Posterior Oropharyngeal Wall Research Articles

Disseminated tuberculosis revealed by a pharyngeal location

Tuberculosis of the posterior oropharyngeal wall is a rare disease. Usually it is revealed by a sluggish or chronic odynophagia, sometimes very painful. We report a case of tuberculosis of multiple localizations: posterior oropharyngeal wall, neck lymph node and lungs. Clinical fea- tures were pharyngeal ulcerations with yellow deposits, cervical lymph nodes, and bilateral bronchial crackles. Diagnosis was confirmed by positive findings of acid-fast bacilli in smears, and epithelioid granuloma with giant cells in surgical pathology examination of biopsy samples from posterior oropharyngeal wall and from cervical adenectomy. The diagnosis was disseminated tuberculosis with pulmonary, pharyngeal and lymphatic locations. Specific antituberculous treatment led to a favourable outcome. Oropharyngeal tuberculosis has to be evoked in a case of odynophagia and dysphonia.

A Unique Case of Deep Neck Infection in an Older, Immune‐Competent Adult

Upon examination, the patient was noted to have erythematous swelling of the left posterior oropharyngeal wall with friable mucosa. Palpation of the neck was negative for lymphadenopathy or masses. CT scan of the neck demonstrated a large fluid collection in the retropharyngeal space that extended laterally into the left parapharyngeal space, as well as anteriorly to the left thyroid cartilage (FIG 1 & 2).

Squamous carcinoma of the posterior pharyngeal wall

We present 70 patients with tumours of the posterior pharyngeal wall, considering tumours of the posterior hypopharyngeal and posterior oropharyngeal wall as one unit. Almost half (45%) of the patients were in poor general condition at the time of presentation, and 60% had Stage III or IV tumours. One-third of the patients were untreated, and surgery was mainly reserved for patients with Stage I and II tumours. The larynx could be preserved in two-thirds of those undergoing surgery. The best current method of repair of the posterior pharyngeal wall after partial pharyngectomy appears to be a revascularized radial forearm flap. The median survival for patients with Stage I tumours was 236 weeks, but for patients with Stages II-IV tumours was only 33 weeks. There was no significant difference between the survival for II–IV stage groups, but there was between Group I and the rest. We identify 2 defects in the UICC classification system: lack of definition of the lateral limit of the posterior pharyngeal wall, and a gross discrepancy between size and T staging of tumours arising primarily from the posterior wall of the hypopharynx.

Cine-MRI swallowing evaluation after tongue reconstruction

Objective To determine the feasibility of cine-MRI for non-invasive swallowing evaluation after surgery for lingual carcinoma with reconstruction using microvascular free flaps. Methods Ten patients with stage IV carcinoma of the mobile tongue and/or tongue base treated by surgical resection and reconstruction with a free flap were evaluated after an average of 4.3 years (range: 1.5–11 years), using cine-MRI in “single-shot fast spin echo” (SSFSE) mode. Fiberoptic laryngoscopy of swallowing was performed before MRI to detect aspiration. The tolerance and ability to complete the exam were noted. The mobilities of the oral and pharyngeal structures visualized were evaluated as normal, reduced or increased. Results Cine-MRI was well tolerated in all cases; “dry” swallow was performed for the 2 patients with clinical aspiration. Tongue base-pharyngeal wall contact was observed in 5 cases. An increased anterior tongue recoil, increased mandibular recoil, increased posterior oropharyngeal wall advancement and an increased laryngeal elevation were observed in 4 cases. One case of a passive “slide” mechanism was observed. Conclusions Cine-MRI is a safe, non-invasive technique for the evaluation of the mobility of oral and oropharyngeal structures after free-flap reconstruction of the tongue. For selected cases, it may be complementary to clinical examination for evaluation of dysphagia after surgery and free-flap reconstruction. Further technical advances will be necessary before cine-MRI can replace videofluoroscopy, however.

