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Hello everyone, Sidney Levy here continuing our

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discussion of the anatomy of the oropharynx.

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Today I'd like to focus on the palatine tonsils.

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So what are the palatine tonsils?

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They are the tonsillar tissue between the anterior

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and posterior tonsillar pillars, or, thinking

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of it in another perspective, the palatoglossal

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and palatopharyngeal arches, which would be more

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familiar to an ear, nose, and throat surgeon.

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How do we find them, particularly in an

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elderly patient, which is what we have here

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where the tonsils are quite diminutive.

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So they're easiest to see on the axial projection.

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It's very important to be able to identify

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them because they are the most common site

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of oropharyngeal squamous cell malignancy.

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So what we can do is we can start off with

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the uvula, which we have here in the midline.

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And if we follow the uvula

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down, we see a couple of arches.

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So anteriorly, we have the palatoglossal arch,

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or alternatively, more readily recognizable

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to many, the anterior tonsillar pillar.

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As you keep going, there's also a

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palatopharyngeal arch, or posterior tonsillar

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pillar, which I'm showing here with my cursor.

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These split, and then in between

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them is where the tonsils live.

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So I'm going to pick a plane here, and then I'm

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going to draw the tonsils for you at this point.

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Not much tonsillar tissue in this patient, but

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often they're quite prominent and appear between

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the anterior and posterior tonsillar pillars.

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What are their relationships?

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I've just shown you the superomedial

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relationship, which is the soft palate,

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which is one of the other oropharyngeal subsites.

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Posteromedially, we have another oropharyngeal

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subsite, the posterior oropharyngeal wall.

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And that is all of this.

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Anteromedially and slightly inferiorly,

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we have the tongue base, which is

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another important oropharyngeal subsite.

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So that's anterior to the level of the

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base of the anterior tonsillar pillar.

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Anterior tonsillar pillar, posterior tonsillar pillar.

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Easier to appreciate as I'm scrolling

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because it's easier to connect it with

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the soft palate when you're looking.

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But then, anteromedial and inferior to this

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level, we have the tongue base, which is here.

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So in summary, the palatine tonsils are

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often best viewed on the axial projection.

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They consist of the tonsillar tissue between the

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anterior and posterior tonsillar pillars, which are

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sometimes also referred to as the

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palatoglossal and palatopharyngeal arches.

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And their relationships are anteromedial

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and inferior is the tongue base.

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Posteromedial is the posterior oropharyngeal

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wall and superomedial is the soft palate.

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The last thing to mention is you may possibly hear the

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term glossotonsillar sulcus. If you do hear that term,

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it is merely the juncture between the base of the

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anterior tonsillar pillar and the tongue base.

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People will not uncommonly say that

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the tumor has spread from the palatine

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tonsil to the glossotonsillar sulcus.

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But what you're really saying is that it has

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spread to the margin of the base of tongue.

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And what's perhaps more important is

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to say, is the base of tongue involved?

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Thank you.