Dissection of the inferior pole
fibrous connective, peritonsillar, avascular
In all patients, the procedure was performed under general anesthesia. A Boyle–Davis mouth gag was used to stabilize the tracheal tube during surgery to ensure visualization of the oropharynx.The triangular area above the upper pole of the tonsil was identified, and the upper pole was separated by digital palpation. The tonsillar tissue of the upper pole was grasped with small forceps and pulled medially and inferiorly to reveal the avascular space (i.e., peritonsillar space) above the tonsil (Fig. During dissection, traction was applied in the medial and superior directions to expose the inferior pole of the tonsil. The inferior pole capsule is linked to the lingual lymphoid tissue through a narrow and dense tract of fibrous connective tissue, which contains a rich arterial vessel network. Care should be taken to ensure that the pharyngeal constrictor muscle is not damaged during dissection of the inferior pole; specifically, the dissection should be limited to the inferior pole capsule to minimize the risk of injury to the narrow and dense fibrous connective tissue (Fig. 