Faucial Tonsils Research Articles

A Clinical Study of Serum Vitamin D Levels in Chronic Tonsillitis among Paediatric Age Group

Introduction
 Infectious diseases of the faucial tonsils are most frequently encountered by Oto-rhino-laryngologists. Vitamin D has got an important role in the production of surface Anti-microbial peptides (AMPs). Overall, the active form of vitamin D plays a vital role in maintaining the immune system of the body. This study aims to evaluate the association of vitamin D deficiency in chronic tonsillitis among paediatric age group.
 Materials and Methods
 It is a clinical study carried out in the Department of Oto-rhino-laryngology and Head and Neck surgery at a medical college in Ballari, Karnataka, India from January 2018 to January 2019 for the time period of 12 months. Patients were evaluated with the relevant investigations and digital X-ray nasopharynx along with serum Vitamin D level assessment.
 Results
 A total of 60 children with chronic tonsillitis were enrolled in this study. There were 26(43.3%) male children and 34(56.7%) females, ranging in age group from 5 to15 years, mean age is 9.82. The common clinical presentation was recurrent episodes of throat pain seen in all the patients (100%). On serum 25-hydroxyvitamin D assessment, 40(66.7%) patients were found to have deficiency and 20(33.3%) patients were having insufficiency. Mean is 17.99ng/ml and ranging from 9.13-28.58ng/ml.
 
 Conclusion
 The study concludes that, the serum vitamin D levels in chronic tonsillitis among the paediatric age groups is found to be below normal levels and is unrelated to the socio demographic factors.

Primary extranodal Hodgkin′s lymphoma of the faucial tonsil

Primary extranodal involvement of Waldeyer's ring by Hodgkin's lymphoma (HL) is a rare occurrence and only isolated cases have been described. The aims of the study were to review primary extranodal HL of the tonsillar region and to present a new case without evidence of systemic involvement. The differential diagnoses, immunologic findings, and features of these rare tumors are discussed. All manuscripts published on primary extranodal HL of the pharynx were retrieved from the literature, using PubMed as a search engine, and the data compared with a case diagnosed in a 64-year-old male. Although a diagnosis of HL is not considered generally in the differential diagnosis of the pharyngeal mass, histopathologists should be aware of its possible occurrence.

Adenotonsillar Disease

Adenotonsillar disease (adenoiditis and recurrent tonsillitis) is a prevalent otolaryngologic disorder aetiologically based on chronic inflammation triggered by a persistent bacterial infection. These bacteria, mostly Staphylococcus aureus, Haemophilus sp., and Streptococcus sp., persist predominantly intracellular and within mucosal biofilms. The recurrent or chronic inflammation of the adenoids and faucial tonsils leads to chronic activation of the cell-mediated and humoral immune response, resulting in hypertrophy of the lymphoid tonsillar tissue. This hypertrophic tissue is the cause for the prominent clinical symptoms: obstruction of the upper airways, snoring, and sleep apnea for adenoiditis or sore throat, dysphagia and halitosis for recurrent tonsillitis. Treatment strategies should target the persisting bacteria within their biofilm or intracellular shelter. Macrolide antibiotics like clarithromycin are able to modulate the immune system and to interfere in bacterial signaling within biofilms. Clindamycin, quinupristin-dalfopristin, and oritavancin are intracellular high active compounds. Surgical removal of the hypertrophic tissue by modern procedures like laser tonsil ablation, eliminates not only a mechanical obstacle of the airways, it removes also the basis for the aetiologic cause, the "biofilm carrier". This review summarizes the role of bacterial persistence in mucosal biofilms for the aetiology, diagnosis and treatment of adenotonsillar disease and relevant patents.

