A. Anatomy and Physiology

The pharynx is part of both the respiratory and digestive system. Both systems have entrances to the pharynx but they are separated from each other by the soft palate. During exercise or during respiratory distress, the mouth can be used as an additional opening of the respiratory system and then the oropharynx also becomes an air-way. The pharynx can be split into different regions - the oropharynx, laryngeal pharynx also referred as the oesophageal pharynx and the nasopharynx. The opening of the larynx is on the floor of the pharynx. Caudal and dorsal to the laryngeal opening is the opening into the oesophagus. In the dorsal region of the nasopharynx, there are paired openings into the auditory tubes. The lining of the middle ear cavity and auditory tube is continuous with that of the nasopharynx. The pharynx is located between the base of the skull and the first two cervical vertebrae dorsally and the larynx ventrally. The mandible, pterygoid muscles and hyoid apparatus are located laterally. Laterally, two pairs of palatopharyngeal arches are present from the soft palate to the oesophagus. The walls of the pharynx contain striated muscle. During swallowing, the soft palate is raised which divides the pharynx into dorsal and ventral sections. The dorsal compartment is the nasopharynx and the rostral compartment is the oropharynx. The laryngeal pharynx is separated from the oropharynx by the epiglottis. Tonsils are present on the lateral walls of the oropharynx and are covered by flaps of mucosa.

The tonsils are two masses of lymphoid tissue placed one in each tonsillar fossa and projecting into the oropharynx. These are dense compact bodies of lymphoid tissue that are located in the lateral wall of the oropharynx, bounded by the palatoglossus muscle anteriorly and the palatopharyngeus and superior constrictor muscles posteriorly and laterally. Each tonsil is composed of tissue similar to lymph nodes, covered by pink mucosa. Running through the mucosa of each tonsil are pits, called crypts. The tonsils are also a part of the lymphatic circle which surrounds the oropharynx called the walder's ring and also helps to fight infections. However, removal of the tonsils does not seem to increase susceptibility to infection. Tonsils vary widely in size and swell in response to infection.The mucous membrane and their pharyngeal surface is marked by small apertures which indicates the opening of the crypts. The epithelial lining of the crypts are reflected from the surface coveringIn the neighboring part of the pharynx near the Eustachian tube, the upper part of the pharynx and the base of the tongue, there are masses of lymphoid tissue similar to the structure of the tonsils which also contains crypts

B. Pathophysiology

Tonsillopharyngitis is acute infection of the pharynx or palatine tonsils or both. Symptoms may include sore throat , dysphagia, cervical lymphadenopathy, and fever . Diagnosis is clinical, supplemented by culture or swift antigen test. Treatment is dependent on symptoms and involves antibiotics .

Tonsillopharyngitis is usually viral, most regularly caused by the adjectives cold viruses (adenovirus, rhinovirus, influenza , coronavirus, respiratory syncytial virus), but occasionally by Epstein-Barr virus , herpes simplex virus , cytomegalovirus , or HIV . In Some cases, the cause is bacterial . Group A β-hemolytic streptococcus (GABHS) is most adjectives, but Staphylococcus aureus, Streptococcus pneumoniae, Mycoplasma pneumoniae, and Chlamydia pneumoniae are

sometimes involved. Rare causes include pertussis , Fusobacterium, diphtheria , syphilis , and gonorrhea. The inflammation and infection of tonsil crypts rather than the tonsils themselves.