicular nodes Digastric muscle Internal Jugular vein Jugulo-omohyoid node JUGULO-DIGASTRIC NODE
    • Nerve supply Lesser palatine branch of sphenopalatine ganglion Glossopharyngeal nerve
    • Nerve supply Lesser palatine branch of sphenopalatine ganglion Glossopharyngeal nerve
    • Waldeyer’s lymaphatic ring
    • Functions of tonsil It has a protective function in that it prevents entry of pathogens through the nasal and oral route The crypts on the surface of the tonsil serve to increase the surface area and increase the efficiency of protection against pathogens It forms a part of Waldeyer’s lymphatic ring Applied anatomy Tonsils prevent infection. Infected tonsils act as septic focus Damage of paratonsillar vein during tonsillectomy leads to excessive venous haemorhhage Damage to glossopharygeal nerve leads to loss of taste sensation Infected tonsillar pain may be referred to middle ear because of Same nerve supply