The document discusses the anatomy, causes, symptoms, diagnosis and treatment of tonsillitis. It describes the anatomy of the palatine tonsils and their location in the oropharynx. Acute tonsillitis is usually caused by streptococcal or other bacterial infections and causes sore throat and fever in children and adults. Chronic tonsillitis can develop from repeated acute infections and causes long-term throat irritation. Treatment involves antibiotics for acute cases and tonsillectomy may be required for chronic or recurrent tonsillitis.

1. TONSILLITIS
Manisha Mistry

2. ANATOMYOF PALATINE
TONSIL
 Pairedstructuressituatedinlateralwallof
oropharynxbetweenanteriorandposterior
pillars
 Consistsof twosurfaces(medialandlateral)and
twopoles(upperand lower)
 Medialsurfaceiscoveredbynonkeratinizing
stratifiedsquamous epithelium
 Thereare12-15 cryptsonthemedialsurface
 Largestcryptiscalledcryptamagnaor
intratonsillar cleft

3. ANATOMYOF PALATINE
TONSIL
 Lateralsurfaceof tonsilpresentsawelldefined
fibrous capsule
 Looseareolartissueliesbetweenthetonsillar
bedandthecapsule,itisthesiteforcollectionof
pusinperitonsillarabscess(Quinsy)
 Upperpoleof tonsilextendsintosoftpalate,its
medialsurfaceiscoveredbysemilunarfold
plica semilunaris
 Lowerpoleof tonsilisattachedtothetongue,
triangularfoldof mucousmembraneextends
fromanteriorpillartoantero-inferiorpartof tonsil
enclosingplica triangularis
 Tonsilisseperatedfromthetonguebytonsilo-
lingual sulcus

4. ANATOMYOF PALATINE
TONSIL

5. TONSILLARBED
 Formedby
 Looseareolartissuecontainingparatonsillar
vein
 Pharyngo-basilar fascia
 Superiorconstrictor muscle
 Bucco-pharyngeal fascia
 Styloglossus
 Medialpterygoid muscle
 Glossopharyngeal nerve
 Facial artery

6. BLOODSUPPLYOF TONSIL

7. LYMPHATIC DRAINAGE
 Lymphatics pierce the superior constrictor
and drain intoupper deep cervical(jugulo-
digastric)node

8. FUNCTIONSOFTONSIL
 Itisthecomponentof innerwaldeyer’s
ring
 Ithasaprotectiveroleandactsasa
sentinalatportalof airandfood passage
 Cryptsincreasethesurfaceareafor
contactwithforeignsubstances

9. ACUTETONSILLITIS
 Mostlyaffectschildrenintheagegroupof
5-15 years,mayalsoaffectadults
 Organisms beta-hemolyticstreptococci
(mostcommon),staphylococci,
pneumococci,H.influenzae
 Symptoms:sorethroat,difficultyin
swallowing,fever,earache,constitutional
symptoms

10. ACUTETONSILLITIS-TYPES
 Acute catarrhal/superficial  heretonsillitisisa
partof generalizedpharyngitis,mostlyseenin
viral infections
 Acute follicular  infectionspreadintothecrypts
with purulent material, presenting at the opening
of cryptsasyellowspots
 Acute parenchymatous  tonsilinuniformly
enlargedand congested
 Acute membranous  followsstageof acute
folliculartonsillitiswhereexudatescoalesceto
formmembraneonthesurface

11. Acute catarrhal/superficial

12. Acute follicular

13. Acute membranous

14. SIGNS
 Halitosis
 Coated tongue
 Congestionof pillars,softpalateand uvula
 Jugulo-digastricnodesenlargedand
tender
 Tonsilsarecongestedandenlarged
dependingontypeof acute tonsillitis

15. TREA
TMENT
 Bed rest
 Plentyof oral fluids
 Analgesics
 Antimicrobialtherapy penicillin
 Incaseof penicillinsensitivitymacrolides
are given

16. COMPLICATIONS
 chronic tonsillitis
 peritonsillarabscess
 parapharyngeal abscess
 cervicalabscess
 acuteotitismedia
 rheumatic fever
 acuteglomerulonephritis
 subacutebacterialendocarditis

17. DIFFERENTIALDIAGNOSIS
OF MEMBRANEOVERTHE
TONSIL
 Membranoustonsillitis
 Diphtheria
 Vincentsangina
 Infectiousmononucleosis
 Agranulocytosis
 Leukaemia
 Traumaticulcer
 Aphthous ulcer
 malignancy

18. CHRONICTONSILLITIS
 Aetiology:
 Complicationof acute tonsillitis
 Subclinicalinfectionof tonsil
 Chronicsinusitisordentalsepsis
 Mostlyaffectschildrenandyoungadults

19. TYPESOF CHRONIC
TONSILLITIS
 Chronicfollicular tonsillitis
 Chronicparenchymatoustonsillitis: tonsils
areverymuchenlargeduniformlyand
mayinterferewithspeech,deglutitionand
respiration,longstandingcasesmay
developpulmonary hypertension
 Chronicfibroid tonsillitis

20. CLINICALFEATURES
 recurrentattacksof sore throat
 chronicirritationinthroatwith cough
 halitosis
 dysphagia
 odynophagia
 thickspeech

21. SIGNS
 Tonsilmayshowvaryingdegreeof
enlargementdependingonthe type
 Irwin-mooresign pressureonthe
anteriorpillarexpressesfrankpusor
cheesymaterial mainlyseeninfibroid
type
 Flushingof theanteriorpillarcomparedto
restof thepharyngeal mucosa
 Enlargementof thejugulo-digastricnode
 softnon tender

22. TREA
TMENT
 conservativemanagement
 tonsillectomy

23. COMPLICATIONS
 Peritonsillar abscess
 Parapharyngeal abscess
 Retropharyngeal abscess
 Intratonsillar abscess
 Tonsillar cyst
 Tonsillolith
 Focusof infectionfor RF
, AGN

24. Peritonsillarabscess

25. STYALGIA(EAGLE’S
SYNDROME)
 Duetoelongatedstyloidprocessor
calcificationof stylohyoidligament
 Patientcomplainsof painintonsillarfossa
andupperneckwhichradiatesto
ipsilateralear
 Itgetsaggravatedon swallowing
 Diagnosisisbytransoralpalpationin
tonsillar fossa
 X-rayTownesviewishelpfulindiagnosis
 Treatmentisbyexcisionof styloidprocess
bytransoralorcervicalapproach

26. Thank you…