Lingual Tonsil Research Articles

Bovine Lingual Tonsil: Histomorphological Characteristics With Special Reference to the Follicular Dendritic Cells

In the bovine, the lingual tonsil is localized at the lingual radix. However, as the expansion of the tonsillar tissue was presumed to be much larger than the macroscopically visible part, selected specimens from the bovine tongue were examined to clarify if lymphatic tissue of the lingual tonsil was present rostral of a defined macroscopical landmark, i.e. rostral of the most caudal of the papillae vallatae. The identification of the lymphoreticular system was validated by means of the detection of reticulum cells, especially follicular dendritic cells (FDC). They characterize the tonsillar lymph nodules and distinguish them structurally from unspecific accumulations of lymphocytes. In our study, two monoclonal antibodies, i.e. CNA.42 and D46, detected bovine FDC cells in situ. 'Organized' lymphoid tissue--i.e. solitary lymph nodules and aggregations of lymph nodules, both either with or without surrounding connective tissue, and with or without crypts, but with immunopositive reactions for FDC--could be observed up to 30 mm rostral of the most caudal of the papillae vallatae. As these formations were not identified macroscopically, they shall be referred to as the disseminate part of the lingual tonsil.

Neurotrophins and their receptors in human lingual tonsil: an immunohistochemical analysis.

Lymphoid organs are supplied by many nerve endings associated with different kinds of cells and macrophages. The role of this innervation on the release of locally active molecules is still unclear. Lingual tonsils belong to Waldeyer's Ring, in close association with palatine tonsils and nasopharyngeal (adenoids) tonsils, thus constituting part of NALT (nasal-associated lymphoid tissue) together with the tubal tonsils and lateral pharyngeal bands. In this study, we focused our attention on the expression of some neurotrophins (NTs) and their high- and low-affinity receptors in human lingual tonsils. Light immunohistochemistry showed that human tonsillar samples were generally positive for all the NTs investigated (NGF, BDNF, NT-3, NT-4) and their receptors (TrKA, TrKB, TrKC and p75) with some different expression levels. NGF and TrKC were strongly expressed in macrophages, but weakly in lymphocytes. However, BDNF and TrKB was highly expressed in lymphocytes and weaker in macrophages. The low-affinity receptor for NGF, p75, was mainly moderately expressed in the analysed samples. These results suggest the presence of a pattern of neurotrophin innervation in the human lingual tonsil which may play a role in sustaining inflammatory conditions and in modulating a close interaction between the nervous system and the different immune cellular subtypes.

Early pathogenesis of equineStreptococcus equiinfection (strangles)

Little is known about entry and subsequent multiplication of Streptococcus equi following exposure of a susceptible horse. This information would have value in design of intranasal vaccines and understanding of shedding and protective immune responses. To determine entry points and sites of subsequent replication and dispersion of S. equi at different times after intranasal infection or commingling exposure. Previously unexposed horses and ponies were subjected to euthanasia 1, 3, 20 or 48 h following intranasal inoculation with biotin labelled or unlabelled S. equi CF32. Some ponies were inoculated with suspensions of equal numbers of CF32 and its mutants lacking capsule, S. equi M-like protein or streptolysin S. Others were infected by commingling exposure and subjected to euthanasia after onset of fever. Tonsils and lymph nodes were cultured for S. equi and tissues sectioned for histopathological examination and fluorescent microscopy. Tonsillar tissues of both the oro- and nasopharynx served as portals of entry. Entry was unexpectedly rapid but involved few bacteria. Small numbers of organisms were detected in tonsillar crypts, in adjacent subepithelial follicular tissue and draining lymph nodes 3 h after inoculation. By 48 h, clumps of S. equi were visible in the lamina propria. At onset of fever, tonsillar tissues and one or more mandibular and retropharyngeal lymph nodes were heavily infiltrated by neutrophils and long chains of extracellular S. equi. Mutant S. equi lacking virulence factors were not seen in draining lymph nodes. Although very small numbers of S. equi entered the lingual and nasopharyngeal tonsils, carriage to regional lymph nodes occurred within hours of inoculation. This observation, together with visual evidence of intracellular and extracellular multiplication of S. equi in tonsillar lymphoid tissue and lymph nodes over the following days, indicates involvement of potent antiphagocytic activity and failure of innate immune defences. Future research should logically address the tonsillar immune mechanisms involved including identification of effector cell(s) and antigens.