Ultrasonic adenotonsillectomy for the treatment of obstructive sleep apnea in a child with hemophilia A

Background: Adenotonsillectomy is now approved to be a primary treatment for obstructive sleep apnea syndrome (OSAS) in children. On the other hand, this surgery has historically been contraindicated in hemophilia. We show a case with OSAS and severe hemophilia A, in which adenotonsillectomy was successfully performed using an ultrasonic instrument. Case history: A 7-year-old boy with hemophilia A was diagnosed with OSAS by polysomnography (PSG). Since his adenoids and faucial tonsils remarkably hypertrophied, adenotonsillectomy was indicated. The preoperative screening tests exhibited that activated partial thromboplastin time was prolonged to 89.8 s and factor VIII was 1.1%. Fifty units per kilogram of the recombinant antihemophilic factor (Recombinate™, Baxter, USA) were administered preoperatively to obtain more than 100%, and 25 units/kg were given every 6 h for 12 days after surgery to maintain 50%. The ultrasonic scalpel (Harmonic Scalpel™, Ethicon Endosurgery, USA) was introduced into the operation for a complete hemostasis. As a result, intraoperative bleeding was successfully controlled to 8.5 g. He has been free from the disease after surgery. Conclusion: Adenotonsillectomy in a hemophilic child can be challenged using an ultrasonic instrument if the close collaboration of otolaryngologists and pediatricians is established.

Pediatric localized amyloidosis in mesopharynx

Primary localized amyloidosis of the mesopharynx is rare. We present the case of a 12-year-old girl; as far as we are aware, our case is the third pediatric case in the English literature. Her chief complaint was a pharyngeal mass identified by the health examination at primary school. Physical examination revealed a mass in the faucial tonsil. Histologically, the lesion was composed of deposition of amyloid and chronic inflammatory cell infiltration. Immunohistochemical studies showed that the lesion was positive for amyloid P component (AP) and negative for amyloid L (AL). No treatments were applied, because she had no symptoms. During the observation period of 24 months, the mesopharyngeal mass showed no remarkable change.

The clinical importance of cystic squamous cell carcinomas in the neck: a study of 136 cases.

Predominantly cystic squamous cell carcinomas in the neck often present without a clinically apparent primary and therefore are frequently considered to be of branchial cleft origin. It is the authors' hypothesis that the anatomic site of the primary carcinoma that produced the neck metastasis can often be predicted on the basis of the histologic features. Cases of cystic squamous cell carcinoma in the neck diagnosed between 1971 and 1991 were retrieved from the Otorhinolaryngic Pathology Registry of the Armed Forces Institute of Pathology. Histologic features were reviewed and patient follow-up was obtained and analyzed. In cases wherein the primary site was discovered subsequently, 64% of the primaries were in the lingual or faucial tonsil. An additional 8% of cases were in nasopharyngeal tonsillar tissue. The cases that did not originate in Waldeyer's tonsillar ring generally differed in histologic appearance from the tonsillar cases. The tonsillar primaries were discovered within an average of 12.4 months, but many were not discovered for years (up to 11 years). Most were small, indicating a slower growth of the primary than is usually expected for squamous cell carcinoma. Patients with such carcinomas had a much better prognosis than patients with metastatic squamous cell carcinomas of other upper airway mucosal sites. In most cases of prominently cystic squamous cell carcinomas in the upper neck, the origin of the primary site will be in faucial or lingual tonsillar crypt epithelium. Knowledge of the probable site of origin allows for more tailored therapy in which the patients can be treated relatively conservatively with surgical excision and subsequent field-limited radiation therapy only, with 77% survival at 5 years. None of the cases reviewed in this study was a branchiogenic carcinoma.

Ki-1 positive B-cell lymphoma with bizarre giant cells

A 55-year-old woman had complained of swelling on the left side of the neck for 3 weeks. The tumor involved lateral cervical, and inguinal lymph nodes and the faucial tonsil on the left side. The histological diagnosis was Ki-1 positive, non-Hodgkin B-cell lymphoma, with diffuse large cells and bizarre giant cells. Under electron microscopic examination, the tumor cells contained markedly cleaved nuclei, many mitchondria and lamellar rough endoplasmic reticulum. This is the fourth case of Ki-1 positive B-cell lymphoma reported in Japanese literature.

