anatomia tonsilelor amigdaliene

THE ANATOMY OF THE PALATINE TONSILS. By G. SECCOMBEHETT, M.B., F.R.C.S., and HS. G. BUTTERFIELD, B.A.

IT is the object of this paper to give a description of the anatomy of thepalatine tonsil.

With this idea, investigation of the various points in the anatomyand in the comparative anatomy of the tonsils has been carried out, andail explanation sought from developmental data. For this purpose weexamined some thousand tonsils from human subjects both living and inthe post-mortem room, and have collected a large series of muanmmalian tonsils.

In 1846, Tourtual., in his book, Neqte Ulter-s(tchityeit iibei- den Bait(s menuschlichen Schittmui- quad Kehllkopfes, described a cavity on theunder surface of the soft palate, at the junction of the anterior andposterior pillars of the fauces, four lines long, into which branching ductsopened, surrounded by lymphoid tissue, and which he regarded as anaccessory tonsil. This structure was situated above the ordinary tonsil.

His, in his A itatovmbe ienischlicheit Elnbryoten, 1885, in describing thetonsil of a four months' fetus describes a triangular fold, "whose point isattached to the velum and the base widely inserted into the lateral marginof the tongue; the attached margin being inserted into the anterior pillarof the fauces, while its hinder edge is free and guards a fossa, whichcorresponds to the 2nd bronchial cleft and which is coated with a con-tinuation of mucous membrane. The lining membrane of this fossa swellsout subsequently and becomes transformed into the tonsil." The directionof the supratonsillar fossa, according to His, is upwards and backwards,and behind it in all cases lies the inusculus palato-pharyngeus, and thismuscle separates the fossa supratonsillaris from Rosenmtiller's fossa.

Sappey, in the third edition of the Traite'd'A natoqnie, 1873, had previouslymentioned a similar structure, and he says, speaking of the tonsils: " Theirupper end does not fill up the summit of the fossa, for between the highestportion of the tonsil and the summit of the fossa on the one side and theanterior pillar on the other there usually exists a deep depression of6 mm., which one night call a supratonsillar excavation. On lifting themusculo-mucous fold onl the pillar which partly hides this excavation agroup of orifices are seen on the corresponding portion of the tonsil, whichopen into extremely irr eular cavities,"

Mr G. Seccombe Hett and Mr H. G. Butterfield

Merkel, in his Handbach der topogr. A flatomie, vol. i. p. 403, speakingof the fossa supratonsillaris, says, " It is covered by a fold of mucous inem-brane, which curves backwards from the anterior palatine arch, and itscavity may be deeper than one centimetre, stretching backwards into thepalate, and was known to His as the recessus infundibuliformis from the2nd branchial cleft."

Kostanecki (Alich. t7 path. Amdeat., cxvii.) also describes the cavity, anddiscusses the question of bronchial fistular in connection with it.

Poirier, in his Tr'aqite' d'Aiiatomtie Hamxtine, iv. 127, refers to His, ascited above, and to Neuhbfer, Schrotter, Watson, and Kostanecki as sayingthat it is a frequent site of bronchial fistulhT.

His then states, "that the tonsil rises as an etmiinence in the 2nd cleftdepression, the supratonsillar fossa lying above it, and representing theremains of the 2nd branchial cleft."

Killian, in the APchiv volt Lwyqnqfologie, vol. vii., 1898, has written atlenglt Upon the tonsil and analysed the conclusions of former workers.He slhows that Tourtual's cavity and the supratonsillar fossa of His aremerely varieties of the same cavity, and he proposes to call this cavity thepalatine recess. Killian's description of the anatomy of the tonsil is morecomplete than that of his predecessors, and we have been able to confirmhis description of the distribution of lyinphoid tissue in the walls of thetonsillar stac.

His, writing in 1880, describes the development of the pharynx and theorigin of the salivary glands, the tonsil, thymnus, and lateral thyroid bud,and shows howv they arise as diverticula from the epithelium of the pharynx,which passes out respectively into the 2nd, 3rd, 4th, and 5th bronchialclefts.

