Main Article Content
Background: Despite being a relatively common condition, acute suppurative tonsillitis may be sometimes confused with other tonsillar disorders, including the equally common tonsillar detritus accumulation connected with halitosis or the less common tonsillar keratin cyst.
Aim: The purpose of this paper was to demonstrate the differences in gross and microscopic presentation between suppurative tonsillitis, tonsillar detritus accumulation, and tonsillar keratin cysts.
Material and methods. We documented these conditions photographically and conducted microscopic evaluations of the following samples: 1) tonsillar surface swab from 3 patients with suppurative tonsillitis, 2) detritus from tonsillar crypts in 8 patients, and 3) tonsillar keratin cyst contents extracted via cyst incision and drainage in a 63-year-old woman and 18-year-old man. Two patients had both acute suppurative tonsillitis and tonsillar detritus accumulation.
Results and discussion. In the case of acute suppurative tonsillitis, the surface of tissues with bacterial colonies is covered by a profuse exudate containing necrotic tissue and numerous neutrophils. In contrast, a microscopic examination of tonsillar detritus reveals necrotic homogeneous discharge, typically without any clear cells but with visible bacterial colonies which do not induce an inflammatory response. Tonsillar keratin cyst contents demonstrated the presence of superficial squamous epithelial cells and mononuclear inflammatory cells.
Conclusions. Gross and microscopic assessments may reveal significant differences between suppurative tonsillitis, detritus accumulation in tonsillar crypts, and tonsillar keratin cysts, all of which require different treatment methods.
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
1. Al-Abbasi AM. Tonsillectomy for the treatment of halitosis. Niger J Med. 2009 Jul-Sep;18(3):295-8
2. Altemani A, Endo LH. Histopathology of the palatine tonsil in the newborn infant. Acta Otolaryngol Suppl. 1996;523:12-3.
3. Altemani A, Endo LH, Chone C, Idagawa E. Histopathological concept of chronic tonsillitis in children. Acta Otolaryngol Suppl. 1996;523:14-6.
4. Ata N, Ovet G, Alataş N. Effectiveness of radiofrequency cryptolysis for the treatment of halitosis due to caseums. Am J Otolaryngol. 2014 Mar-Apr;35(2):93-8.
5. Brodsky L, Frankel S, Gorfien J, Rossman J, Noble B. The role of dendritic cells in the development of chronic tonsillar disease in children.Acta Otolaryngol Suppl. 1996;523:98-100.
6. Ferguson M, Aydin M, Mickel J. Halitosis and the Tonsils: A Review of Management. Otolaryngol Head Neck Surg. 2014 Oct;151(4):567-574.
7. Finkelstein Y, Talmi YP, Ophir D, Berger G. Laser cryptolysis for the treatment of halitosis. Otolaryngol Head Neck Surg. 2004 Oct;131(4):372-7.
8. Gorfien JL, Noble B, Brodsky L. Comparison of the microanatomical distributions of macrophages and dendritic cells in normal and diseasedtonsils.Ann Otol Rhinol Laryngol. 2001 Feb;110(2):173-82.
9. Howie AJ. The cells in tonsillar crypts.Clin Otolaryngol Allied Sci. 1982 Feb;7(1):35-44.
10. Khorov OG, Aleshchik ICh, Rakova SN, Diurd' TI :[Efficiency of the hydrovacuumaspiration technique for the treatment of patients with chronic tonsillitis].
Vestn Otorinolaringol. 2009;(2):29-32.
11. Krespi YP, Kizhner V. Laser tonsil cryptolysis: in-office 500 cases review. Am J Otolaryngol. 2013 Sep-Oct;34(5):420-4.
12. Mesolella M, Cimmino M, Di Martino M, Criscuoli G, Albanese L, Galli V. Tonsillolith. Case report and review of the literature. Acta Otorhinolaryngol Ital. 2004 Oct;24(5):302-7.
13. Nesterova KI, Mishen'kin NV, Makarova LV, Verimeevich LI.
[Conservative therapy of chronic tonsillitis: comparison of different methods]. Vestn Otorinolaringol. 2005;(2):43-6.
14. Noble B, Gorfien J, Frankel S, Rossman J, Brodsky L. Microanatomical distribution of dendritic cells in normal tonsils.Acta Otolaryngol Suppl. 1996;523:94-7.
15. Ovchinnikov IA, Dobrotin VE, Klimova LA, Filimonov GP, Bakhtadze MA.
[On validity of intralacunar exposure to surgical laser beam in chronic tonsillitis (experimental study)]. Vestn Otorinolaringol. 2003;(2):20-1
16. Psakhis BI, Gasymov AV, Parilov VE. [Treatment of chronic tonsillitis by lacunar cryosurgery]. Vestn Otorinolaringol. 1990 May-Jun;(3):79. Russian.
17. Rio AC, Franchi-Teixeira AR, Nicola EM. Relationship between the presence of tonsilloliths and halitosis in patients with chronic caseous tonsillitis. Br Dent J. 2008 Jan 26;204(2):E4.
18. Staroverova TK, Shul'diakov VA, Raĭgorodskiĭ IuM, Tatarenko DA.
[Endolacunar laser radiation of the tonsils in conservative treatment of chronic tonsillitis]. Vestn Otorinolaringol. 2007;(4):56-9. Russian.
19. van den Akker EH, Schilder AG, Kemps YJ, van Balen FA, Hordijk GJ, Hoes AW. Current indications for (adeno)tonsillectomy in children: a survey in The Netherlands. Int J Pediatr Otorhinolaryngol. 2003 Jun;67(6):603-7.
20. Zbyshko YB. [Efficacy of CO2 laser in the treatment of patients with chronic tonsillitis]. Vestn Otorinolaringol. 2007;(5):57-9.