Human Bocavirus in Tonsillar Lymphocytes

Human Bocavirus in Tonsillar Lymphocytes

Failed Tracheal Intubation with the LMA-CTrach™ in Two Patients with Lingual Tonsil Hyperplasia

The LMA-CTrach combines the features of the Intubating Laryngeal Mask Airway with a fiberoptic system and a screen for visualization of the airway. Local pathology, such as lingual tonsillar hyperplasia, may obstruct the view of the airway leading to unanticipated difficult intubation. We present two cases of failed intubation with the LMA-CTrach in patients with lingual tonsillar hyperplasia. In both cases, the LMA-CTrach maintained adequate ventilation, giving time to prepare alternative strategies.

Lingual Tonsillectomy for Persistent Pediatric Sleep Apnea

Objective 1) To describe our experience with a technique of lingual tonsillectomy using coblation with endoscopic visualization. 2) To document its utility for treating children with persistent sleep apnea after adenotonsillectomy who on sleep endoscopy have enlarged lingual tonsils and tongue base obstruction. Methods Retrospective cohort study in a tertiary pediatric medical center. Between 2005 and 2007, 20 patients (ages 3 -18), who had a previous adenotonsillectomy (T&A) for obstructive sleep apnea (OSA), were diagnosed with persistent OSA by polysomnography (PSG). These children had both in-office unsedated fiberoptic laryngoscopy and dynamic anesthesia-assisted sleep fiberoptic laryngoscopy, both of which demonstrated lingual tonsillar hypertrophy contributing to tongue base obstruction of the hypopharynx. With a visually confirmed site of lesion, these children underwent endoscopic lingual tonsillectomy for treatment. Pre- and post-operative PSG data were paired and analyzed statistically. Results Statistically significant reductions in respiratory distress index (RDI) were observed when pre- and post-operative data were compared (mean 14.9 vs. 7.8, median 12.6 vs. 3.3). There were similar reductions in the number of apneas and hypopneas. The mean and median low O2 saturations did not change significantly. Conclusions Endoscopic lingual tonsillectomy is an effective technique for the treatment of lingual tonsillar hypertrophy causing persistent obstructive sleep apnea after T&A. Anesthesia-assisted sleep endoscopy is key to diagnosing the obstructive contribution of the enlarged lingual tonsils. The combination of endoscopic access with the near bloodless technique for ablation of the lingual tonsils provides a consistently reproducible method of treating children with this uncommon problem.

S266 – Review of Endoscopic Findings in Children with GERD

Objectives Many children with gastroesophageal reflux will initially present with respiratory symptoms including cough, stridor, increased work of breathing, apneic events, and recurrent episodes of croup. Despite a growing body of literature that suggests a correlation between airway pathology and GERD, there still remains much controversy. Our objective is to systematically review published literature correlating findings on endoscopic evaluation of the larynx and trachea in the pediatric population with the incidence of gastroesophageal reflux disease. Methods A systematic review was performed of 19 articles relating the presence of gastroesophageal reflux disease in the pediatric population to findings on endoscopic airway evaluation. These were identified through a structured PubMed search of English language literature using the key terms laryngopharyngeal reflux, extraesophageal reflux, and gastroesophageal reflux. Only those articles studying endoscopic findings in the pediatric population were included. Results All studies evaluated the subjects for the presence of gastroesophageal reflux. The most commonly utilized methods of diagnosis include barium esophagram, video fluoroscopy, gastric scintiscan, 24 hour pH probe, and esophageal biopsy. Arytenoid, postglottic and vocal fold edema and erythema, lingual tonsil hypertrophy, laryngomalacia, and subglottic stenosis are among the endoscopic findings most frequently identified in disease-positive patients. Conclusions Certain commonly encountered findings on endoscopic evaluation of the larynx and trachea performed in children presenting with respiratory symptoms do indeed demonstrate a correlation with presence of gastroesophageal reflux and may indicate that antireflux therapy should be considered in the treatment of this population of patients.