Hammar figures the diverticulum with secondary diverticula from itwhich form the crypts, and round which the lymphoid tissue of the tonsilis developed. In Hamnmar's diagram is shown an elevation in the floor ofthe diverticulum, dividing the latter into two, which, with the lymphoidtissue and the secondary diverticula, he designates as anterior and posteriorbuds. Speaking of the plica triangularis, he says that its line of attach-inent is to the elevation, and that this marks anterior and posterior groupsof tonisillar outgrowthls.

Poirier (Traite' ('Aimttomnie Hmntixte, 1895), speaking of the bronchialclefts, says, " They show endodermal diverticula, which form the thymus, etc.,and that the tonsil is formed thius in the 2nd cleft." He quotes His assaying that the supratonsillar fossal is limited by the plica triangularis, andis the remains of the 2nd bronchial cleft.

According to Koelliker (1897), "the tonsils appear in the fourth month

36

Anatomy of the Palatine Tonsils

PLATE I.-HUMAN TONSILS.

_ M I

- W_PI

b-T

FIG. 1.-Tonsil of seven months' foetus.

Fig. S. -Imbedded tonsil of male aged 14 years,showing free plica triangularis.

FIG.- 5. -Tonsil of female aged 20, showing three tonsillarmasses and lymphoid tissue in plica triangularis.

FIG. 2.-Tonsil of eight months' fetus.

FIG. 4. -Atrophied tonsil of male aged 40.The supratonsillar fossa can still be seen.

FIG. 6.--Projecting tonsil of male aged 19 years,showing large plica triangularis and threetonsillar masses.

EXPLANATION OF PLATES I. AND II.ST. Supratonsillar fossa. M2. Middle tonsillar mass.PIT. Plica triangularis. M3. Lower or anterior tonsillar mass.PIS. Plica semilunaris or supratonsillaris. P. Anterior pillar of fauces.PI. Plica infratonsillaris. T. Pars triangularis.PP. Plica pretonsillaris. LP. Lingual prolongation.Ml. Upper or posterior tonsillar mass.

.4.

...,N/I141 ..-I.Oi..,

Al r (. Seccoinbe Hett and Mlr H. G. Butterfield

of fetal life in the form of a simple cleft or cleft-like diverticulumn of themucous membrane on each side. The lateral wall and the base of the sacare already considerably thickened by an abundant deposit of cell elementsin the connective tissue, which appears to be a continuous process. Thelymphatic nodules as follicles are first seen distinctly at full terlln."

According to Bickel, " the palatine tonsil first appears in the fetus as aninvagination of the mucous membrane. A prominence gradually rises fromtthe aperture of the invagination in a circular direction, and forms an areolaaround it. The latter subsequently disappears, though traces of it maysometimes persist to a later period of life."

Stoelhr, in 1884, examined animal and human tonsils, but lie was ma-linlyconceriied in tracing immigration of leucocytes into the epitheliunm. Buthe does say that "the epithelium of the pharynx is continued as aninvagiination into the, hollows Cand fissures around which leucocytes arecolngfregated to forin the tonsil."

In the humaiian fotus of about five months we found onl cutting, sectionsthrough the pharynx, a tonsillar sac existing as aii epitlhelial diverticulullmfroni the phlarynx, the blind end and outer wall of which showed a bulg(ing,so that it became bifurcated and divided by the eminence into twosecondary sacs. The epitheliumn showed budding from these sacs into thedeeper tissue. In fetuses at the end of the fifth month there was seen,between the pillars of the fauces, a sickle-shaped opening which led into aslit-like recess, directed upwards and forwards. The inner wall of tlmerecess was formed by the sickle-shaped fold which was attached to theanterior pillar, and whose free imargin limited the outlet of the recess. Theouter wall of the recess was occupied by a plaque of tissue, withi somegrooves upon it (Plate I. fig. 1). Later oIn in fetal life and towards thetime of birth, the posterior border of the free margin can be seen to end bysplittingr oIn and blending with the embryonic tonsil (fig. 2). As f(etal lifeadvances, the tomisillar mIass tends to be less covered by this plica trian-gularis.