Local control of oropharyngeal carcinoma by irradiation alone

The authors of this study reviewed the management of 402 patients with squamous cell carcinomas of the faucial tonsil and the base of the tongue. These patients received radiation therapy at Massachusetts General Hospital and the Massachusetts Eye and Ear Infirmary from 1970 through 1993. Radiation therapy remains the treatment of choice for these lesions. Although the data from this review were not randomized, the accelerated hyperfractionated radiation therapy twice-daily program was shown to achieve significantly higher 5-year local tumor control rates and disease-specific survival rates than the conventional once-daily radiation therapy program (historical control). In patients with early tumors of the faucial tonsil (cancer stages T1 and T2), the 5-year actuarial local tumor control and disease-specific survival rates following the twice-daily radiation therapy program were 91% and 77%, respectively. In patients with advanced tumors (T3), the corresponding rates following twice-daily radiation therapy showed marked improvement and were 80% and 68%. While the treatment results for carcinoma of the base of the tongue generally were inferior to those for carcinoma of the faucial tonsil, they were still much better after the twice-daily program than after conventional once-daily irradiation. For patients with carcinoma of the base of the tongue, the local tumor control and disease-specific survival rates for T1 and T2 lesions were 85% and 76%, respectively. For T3 lesions, the corresponding rates were 54% and 53%. Extensive T4 tumors are better managed by combined surgery and postoperative irradiation. Residual metastatic nodal disease is managed by neck dissection.

Estimation of functional state of faucial tonsils in chronic tonsillitis by prednisolone test

The prednisolone test with the following morphometry of tonsils structural components is recommended for the estimation of the functional state of faucial tonsils in patients with chronic tonsillitis and accompanying neurocirculating dystonia.

Local control of oropharyngeal carcinoma after two accelerated hyperfractionation radiation therapy schemes

In October 1979 we started an accelerated hyperfractionation program consisting of 1.6 Gy/fraction, 2 fractions/ day for 12 days or 38.4 Gy. Due to acute toxicity, the patients were then given a 2-week break and resumed once daily radiation therapy with 1.8 Gy/fraction up to 65 Gy, designated as the b1d.-q.d. program. In August 1982, the program was changed and the latter part of the treatment was continued on the twice daily program with 1.6 Gy/fraction for a total of 64 Gy, designated as the b.i.d. b.i.d. program. We evaluated the local control rates of 140 patients with squamous cell carcinomas arising from the oropharynx, that is faucial tonsil and base of tongue. After these treatment regimens, the 36 month actuarial local rates for the T1-4 lesions were 56% for b1d.-q.d. (52 patients) and 85% for b.i.d. b.i.d. (88 patients) with a p value of 0.0013. For the TI-2 lesions the corresponding rates were 81% (13 patients) and 97% (44 patients) with a p value of 0.53. The difference was marked for the T3-4 lesions, that is 47% vs 77% respectively with a p value of 0.017, and those patients without nodal metastases, that is 46% vs 93% with a p value of 0.00043. The improvement was probably due to marked shortening of the overall treatment course following b.i.d. b.i.d. accelerated program—in this case 1 1 2 weeks. Our preliminary data suggests that the b.i.d. b.i.d. program is superior to the b1d.-q.d. program. The seemingly improved local control rates for the treatment of oropharyngeal carcinomas requires a clinical prospectively randomized trial for confirmation, that is b.i.d. b.i.d. versus b1d.-q.d. versus standard fractionation (q.d.) program.

Immunohistological characterization of malignant lymphomas of the Waldeyer's ring other than the nasopharynx.

Among extranodal lymphomas, the Waldeyer's ring is the second most frequently involved site after the gastrointestinal tract. Fresh tissue from 23 consecutive cases of malignant lymphoma of the faucial tonsil, palate and base of tongue were studied histologically and with a panel of 25 monoclonal antibodies. Twenty cases were primary Waldeyer's ring lymphoma, and all were found to express B-cell phenotype. Most cases were classified as diffuse centroblastic lymphoma, polymorphic subtype, in which there were immunoblast-like, centrocyte-like and/or multilobated centroblasts. All except one case expressed all three B-cell lineage antigens CD19, CD20 and CD22, but they showed inconsistent expression of the B-cell antigens CD9 and CD24. Four cases lacked surface immunoglobulin. Six cases expressed interleukin-2 receptor, suggesting that they were composed of highly activated B-cells. Three cases represented relapse in the tonsil or tongue in patients with known malignant lymphoma in other sites; one case expressed T-cell and two cases B-cell phenotype (both of which also expressed interleukin-2 receptor). The clinical features and immunohistological findings suggest that Waldeyer's ring lymphomas, other than those of the nasopharynx, share some of the characteristics of 'mucosa-associated lymphoid tissue' lymphomas. In contrast, nasopharyngeal lymphomas are more related to nasal lymphomas, and are almost exclusively peripheral T-cell neoplasms.

