A imputation of Tonsil 1 1 1 



THE TONSIL 



The tonsil is a lymphoid mass placed in the recess between the 

 anterior and posterior pillars of the fauces (p. 107). Its situation cor- 

 responds to the angle of the jaw, and when the gland is enlarged it 

 may cause a fulness in that neighbourhood. It is covered internally 

 by the mucous membrane of the mouth, and upon its free surface are 

 the openings of a dozen or fifteen crypts which extend into the sub- 

 stance of the tonsil. They have an epithelial lining, and upon the 

 deep side of their basement membrane are nodules of lymphoid tissue. 



Relations. In front is the fold of membrane enclosing the 

 palato-glossusj and behind is that enclosing the palato-pharyngeus ; 

 above is the soft palate, and below is the hinder part of the tongue. 

 On the outer side is the superior constrictor of the pharynx, and more 

 externally still are the internal carotid artery and the internal jugular 

 vein ; the vagus ; the sympathetic ganglion, and the ascending pharyn- 

 geal artery. As the internal carotid is not only external to the tonsil, 

 but also somewhat posterior to it, the jugular vein is still further away. 



Supply. The arteries are derived from the ascending pharyngeal ; 

 the ascending palatine and tonsillar of the facial ; the dorsalis linguae, 

 and the descending palatine of the internal maxillary. The veins 

 form a plexus which empties into the pharyngeal veins and so into 

 the internal jugular. The lymphatics pass to the glands below the 

 angle of the jaw, and into those beneath the sterno-mastoid. The 

 nerves are derived from the glosso-pharyngeal, and from descending 

 branches of Meckel's ganglion. 



Hypertrophy. When the tonsils are enlarged they project from 

 between pillars of the fauces, and may actually meet across the middle 

 line. There is difficulty in swallowing, and as the masses obstruct the 

 passage of air from the posterior nares the subject sleeps with his 

 mouth open, so that air may enter also by the mouth. His respira- 

 tion is always noisy, and at night he snores. Insufficient supplies of 

 air entering, the chest is badly developed, and the excessive atmo- 

 spheric pressure upon the exterior causes the child to become pigeon- 

 breasted. Because the mouth is constantly open, the face becomes 

 elongated, and because but little air passes through the nares the 

 nose is small and flattened from side to side, and the nostrils are very 

 narrow. Thus, the surgeon can often recognise the hypertrophy by 

 the aspect of the patient. The voice is ' thick.' 



Being below the soft palate, whilst the opening of the Eustachian 

 tube is above it, the enlarged tonsil cannot actually occlude that open- 

 ing, but deafness is often associated with the enlargement because the 

 lymphoid tissue about the Eustachian orifice is simultaneously hyper- 

 trophied. 



Amputation of the tonsil is best performed by dragging the mass 