The plica triangularis, on reaching the tonsillar mass, splits into twoportions, one of which continues the line of the free mimargin of the plicatowards the posterior pillar of the fauces, while the other passes downwardstowards the side of the tongue, and is knowii as the plica pretonsillaris(see figs. 2 and 6).

There are two principal furrows on the tonsillar umass, running ill theloiug axis of the tonsil, and parallel withi one another, thus dividing themass into a median elevation, with a groove oil either side of it separatingit from two lateral elevations. The masses thius marked out are upper,middle, and lower, or mmmy be tearnied posterior, middle, and anterior, having

38


PLATE II.-HUMAN TONSILS.

FIG. 7.-Tonsil showing large posterior mass.

FIG. 9.-Tonsil dissected from the outerside, showing interlacing of muscu-lar fibres over the lower part of thecapsule.

FIG. 8.-Tonsil of female aged 25 years,showing well-marked lingual prolongation.

FIG. 10.-Tonsil of male aged 14 years, showingsupratonsillar fossa surrounded by lymphoidtissue which has proliferated on the plicatriangularis and plica semilunaris.

8g9

40r GU. Seccombe Hett and -Mi H. (". Butterfield

view to the obliquely directed axis of the tonsil. The grooves run undercover of the plica triangularis, but not to the apex of the tonsillar sac, andhence here the tonsillar sac is not divided into three masses (see fig. 1).

A small fold passes between the anterior and posterior pillars at theirjunction; this is known as the plica supratonsillaris or the plica semlilunlaris(see fig. 3).

As above mentioned, the tonsillar mnass tends to be less under cover ofthe plica triangularis as f(otal life advances, but during the first years oflife the deeper portion of the tonsil, which is under cover of the plica andthe anterior pillar, tends to undergo() imuch lymnphoid proliferation, andextends up under cover of the soft palate so that a third of the tonsil isnormally thus hidden (this is known as the pars palatiina); in other words,the normal tonsil of the early years of life is of the embedded type(see figs. 3 and 9).

In the years succeeding birth there is a proliferation of lymphoidtissue round the outlet of the tonsillar sac. This takes l)lace under theepithelium in definite directions, and eventually overshadows and largelytakes the place of the f(etal tonsillar plate in formingt the main mass ofthe tonsil.

By middle age, and often much earlier, the pars palatina is reduced toa remnant in which, however, the supratonsillar fossa can usually berecognised, and the tonsil fromt being an embedded, globular, or cone-shaped mass, has become a flattish plaque (see fig. 4). As previouslymentioned, the pars palatine becomes reduced in size, and lyniphoid tissueat tlre outlet of the sac frequently proliferates. Lymphoid tissue is oftenlaid down in the plica triangularis, but less frequently in the plicasupratonsillaris (see figs. 5 and 1.0).

In the space between the plica infratonsillaris and plica pretonsillarisproliferation takes place, the resultant mnass being known as the parstrianogularis, and this proliferation often assumes the formn of a hemi-spherical nodule with one or two crypts, opening into the pharynx on itsconvexity (see fig. 6).

,rhlie plica triangularis may remain free and develop lymphoid tissuewithin it, so as to form an extra tonsillar mass, and in this case a grooveruns up between it and the rest of the tonsil, into the supratonsillarfossa. Or it may become blended with the lower tonsillar mass throughoutthe greater part or whole of its extent (see figs. 5 and 7).

The posterior or upper mass, though less in size than the two maintonsillar masses, may yet hypertrophy and overhang the tonsillar sac inits upper or posterior portion, and has been likened by Killian to a helmet.If this is the case, and if the plica triangularis be blended with the tonsil,

40


PLATE III.-SECTIONS THROUGH HUMAN SUPRATONSILLAR FOSS2E.

6-

4-

6-

3

FIG. 1.-Longitudinal section throughsupratonsillar fossa of full-time fetus.

FIG. 2.-Longitudinal section through supraton-sillar fossa of female aged 15 years, showingcrypt opening into fossa.

_90.....2 53

41

FIG. 3.-Longitudinal section through supra-tonsillar fossa of male aged 39 years.