Non-Hodgkins lymphoma of the faucial tonsil

Non-Hodgkins lymphoma of faucial tonsil usually presents with symptoms of mechanical interference and obstruction with unilateral tonsillar enlargement which can be mistaken as peritonsillar abscess. Cervical lymphadenitis is a common feature. Present case showed involvement of superior laryngeal nerve which is a rare feature. Diagnosis is made on clinical, heamatological and histological findings. Radiotherapy (Co 60) is the treatment of choice.

CT of the oropharynx, tongue base, and floor of the mouth: normal anatomy and range of variations, and applications in staging carcinoma.

CT scans of 35 patients were obtained during rapid drip infusion of contrast material to determine the range of normal variation in the structures of the oropharynx and the floor of the mouth. Superficial structures such as the tonsillar pillars and lingual and faucial tonsils vary so much in appearance that they are not useful indicators in the detection of subtle lesions; in fact, they are potential sources of "pseudomasses." Asymmetric obliteration of the parapharyngeal space is useful for the detection of subtle lesions of the upper tonsillar fossae; however, confident diagnosis in regard to the lower oropharynx depends on visualization of a mass lesion or loss of the more constant planes in the floor of the mouth and the tongue base. CT findings added unique and valuable information in eight of 12 cases of carcinoma, confirmed the clinical impression of the extent of the lesion in four cases, and were potentially misleading in one case. CT is a valuable adjunct to the detection and staging of an oropharyngeal malignancy.

The rhinoceros faucial and laryngopharyngeal tonsils

The literature of mammalian splanchnology contains but a single reference to the tonsillar morphology of the Rhinocerotidae, viz. Owen's (1852) cursory description of the faucial (palatine) tonsil in an Indian rhinoceros {Rhinoceros unicornis). Herein a fuller account is given of the tonsillar formations present in the lateral food channel of another Indian rhinoceros specimen and of specimens of the Sumatran rhinoceros (Didermocerus suma‐trensis), the African White rhinoceros (Ceratotherium simum) and the African Black rhinoceros (Diceros bicornis). Attention is drawn to the invariable presence of tonsillar tissue in the rhinoceros pyriform fossa and to its frequent manifestation therein as an anatomically discrete and hitherto unrecognized organ, the laryngopharyngeal tonsil. This structure, functionally supplementary to the faucial tonsil, would appear to develop independently from the lympho‐thymic primordium of the embryonal third pharyngeal pouch. Its anatomy is described and its morphological significance is discussed.

Malignant lymphoma of the faucial tonsil

Ten cases of malignant lymphoma of the faucial tonsil treated in the R.U.H., Bath, during 1965--1975 are reviewed. Dysphagia and irritation in the throat are predominant symptoms. Enlarged tonsil is the commonest feature. Radiotherapy is the treatment of choice and the prognosis has improved considerably with modern supervoltage radiotherapy.

Concentration of Immunoglobulins in the Tonsils

The concentration of various immunoglobulins in the faucial tonsil was determined and expressed as a portion of the total protein centration of IgA rises with age while that of IgM falls. IgE was found to be relatively high and the highest levels of all immunoglobulins examined were noted in hypertrophied tonsils. They were lowest in the atrophic tonsils of children and in adult tonsils. The results are discussed in their relevance to the overall immunological function of the faucial tonsil.

Acute Monocytic Leukemia in the Faucial Tonsil, appearing as Malignant Tumor

Acute Monocytic Leukemia in the Faucial Tonsil, appearing as Malignant Tumor

Malignant lymphoma of Waldeyer's ring.

