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ANATOMY AND PHYSIOLOGY
 OF THE PALATINE TONSIL


             By
             Dr. Syed Salman Hussaini
             PG in ENT

    OVERVIEW

    EMBRYOLOGY

    GROSS ANATOMY

    MICROSCOPIC ANATOMY

    FUNCTION

    IMMUNOLOGY
OVERVIEW

    The palatine tonsils are dense compact bodies
    of lymphoid tissue that are located in the
    lateral wall of the oropharynx.

    The palatine tonsil represent the largest
    accumulation of lymphoid tissue in Waldeyer's
    ring.

    The Waldeyer ring is involved in the
    production of immunoglobulins and the
    development of both B-cell and T-cell
    lymphocytes.
WALDEYER'S RING


    Waldeyer's-Pirogov tonsillar ring (or
    pharyngeal lymphoid ring)
The ring consists of (from superior to inferior):

    Adenoids (superiorly in the nasopharynx).

    Palatine tonsils (laterally in the oropharynx).

    Lingual tonsils (inferiorly in the hypopharynx and
    posterior one-third of tongue).

    In addition, it includes lateral pharyngeral bands and
    scattered lymphoid follicles throughout the pharynx,
    particularly adjacent to the Eustachian tubes called
    Tubal tonsil.

    All structures in the Waldeyer's ring have similar
    histology and similar functions (production of
    immunoglobulins and the development of both B and
    T cell lymphocytes).
WALDEYER'S EXTERNAL RING

    Superficial Lymph Node System

    The component lymph nodes are:
        −   Occipital
        −   Post auricular
        −   Parotid
        −   Pre auricular
        −   Facial or Buccal (superficial – upper, middle,
            lower; deep)
        −   Submandibular
        −   Submental
        −   Superficial cervical
        −   Anterior cervical
DEVELOPMENT

    Begins in 3rd month of I.U.L

    Ventral part of 2nd pharyngeal pouch
    (endoderm)

    Lymphocytes (mesodermal).

    8-10 buds of pharyngeal squamous epithelium
    grow into pharyngeal walls

    Crypts

    8 weeks: Tonsillar fossa and palatine tonsils
    develop from the dorsal wing of the 1 st
    pharyngeal pouch and the ventral wing of the
    2nd pouch; tonsillar pillars originate from
    2nd/3rd arches.

    Crypts 3-6 months; capsule 5th month;
    germinal centers after birth.
GROSS ANATOMY

    SITUATION: The palatine tonsils occupy the
    tonsillar sinus or fossa between the diverging
    palatoglossal and palatopharyngeal arches.

    SURFACE MARKING

    SIZE:
        −   Variable, 10-15 mm in transverse diameter
            and 20-25 mm in vertical dimension.
        −   Bigger that which appears from the surface.

    FEATURES
        −   Two surfaces
        −   Two poles
        −   Two borders
Medial Surface

    Covered by non-keratinizing stratified
    squamous epithelium.

    Tonsillar Crypts

    Crypta Magna or
intra tonsillar cleft
Lateral Surface

    Well-defined fibrous tonsillar hemicapsule.

    Formed by the condensation of pharyngo basillar
    fascia.

    Loose areloar tissue between capsule and bed of
    tonsil.

    Palatine vein/external palatine/paratonsillar vein
    descends from the palate in the loose areloar tissue.

    Capsule is firmly attached anteroinferioly to the side
    of the tongue, just in front of the insertion of
    palatoglossus and palatopharyngeus muscles.

    Tonsillar artey enters near this firm attachment.

    The fascia extends into the tonsil forming septa for
    passage of vessels and nerves.

    UPPER POLE
      −   Extends into soft palate
      −   Semilunar fold/plica semilunaris (40%)
      −   Supratonsillar fossa

    LOWER POLE
      −   Attached to the tongue
      −   Triangular fold/plica trangularis
      −   Anterior tonsillar space
      −   Tonsillolingual sulcus
Bed of tonsil

    Superior Constrictor (above) and Styloglossus
    (below).