2

FIG. 4.-Longitudinal section through supra-tonsillar fossa of female aged 48 years.

FIG. 5.-Transverse section through supratonsillar fossa.

EXPLANATION OF PLATE III.1. Supratonsillar fossa. 4. Capsule of tonsil.

2. Epithelium covering tonsil and lining 5. Mucous tissue.supratonsillar fossa. 6. Connective tissue.

3. Lymphoid tissue.

41

2Mr G. Seccoinbe Hett and Mr H. G. Butterfield

one groove only will be seen passing into the supratonsillar fossa frombelow upwards and forwards, between the helmet-like posterior mass andthe rest of the tonsil (see fig. 7).

Below and behind the pars triangularis there is a composite massattached to the lowest part of the tonsil and stretching from there to theside of the tongue in front of the epiglottis. This consists of mucous glandsinterspersed with lymphoid follicles. Together with a similar prolongationon the other side, this mass is knnown as the lingual tonsil. But it seemsto us more reasonable to call it the lingual prolongation of the palatinetonsil, as it is closely connected with the latter, and is essentially a bilateraland not a median structure (see fig. 8).

It is difficult to establish what is a normal tonsil at various ages, andout of mnamly tonsils examined there are few which do not show traces ofold inflammation or of hypertrophy. But one can perhaps go so far asto say that for the first four or five years of life the tonsils are globularand deeply imbedded structures, and that after this the deeper portionstend to atrophy, while front birth onwards to the fourteenth year theadenoid proliferation continues at the outlet of the tonsillar sac and onthe lateral pharyngeal wall. Fromn the age of fourteen the tendency is forthe tonsil to retrogress and for the tonsillar sac to flatten out and presentonly atrophic remains of lymiphoid tissue. During young adult life (twentyto thirty) the plica triangularis, covered with lymphoid tissue, is frequentlythe most prominent portion of the tonsil.

It is difficult to establish a standard of normality in man, for, apart fromcases of inflammation and hypertrophy, the tonsils show so mianly varieties.But the tonsil generally; consists of one or other of the fetal masses.

A type, which is conimouly figured in the text-books as being the normaltonsil, is a rounded mass projecting between the pillars of the fauces, withthe openings of crypts dotted over its convexity, this appearance beingdue to a preponderance of the middle nitass together with a fused plicatriangrularis.

Another commition form is that in which there is a prominent parstriangularis attached by its base to the opening of the tonsillar sac, whichhangs freely in a downward and backward direction into the pharynx(see fig. 6).

Lastly, the upper or posterior mass may hang like a helmet, forming adeep groove between it and the rest of the tonsil.

If the plica infratonisillaris cuts deeply into the tonsil, and the middlemass above it and the pars triangularis below it are both prominent, thetonsil will be divided by a transverse groove into upper or lower portions(see fig. 6).

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PLATE IV.-AIAMIMALIAN TONSILS.

FIG. 1.-Persian leopard.

FIG. 2.-Lemur.

FIG. 3.-Agile gibbon.

CAurt, ly qua tonwiIdkWalteolwdanyegrt -by arnd y.tonsil

Krzpottasil FIG. 4.-Marmoset.

A

FIG. 5.-Badger (young).

FIG. 6.-Banded mongoose.

ZM

_M2-M3

FIG. 7.-Liorilla (young). FIG. 8.-Bonnet monkey.

EXPLANATION OF PLATrES IV. TO X.Small a attached to Roman figure denotes microscopic section of corresponding tonsil. A =

anterior pillar where this exists and shows direction of tip of tongue. Other letters and numbersas in preceding plates.

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Alr G. Seccombe Hett and Mlr H. G. Butterfield

Thle crvpts of the pars palatina open into the fos,8sa supratonsillaris, thoseof thle maiCin tonsillar plate into the outlet of the tonsillar sac, those of thepars triancgularis below this into the cavity of the phlarynx (see sections ofsupratonsillar fossa). (Plate III.)