Malignant lymphomas, other than Hodgkin's disease, often have been considered incurable and commonly are approached pessimistically with radiation therapy of palliative intent. Experience has shown that extranodal malignant lymphomas, such as primary reticulum-cell sarcoma of bone and gastrointestinal tract, are in fact radiocurable; and in the early stage of the disease, the five-year survival is quite good after aggressive radiation therapy (1–6). The faucial, nasopharyngeal, and lingual lymphoid tonsils constitute the so-called Waldeyer's ring. A malignant lymphoma arising primarily from these sites presents certain interesting clinical and radiotherapeutic features. The purpose of this paper is to present a study of 75 patients with such disease who were seen and treated at the Massachusetts General Hospital and Massachusetts Eye and Ear Infirmary from 1941 to 1967 inclusive. The disease was histologically proved in each case, and the follow-up information was complete. Those patients having preexisting generalized malignant lymphoma with secondary involvement of the Waldeyer's ring were not included. Material Of a total of 75 patients, 40 had involvement principally of the faucial tonsil, 23 of the nasopharyngeal tonsil, and 12 of the lingual tonsil. The records of these patients were reviewed, and the lesions were separated into stages according to the extent of the disease. The classification proposed by Peters (5) was used. In Stage I the lesions are limited to the primary site of the Waldeyer's ring, and in Stage II to the primary site with involvement of the adjacent lymphatic region. Stage III indicates the presence of generalized involvement. Of this group, 34 patients had Stage I, 28 Stage II, and 13 Stage III disease. Malignant lymphoma of Waldeyer's ring is predominantly a disease of the middleaged and the elderly. Approximately two-thirds of the patients were between the sixth and eighth decades of life, although ages in the group ranged from the teens to the eighties. In contrast to squamous-cell carcinoma of the head and neck, lymphoma occurs relatively more often in the female, but the male-to-female ratio in this study was 1.8: 1 (Table I). Clinically, malignant lymphoma of Waldeyer's ring varies in its growth appearance. Most of the tumors tend to be exophytic, smooth, submucosal, fleshy, and nonulcerative. A few, however, may be indistinguishable from ulcerative squamous- cell carcinoma. The local lesions are often extensive and become large and massive. At times the exact site of origin from the Waldeyer's ring can be determined only with great difficulty. Approximately 50 per cent of 40 patients with faucial lymphoma and 40 per cent of 12 patients with lingual lymphoma had massive lesions with involvement of multiple structures.

Chondroma or metaplastic chondrosis of soft palate

A case of a nodule of cartilage in the soft palate has been presented. The lesion is considered to be either a chrondroma or analogous to similar nodules commonly found in the faucial tonsils and thought by Weller to be metaplastic.

A STUDY ON THE FIBRINOLYTIC ACTIVITY IN THE EXTRACT OF NASAL MUCOUS MEMBRANE: WITH OBSERVATION ON THE RELATED TISSUES

Fibrinolytic activity was measured in isotonic saline extract of such tissues as mucous memb-rane of maxillary sinus, inferior turbinate, nasal polyp, faucial tonsil, pharyngeal tonsil, and stomach mucous membrane.The mucous membrane of maxillary sinus, inferior turbinate, nasal polyp, faucial tonsil, phary-ngeal tonsil and stomach mucous membrane were taken from the patients ailing such diseases as sinusitis, tonsillitis, gastritis, gastric ulcer and gastric cancer.1. Results obtained indicated that(1) the strongest activity was observed in the extract from the mucous membrane of the inferior turbinate, (2) stronger activity was in the extract from the mucous membrane of the maxillary sinus, (3) fibrinolytic activity was weaker in the nasal polyp.(4) fibrinolytic activity was not observed at all in the faucial tonsil, the pharyngeal tonsil and the atomach.2., Fibrinolytic activity in the extract of nasal mucous membrane using isotonic saline solution was in the globulin fraction, not in the albumin fraction.3. Fibrinolytic activity of nasal mucous membrane was decreased to a certain extent by the addition of cystein; it was completely inhibited by the addition of e-aminocapronic acid.4. This fibrinolytic activity belongs to the plasmin enzyme system.5. It is under the investigation that whether this fibrinolytic activity is due to plasmin itseff or the activator.6. The relation of the plasmin-like substance in the nasal and paranasal mucous membrane and the inflammatoy changes in the tissue was also discussed.