Successful intubation in a patient with extreme lingual tonsil hypertrophy using an intubating laryngeal mask

Acta Anaesthesiologica ScandinavicaVolume 52, Issue 7 p. 1030-1030 Successful intubation in a patient with extreme lingual tonsil hypertrophy using an intubating laryngeal mask R. Obata, R. ObataSearch for more papers by this authorY. Obata, Y. ObataSearch for more papers by this authorY. U. Adachi, Y. U. AdachiSearch for more papers by this authorS. Sato, S. SatoSearch for more papers by this author R. Obata, R. ObataSearch for more papers by this authorY. Obata, Y. ObataSearch for more papers by this authorY. U. Adachi, Y. U. AdachiSearch for more papers by this authorS. Sato, S. SatoSearch for more papers by this author First published: 09 July 2008 https://doi.org/10.1111/j.1399-6576.2008.01676.xCitations: 1 Address:Dr Yushi U. AdachiIntensive Care Unit of University HospitalHamamatsu University School of Medicine1-20-1 Handayama, Higashi-ku, Hamamatsu City 431-3192Japane-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume52, Issue7August 2008Pages 1030-1030 RelatedInformation

Avid Flourine-18 FDG uptake in a tonsillolith: Additional benefits of incorporating CT appearances in the interpretation of PET/CT

This case describes an incidental finding of unilateral avid Flourine-18-fluorodeoxyglucose (FDG) uptake in the right lingual tonsil associated with a tonsillolith in a patient with head and neck cancer. The lesion was detected incidentally during PET–CT study in a post-operated 68-year-old gentleman with previous history of infiltrating basal cell carcinoma in the left posterior auricular region and left facial palsy. Follow up computed tomography (CT) scan revealed no evidence of middle ear disease. This case illustrates the additional benefits of incorporating CT appearances into the interpretation of PET–CT studies apart from using it only for anatomical localization. Had it not been for the CT correlation on PET–CT study, there would have been a greater likelihood of considering the tonsillar FDG uptake as malignant leading to further unwarranted invasive procedures.

The Frequency of Lingual Tonsil Enlargement in Obese Children

Enlargement of the lingual tonsils is being increasingly recognized as a not uncommon and treatable cause of obstructive sleep apnea, particularly in patients with Down syndrome who have undergone palatine tonsillectomy and adenoidectomy. We have recognized an increasing number of patients who are obese and have obstructive sleep apnea with enlarged lingual tonsils. The purpose of this study was to evaluate the frequency of enlarged lingual tonsils in obese children. Seventy-one obese children (mean body mass index = 41.6 kg/m(2)) underwent sagittal fast spin-echo inversion recovery imaging. Lingual tonsils were identified and measured in the greatest anteroposterior diameter. Lingual tonsils > 10 mm were considered markedly enlarged. The subgroup with absent palatine tonsils (previous tonsillectomy) (n = 41) were compared with those with palatine tonsils present (n = 30). Forty-four (62%) of the obese children had measurable lingual tonsils, which is greater than the frequency previously reported in normal subjects (0%), subjects with obstructive sleep apnea (33%), or subjects with Down syndrome and obstructive sleep apnea (50%). Ten (14%) had lingual tonsils > 10 mm. Obese subjects with absent palatine tonsils (previous tonsillectomy) had a higher prevalence of measurable lingual tonsils than those with palatine tonsils (78% vs 22%, respectively; p < 0.001) and a higher prevalence of lingual tonsils > 10 mm (90% vs 10%, p < 0.001). Obese children have a high frequency of enlargement of the lingual tonsils with a significantly higher prevalence in those with previous tonsillectomy. Enlarged lingual tonsils may play a role in the pathogenesis of obstructive sleep apnea in obese children.

Cystic lymph node metastasis in patients with head and neck cancer: An HPV‐associated phenomenon

: Cystic lymph node metastases have been associated with tonsil cancer. A subset of oropharyngeal cancers contain human papillomavirus (HPV) DNA. The clinical and virologic associations of cystic nodal metastasis in head and neck cancer (HNSCC) were investigated. : A retrospective review of patients undergoing neck dissection between 2002 and 2004 identified patients with cystic lymph node metastases. Clinical and pathologic information was recorded. The presence of HPV DNA was analyzed using in situ hybridization in a subset of patients. : One hundred neck dissections were reviewed and 20 had cystic nodes. Seventeen of these patients had primary tumors arising in the palatine or lingual tonsil. Three were "unknown primary." HPV DNA was present in 11 of 13 patients with cystic metastases with tissue available for analysis (87%). No HPV DNA was identified in tumor from 21 patients with solid nodal metastasis (p <.0001). : Cystic cervical lymph node metastasis is strongly associated with HPV-related tonsillar HNSCC: (c) 2008 Wiley Periodicals, Inc. Head Neck 2008.

