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To properly grasp the grading of tonsil hypertrophy, we first need to understand the following key anatomical landmarks in the figure below, which will be used in the grading.
Note: Some students tend to confuse the palatopharyngeal arch with the palatoglossal arch. The arch closer to the tongue is the palatoglossal arch, and the one closer to the pharynx is the palatopharyngeal arch. Now there should be no confusion!
Grade I Tonsil Hypertrophy
Extends beyond the palatoglossal arch but does not exceed the palatopharyngeal arch
The area within the red circle in the figure is Grade I.
Grade II Tonsil Hypertrophy
Extends beyond the palatopharyngeal arch but does not reach the midline of the posterior pharyngeal wall
Real picture of Grade II (red line indicates the palatopharyngeal arch)
Grade III Tonsil Hypertrophy
Reaches or exceeds the midline of the posterior pharyngeal wall
Real picture of Grade III