Oropharynx Infections (Sore Throat)

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The oropharynx is a common site of viral and bacterial infections (sore throat).

Diphteritic pharyngotonsillitis

Enlargement of the palatine tonsils as a result of inflammation is common.

The mucosa-associated lymphoid tissue around the pharynx (Waldeyer's ring) comprises 
the palatine tonsils (tonsils), the nasopharyngeal tonsil (adenoids), and the lymphoid
tissue in the sub-mucosal region of the posterior third of the tongue (lingual tonsil).
As part of the immune system, the lymphoid tissue in these areas reacts to inflammation 
or infection in the region by undergoing lymphoid hyperplasia. The changes are most easily
seen in the prominent palatine tonsils; reactive lymphoid hyperplasia is the most 
common cause of tonsillar enlargement, particularly in children and juveniles, often occurring
as a response to a viral or bacterial pharyngitis.

Acute tonsillitis usually occurs as a component of a widespread acute bacterial 
pharyngitis, usually due to a-haemolytic streptococci. The tonsils are swollen.
red due to mucosal hyperaemia, and partly covered by creamy acute inflammatory exudate (acute
parenchymatous tonsillitis). Sometimes there are scattered, creamy yellow spots on the surface
(acute follicular tonsillitis) due to beads of pus extruding from the mouths of the infected 
epithelial-lined crypts. Acute streptococcal pharyngitis and tonsillitis may be complicated by
the development of a peritonsillar abscess (quinsy) or, rarely, by spreading cellulitis
in the neck (Ludwig's angina) or retropharyngeal abscess formation. Acute tonsillitis 
may also be a component of a severe viral pharyngitis, e.g. in glandular fever and some
adenovirus infections.
In adults the tonsils usually become progressively smaller as the lymphoid component atrophies.
However, in some cases the lymphoid element remains prominent, in association with enlarged 
crypts distended with keratin, in which numerous bacterial colonies (particularly Actinomyces
species) are seen. This is sometimes called chronic tonsillitis, although the organisms
are considered to be commensals.

Tumours of the tonsil are usually squamous cell carcinoma or malignant lymphoma

Benign tumours of the tonsil are very rare, and most tumours are malignant. Squamous
papillomas of the tonsillar region are mainly benign viral overgrowths, and occur on the
faucial pillars rather than on the tonsil.

Squamous cell carcinoma presents as a mass or an ulcer with raised edges, usually 
in elderly men. The tumour invades the tongue and fauces, and lymphatic spread to neck 
nodes occurs early. Often, late presentation means that local and lymph node spread is 
advanced, and complete surgical removal is impossible.

Lymphomas of the tonsil are nearly always non-Hodgkin's lymphomas. Most are high-grade lesions,
which can occur in children and young adults; a smaller number are low-grade lesions , which tend
to occur in elderly patients. Sometimes there is associated lymphoma in the rest of Waldeyer's
ring or in the gastrointestinal tract . 

Lymphoma of the tonsil has a better prognosis than squamous carcinoma because of the good
response to chemotherapy.
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