Anatomy-Lexicon

Palatine tonsils

What are tonsils?

As a palatine almond (lat: Palatine tonsil) is the name given to the accumulation of lymphatic tissue between the palatal arches in a capsule. One of these tonsils sits on the right and left at the transition from the oral cavity to the throat. Like all almonds, they belong to the secondary lymphatic organs and are part of the Waldeyer's throat ring. As lymphatic organs, they serve to ward off and fight against pathogens.

anatomy

The palatine almond has a similar structure to the other almonds of the Waldeyer's throat ring. It belongs to the so-called MALT (= mucosa associated lymphatic tissue). Many lymph follicles can be found in the lymphoid tissue of the palatine tonsil. These lymph follicles are made up of large collections of immune cells (e.g. B lymphocytes). The palatine tonsil is formed by indentations (so-called. Septa) divided into lobules. It is surrounded by a connective tissue capsule and overgrown by a mucous membrane (multi-layered uncornified squamous epithelium). There are numerous depressions in the mucous membrane. Crypts). These serve to enlarge the surface of the palatine tonsil.

So-called detritus can collect in the crypts. This consists of food residues, dead cells and cells of the immune system. If the detritus is excreted from the crypts, it can be seen as a whitish elevation on the tonsil (so-called. Almond plugs / almond stones). Near the tonsils there are small salivary glands that flush the tonsils and thus clean them.

The tonsils are usually 1 - 2 cm in size and almond-shaped.

The arterial supply of the palatine tonsil is supplied by the ascending palatine artery (branch of the fascial artery), the descending palatine artery (branch of the maxillary artery) and smaller branches of the lingual artery. The venous blood flows through the pharyngeal plexus (plexus venosus pharyngeus) into the internal jugular vein. The lymph drains into the deep cervical lymph nodes (Nodi lymphatici profundi) and into the lymph nodes under the outer jaw (Nodi lymphatici submandibularis).

The palatine tonsils are neural from the 9th cranial nerve (Glossopharyngeal nerve) and from the 10th cranial nerve (N. vagus) provided.

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Where exactly are the tonsils located?

There are two tonsils in the mouth, one on the right and one on the left. The palatine tonsil is therefore a paired organ. They lie between the anterior palatal arch (lat. Arcus palatoglossus) and the posterior arch of the palate (lat. Arcus palatopharyngeus). The two palatal arches are made up of two muscle strands (M. palatoglossus and Palatopharyngeal muscle) raised. The area that they delimit is also known as the tonsillar bay. The tonsils can be seen well with the mouth open, even if they are not abnormally enlarged.

Illustration of the tonsils

Illustration of the oral cavity (A) and side wall of the right facial region (B) with tonsils

Palatine almond (blue) -
Palatine tonsil
Pharyngeal tonsil (green) -
Pharyngeal tonsil
Tongue almond (yellow) -
Lingual tonsil
Posterior palatal arch -
Arcus palatopharyngeus
Tongue - Lingua
Hard palate -
Palatum durum
Soft palate -
Palatum molle
Anterior palatal arch -
Arcus palatoglossus
Incisors -
Dens incisivus
Lower jaw - Mandible
Hyoid bone - Hyoid bone
Epiglottis - epiglottis
Throat - Pharynx
Nasal cavity - Cavitas nasi
S - food route
L - airway

You can find an overview of all Dr-Gumpert images at: medical illustrations

function

The tonsils serve as a secondary lymphatic organ for defense against pathogens. The tonsils can be infected with pathogens via the lymph, blood or their surface. Pathogens) get in touch. The part of the pathogen that the immune system responds to is called the antigen. The numerous immune cells found in the tonsils get to know the antigens in this way.

The different immune cells react differently to the antigen contact: The B lymphocytes begin to produce exactly the right antibodies. The T lymphocytes stimulate and support the further immune response. In addition, the cells in the tonsils that can effectively fight the pathogens multiply particularly strongly. In this way, the immune system reacts to the tonsils. Due to their close contact with the mucous membranes, the tonsils make it difficult for pathogens to spread along this structure. Due to its position between the mouth and throat, it is particularly useful for monitoring these two areas.

Diseases of the tonsils

The tonsillitis

The causes of tonsillitis

Inflammation of the tonsils (Tonsilitis, angina tonsiliaris) it comes from the infestation of the palatine tonsil with pathogens. In most cases, the pathogens are viruses (e.g. Adenovia), but also bacteria (e.g. beta-hemolytic streptococci, pneumococci, hemophilus influenza) or fungi (e.g. Candida albicans) can trigger inflammation. Most of these pathogens are also found in the mouth under physiological conditions. If the immune system is weakened or if a form of the pathogen appears that is not yet immune to it, inflammation occurs. The inflammation can be limited to one side (unilateral tonsilitis) or both tonsils can be affected (bilateral tonsilitis).