If a tonsil during its time of active grrowthl be dissected fromt without,it will be found as a cone-slhaped mass projectingupwrrds and forwardsunder cover of the superior constrictor. Anteriorly the fibres of the palato-glossus pass downwards and forwards in front of it to the side of thetoiigue, nearly at right angles to its long axis, while the palato-plharyngetuspasses down behind it to the side of the pharynx in a direction inorepalallel to its axis. As they do so, these muscles form an interlacementover the tonsil with the superior constrictor (see fig. 19).

Over the upper two-thirds of time tonsil there is a loose areolar spacebetween it and the muscles; but at the lower and posterior portion of tlhetonsil the capsule of the latter and the muscular slheet are intimatelyIbleliled. So inuch is this the case that iii enueleatingy tonsils, a smallportion of muscle is usually brought away adherent to the capsule at thispoint. It is here, too, that most of the vessels enter.

Plates I. and II. illustrate the form of the tonsil at various ages, andalso sonic of the conmmlon varieties met with.

For the purposes of this paper the histology of the lhumian and animalembryo was undertaken to ascertain the distribution of time lym1)hoidtissue, the extent of the capsule, and the connections of the mIlucous glandsso often found in close proximity to the tonsil. Of particular interest withregard to the lymphoid tissue is its extent in tlme human supratonsillarfossa. The diagrams of sections of human tonsils show that lyniphoidtissue is present iii every case to a greater or less extent (Plate III.) Trlesection taken fromn a full-terin human fetus (Plate III. fig. 1) shows adefinite laver of lyinpboid tissue occupying the whole of time fossa, thatfront a young adult slhowvs a considerable thickness (Plate III. fig. 2), whilstthose of mnore elderly subjects show a tendency for the lymplhoid tissue toatrophy iii this region (Plate III. figs. 3 and 4). In every case there arefound crypts leadingr into the fos1sa, and time whole of the lymphoid tissue,i)^Ct(lkirlr that of the fossta, is a'ithiit the cajpsule, thus showing that theso-called " supratonsillar fossa " is not merely an embryonal remnant apartfrom tlme tonsil, but is an integral part of it (Plate III. fig. 5).

On dissectinym a young human tonsil its long axis is found to extend asa cone into the soft )alate. If the muscles be now dissected off the deepor external aspect -t space containing loose areolar tissue is exposed, amidthen the thin but (quite defimmite capsule. The latter is firmly attached tothe tonsil, but not to the tissues outside it except over its lower and

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PLATE V.-MAMMALIAN TONSILS.

FIG. 9. -Moustached monkey. FIG. 9a.

I i

i-. o6

FIG. 10.-Vervet monkey. FIG. IOa.

ST

FIG. 11.-Cat.

a, 4

FIG. 1la.

.sT

FIG. 12.-Kangaroo.

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L

who. 12a.

6Mr G. Seccombe Hett and Mr H. G. Butterfield

posterior part, where muscle fibres are inserted into it. If now a probe bepassed into the supratonsillar fossa it will be seen to pass to the cone-shapedapex of the tonsil, but underneath the capsule and a thin layer of lymphoidtissue which surrounds it.

It has been shown that whereas the human tonsil presents manyvarieties, some of these can be explained by, and referred to, the distributionof lymphoid tissue in the developing tonsil.

Well-defined tonsils seem to occur with few exceptions throughout themalliumalia, and, as shown below, present a well-marked gradation from thesimple diverticulumi to the tonsil of the higher apes, which approximatesclosely to that of man. (Plates IV. to IX.)

Titbitlm- Tovsils.-The tiger and the leopard have tonsils which formthe startincg-point of the series. In these animals there is a V7-shapedopening ill the mucous mem-brane of the pharynx leading into a laterallycompressed blunt-ended tube. This tube passes forwards with a slightlycurved course parallel to the tongue. The tube is only separated from thebuccal cavity by the mucous membrane, through which the outline can beseen. It is lined by epithelium continuous with that of the pharynx, andthis is surrounded by lymphoid tissue. (Plate IV. fig. 1.)

The lymphoid tissue reaches nearly to the outlet of the tonsillar tube,except at the upper margin, where it falls a little short of it.