    Glossopharyngeal Nerve and Stylohyoid
    ligament.

    Structures outside Superior Constrictor.

    Internal Carotid artery.
BLOOD SUPPLY

    Upper Pole
       −   Descending Palatine br. Of Maxillay artery
           (Ant.)
       −   Ascending pharyngeal artery br. Of Ext.
           Carotid artey (Post.)

    Lower Pole
       −   Dorsal Lingual br. Lingual Artery (Ant.)
       −   Tonsillar br. Of Facial Artery (Main)
       −   Ascending palatine br. Of Facial Artery
           (Post.)

    VENOUS DRAINAGE
      −   Paratonsillar vein – common facial vein –
          pharyngeal venous plexus – int. Jugular vein

    LYMPHATIC DRAINAGE
      −   Upper deep cervical nodes particularly
          jugulodigastric (tonsillar) node.

    NERVE SUPPLY
      −   Tonsillar br. Of Maxillary Nerve through
          Lesser palatine br. Of Sphenopalatine
          Ganglion
      −   Glossopharyngeal N.
HISTOLOGY

    Oral aspect – Non-keratininzing stratified
    squamous epithelium

    Crypts greatly increase the contact surface –
    295 cm2

    4 lymphoid conpartments
        −   Reticular cell/crypt epithelium
        −   Extrafollicular area
        −   Mantle zone of lymhoid follicle
        −   Germinal centre of lymphoid follicle
IMMUNOLOGY

    Act as sentinels at the portal of aero-digestive
    system

    Secondary lymphoid organ

    Predominantly B-cell type

    Antigen uptake

    Weak antigenic stimulus: differentiation of
    lymphocytes to plasma cells.

    Strong antigenic stimulus: proliferation of B-
    cells in germinal centres.

    Most active: 4-10 years of age
REFERNCES

    1. Scott-Brown's Otorhinolaryngology, Head
    and Neck Surgery, 7th edition

    2. Cummings Otolaryngology Head and Neck
    Surgery, 5th edition

    3. Ballenger's Otolaryngology Head and Neck
    Surgey, 17th edition

    4. Gray's Anatomy, 39th edition

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Anatomy and physiology of the palatine tonsil

