Palatine Tonsils and Lymphatic System Quiz

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Questions and Answers

What is the role of Waldeyer’s Ring in the lymphatic system?

It initiates an immune response against pathogens. (correct)

It helps in the filtration of blood.

It produces lymphocytes exclusively.

It separates the respiratory and digestive tracts.

Which artery supplies blood to the inferior pole of the palatine tonsil?

Lingual artery

Internal carotid artery

Facial artery (correct)

Ascending pharyngeal artery

What anatomical structure separates the palatine tonsils from the superior constrictor of the pharynx?

Capsule

Buccopharyngeal fascia

Lingual tonsil

Pharyngobasilar fascia (correct)

Which nerve is primarily responsible for the sensory innervation of the palatine tonsils?

Glossopharyngeal nerve (IX) Signup and view all the answers

What is the main component of the lateral surface of the palatine tonsil?

Fibrous tissue capsule Signup and view all the answers

Which symptom is NOT typically associated with obstructive sleep apnea (OSA)?

Chronic mouth breathing Signup and view all the answers

What is a common craniofacial change associated with chronic mouth breathing in children?

Narrow and pinched nose Signup and view all the answers

What is considered a significant complication of adenotonsillectomy?

Post-op pulmonary edema Signup and view all the answers

Which diagnostic method is used to assess the lateral postnasal space?

Lateral soft tissue x-ray Signup and view all the answers

Which symptom is NOT typically associated with adenoid facies?

Pigeon chest Signup and view all the answers

Which of the following is NOT a predisposing factor for acute tonsillitis?

Immunization against Strep pneumoniae Signup and view all the answers

What is the primary blood supply for the adenoids?

Ascending palatine artery Signup and view all the answers

Which organism is NOT commonly associated with acute tonsillitis?

E. coli Signup and view all the answers

Which condition is characterized by the collection of pus between the fibrous capsule of the tonsil and the superior constrictor muscle of the pharynx?

Quinsy Signup and view all the answers

What is the most common clinical feature of acute tonsillitis?

Fever Signup and view all the answers

Which of the following is a nonsuppurative complication of acute tonsillitis?

Poststreptococcal glomerulonephritis Signup and view all the answers

Chronic Adenotonsillar hypertrophy can lead to severe respiratory conditions in children. Which of the following is NOT a potential complication?

Laryngeal cancer Signup and view all the answers

Tonsillectomy may be indicated for several conditions. Which of the following is NOT a relative indication?

Chronic or recurrent acute tonsillitis Signup and view all the answers

Which of the following best describes Quinsy?

A unilateral collection of pus Signup and view all the answers

What is the primary nerve supply to the adenoids?

Pharyngeal plexus Signup and view all the answers

What grading indicates that the medial surface of the tonsil is hidden behind the anterior pillar?

Gr I Signup and view all the answers

Which of the following is NOT a treatment option for Quinsy?

Antihistamines Signup and view all the answers

Which of the following symptoms is especially associated with Quinsy?

Severe trismus Signup and view all the answers

What complication is associated with a peritonsillar abscess?

Jugular vein thrombosis Signup and view all the answers

Study Notes

Adenoids and Tonsils

Adenoids are lymphoid tissue located in the nasopharynx.
Tonsils are lymphoid tissue found in the oropharynx.
Waldeyer's Ring: A ring of lymphoid tissue that surrounds the entrance to the digestive and respiratory tracts.
Plays a crucial role in early recognition of pathogenic microorganisms and initiating an immune response.
The pharyngeal tonsil (adenoid) is one structure within the ring.
Tubal and palatine tonsils (tonsils) are also part of Waldeyer's ring.
Lingual tonsils are located at the base of the tongue.
Palatine tonsils have a paired structure lying on either side of the oropharynx.
Anterior and posterior pillars form part of the tonsils' location.
Medial surface is lined with mucous membrane with crypts (8-30 indentations).
The crypta magna is the largest crypt and separates the upper and lower poles of the tonsil.
The fibrous capsule separates it from superior constrictor muscle and the buccal pharynx fascia.
Blood supply: Inferior pole - tonsillar branch of facial artery and ascending palatine artery.
Blood supply: Superior pole- ascending pharyngeal artery, descending palatine artery, and dorsal lingual artery.
Venous drainage: Peritonsillar plexus - lingual and pharyngeal veins (IJV).
Nerve supply: Branches of lesser palatine nerves and IX (CN).
Lymphatic drainage: Upper deep cervical lymph nodes (esp. jugulo-diagastric LN)

Adenoids

Located at the junction of the roof and posterior wall of the nasopharynx.
Situated inferolaterally to the eustachian tube.
Blood supply: ascending pharyngeal artery, ascending palatine artery, ascending branch of maxillary artery, artery of pterygoid canal and tributaries from the facial artery.
Venous drainage: pharyngeal plexus-pterygoid plexus – IJV.
Nerve supply: pharyngeal plexus.
Lymphatic drainage: Retropharyngeal space and pharyngomaxillary nodes.

Diseases of Tonsils and Adenoids

Inflammatory Diseases:
- Acute tonsillitis: Common in children, organisms include Strep pneumoniae, H. influenzae, Moraxella catarrhalis, Staph aureus, and viral infections.
- Peritonsillar abscess (Quinsy): Pus collection between the fibrous capsule of the tonsil, superior constrictor muscle of pharynx.
- Chronic/recurrent tonsillitis: Chronic or recurrent tonsillitis, chronic specific tonsillitis – diphtheria, syphilitic, tubercular.
Tumors:
- Benign and malignant tumors.