Intramuscular hemangioma of the retropharyngeal space

Intramuscular hemangioma (IMH) is a distinctive type of hemangioma occurring within skeletal muscle. Most IMH are located in the lower extremity, particularly in the muscles of the thigh. When present in the head and neck region, the masseter and trapezius muscle are the most frequently involved sites. We reported a case of unusual localization of the head and neck IMH occurring within the retropharyngeal space (RPS). To our knowledge, this is the second such case reported in the English literature. The tumor presented as a left-sided neck mass with bulging of the posterior and left lateral oropharyngeal wall on indirect laryngoscopy. Computed tomography (CT) scan revealed an ill-defined mass in the RPS at the oropharyngeal level. The lesion was excised via a transoral approach and microscopically diagnosed as IMH, the complex malformation subtype. Although surgical margins were positive, no recurrence of the tumor was noted in the 17-month follow-up. Intramuscular hemangioma should be considered in the differential diagnosis of deep head and neck masses. The knowledge of the infiltrative nature and recurrence rate of an IMH is useful for appropriate managment.

Application of the ‘pull-off’ force method for measurement of surface tension of upper airway mucosal lining liquid

Upper airway luminal patency is influenced by a number of factors including: intraluminal air pressure, upper airway dilator muscle activity, surrounding extraluminal tissue pressure and surface tension acting within the liquid layer lining the upper airway. In this study we examine the performance characteristics for the ‘pull-off’ force method for measuring the surface tension (γ) of liquids. This method is then used to examine the γ of the liquid lining the oro-pharynx in awake human subjects. The γ of UAL samples (∼0.2 µL) obtained from the posterior pharyngeal wall was quantified using the pull-off force technique in which γ is measured as the force required to separate two curved silica discs bridged by the liquid sample. Pull-off force measurement was not influenced by sample volumes or under different temperature or humidity conditions. The coefficients of variation for repeated measurements using the pull-off force technique for the three standard liquids ranged from 1.2% to 5.6%. The pull-off method tended to give slightly lower values than the Wihelmy balance method with the mean difference being 2.4 ± 1.8 mN m−1. For the group, the γ of saliva was 59.2 ± 0.6 mN m−1 (CV 4.9 ± 0.9%) for five measurements of a single sample. There was no significant relationship between the measured γ values for five subjects measured on five separate days and the day of collection of the sample for any of the subjects or the group as a whole (both p > 0.6). There was no significant difference (p = 0.53, ANOVA) between the γ values for samples obtained from under the tongue (61.6 ± 1.7 mN m−1), at the oral surface of the soft palate (56.1 ± 3.2 mN m−1) and from the posterior oro-pharyngeal wall (58.1 ± 2.4 mN m−1). The pull-off force method provides adequate reproducibility to be able to measure the γ of UAL. In healthy humans the γ of UAL is similar to that of saliva.

Cephalometric comparison of pharyngeal changes in subjects with upper airway resistance syndrome or obstructive sleep apnoea in upright and supine positions.

The aim of the present study was to cephalometrically compare pharyngeal changes between upright and supine positions in patients with upper airway resistance syndrome (UARS) or obstructive sleep apnoea (OSA). Eighty-two OSA patients, 70 men (mean age 49 +/- 11.8 years) and 12 women (45.9 +/- 8.3 years), underwent cephalometric sleep apnoea analysis. One upright and one supine radiograph were taken of each patient (a total of 164 cephalometric radiographs). The results showed no significant changes either in naso- or hypopharyngeal soft tissues between the two positions. In contrast, the shortest distance from the soft palate (ve1-ve2) and the tip of the soft palate (u1-u2) to the posterior oropharyngeal wall was significantly narrower (P < 0.001) in the supine position. Furthermore, in the supine position a slight thickening in the soft palate (sp1-sp2, P < 0.05) was detected with no change in the length of the soft palate (PNS-u1). The form of the tongue changed significantly: it was shorter (Tt-Tgo, P < 0.001; Tt-va, P < 0.001) and thicker (Ts/Tt-Tgo, P < 0.05) in the supine position. The present results suggest that OSA patients are prone to significant narrowing of their oropharyngeal, but not of their naso- or hypopharyngeal, airways in the supine position. Thus, treatment of OSA and UARS patients should mainly be aimed at preventing further oropharyngeal airway narrowing as a result of supine-dependent sleep.