In the cats and lynxes the tonsil is similar, but lymphoid tissue protrudesfromn the opening at the lower margin of the outlet.

Pocl-e(t-s.h4wed Twsoils.-The lemur has a tonsil which is pocket-shaped.(Plate IV. tigr. 2.) In many monkeys, such as the marmosets, gibbons andcercopithecus, the tube has become shortened, so that the tonsillar diver-ticulum is pocket-shaped. It is more or less surrounded by lyniphoidtissue, but the lower or inner lip of the pocket tends to have a greaterdeposit of lymphoid tissue than time outer wall. (Plates IV'. and V.)

The pocket-shaped tonsil, with a vary7ing amount of lymphoid tissue onthe inner and outer walls, is found through a wide range of mainnmals,including the above monkeys, the opossums, womiibat, Tasmanian devil,kangaroo, etc. (Plates V. and AlI.)

The byana has a tonsil of this form with a prominent rounded lower lip.(Plate VIII. fig. 23.)

Solid P/Yqjectiify Tonsils.-A type of tonsil found in the dog, bear,badger, kinkajou, etc., is the solid projecting tonsil. This is an evolution ofthe last form, as is seen by cutting sections at right angles to the long axisof the tonsil. The lymphoid tissue is then seen to extend for some distanceround the recess above fie protruding portion. (Plates VII. and VIII.)

Time tonsil of the broad-batnded mongoose is seen to be very like the

46


PLATE VI.-MAIvIMALIAN TONSILS.

ST.

FIG. 14. FIG. 15.-Bonnamis potto.Rat-tailed opossum.

FIG. 13.-Rabbit-eared bandicoot.

4 1

FIG. 1Sa.

FIG. 16.- Marine opossum.

FIG. 15a.

FIG. 14a.

FIG. 18.-Crab-eating opossum.

FI(n. 17.-Slinder Loris.

-3

-6

FIG. 17aG FIG. 18X,.F IG. 1 da.


tonsil of the lynxes, but the fossa has become very short, so that only theanterior extrem-ity of the tonsil is enclosed within it. The prominentprotruding mass is, however, distinct. (Plate IV. fig 6.)

The bear's tonsil has the protruding portion divided posteriorly by twogrooves into three masses. (Plate IX. fig. 24.)

In the badger the lower lip of the recess is prominent, and is joined atits centre by a fold to the outer wall, so that the tonsillar sac is dividedinto two cavities. (Plate IV. fig. 5.)

The walrus has a prominent upper as well as lower and outer lip, andthe crypts open into the fossa at the angle at which they meet. (Plate VIII.fig. 22.)

In the ant-eater there is a central -tonsillar mass, which rises up as aridge from the centre of the fossa. The section shows that there is also alymphoid mass on the upper and lower wall of the sac. (Plate VII. ficr. 21.)

In the solid tonsils it appears as though the tonsillar sac had openedout, leaving the lymnphoid tissue exposed, the tonsil of the mongooseshowing a transitional form between this type and the tonsil of the cats,while that of the walrus shows a later stage of the same process.

The seal has a central fossa, but the lymphoid tissue, instead of beingdisposed in prominent upper and lower lips, as is the case in the walrus, isarranged round a central recess. The tonsillar tissue reaches the surface,but does not protrude. (Plate IX. fig. 26.)

In the ox, goat, and sheep the tonsillar recess is directed outwards atright angles to the pharynx, amid the lymiphoid tissue is arranged round it.In the eal-f the lyiuphoid tissue is arranged in three masses round secondarydiverticula of the main tube. In the goat there are two such masses, whilein the domestic sheep there are also two, but in the wild sheep and themoufflon three masses are found. (Plate IX.)

In the sheep the openings appear on the surface, owing to proliferationof lymnphoid masses in this direction and to a partial evagination of thediverticuluin. It is noteworthy that in several of the monkeys we foundtwo tonsillar sacs. Apparently these were varieties, as they did not occurconsistently in the sane species, and in one rhesus monkey the conditionwas unilateral.

