tonsil ent revision notes for neet pg preparation waldeyer ring tonsillar bed blood supply of tonsil histology tonsillitis stylocarotid syndrome irwin moores sign indications of tonsillectomy recurrent tonsillitis

1. Tonsils
TONY SCARIA 2010 KMC

2. Waldeyer ring
TONY SCARIA 2010 KMC

3. Tonsils are partially encapsulated
TONY SCARIA 2010 KMC

4. • Anterior pillar 
palatoglossus
• Posterior pillar 
palatopharyngeus
TONY SCARIA 2010 KMC

5. Bed of tonsil
TONY SCARIA 2010 KMC

6. Bed of tonsil is formed by
• Loose areolar tissue
• Pharyngobasilar fascia
• superior constrictor
• Buccopharyngeal fascia
• Styloglossus
TONY SCARIA 2010 KMC

7. Loose areolar tissue in bed of tonsil
• Plane of dissection during tonsillectomy
• Site of collection of pus in peritonsillar abscess
TONY SCARIA 2010 KMC

8. • Styloglossus &
superior
constrictor form
bed of stomach
TONY SCARIA 2010 KMC

9. TONY SCARIA 2010 KMC

10. TONY SCARIA 2010 KMC

11. Lined by stratified squamous epithelium
TONY SCARIA 2010 KMC

12. • The medial surface of palatine tonsils is
covered by non keratinizing stratified
squamous epithelium which dips into
the substance of tonsil in the form of
crypts. One of these crypts is very large
and deep and is called crypta magna or
intratonsillar cleft.
• Ventral part of 2nd pharyngeal pouchTONY SCARIA 2010 KMC

13. TONY SCARIA 2010 KMC

14. Blood supply of tonsils
TONY SCARIA 2010 KMC

15. • Commonest cause of bleeding  paratonsillar vein
• Commonest arterial cause of bleeding tonsillar branch of facial A
TONY SCARIA 2010 KMC

16. Internal carotid artery aneurysm  pulsatile
tonsil
TONY SCARIA 2010 KMC

17. • Pain of palatine tonsil is referred along glossopharyngeal nerve to
middle ear
TONY SCARIA 2010 KMC

18. Eagle syndrome
Calcified stylohyoid
ligament  appears as
elongated styloid process
TONY SCARIA 2010 KMC

19. TONY SCARIA 2010 KMC

20. Eagle syndrome
• Calcified stylohyoid ligament may compress glossopharyngeal nerve
 referred otalgia
• Presents as swelling behind posterior pillar
TONY SCARIA 2010 KMC

21. Stylo carotid syndrome
• Elongated styloid process may
compress internal carotid artery 
syncope on turning head to one
side
TONY SCARIA 2010 KMC

22. Styloid apparatus
Ligaments
• Stylohyoid
• Stylomandibular
Muscles
• Stylohyoid
• Stylopharyngeus
• StyloglossusTONY SCARIA 2010 KMC

23. Lymphatic drainage of tonsil
• upper deep cervical nodes particularly the jugulodigastric (tonsillar)
node situated below the angle of mandible
TONY SCARIA 2010 KMC

24. • Tonsils reach maximum size
• From birth to 3 years after that from 7 years to 12 years afer that it undergoes
atrophy
TONY SCARIA 2010 KMC

25. TONY SCARIA 2010 KMC

26. Acute tonsillitis
1. Acute catarrhal or Superficial tonsillitis – seen in viral infection
2. Acute follicular tonsillitis – Purulent material seen in crypts as
yellowish spots
3. Acute parenchymatous - tonsillar substance is affected causing
uniform enlargement and redness
4. Acute membrane tonsillitis – exudation coalesce to form membrane
TONY SCARIA 2010 KMC

27. a/c tonsillitis
• Grp A beta haemolytic streptococci  mc organism
• Signs
• Enlarged jugulodigastric nodes
• i
TONY SCARIA 2010 KMC

28. TONY SCARIA 2010 KMC

29. D/D of Membrane over the tonsils:
1. Membranous tonsillitis
2. Diphtheria: membrane is dirty Grey, removal causes bleeding
3. Vincent’s angina
4. Infectious mononucleosis
5. Agranulocytosis
6. Leukemia
7. Aphthous ulcer
8. Malignancy tonsil
9. Traumatic ulcer
10. Candidiasis
All except vincents anginaforms a
white membrane
TONY SCARIA 2010 KMC

30. • IRWIN MOORE'S SIGN——– positive squeeze test in chronic tonsillitis
TONY SCARIA 2010 KMC

31. Indications for tonsillectomy
Absolute indication
• Huge hypertrophic tonsil
causing Obstructive sleep
apnea or oropharyngeal
obstruction
• 2nd episode of quinsy
• Suspected malignancy
tonsils for biopsy
Relative C/I
• Recurrent tonsillitis
• Tonsillitis causing febrile
seizure
• IgA nephropathy
As a part of other surgery
• Uvulopalatopharyngoplasty
• An approach to IX CN &
styloid process
TONY SCARIA 2010 KMC

32. Recurrent tonsillitis
• > 7 culture proven episodes of a/c tonsillitis in 1 year
• >5 episodes per year in 2 years
• >3 episodes per year in 3 years
TONY SCARIA 2010 KMC

33. Absolute C/I for tonsillectomy
• Epidemic of poliomyelitis
• Polio virus gets concentrated in lymphoid tissue
• a/c tonsillar infection
• Recent URTI
TONY SCARIA 2010 KMC

34. Methods of tonsillectomy
• Dissection & snaring method of choice
• Harmonic scalpel
• Dissection & snaring
• Diathermy
TONY SCARIA 2010 KMC

35. Position for tonsillectomy rose’s position
TONY SCARIA 2010 KMC

36. After tonsillectomy patient lies in tonsil
position to Px aspiration of clots
Pillow under thorax
TONY SCARIA 2010 KMC

37. Tonsillectomy complications
• Haemorrhage  most common complication
Primary
haemorrhage
• During surgery
• d/t recent
infection
• Bleeding
diathesis
• Poor technique
Reactionary
haemorrhage
• With in 7-24 hours
• Increase in BP
• Slipping of
ligatures
• Postoperative
retching
Secondary
haemorrhage
• After 7 days
• d/t infection
TONY SCARIA 2010 KMC

38. Eves tonsillar snare
TONY SCARIA 2010 KMC

39. • In case of haemorrhage  reoperate immediately
TONY SCARIA 2010 KMC

40. u/l enlargement of tonsil
• Quinsy
• Parapharyngeal space
• Parapharyngeal tumour
• Metastasis
• Lymphoma
• Scc TONY SCARIA 2010 KMC

41. Malignancy of tonsil
• SCC is commonest malignancy
• Diagnostic sign  induration on palpation
TONY SCARIA 2010 KMC