  • 1. ANATOMY AND PHYSIOLOGY OF THE PALATINE TONSIL By Dr. Syed Salman Hussaini PG in ENT
  • 2. OVERVIEW  EMBRYOLOGY  GROSS ANATOMY  MICROSCOPIC ANATOMY  FUNCTION  IMMUNOLOGY
  • 3.
  • 4. OVERVIEW  The palatine tonsils are dense compact bodies of lymphoid tissue that are located in the lateral wall of the oropharynx.  The palatine tonsil represent the largest accumulation of lymphoid tissue in Waldeyer's ring.  The Waldeyer ring is involved in the production of immunoglobulins and the development of both B-cell and T-cell lymphocytes.
  • 5. WALDEYER'S RING  Waldeyer's-Pirogov tonsillar ring (or pharyngeal lymphoid ring)
  • 6. The ring consists of (from superior to inferior):  Adenoids (superiorly in the nasopharynx).  Palatine tonsils (laterally in the oropharynx).  Lingual tonsils (inferiorly in the hypopharynx and posterior one-third of tongue).  In addition, it includes lateral pharyngeral bands and scattered lymphoid follicles throughout the pharynx, particularly adjacent to the Eustachian tubes called Tubal tonsil.  All structures in the Waldeyer's ring have similar histology and similar functions (production of immunoglobulins and the development of both B and T cell lymphocytes).
  • 7. WALDEYER'S EXTERNAL RING  Superficial Lymph Node System  The component lymph nodes are: − Occipital − Post auricular − Parotid − Pre auricular − Facial or Buccal (superficial – upper, middle, lower; deep) − Submandibular − Submental − Superficial cervical − Anterior cervical
  • 8.
  • 9. DEVELOPMENT  Begins in 3rd month of I.U.L  Ventral part of 2nd pharyngeal pouch (endoderm)  Lymphocytes (mesodermal).  8-10 buds of pharyngeal squamous epithelium grow into pharyngeal walls  Crypts
  • 10.
  • 11. 8 weeks: Tonsillar fossa and palatine tonsils develop from the dorsal wing of the 1 st pharyngeal pouch and the ventral wing of the 2nd pouch; tonsillar pillars originate from 2nd/3rd arches.  Crypts 3-6 months; capsule 5th month; germinal centers after birth.
  • 12.
  • 14. SITUATION: The palatine tonsils occupy the tonsillar sinus or fossa between the diverging palatoglossal and palatopharyngeal arches.  SURFACE MARKING  SIZE: − Variable, 10-15 mm in transverse diameter and 20-25 mm in vertical dimension. − Bigger that which appears from the surface.  FEATURES − Two surfaces − Two poles − Two borders
  • 15. Medial Surface  Covered by non-keratinizing stratified squamous epithelium.  Tonsillar Crypts  Crypta Magna or intra tonsillar cleft
  • 16. Lateral Surface  Well-defined fibrous tonsillar hemicapsule.  Formed by the condensation of pharyngo basillar fascia.  Loose areloar tissue between capsule and bed of tonsil.  Palatine vein/external palatine/paratonsillar vein descends from the palate in the loose areloar tissue.  Capsule is firmly attached anteroinferioly to the side of the tongue, just in front of the insertion of palatoglossus and palatopharyngeus muscles.  Tonsillar artey enters near this firm attachment.  The fascia extends into the tonsil forming septa for passage of vessels and nerves.
  • 17.
  • 18. UPPER POLE − Extends into soft palate − Semilunar fold/plica semilunaris (40%) − Supratonsillar fossa  LOWER POLE − Attached to the tongue − Triangular fold/plica trangularis − Anterior tonsillar space − Tonsillolingual sulcus
  • 19. Bed of tonsil  Superior Constrictor (above) and Styloglossus (below).  Glossopharyngeal Nerve and Stylohyoid ligament.  Structures outside Superior Constrictor.  Internal Carotid artery.
  • 20.
  • 21. BLOOD SUPPLY  Upper Pole − Descending Palatine br. Of Maxillay artery (Ant.) − Ascending pharyngeal artery br. Of Ext. Carotid artey (Post.)  Lower Pole − Dorsal Lingual br. Lingual Artery (Ant.) − Tonsillar br. Of Facial Artery (Main) − Ascending palatine br. Of Facial Artery (Post.)
  • 22.
  • 23. VENOUS DRAINAGE − Paratonsillar vein – common facial vein – pharyngeal venous plexus – int. Jugular vein  LYMPHATIC DRAINAGE − Upper deep cervical nodes particularly jugulodigastric (tonsillar) node.  NERVE SUPPLY − Tonsillar br. Of Maxillary Nerve through Lesser palatine br. Of Sphenopalatine Ganglion − Glossopharyngeal N.
  • 24. HISTOLOGY  Oral aspect – Non-keratininzing stratified squamous epithelium  Crypts greatly increase the contact surface – 295 cm2  4 lymphoid conpartments − Reticular cell/crypt epithelium − Extrafollicular area − Mantle zone of lymhoid follicle − Germinal centre of lymphoid follicle
  • 25.
  • 26.
  • 27. IMMUNOLOGY  Act as sentinels at the portal of aero-digestive system  Secondary lymphoid organ  Predominantly B-cell type  Antigen uptake  Weak antigenic stimulus: differentiation of lymphocytes to plasma cells.  Strong antigenic stimulus: proliferation of B- cells in germinal centres.  Most active: 4-10 years of age
  • 28. REFERNCES  1. Scott-Brown's Otorhinolaryngology, Head and Neck Surgery, 7th edition  2. Cummings Otolaryngology Head and Neck Surgery, 5th edition  3. Ballenger's Otolaryngology Head and Neck Surgey, 17th edition  4. Gray's Anatomy, 39th edition