Proximal pharyngeal reflux correlates with increasing severity of lingual tonsil hypertrophy

To determine if degree of lingual tonsil hypertrophy (LTH) correlates with pharyngeal reflux. Prospective. Patients with flexible laryngoscopic evidence of LTH were included. Degree of LTH was graded mild, moderate, or severe by two otolaryngologists blinded to pH study results. Three-sensor pH study results were correlated to LTH grade. Nineteen patients were included (five with mild LTH, eight with moderate LTH, and six with severe LTH). Nasopharyngeal reflux (NPR) events <pH4 were found in four of six severe LTH patients but no mild or moderate LTH patients (P = 0.006). All severe LTH patients had NPR events <pH5, compared with only 4 of 11 mild or moderate LTH patients (P = 0.017). At the UES, 4 of 6 severe LTH patients had pathologic reflux, compared with 4 of 13 mild or moderate (P = 0.025). Interobserver reliability calculated by Cohen's kappa was excellent (0.92). Our study shows a continuum of increasing pharyngeal reflux with higher LTH severity. Severe LTH may be a reliable physical sign of pharyngeal reflux, especially NPR.

Lingual tonsillitis presenting as hemoptysis

Summary To the best of our knowledge, hemoptysis caused by hemorrhagic lingual tonsils has not been reported. We describe a case of hemoptysis caused by bleeding from inflamed, hypertrophied lingual tonsils. Treatment with antibiotics did not resolve the bleeding. Carbon dioxide laser lingual tonsillectomy was curative.

Distribution of the Lingual Tonsils of Cattle Designated as Specified Risk Materials

The tonsils of cattle, including palatine tonsils, pharyngeal tonsils, tubal tonsils and lingual tonsils, are designated as specified risk materials (SRM). However, the detailed distribution of lingual tonsils in cattle is unknown. We therefore histologically examined their distribution in 198 tongue specimens from cattle. The examinations confirmed that the presence of lingual tonsils was limited to the tissue of the lamina propria on the dorsal and lateral aspects of the tongue, not reaching the muscular layer below. More than 90% of the lingual tonsils were located between the distribution center of the vallate papillae and the radix linguae (root of the tongue). However, they were also found in the area extending from the lingual torus to the rostral-most vallate papilla in an individual, suggesting that the complete removal of the lingual tonsils requires elimination of the lamina propria extending from the lingual torus to the radix linguae.

Malignant lymphomas in Waldeyer's ring in Asian countries: Association with histologic types and Epstein-Barr virus

The present study examines clinicopathologic findings and their association with the Epstein-Barr virus (EBV) in Waldeyer's ring lymphomas (WRLs) from Indonesia (91 cases), P.R. China (31 cases), Korea (101 cases) and Japan (61 cases). Waldeyer's ring (WR) was categorized into upper and lower parts comprising the pharyngeal and tubal tonsils (upper WR) or palatine and lingual tonsils (lower WR), respectively. Diffuse large B-cell lymphoma (DLBCL) pre-dominated in the lower WR in all countries at a frequency of 78.9-100%. Natural killer/T-cell lymphoma (NKTCL) was predominant in the upper WR in China, Korea and Japan at a frequency of 50-62.5%, while in Indonesia it occcurred at a frequency of less than 10%. On the whole, patients with NKTCL were significantly younger (median 43 years) than those with DLBCL (57 years). Patients with DLBCL in the lower WR were significantly younger in Indonesia (median 50 years) than in China (63 years) or Japan (69 years). The percentage of EBV-positive cases was much higher in NKTCL (78.6-100%) than in DLBCL (2.2-6%). This study evaluates the differences between East and Southeast Asian countries in terms of histologic type and age distribution in WRLs categorized by the location of the lesions in WR.

Recurrent Obstructive Sleep Apnea due to Compensatory Hypertrophy of Lingual Tonsils following UPPP

The lingual tonsils comprise the lymphoid tissue located in the base of the tongue between the circumvallate papilla anteriorly and the epiglottis posteriorly. Lingual tonsil hypertrophy (LTH) may cause OSA or upper airway obstruction, but may only be associated with mild symptoms such as sore throat, globus sensation, speech change or dysphagia (1, 2). However, LTH is a potential cause of unanticipated airway obstruction following induction of general anesthesia (1 ,2). We report a case of recurrent obstructive sleep apnea due to compensatory LTH following UPPP (uvulopalatopharyngoplasty).

Diffuse Large B-Cell Lymphomas of the Waldeyer's Ring Frequently Have a Germinal Center-Like Phenotype: A Clinico-Pathological Study of 209 Patients from the Groupe d'Etude des Lymphomes de L'Adulte (GELA).