The different forms of tonsillitis

Tonsilitis can be divided into an acute and a chronic form.
The acute form (Acute tonsilitis) is mostly caused by viruses. It occurs quickly and symptoms can develop within hours. The main symptom is severe pain in the throat, which intensifies when speaking and swallowing. The pain can continue to radiate to the head, neck, and ears. Since swallowing makes the symptoms worse, people eat and drink less often during the illness. You may also experience increased salivation, tightness, and difficulty breathing. Acute tonsilitis is often associated with a strong feeling of illness and increased body temperature. The palatine pins are significantly swollen and reddened during inflammation. They are often with whitish coatings (Stipple), which are made up of pus and fibrin (a coagulation factor). The cervical lymph nodes may also be swollen. A tonsillitis is often caused by bad breath (Foeter ex ore) accompanied. The inflammation parameters such as CRP and ESR are often increased.

Learn more about the acute tonsillitis

Chronic tonsillitis is mostly triggered by bacteria (especially beta-hemolytic streptococci). The almonds can also be attacked by various types of bacteria (aerobic and anerobic types). The chronic form of tonsillitis can develop from the acute form. This occurs especially when harmful bacteria remain in the crypts of the tonsils and are not completely eliminated by the immune system. The inflammation then occurs again and again (recurrent) and is latent. Chronic tonsillitis has significantly fewer symptoms than acute. Slight swallowing difficulties, recurring scratching and dryness in the throat and redness of the throat indicate chronic tonsillitis. Due to the constant inflammatory process, the tonsils begin to scar and crack. The lymph nodes in the neck area are often permanently swollen in chronic tonsillitis. Bad breath can also occur. The inflammation parameters are often increased even with chronic tonsillitis.

If you discover these symptoms you should consult a doctor. This also serves to rule out differential diagnoses such as Pfeiffer's glandular fever.

Read more about Chronic tonsillitis

Risk of contagion

The risk of infection is very high with tonsillitis. One or two days before you feel sick you can spread the pathogen. The risk of infection only decreases once the symptoms have subsided.

You can also read about this: This is how contagious tonsillitis is

recovery

The recovery from tonsillitis is supported by a lot of rest and protection. In addition, despite the discomfort when swallowing, sick people should drink plenty of fluids. Antibiotics are prescribed for inflammation caused by bacteria or to prevent further infections. In the case of chronic or recurrent inflammation and severe disease (e.g. with abscess formation), therapy consists of removing the tonsils.

Get information about the Treatment of tonsillitis

Swelling of the tonsils

A swelling of the palatine tonsil can usually be seen without further aids when the mouth is open. The swelling of the tonsils usually has harmless causes and goes away by itself after a while. Nevertheless, a doctor should be consulted to rule out serious illnesses. This is especially true if other symptoms such as malaise, pain, lymph node swelling or plaque appear on the tonsils.

A swelling (Latin tumor) is one of the five classic signs of inflammation (reddening (Rubor), Overheat (Calor,) Pain (Dolor), Functional restriction (Functio laesa)). So it occurs in inflammation of the most varied of types. E.g.in chronic or acute tonsillitis.

In addition, the tonsils can be attacked by other pathogens if the disease is already present. This is called secondary or super infection. The immune system is so challenged to fight the actual disease (primary infection) that it can no longer effectively protect the mucous membranes of the throat, for example. These are then colonized by pathogens that could hardly have harmed a healthy person (secondary infection). A secondary infection can attack the tonsils and swell; this can be the case, for example, with real flu.

Plaut-Vincent angina can also cause swelling of the tonsils. This is a rare form of tonsillitis. It is triggered by the simultaneous infection of the tonsils by two different types of bacteria (Treponema vincenti, Fusobacterium nucleatum). With this disease, an ulcer forms on the tonsils, which is usually painless. In addition, the mucous membrane around the tonsils dies and so-called necroses are formed. The almond itself is covered by a gray to greenish coating.

In addition, glandular fever (Mononucleosis) lead to swollen tonsils. This disease is caused by the Epstein-Barr virus. It is often noticeable in what is known as a monocyte angina, which causes severe sore throats. In contrast to classic tonsillitis, the tonsils are covered by a gray, non-white coating. This is usually strictly limited to the tonsils and does not affect the surrounding tissue.

Diphtheria can also cause tonsils to swell. This disease caused by Cornybacterium diphtariae is symptomatic, among other things, by white to yellow coatings on the tonsils. These can quickly spread throughout the throat.

The childhood disease scarlet fever, which can also affect adults, also causes a severe sore throat (scarlet fever angina). This infection can also lead to tonsillitis and thus to swollen tonsils.

Read more on the topic: Swollen tonsils

Abscess on the tonsils

An abscess is an encapsulated collection of pus. If an abscess forms near the tonsils, it is called a peritoneal abscess. Such an accumulation of pus is usually found between the tonsils and the muscles of the back of the throat (M. constrictor pharyngis superior, M. constrictor pharyngis medius, M. constrictor pharyngis inferior). The abscess formation is usually triggered by an infection with different pathogens at the same time. Streptococci are particularly often involved here.

A peritoneal abscess is often associated with acute tonsillitis (Tonsillitis) ahead. But also as a result of chronic tonsilitis or a sore throat (Pharyngitis) an abscess can occur. Inflammation of the tonsil or throat invades the tissues around the tonsil capsule. Pus forms there as a result of the infection.

