2. • Definition
– Palatine tonsils are dense compact bodies of
lymphoid tissue located in the lateral wall of the
oropharynx, bounded by the palatoglossus muscle
anteriorly and the palatopharyngeus and superior
constrictor muscles posteriorly and laterally
6. Relations of tonsillar bed (Inside out)
1. Tonsillar capsule
2. Peritonsillar space with paratonsillar vein
3. Pharyngobasilar fascia , Superior constrictor muscle,
Bucco-pharyngeal fascia
4. Styloid process, muscles, glossopharyngeal nerve
5. Internal carotid artery, tonsillar artery
6. Medial pterygoid, submandibular salivary gland
7. Mandible
7. Differences between tonsils and lymph node
Tonsils Lymph Nodes
Subepithelial Connective Tissue
Partly encapsulated Fully encapsulated
Efferent only Afferent + Efferent
Crypts present Absent
No cortex or medulla Present
Growth curve present Absent
8. Differences between adenoids and Tonsils
Adenoids Tonsils
Ciliated columnar
epithelium
Non-keratinizing
squamous epithelium
No capsule Partly encapsulated
Has furrows Has crypts
Peak growth : 6 yrs 8 yrs
Growth stops at 12 yrs 15 yrs
Disappears at 20 yrs Partial regression at 18 yrs
9. Acute tonsillitis
• Superficial / catarrhal: as a part of generalized
pharyngitis
• Follicular: Crypts filled with pus, visible as yellow-
white dots
• Membranous: Multiple follicles join to form a
yellow-white membrane
• Parenchymatous: Infection of lymphoid
parenchyma
14. Types of chronic tonsillitis
• Follicular: crypts filled with pus, visible as yellow-
white dots
• Parenchymatous: infection of lymphoid parenchyma
tonsil enlargement
• Fibrotic: small tonsil with hidden pus inside,
expressed by pressure on anterior tonsillar pillar
(tonsillar squeeze)
16. Signs of tonsillitis
• Congested tonsil and tonsillar pillars
• Enlarged tonsil (except chronic fibrotic type)
• Tonsil squeezed by tongue depressor pressing on
anterior tonsillar pillar pus comes out in chronic
fibrotic tonsillitis (Irwin Moore sign)
• Jugulo-digastric lymph node enlarged ( tender in
acute tonsillitis)
28. Treatment of faucial diphtheria
• Isolation and bed rest
• I.V. benzyl penicillin 600 mg q6h
• Diphtheritic anti - toxin infusion in saline
– 20,000 – 40,000 U : 48 hrs duration, tonsillar
– 40,000 – 80,000 U : nasopharynx / larynx
– 80,000 – 120,000 U : 48 hrs, neck edema
• Emergency tracheostomy required for stridor
29. Tonsillolith and Tonsillar cyst
Recurrent tonsillitis / retention of debris
Blockage of tonsillar crypts
pus and debris
calcify
yellow colored
inclusion cyst
Tonsillolith tonsillar cyst
30. Tonsillolith and Tonsillar cyst contd…...
• Clinical features
– Halitosis, bitter taste in mouth
– White outgrowths from tonsillar crypts or yellow
cyst in supra-tonsillar cleft
• Treatment
– Asymptomatic drainage of cyst or manual
expression of tonsillolith
– Severe symptoms tonsillectomy
31. Keratosis pharyngis
• Benign , self limiting condition
• Etiology : Smoking, alcohol, vitamin
A deficiency
• O/E:
– Yellowish, horn-like outgrowths
from mucosa of tonsil that cannot
be wiped off
• Histopathology :
– Hypertrophy and
hyperkeratinization of epithelium
– Absence of inflammation
• Treatment:
– Reassurance
– Tonsillectomy in severe cases