Diffuse large B-cell lymphomas (DLBCLs) are markedly heterogeneous, and there is increasing evidence that the biological features of these tumors vary according to the primary site of disease (lymph node or various extranodal organs). The Waldeyer's ring (WR), a circular band of mucosa-associated lymphoid tissue composed of the palatine, lingual and pharyngeal tonsils, is the second most common site of extranodal invovlement by DLBCL. The presence of focal follicular features in tonsillar DLBCLs has been previously reported. In this study we included 209 adult patients with de novo DLBCL presenting in the WR consecutively included in the GELA protocols during a 10-year period (1993–2004). All patients (M/F ratio: 1,77/1, mean age 59 years) comprising 81% with stages I–II and 19% with stages III–IV disease, received intent-to-cure anthracyclin-based polychemotherapy. Morphology, pattern of growth, immunophenotype and differentiation profile were analyzed and correlated to the clinical features. Survival and outcome were analyzed in comparison to a matched cohort of patients with primary nodal DLBCL. By morphology, 55% of tonsillar cases were classified as centroblastic, 39% as centroblastic-polymorphous, 3% as immunoblastic, and 3% were unclassifiable. Among large biopsy specimens (n=79), 18% had a prominent nodular pattern consistent with transformed follicular lymphomas, 35% had a minor nodular component (<50%) interpreted as follicular colonization and 47% were purely diffuse. The nodular pattern correlated with centroblastic morphology (p=0,0007). The prevalence of antigen expression was: bcl-2: 105/189 (60%); CD10: 75/178 (42%); bcl-6 :40/76 (53%); mum-1:40/109 (37%). Global immunophenotypic profile assessed on 136 cases was GC-like in 60% and non-GC-like in 40%. The GC-like profile correlated with absence of bcl-2 expression (p<0,0001) and with centroblastic morphology (p=0,04). In multivariate analysis, the GC-like phenotype correlated with better OS (p=0.014), and CD10 expression correlated with better EFS (p=0.0061). For 144 paired tonsillar/nodal cases, the complete remission rate was significantly better for tonsillar patients (p=0.01) but the 5-y OS and EFS rates - respectively, 79,7% and 70,9% for tonsillar patients, and 76,7% and 66,7% for nodal patients - did not significantly differ. When restriciting the comparison to the cases with no factor of the age-adjusted IPI (109 paired patients), the primary tonsillar localization was associated with a higher 5-y EFS (78,5% vs. 71,2%; p=0,029) and 0S (84,7% vs. 79,8%; p=0,047) rates. In conclusion, WR DLBCLs frequently have a partially follicular pattern of growth, and a GC-like phenotype. In DLBCL patients with no factor of the age-adjusted IPI, the tonsillar localization appears to confer a better outcome than primary nodal involvement.

A case of unexpected difficult airway due to lingual tonsil hypertrophy

Clinical value of preoperative bedside screening tests for predicting difficult airway remains limited. Asymptomatic lingual tonsil hypertrophy is a known cause of unexpected difficult airway. We report a case as a reminder of this.

Negative pressure in pharyngo-oral cavity can treat lymphedema and related disorders

With the finding of specific markers and growth factors for lymphatic vessels, more and more attentions were paid to research on lymphatic vascular system. But the treatment of lymphedema and related disorders is still difficult. Waldeyer's ring is the lymphoid tissues that form a ring around the opening of the throat including tonsils laterally, adenoids superiorly, and lingual tonsil at the base. We hypothesized that negative pressure in pharyngo-oral cavity can improve lymphatic system circulation by affect Waldeyer's ring. And this treatment is proved to be useful in the therapy of lymphedema and chyloperitoneum. So we came to the conclusion that negative pressure in pharyngo-oral cavity was helpful in the treatment of lymphedema and related disorders. But the mechanism of this treatment still need further study. The future of this field of research is very promising and may eventually lead to better treatment of lymphedema and related disorders.

Obstructive lingual tonsil hypertrophy in recurrent thyroglossal duct cyst

The association between recurrent thyroglossal duct cyst (TGDC) and obstructive lingual tonsil hypertrophy has not previously been discussed. We present the case of a 7-year-old child whose medical and surgical course was complicated by these synchronous factors. The aim of this report is to present the risk factors for recurrence of TGDC and the unique challenge that concurrent lingual tonsil hypertrophy and airway obstruction present to management of patients.