Tonsillectomy in adults

Author
Jose W Ruiz, MD
Section Editor
Marvin P Fried, MD, FACS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION
Tonsillectomy is a well-established operative procedure. Most patients have an uncomplicated course, but
bleeding and pain can be significant perioperative issues.

ANATOMY
The tonsils consist of lymphoid tissue covered by respiratory epithelium. "Tonsils" refers specifically to the
palatine tonsils, and "adenoids" refers to the pharyngeal tonsils. In addition, there are lingual tonsils on
the posterior tongue and tubal tonsils just posterior to the Eustachian tube opening. Waldeyer's ring is the
ring of these four lymphoid tissues in the pharynx formed by the palatine tonsils ("tonsils"), pharyngeal
tonsils ("adenoids"), tubal tonsils, and lingual tonsils (figure 1A-B).
The tonsils are positioned laterally in the pharyngeal wall between the palatoglossal arch and
palatopharyngeal arch (the anterior and posterior tonsillar pillars) which merge superiorly to become the
soft palate (figure 2). Each tonsil is contained within its own fascia. A potential space between the tonsil
and the pharyngeal constrictor muscle can accumulate pus and become a peritonsillar abscess. The
tonsil is innervated by branches from the glossopharyngeal nerve. Lymphatic drainage includes the upper
jugular and jugulo-diagastric lymph nodes.
The tonsillar vascular supply is from branches of the external carotid artery (figure 3).