Congenital Anomalies of Waldeyers Ring

Congenital anomalies include the extremely rare absence of palatine tonsils and accessory tonsils within the oral cavity [68, 155]. Slightly more common is the "hairy polyp", a choristoma, which arises from remnants of the ectodermal and mesodermal germ layers in the palatine tonsil and nasopharynx (see also Sect. 6.2.3.2). The unilateral pedunculated hairy polyps of up to 5 cm arise mostly on the superior pole of the palatine tonsil and present with acute respiratory distress [129]. A rare bilateral presentation has been described [52]. These polyps show a mesenchymal fibrovascular core, often with adipose tissue and skeletal muscle fibres and are covered in regular skin with hair appendages. In tonsillar hairy polyps, submucosal plates of elastic cartilage of uniform thickness resembling the external ear auricular tags and auricular cartilage have been reported [78]. Hairy polyps of the tonsils have been postulated to arise from the second pharyngeal pouch [17], but due to the presence of the cartilage plates they have also been interpreted as accessory auricles with a postulated origin from the first pharyngeal arch [78].

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