The palatine tonsils are a pair of tonsils located between the linguopalatine and pharyngopalatine arches, which are oval in shape and covered by a complex layer of squamous epithelium. The epithelium plunges into the tonsil interior to form 10-20 crypt foci, which contain shed epithelial cells. Lymphocytes and bacteria are present. Lymph nodules and diffuse lymphoid tissue are densely distributed below the epithelium and around the crypt. The peritoneum of the tonsils is a dense connective tissue that separates the palatine tonsils from adjacent organs and acts as a barrier to prevent the spread of infection in the palatine tonsils.
The tonsils produce lymphocytes and antibodies, so they have an anti-bacterial and anti-viral defense function. The pharynx is a necessary route for eating and breathing air, and frequent contact is easier to hide germs and foreign bodies. The rich lymphoid tissue and tonsils of the pharynx perform the task of defense and protection of this special area of the body. However, it is also susceptible to inflammation by germs such as Streptococcus haemolyticus, Staphylococcus and Pneumococcus. These bacteria are usually found in the pharynx and tonsillar fossa. Under normal circumstances, the body is kept healthy because the epithelium on the surface of the tonsils is intact and the mucus glands are constantly secreting to expel bacteria from the crypt with the shed epithelial cells. When the body’s resistance decreases due to excessive fatigue, cold, etc., the epithelial defense function is weakened, and the glandular secretion function is reduced, the tonsils become infected with bacteria and become inflamed. The pharyngeal lymphatic ring consists of the palatine tonsils, pharyngeal tonsils, pharyngeal tonsils and lingual tonsils.
Tonsil stones are mostly found in the upper tonsillar fossa, where long-term obstruction, poor drainage of secretions, and accumulation of cheese-like material lead to the deposition of inorganic salts such as calcium and magnesium, which are not easily dissolved. The core can be a small foreign body, shed epithelial cells or bacteria. Stones can also occur around ciliated mycelia.
A tonsil stone weighing 6.4 g has been reported. Stones scattered in the lymphatic tissue of the pharyngeal wall are small, soft and friable; tonsil stones are larger and hard as stones. Stones buried in the submucosa have a nodular surface. The surface of the mucosa can be eroded by pressure and a fistula can occur, often causing adhesions between the superior tonsillar fossa and the tongue and palate arch.
Tonsil stones are caused by the accumulation of calcified material in the fissures or crypt of the tonsils. These calculi are white or milky white and can vary in size from the size of a pinhead to the size of a pea. Often these stones do not smell very good, which is caused by hydrogen sulfide, methyl mercaptan, or other substances in the stone. Large stones may give a foreign body sensation. Such stones usually attract the attention of the patient, who may think it is an acute or chronic infection. Tonsil stones usually cause bad breath and are not otherwise harmful.
Adults are more likely to have tonsil stones than children. The symptoms of tonsil stones are varied. Patients may find their bad breath annoying, may be irritated to the point of vomiting when they smell bad, or may have a metallic taste in their mouth. Most small tonsil stones are not associated with significant symptoms. Sometimes they are found unintentionally by patients who have had an x-ray, or when they think they have inflamed tonsils and are examined. Large tonsil stones are usually accompanied by a variety of symptoms, such as recurrent bad breath, sore throat, a bad taste in the back of the throat, difficulty swallowing, or occasional metastatic ear pain.
Second, tonsil stones should not be picked by hand Tonsil stones mostly occur in the superior tonsillar crypt. Everyone may have tonsil stones, but some may fall off and swallow on their own, while others may have a foreign body feeling in their throat. Stones can be one or more and can vary in size. Some are small, soft, and easily broken, while others are larger and hard as stones. Some diagnosed patients believe that a foreign body is left behind without a consultation and choose to gargle or even use cotton swabs or fingers to pick out the stones. Although some stones can be picked out, unfortunately, they commonly damage their tonsils in the process. In addition, simple removal of stones, especially after removal of large stones, the residual pouch-like gap is prone to food residue or foreign body retention, plus chronic inflammatory stimulation due to tonsil injury, which can lead to stone recurrence.
Once tonsil stones are diagnosed, attention should be paid to oral hygiene, especially after meals to insist on rinsing the mouth. If the effect is not good and the patient is uncomfortable, surgical treatment can be chosen to remove the tonsils and stones together to eliminate future problems.
For tonsil stones, the main treatment method is tonsil removal.
Tonsil removal is supposed to be one of the most common procedures worldwide and has a very long history. Tonsil removal is generally considered in the following cases: 1. Repeated acute tonsillitis, peri-tonsillar abscesses, and tonsil removal is feasible in young children due to tonsillar hyperplasia and hypertrophy resulting in upper respiratory tract discomfort and even respiratory difficulties and swallowing inconvenience.
2.Tonsillectomy can be performed if the chronic tonsillitis causes disorders of neighboring organs, such as recurrent acute rhinitis, pharyngitis, otitis media, cervical lymphadenitis, etc., which are related to the tonsils.
3, chronic tonsillitis as a focal point and cause other organs in the body, such as rheumatic fever, rheumatic heart disease, arthritis and nephritis, etc., can be considered for tonsillectomy.
4.Sleep apnea syndrome will also be considered for this surgery.