Symptoms include difficulty swallowing and opening the mouth (jaw clamp). This can lead to decreased food intake. In addition, increased saliva is formed (Hypersalivation). Sufferers complain of pain shooting into the ear (Otalgia). The disease is accompanied by a severe sore throat and fever, as well as swelling of the lymph nodes in the neck.

A tonsil abscess should be treated by a doctor as soon as possible. The collection of pus can be removed through an incision (Incision) are emptied. If this is not enough, the abscess is removed together with the palatine tonsil (Abscess tonsillectomy). Antibiotics are also prescribed to combat inflammation.

Learn more about the topic Tonsil abscess

Can you remove the tonsils?

The removal of the tonsils (tonsilla palatina) is possible and in many cases even of considerable benefit for the patient. The palatine tonsil can either be removed completely (Tonsillectomy) or only partially (Tonsillotomy). The tonsillectomy is still one of the most common operations in Germany. Since the palatine tonsil is now assigned a greater role in the defense against infections, attempts are now being made to at least partially preserve it.

Nevertheless, there are indications for which a tonsillectomy is recommended. These include e.g.

Frequently recurring or chronic tonsillitis (tonsillitis)
Abscesses on the tonsils (Peritonsillar abscess)
malignant tumors
Impairment of breathing or swallowing and sleep apnea from the size of the tonsils.

In Germany, tonsils are usually removed in a hospital. The patient is admitted to the hospital for about a week. The operation usually takes place under general anesthesia, but local anesthesia can also be used for adults. There are many different tonsillectomy techniques. In the most common, the tonsil under the mucous membrane is exposed during the operation and then peeled off. It usually takes four weeks for the wound to heal completely. During this time you may experience pain and discomfort when swallowing. In addition, physical exertion should be avoided.

A doctor should be consulted in the event of complications such as secondary bleeding, wound infections, taste or swallowing problems.

Read more on the subject Remove the almonds

Can tonsils grow back?

The tonsils can grow back after removal. This happens a little less than half the time. Lymphatic tissue of the tongue tonsil or the lateral cord colonizes the place where the removed tonsil was. A new palatine tonsil forms there. However, the new formation usually takes several years. If there is an indication to remove the tonsils that have regrown, this is also possible with them.

What is the difference between tonsils and tonsils?

Palatine almond (Palatine tonsil) and pharynx (Pharyngeal tonsil) differ mainly in their location and number. Two tonsils lie to the right and left of the mouth between the palatal arches. The pharyngeal tonsil, on the other hand, is an unpaired organ, the pharyngeal tonsil "hangs" on the roof of the throat. It is popularly referred to as "polyp" or "polyp".

Histologically, the two tonsils differ mainly in the depth of the indentations (Crypts) that pull them through. These are more pronounced in the pharynx. In addition, the pharyngeal tonsil contains strands of connective tissue that subdivide it (Connective tissue septa).

What are the causes of bad breath?

Bad breath (Foreter ex ore) can have many different causes. In most cases these are harmless, but the cause should be clarified more precisely, especially if symptoms of the disease occur at the same time. The problem usually lies in the mouth and throat area, the gastrointestinal tract or systemic diseases are less likely to be involved. Possible causes are:

Foods like garlic, alcohol, or nicotine
certain drugs, especially those containing sulfur
decreased salivation (Xerostomia, can also be triggered by certain drugs)
Inadequate oral or dental care (leftover food that is not removed by regular toothbrushing begins to rot and gives off foul-smelling gases. In addition, poor oral hygiene can lead to tooth decay, which can also cause bad breath)
Inflammation of the mouth and throat
a colonization of the mouth with fungi (usually Candida albicans), also called thrush
Tonsil stones
malignant tumors
Bulging of the wall of the esophagus (esophageal diverticulum)
an excess of sugar in a known diabetes disease (sweet smell of nail polish remover)
impaired kidney or liver function

Causes of enlarged tonsils

There are many different causes of enlarged tonsils. Especially in small children, the tonsils often grow beyond the normal amount (Hyperplasia). This is usually only a sign that the immune system is dealing with as yet unknown pathogens. These enlargements often regress with age. However, they should be treated if they have problems such as swallowing difficulties or difficulty breathing while sleeping (Sleep apnea) prepare.

Since the tonsils serve the immune defense, they often enlarge in the course of infections. The pathogens are very different. Even a simple cold can lead to such an enlargement. But flu viruses, glandular fever, scarlet fever or an HIV infection can also lead to this reaction.

Acute or chronic inflammation of the tonsils (Tonsillitis) is usually accompanied by swelling, which also makes the tonsils appear enlarged. Also a collection of pus around the tonsil (Peritoneal abscess) causes the tonsils and the surrounding tissue to swell.

In addition, both benign (benign) as well as malicious (malignant) Tumors of the palatine tonsil cause enlargement.

Since swelling of the tonsils can have so many different causes, it should be clarified by a doctor.