ANATOMY AND PHYSIOLOGY OF THE

PALATINE TONSILS
• The palatine tonsils are dense compact bodies of
lymphoid tissue that are located in thelateral 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
FUNCTIONS OF TONSIL
The activity of this lymphatic organ is especially pronounced during
childhood, when immunologic challenges from the environment
induce hyperplasia of the palatine tonsils. Following this
“active phase” of immune initiation, which lasts until about 8–10
years of age, the lymphatic tonsillar tissue becomes less important
as an immune organ, and there is a corresponding decline in the
density of lymphocytes in all regions of the tonsils. While the tonsils
become less important immunologically with ageing, the tonsillar
tissue continues to perform immune functions even at an advanced
age, although this should not alter the decision to remove the
tonsils if a valid indication for tonsillectomy exists.
WALDEYER'S RING
•  Waldeyer's-Pirogov tonsillar ring (orpharyngeal 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
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 divergingpalatoglossal 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

• Lined by non-keratinizing stratified squamous epithelium which

is continuous with that of palatoglossal fold and tongue
• Mucosa invaginates into the substance of tonsil to form 12-15
tonsillar crypts
• Largest crypt known as crypta magna or intratonsillar cleft
opens near the upper part (represents ventral part of 2nd
pharyngeal pouch)
• Crypts increase the surface area of tonsil
 LATERAL SURFACE
• Covered by tonsillar hemicapsule formed by the condensation of
pharyngobasillar fascia which extend into the tonsil to form septa that
conduct nerves and vessels
• Tonsillar bed is separated from the capsule by loose areolar tissue which
forms peritonsillar space
• Palatine/External palatine/Paratonsillar vein descends from palate in the
loose areolar tissue
• Capsule is firmly attached anteroinferiorly to the side of  the tongue, just
in front of the insertion of palatoglossus and palatopharyngeus muscle
• Tonsillar artery enters near this firm attachment
2 POLES:
1. Upper pole:
• Extends into soft palate
• Plica semilunaris: Semilunar fold of mucous membrane which extends from the
anterior pillar to posterior pillar and covers the medial part of upper pole
• Supratonsillar fossa: Potential space enclosed by the semilunar fold
2. Lower pole:
• Attached to the tongue
• Triangular fold: of mucous membrane extends from anterior tonsillar pillar to the
lower pole
• Anterior tonsillar space: Potential space enclosed by the triangular fold
• Tonsillolingual sulcus: separates tongue from the lower pole and is a seat of
carcinoma
 2 BORDERS:
1. Anterior border: related to palatoglossal arch (anterior tonsillar pillar)
2. Posterior border: related to palatopharyngeus arch (posterior tonsillar pillar)
 BED OF TONSIL
From within outwards, tonsillar bed consists of:
• Pharyngobasillar fascia
• In upper and posterior part: Palatopharyngeus muscle
• In postero-superior 2/3 rd: Superior constrictor muscle
• In antero-inferior 1/3 rd: Styloglossus muscle accompanied by glossopharyngeal
nerve (CN IX)
RELATIONS OF TONSILLAR BED
• Arteries:
• Facial artery and it’s ascending palatine branch
• Ascending pharyngeal artery
• Internal carotid artery (lies about 25 mm behind and lateral to
the tonsil)
• Styloid process (if enlarged)
• Submandibular salivary gland
• Medial pterygoid muscle
• Angle of mandible
TONSILS MAINTAIN ITS POSITION
• By the suspensory ligament of the tonsils it is connected with
the tongue
• The palatoglossus and palatopharyngeus muscles attached to
the fibrous capsules of the tonsils
• By the perivascular stalks
ARTERIAL SUPPLY: 5 ARTERIES

Anterior tonsillar artery (1): from dorsal lingual branches of lingual artery

Posterior tonsillar artery (2): from ascending palatine branch of facial, and ascending
pharyngeal arteries
Superior tonsillar artery (1): from greater palatine branch of maxillary artery
Inferior tonsillar artery (1; main artery): from facial artery
• Venous drainage: 
Tonsillar vein → Common facial vein
Paratonsillar vein → Pharyngeal venous plexus or Common facial vein → Internal
Jugular Vein (IJV)
• Lymphatic drainage:
Upper deep cervical lymph nodes: Also known as tonsillar lymph nodes
• Nerve supply:
Glossopharyngeal nerve (CN IX)
Greater and lesser palatine nerve (CN V)
DIFFERENCE BETWEEN ADENOID AND TONSIL

Adenoid Tonsil
Ciliated columnar Non-keratinizing
epithelium squamous epithelium
No capsule Hemicapsule
Has furrows Has crypts
Peak growth: 6 years 8 years
Growth stops: 12 years 15 years
Disappears: 20 years Partial regression: 18
years
DIFFERENCE BETWEEN TONSIL AND LYMPH
NODE

Tonsil Lymph node

Subepithelial Connective tissue
Hemicapsule Fully encapsulated
Efferent only Afferent and Efferent
Crypts present Absent
Cortex or medulla absent Present
Growth curve present absent
APPLIED ANATOMY
• 1. Accumulation of pus in in the peritonsillar space in chronic tonsillitis gives  rise to peritonsillar
abscess or quinsy. It is drained by an incision in the most prominent part of the abscess where
softening can be felt.
• 2. Jugulo-digastric lymph node is often enlarged in tonsillitis.
• 3. Tonsils prevent infection but when these are infected, acts as septic foci of the body which
require surgical removal.
• 4. Peritonsillar space is the plane of dissection during tonsillectomy.
• 5. In tonsillectomy, the tonsil is dissected out along with its capsule from its bed.
• 6. Internal carotid artery, although only 1 inch (2.5cm) behind the tonsil, is never injured in this
operation since it lies safely freed from the pharynx by fatty tissue around the carotid sheath.
• 7. Almost always in surgery, clots are not removed to prevent hemorrhage, but this rule doesn’t
apply to tonsils and uterus. After tonsillectomy, blood clots present in the tonsillar fossa are
removed. This is done to prevent post-operative hemorrhage because the clots in the tonsillar
fossa interfere with the retraction of vessel walls by preventing the contraction of surrounding
muscles i.e. the muscles forming boundaries of the tonsillar fossa.