The lymph vessels play a key role in the drainage of interstitial fluid from the tissues to the blood and fat absorption, whereas the lymphoid organs mediate the proliferation and maturation of the cells of the immune system, which protect the body against ingested or inhaled foreign pathogens. Lymphoid system, as a component of the immune system, consists of lymph vessels, nodes, and organs that regulate the immune response directly or indirectly. The tonsils are lymphoepithelial organs acting as a guardian at the entrance of the upper aerodigestive tract. Immune function of the tonsils in Waldeyer’s ring A detailed knowledge of the surgical anatomic landmarks in the tonsillar region and the spaces around it is required for preoperative planning and to prevent iatrogenic complications.Ģ. Lingual tonsils and lymphoid aggregations close to the epiglottisĭue to the close proximity of the palatine tonsil with the surrounding spaces including parapharyngeal, retropharyngeal, masticator, and parotid spaces, the tumors and inflammation of the tonsil commonly spread into these spaces and result in secondary lesions. Įustachian tube tonsils (Gerlach’s tonsils) This annular-shaped lymphoid ring contains four types of tonsils in a fixed position. As part of MALT, the tonsils serve as a protection ring including nasopharynx-associated lymphoid tissue (NALT), which is known as Waldeyer’s tonsillar ring, around the entrance of the upper aerodigestive tract to start the initial immunological barrier to infections. Due to the penetration of benign or malign lesions of the tonsil into the lateral wall of the pharynx, transoral robotic approach to this region is necessary to identify the surgical anatomic landmarks which are required to perform safe and effective surgical intervention.Īs part of secondary lymphoid organs, mucosa-associated lymphoid tissue (MALT) is an aggregate of unencapsulated lymphoid tissue that is located diffusely in the mucosa of the aerodigestive tract and consists of the tonsils, vermiform appendix, and Peyer’s patch. Recent medical studies reported that a detailed understanding of the anatomic risk factors in upper airway obstruction allows to predict treatment response to surgical intervention. Knowledge of the surgical anatomy of the tonsils and variations of the neurovascular and muscular structures around it allows optimal choice of surgical technique to avoid iatrogenic complications during tonsillectomy.
Because of the tonsil enlargement during childhood, upper airway obstruction and obstructive sleep apnea syndrome are mostly seen. Particularly, the palatine tonsils are the largest of the tonsils with deep branching crypts and contain B and T lymphocytes and M cell which plays a role in the uptake and transport of antigens. Waldeyer’s ring is composed of the pharyngeal, tubal, palatine, and lingual tonsils acting as secondary lymphoid tissues. The tonsils represent a circular band of mucosa associated with lymphoid tissues, Waldeyer’s ring, which is located at the entrance of the upper aerodigestive tract, with a significant role in the immune defense system.
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