Waldeyer's Tonsillar Ring

(Named after Heinrich Wilhelm Gottfried von Waldeyer, 1836 - 1921, German anatomist)

Anatomy

Ring of lymphoid tissue, formed by the lingual tonsil, palatine tonsils, and nasopharyngeal tonsils (also called adenoids). It appears during the first few months after birth, is prominent during childhood, and gradually involves from puberty on. Normal lymphoid tissue of Waldeyer's ring appears as homogeneous soft tissue, sometimes lobulated.

Clinical Applications

· Congenital
If no adenoids are seen by the age of 6 months, a problem with the immune system should be suspected.

· Inflammation
Hypertrophy of the nasopharyngeal tonsil and palatine tonsils is commonly seen in children. Hypertrophy of the adenoids commonly causes dysfunction of the eustachian tube, which on its turn causes serous otitis media. Hypertrophy of the palatine tonsils may cause dysphagia (difficulty swallowing) and breathing difficulties; these symptoms are less commonly seen with lingual tonsil hypertrophy.

· Tumour
Waldeyer's ring is a common site for extranodal non Hodgkin lymphoma head and neck manifestation. Primary squamous cell carcinoma head and neck may hide in crypts within lymphoid tissue of Waldeyer's ring.

Tonsillectomy & Adenoidectomy

Tonsillectomy is defined as the surgical excision of the palatine tonsils while adenoidectomy refers to the surgical excision of the adenoids or nasopharyngeal tonsils.

These are some of the risks and complications of tonsillectomy and adenoidectomy:

• Failure to alleviate every episode of sore throat, or resolve subsequent or concurrent ear or sinus infections/nasal drainage. Possible need for additional surgery.
  
• Failure to improve the nasal airway or resolve snoring, sleep apnea, or mouth breathing.
  
• Bleeding. Bleeding may be classified as intraoperative, primary (occurring within the first 24 hours), or secondary (occurring between 24 hours and 10 days).
  
• Infection, dehydration, and/or prolonged pain which could lead to the necessity for hospital admission for fluids and/or pain control.
  
• A permanent change in voice or nasal regurgitation.
  

Source: http://www.medcyclopaedia.com/library/topics/volume_vi_2/w/waldeyers_ring.aspx
http://www.medicinenet.com/tonsillectomy/article.htm

Contributed by John Lee