A bonnet monkey, which is figured, showed a well-marked plicatriangularis, which passed from the anterior pillar to be lost posteriorlyin the tonsil. (Plate IV. fig. 8.)

A young gorilla (three years old) showed a tonsil indistinguishable fromthat of a child of the same age. (Plate IV. ficr. 7.)

Many of the monkeys showed well-marked lingual prolongation (seefig. of section of moustached monkey). (Plate V. fig. 9a.)

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PLATE VII.-AIAMM4ALIAN TONSILS.

FIG. 19.-Retriever pup.

FIG. 20. -Echidna.

FIG. 19a.

FIG. 20a.

F1G. 21. -Tamandua anteater. Fro. 21a.

VOL. XLLV. (THIRD SER. VOL. V.)-OCT. 1909.

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Mr G. Seccombe Hett and Mr H. G. Butterfield

The distribution of the mucous tissue and the arrangement of thecapsule in the mammalian tonsils is as follows:-

The lingual prolongations vary in form from the type with fair-sized,well-marked crypts to a small collection of lymphoid tissue immediatelyunder the epithelium in the neighbourhood of papillae, but in all cases thedemarcation from the surrounding tissues is definite. In many cases theapparent prolongation of the tonsil to the dorsum of the tongue and alongits lateral margin is found on section to be composed entirely of mucousglandular tissue.

The capsule in every case is quite definite, and not only forms theboundary of the tonsil, but appears to enclose mucous glands and theirducts. These mucous glands in connection with the tonsil are generallynumerous throughout the mammalian series. They tend to be morenumerous on the side of the tonsil near the tongue than on the upper andposterior portion. In some cases the tonsil appears among a large massof mucous glands, but in section is seen to be distinctly marked off fromthem by the capsule.

The crypts of the mammalian tonsils show a variety of relations withthe supratonsillar fossa. In the tubular type and its modifications, theflask-shaped and the birds'-nest forms, there are no crypts opening into thefossa, which in these cases is lined by an uninterrupted layer of epitheliumshowing slight variations in density in different parts. In the solid pro-jecting forms, such as those of the bear, small crypts can be seen, whilethese in the case of the dog are very rudimentary or not present. In thesecases lymphoid proliferation on the lower lip has so far surpassed that onthe upper lip as to completely overshadow-when viewed macroscopically-that occupying the fossa. In the embedded types (seal) the crypts ofthe pars palatina are seen in sections to communicate with the supratonsillarfossa. When the human tonsil is examined in the same way, whether thefossa is cut transversely or longitudinally, crypts are found to be openinginto it, generally with secondary diverticula, within their own walls.

The animals whose tonsils are here described show the principalvarieties met with in our dissections, others which are not described beingsimilar to one of the above-mentioned types.

The most primitive type of tonsil is a tubular diverticulum from thepharynx lined with epithelium and surrounded by lymphoid tissue. Thisis seen in the tiger and leopard. (Plate IV. fig. 1.)

At first sight it is not easy to correlate solid projecting tonsils, such asthose of the dog, and embedded tonsils, like those of the sheep or seal, withthe simple tube of the tiger.

If, however, sections through the tonsils and macroscopic specimens be

50

Anatomy of the Palatine Tonsils 51

PLATE VIII.-MAMMALIAN TONSILS.

FIG. 22.-Walrus. FIG. 22a.

I

FIG. 23.-Hynsna. MeG. 23a.


studied together, it is easily seen how they form a series and how thetonsil of man can be regarded as an evolution of the simpler forms. Theabove diagranis of sections through mamnialian toisils were made bydrawing microscopic sections under the microscope by means of thecamera lucida.

By comparing these with drawings of the macroscopic preparations ofthe same animals, the similarity between tonsils of apparently very diverseshapes is made manifest.

The cup-shaped tonsils of the lower monkeys aind the tonsils of theedible birds'-nest shape are seen to be really pockets with an epitheliallining, and to have lymphoid tissue on the outer as well as the inner wallof the pocket, but in varying proportions. The solid projecting tonsils ofthe dog and bear show traces of the original diverticulum, although thishas become opened out owing to the proliferation of lymphoid tissue ofthe lower lip.

