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2.  Annular arrangement of lymphoid tissue in
the pharynx
 Circumscribes the nasopharyx and the
oropharyx
 Constituents: (superior to inferior)
a) nasopharygeal tonsils
b) tubal tonsils
c) palatine tonsil
d) lingual tonsil

4.  Also called “faucial” tonsil
 Two in number, lying in the tonsilar fossa in
the lateral wall of the oropharynx
 Extends upwards into the soft palate
 Downward into the base of tongue
 Anteriorly into the palatoglossal arch
 Two pillars, two surfaces, two poles
 Anterior pillar- palatoglossal arch
 Posterior pillar – palatophargeal arch

5. ANTERIOR
PILLAR
POSTERIOR
PILLAR

6.  Medial surface of tonsil – nonkeratinized
stratified squamous epithelium – which dips
into the substance to form 12-15 crypts –
openings on the surface
 The largest – crypta magna or intratonsillar
cleft- ventral part of 2nd pharyngeal pouch –
seperates upper pole from the tonsillar body
 Lateral surface of tonsil – well defined fibrous
capsule – seperates tonsil from its bed

7.  Tonsillar bed :
superior constrictor muscle
styloglossus muscle
glossopharyngeal nerve
buccopharygeal fascia
 Between capsule and the tonsillar bed is a
layer of loose areolar fat

8.  5 arteries
 Facial artery
 Ascending pharyngeal artery – external
carotid
 Dorsal lingual branches – lingual artery
 Descending palatine branch – maxillary artery
TONSILLAR BRANCH
Ascending palatine

9.  Veins ---- paratonsillar vein----common facial
vein----pharyngeal venous plexus
 Lymphatics---no afferents---efferents(pierce the
superior constrictor)---upper deep cervical nodes
especially the jugulodigastic (tonsillar) nodes
located below the angle of mandible
 Nerve supply – lesser palatine branches of
sphenopalatine ganglion and glossopharyngeal
nerve provide sensory supply

10.  Divided into two:
 ACUTE and CHRONIC

11.  The tonsil consists of
i) surface epithelium which is continuous
with the oropharyngeal lining
ii) crypts- invaginations of the surface
epithelium
iii) lymphoid tissue

12.  as part of general pharyngitis, usually in viral
infections

13.  infection spreads into the crypts – filled with purulent
material – yellowish spots at the openings

14.  uniformly enlarged and erythematous with exudates, edema of uvula and
soft palate

15.  exudation from crypts coalesces to form a membrane on
the surface

16.  Most commonly seen in school-going
children
 Rare in infants and elderly
 Haemolytic streptococcus is most common
 Others: staph, pneumococci, H.influenzae
 Can be primary or secondary to a viral

17.  Sore throat
 Difficulty in swallowing
 Fever
 Earache
 Constitutional symptoms : headache,
myalgia, malaise, constipation

18.  Breath is foetid, tongue coasted
 Hyperaemia of pillars, soft palate, uvula
 Tonsils appear red and enlarged (purulent,
parachymatous, membranous – the
membrane can be easily wiped away with a
swab)
 Jugulodigastic nodes are enlarged and tender

19.  Bed rest and fluids
 Analgesics – aspirin or paracetamol according
to age- to relieve local pain and bring down
fever
 Antibiotics- for 7 to 10 days- penicillin is the
drug of choice- if allergic, erthyromycin

20.  Chronic tonsillitis : due to incomplete resolution of
acute attacks; may persist in lymphoid follicles
forming microabscesses
 Peritonsillar abscess
 Parapharygeal abscess
 Cervical abscess : suppuration of jugulodigastic lymph
nodes
 Acute otitis media
 Rheumatic fever
 Acute glomerulonephritis
 Subacute bacterial endocarditis: mostly due to
viridans, infection in people with valvular heart
disease

21.  Diphtheria
 Vincent angina
 Infectious mononucleosis
 Agranulocytosis
 Leukaemia
 Aphthous ulcers
 Malignancy of tonsil
 Candidal infection of tonsil
 Traumatic ulcer

22.  Complication of acute attacks : pathologically
microabscess walled off by fibrous tissue is
seen in the lymphoid follicles of the tonsils
 Subclinical infections of tonsils without an
acute attack
 Chronic infections of sinuses or teeth can be
predisposing
 Usually occurs in children and young adults,
rarely in elderly

23.  Chronic follicular tonsillitis: tonsillar crpypts
with cheesy infected material – yellow spots
 Chronic parenchymatous tonsillitis :
hyperplasia of the lymphoid tissue of tonsil,
profound enlargement, obstructive
symptoms
 Chronic fibroid tonsillitis: small but infected,
history of repeated sore throats

24.  Recurrent attacks of sore throat or acute
tonsillitis
 Bad breath/ hallitosis due to puss in throat
 Chronic irritation in throat in cough
 Obstructive symptoms: thick speech,
difficulty swallowing, choking spells and sleep
apnoea

26.  chronic parenchymatous type
 Chronic follicular type
 Small tonsils, pressure on anterior pillar
expesses frank pus or cheesy material –
chronic fibroid
 Flushing of anterior pillars compared to the
rest of the pharyngeal mucosa
 Enlargement and tenderness of
jugulodigastic lymph nodes

27.  Chronic sore throat
 Malodorous breath
 Peritonsillar erythema
 Persistent cervical lymphadenopathy
 Presence of tonsillotiths

28.  Attention to general health, diet, treatment of
coexistent infection of teeth, nose and sinuses
 Tonsillectomy
absolute indictations:
i) 7 or more episodes in one year, 5 py for 2, 3 py
for 3, 2 wks or more of lost school or work in 1year
ii) peritonsillar abscess: 4-6 wks after treatment,
two attacks in adults
iii) tonsillitis causing febrile seizes
iv) hypertrophy of tonsils
v) suspicion of malignancy

29.  Peritonsillar abscess
 Parapharyngeal abscess
 Intratonsillar abscess
 usually follows acute follicular
 red and swollen, pain and dysphagia
 Tonsilloliths
cypyt is blocked with the retention of debris
inorganic salts of ca, mg are deposited to form a
calculus/stone, may ulcerate through the surface
local discomfort/foreign body sensation
felt on palpation or gritty feeling on probing
 Tonsillar cyst
 yellowish swelling over tonsil due to blockage
 Focus of infection in rheumatic fever, acute
glomerulonephritis, eye and skin disorders