Acute Tonsillitis

Common in children.
Organism immunity not well established.
Organisms include Strep pneumoniae, H. influenzae, Moraxella catarrhalis, Staph aureus, and viral infections.

Predisposing Factors

Upper respiratory tract infection (URTI)
Chronic sinusitis
Chronic tonsillitis
Exposure to contagious infections
Blood dyscrasias
Excessive use of cold drinks
Lowered body resistance
Excessive pollution
Foreign body impaction

Clinical Features

Symptoms: Fever, sore throat, odynophagia, thick/muffled voice, trismus, pain referred to ear and foul breath.
Signs: Markedly congested pillars, enlarged/hyperemic tonsils, crypts filled with purulent material, enlarged/tender jugulodiagastric lymph nodes.

Investigations

Full Blood Count (FBC)
Differential
Throat swab for culture and sensitivity (C&S)
Plain radiographs
CT/MRI if malignancy is suspected or considered.

Differentials

Scarlet fever
Infectious mononucleosis
Diphtheria
Glandular fever (Infectious mononucleosis or other similar condition)
Thrush

Treatment

Broad-spectrum antibiotics
Analgesics/anti-inflammatory medications
Soft, warm diet OR IV fluids
Bed rest

Complications

Nonsuppurative: Scarlet fever, acute rheumatic fever, poststreptococcal glomerulonephritis.
Suppurative: Peritonsillar abscess (Quinsy), parapharyngeal space abscess, retropharyngeal space abscess, otitis media, septicemia.

Quinsy

Pus collection between tonsil capsule and superior constrictor muscle of the pharynx.
Usually a complication of acute tonsillitis.
Commonly unilateral and frequent in young adult men.
Clinical features: Toxic, febrile, odynophagia (severe pain), dribbling saliva, trismus, muffled voice, otalgia.
Examination findings: Congested/bulging affected side, tonsil pushed downwards/medially.
Asymmetry with edema/hyperemia of the soft palate, enlarged pillars, halitosis (bad breath), severe trismus, tender/enlarged jugulodiagastric lymph nodes.
Complications: Pharyngeal/laryngeal edema leading to respiratory obstruction, parapharyngeal abscess, retropharyngeal abscess, jugular vein thrombosis, septicemia, aspiration of pus into respiratory passage.
Differentials: Abscess related to upper molar tooth, acute tonsillitis, malignancy of tonsil, the parapharyngeal abscess.
Management: Medical (Broad-spectrum antibiotics, Analgesics/anti-inflammatory medications), Soft, warm diet OR IV fluids. Surgical (I&D, tonsillectomy [hot or interval]).

Tonsillectomy

Indications (Absolute): Chronic or recurrent acute tonsillitis, sleep apnea syndrome, malignancy, brachial fistula, chronic otitis media related to adenoids.
Indications (Relative): Quinsy, diphtheria, rheumatic heart disease, benign tumors/cysts, tonsillar foreign body, halitosis, voice changes.

Chronic Adenotonsillar Hypertrophy (ATH)

Tonsils and adenoids are small at birth but progressively enlarge over first to fourth year of life
Etiology: Increased immunologic activity, chronic infection, second-hand smoke exposure.
Complications: Common cause of upper airway obstruction in children, cor pulmonale, pulmonary vascular hypertension, and alveolar hypoventilation.
Treatment: Adenoid/Tonsillectomy (or both)

Grading of Tonsils

Grade I: Medial surface of tonsil is hidden behind the anterior pillar.
Grade II: Medial surface of tonsil is even with the anterior pillar.
Grade III: intermediate size between Grade II and IV.
Grade IV: Tonsils touch or are kissing each other.

Clinical features of chronic adenotonsillar hypertrophy (AH)

Symptoms are not due to increased size of adenoid mass but to disproportion in the size of nasopharynx & adenoids.

Obstructive sleep apnea (OSA)

Symptoms include Apneic attacks, Excessive loud snoring, Frequent awakening during night, Hypersomnulence, Enuresis, Nightmares, and poor school performance.

Chronic Mouth Breathing Symptoms

Chronic mouth breathing, drooling saliva, hyponasal voice, nasal discharge, conductive hearing loss due to otitis media, poor feeding/failure to thrive, craniofacial growth patterns affected, adenoid facies .

General Symptoms

Failure to thrive
Pigeon chest
Flat voice
Protruding abdomen
Halitosis

Adenoid Facies

Open mouth
Loss of nasolabial groove
Pinched/narrow nose
Vacant expression
High arched palate
Malocclusion
Drooling of saliva
Elongated face

Diagnostic Assessment

History (medical record)
Physical examination
Radiologic assessment
Flexible endoscopic nasopharyngoscopy

Preoperative Assessment

Coagulation abnormalities
Chest X-ray (CXR)
Electrocardiogram (ECG)
Cardiology review
Pulmonary evaluation

Adenotonsillectomy Complications

Hemorrhage (intraoperative, reactionary, secondary)
Pain
Airway obstruction (edema more common in patients < 3 years)
Post-operative pulmonary edema
Nasopharyngeal stenosis
Vocal cord paralysis (VPI)
Cervical spine complications, atlantoaxial subluxation (Grisel's syndrome, common in Down's syndrome patients)

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Description

Test your knowledge on the anatomy and function of Waldeyer’s Ring, along with the palatine tonsils. This quiz covers blood supply, innervation, and common conditions related to tonsils and sleep apnea. Challenge yourself with these important aspects of the lymphatic system and craniofacial changes!