The form and direction of the diverticulum around which the tonsil isdeveloped is important, and, if we refer to the diagrams of mammaliantonsils once more, we see that the lymphoid tissue is disposed round it indifferent ways. In the projecting solid tonsil there is apparently no suchspace, but the pocket found above the tonsil represents it, and in some caseslymphoid tissue surrounds the latter (Plate VII. fig. 19). According towhether the tonsil is of the formn of the hyama and dog, of the seal, tiger, ormonkey, this diverticulumn becomes apparently supratonsillar or obviouslyintratonsillar.

With regard to the reflected edge of mucous niembrane at the outlet ofthe tonsillar sac, this shows a sharp margin and is of crescentic shape if thediverticulum be directed obliquely and if no lymnphoid tissue is developedin it (Plate IV. fig. 1). If the diverticulumn is directed outwards at rightangles to the pharynx, and lymphoid tissue protrudes round the mouthof the outlet, then there will be no such well-miarked margin (e.g. seal;Plate IX. fig. 2().

In man the sharp margin forms the plica semnilunaris and plicatriangulairis. and is quite comparable to the sharp fold seen in the tonsil ofthe tiger and that of the cat.

It is reasonable to suppose that the supratonsillar fossa of man representsthe cavity of the original diverticulum round which the tonsil develops.

That, owing, to excessive development of lymnphoid tissue at the outletand on the outer wall of the tonsillar sac, the latter is apparently abovethe tonsil.

That the supratonsillar fossa is within the capsule of the tonsil andsurrounded by the lymiiphoid tissue of the latter, and is never extratonsillar.

52

FIG. 24.


PLATE IX--MANDIALIAN TONSILS.

ST66FA

FIG 24a

-Bear.2

FIG. 25.-Kinkajou.

6 W

FIG. 26a.FIG. 26.-Seal.


The early feetal condition is represented by the tonsil of the leopard.That the three tonsillar masses of the foetus are seen in certain mammals,

e.g. bear and ox.The pars triangularis has its representative among the animals in the

projecting portion of the tonsil of the cats and lynxes.The plica semilunaris and plica triangularis represent the reflexion of

mucous membrane at the edge of the diverticulum, and, owing to the latter'sdirection forwards and upwards, the sharp edge is only found on the upperand anterior aspect of the outlet. This is well marked in the tiger andleopard.

Some types of human tonsils can be explained by a preponderance ofone or other fetal masses. Other forms are due to lymphoid proliferationon the plica triangularis or plica semilunaris.

In certain human tonsils the plica triangularis, free, but containinglymphoid tissue beneath its .mnucous membrane, forms the greater part ofthe tonsil.

That the pars palatina or deep portion of the tonsil is well developedin the first few years of life, so that the normal tonsil is then of theembedded type.

There is then a considerable amount of lymphoid tissue round thesupratonsillar fossa.

Later, this tends to diminish, so that the portion of lymphoid tissuewhich projects from the outlet then becomes the greater part of the tonsil.

Later still, the projecting portion normally atrophies, leaving a flat spacebetween the pillars of the fauces.

The above research was carried out in the Anatomical Department ofUniversity College, Gower Street, and we have to thank Professor G. D.Thane for his kindly advice and encouragement.

We were enabled to dissect and prepare specimens of mammalian tonsilsat the Zoological Society's Gardens, owing to the courtesy of Dr ChalmersMitchell and Mr F. E. Beddard, and we are most pleased to have theopportunity here of acknowledging our indebtedness to these gentlemen fortheir kindness in placing such valuable material at our disposal.

Our thanks are due to Mr Butterworth for the skill and patience whichhe has expended in the preparation of the plates from our sketches anddiagrams.

54


PLATE X.-MAMMALIAN TONSILS.

XI

FIG. 27.-One-horned sheep. FIG. 27a.

(IGnoeir J ade) erFIG. 29.-Calf (posterior view).

FIG. 31.-Wild sheep.

FIG. 28. -Calf.

FIG. 30.-Wild goat.

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anatomia tonsilelor amigdaliene