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General Thermography
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
Acute tonsillitis is a rapid-onset infectious inflammation of the tonsils, situated in the lateral recesses of the oropharynx. Though tonsillitis is most frequently caused by self-limiting viral infections, bacterial infections including streptococci may cause severe febrile disease with neurological and cardiac sequelae. Complications include peritonsillar abscess. Infection of the small pockets within the tonsils (cryptic tonsillitis) may produce chronic foul-smelling, purulent discharges along with local swelling and pain.
Staging of Head and Neck Cancer
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
The oropharynx is the portion of the pharynx extending from the plane of the superior surface of the soft palate to the superior surface of the hyoid bone (or floor of the vallecula). It includes: Anterior subsites (glosso-epiglottic area)Base of tongue (posterior to the vallate papillae or posterior third)ValleculaLateral subsitesLateral wallTonsilTonsillar fossaTonsillar pillarPosterior wallSuperior subsitesInferior surface of soft palateUvula
Head and Neck Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Lorcan O’Toole, Nicholas D. Stafford
The oropharynx comprises the base of tongue (posterior 1/3), vallecula, tonsils, soft palate, and posterior pharyngeal wall. Oropharyngeal cancers (OPC) have been increasing dramatically in incidence worldwide since the late 1990’s. Most recent figures for the UK demonstrate an incidence of 5 per 100,000 persons per year in 2010–2012 or 25% of all HNC. Evidence demonstrates HPV (particularly genotype 16) as an independent risk factor now accounting for up to 70% of cases. Between 60% and 75% of patients have palpable cervical nodes at presentation, and the majority (around 70%) have T3 or T4 primaries.
A rare case of tonsillar mucoepidermoid carcinoma
Published in Acta Oto-Laryngologica Case Reports, 2023
Charbél Talani, Karin Frånlund, Crina Unguras
A 46-year-old previous smoking male presented with a lump in the left neck at level IIa. The lump had been present for almost 2 months and had been growing. Intra oral and flexible endoscopy was normal. An ultrasound of the left neck detected a 29 × 24 × 12 millimeter necrotic node. Fine needle aspiration and core needle biopsy showed malignant cells and a high suspicion of mucoepidermoid carcinoma. A computer tomography (CT) of the neck and thorax showed contrast enhancement in the left palatine tonsil but symmetric conditions in the oropharynx regarding tonsillar size. The necrotic lymph node was the most prominent one in neck level IIa (Figure 1). CT also showed a couple enlarged lymph nodes in left level III. The case was discussed at a Multi Disciplinary Tumor Board meeting (MDTB). The treatment decision was radical tonsillectomy with left side neck dissection levels I–V. The operative pathology report showed a MEC of the left tonsil, measuring 18 × 9×5 millimeter (Figure 2). The tumor was graded according to Brandwein [13] and Armed Forces Institute of Pathology [14] and was scored 9 and 8, respectively thus being a high grade MEC. Two metastases were present in neck levels IIa and Vb. Ki-67 was estimated to 70%. The tumor was graded as pT1N3bM0 according to AJCC [15]. The case was discussed once again at MDTB and postoperative radiotherapy was decided. The patient received 68 Gray to the oropharynx and the left neck. A FDG-PET, three months after the radiotherapy, was conducted showed no pathologic uptake in the head and neck or thorax.
Is 2045 the best we can do? Mitigating the HPV-related oropharyngeal cancer epidemic
Published in Expert Review of Anticancer Therapy, 2022
Ari Schuman, Karen S. Anderson, Andrew T. Day, Jay Ferrell, Erich M. Sturgis, Kristina R. Dahlstrom
For the specialist, there are emerging tools to assist in the evaluation of early lesions of the oropharynx. As noted above, there is no equivalent precancerous lesion in the oropharynx compared to anogenital mucosal sites. OPC are often subtle lesions and difficult to see within the crypts of the base of tongue and tonsils. Technologies that are emerging as useful for the evaluation of the oropharynx are narrow band imaging (NBI) and ultrasound (US) [84–87]. Tirelli et al. found that 8.5% of patients in their study of oral cavity and oropharyngeal cancers had an additional finding on NBI, all of which changed management. In three of these four patients, they found a synchronous primary; in the other, they were able to identify an unknown primary in the tonsil [88]. Muto et al., in a prospective trial of NBI compared to conventional white light imaging, found that NBI had a sensitivity of 100% of for the identification of superficial lesions in the head and neck and esophagus, compared to only 8% for white light alone [89]. The majority of these lesions, 75%, were then removed entirely by biopsy or endoscopic excision with minimal morbidity. In a comparison of magnetic resonance imaging (MRI) and US, Faraji et al. showed that 98% of OPC tumors were detected with US, although this is likely an overestimate as the sonographers were unblinded [87]. The high sensitivity and relatively low cost make US an attractive modality for diagnosis of OPC.
Retropharyngeal abscess as a paradoxical reaction in a child with multi-drug-resistant tuberculosis
Published in Paediatrics and International Child Health, 2019
Lavina Desai, Ira Shah, Manohar Shaan
Retropharyngeal abscess in children presents as fever, neck stiffness, painful swallowing, swelling of the neck, bulge in the oropharynx and lymphadenopathy [6]. This patient had no symptoms related to a retropharyngeal abscess; it was detected only on routine ENT examination in November 2016. The diagnosis of tuberculous retropharyngeal abscess requires positive cultures for MTB or the detection of acid-fast bacilli in the aspirate. Radiological imaging plays an important role in demonstrating the extent of the abscess and involvement of surrounding structures. A CT scan is 89% accurate and MRI is even more so [7]. The aspirate was Xpert-positive but mycobacterial culture was negative, and, in view of her previously normal ENT examination, it is likely that the abscess developed shortly after initiation of second-line ATT in July 2016, the timing of which strongly suggests the possibility that it resulted from a PR.