中咽頭後壁へん平上皮癌の臨床的検討

Clinical features of 33 patients with squamous cell carcinoma of the posterior oropharyngeal wall treated at the Department of Otolaryngology, Head and Neck Surgery, Kurume University Hospital from 1973 to 2003 were analysed. Of these, 23 (21 men and 2 women, mean age: 66 years) underwent radical treatment, and 10 (8 men and 2 women, mean age: 78 years) did not. In those treated radically, 2 were stage I, 5 stage II, 6 stage III, and 10 stage IV. The primary disease was surgically treated in 16, and reconstruction added in 5, using the free jejunum in 4 and a forearm flap. Radical radiotherapy was done in 7. Five-year local control in the 23 was 35.3%. Disease-specific 5-year survival was 32.0%. Seven died of primary oropharyngeal cancer. After treatment, 78.3% were able to eat orally. In conclusion, squamous cell carcinoma of the posterior oropharyngeal wall is relatively rare and has a poorer prognosis than other types of oropharyngeal cancer.

An Electromyographic Analysis of the Deep Cervical Flexor Muscles in Performance of Craniocervical Flexion

This study evaluated an electromyographic technique for the measurement of muscle activity of the deep cervical flexor (DCF) muscles. Electromyographic signals were detected from the DCF, sternocleidomastoid (SCM), and anterior scalene (AS) muscles during performance of the craniocervical flexion (CCF) test, which involves performing 5 stages of increasing craniocervical flexion range of motion--the anatomical action of the DCF muscles. Ten volunteers without known pathology or impairment participated in this study. Root-mean-square (RMS) values were calculated for the DCF, SCM, and AS muscles during performance of the CCF test. Myoelectric signals were recorded from the DCF muscles using bipolar electrodes placed over the posterior oropharyngeal wall. Reliability estimates of normalized RMS values were obtained by evaluating intraclass correlation coefficients and the normalized standard error of the mean (SEM). A linear relationship was evident between the amplitude of DCF muscle activity and the incremental stages of the CCF test (F=239.04, df=36, P<.0001). Normalized SEMs in the range 6.7% to 10.3% were obtained for the normalized RMS values for the DCF muscles, providing evidence of reliability for these variables. This approach for obtaining a direct measure of the DCF muscles, which differs from those previously used, may be useful for the examination of these muscles in future electromyographic applications.

Squamous carcinoma of the posterior oropharyngeal wall

We treated 9 patients with squamous cell carcinoma of the posterior oropharyngeal wall at the Cancer Institute Hospital, Tokyo. All were men averaging 64.1 years of age. One patient each was stage I, stage II or stage III, and 6 were stage IV. Cervical lymph node metastasis was seen in 6 at initial diagnosis. Retropharyngeal lymph nodes were involved in 4, while 5 had second primary cancer such as esophageal, gastric, head and neck cancer. Radical radiotherapy was done for 3 and surgery as initial treatment in 6. Five-year local control was 50% and 5-year disease-free survival was 22%. Total laryngectomy was done for 4 patients. Six died of oropharyngeal cancer and 1 of second primary cancer. Cancer of posterior pharyngeal wall is relatively rare and the prognosis is considered poorer than other types of oropharyngeal cancer for necessitating study to determine which modality may improve treatment results.

Selective Attachment of β-Haemolytic Streptococci Group A to Oropharyngeal Epithelium in Health and Disease

Localization and semiquantification of β-haemolytic streptococci, Group A (GABHS), GABHS attachment and general bacterial attachment to epithelial cells (bacterial number and morphology) were studied during GABHS-positive acute tonsillitis and pharyngitis infections and among healthy GABHS carriers. Samples were collected from various areas of the oropharynx (palatine tonsils, posterior oropharyngeal wall, palatoglossal arch and buccal mucosa). During acute tonsillitis and pharyngitis, GABHS grew in samples obtained from the palatine tonsils and posterior oropharyngeal wall. The ratio of GABHS colonies to other aerobic colonies increased, and GABHS became attached to epithelial cells of both palatine tonsils and posterior oropharyngeal wall. In GABHS carriers, GABHS were found mainly on the palatine tonsils, but these microorganisms were not attached to the epithelium. Overall bacterial attachment to tonsillar and oropharyngeal epithelial cells increased during active tonsillitis and pharyngitis.

Primary posterior oro pharyngeal wall tuberculosis

Tuberculosis involvement of pharynx is a rare entity. Whenever encountered, it is usually associated either with pulmonary tuberculosis or cervical lymphadenopathy. Isolated involvement of posterior oropharyngeal wall tuberculosis is presented in this paper.

A nationwide study of the epidemiology, treatment and survival of oropharyngeal carcinoma in The Netherlands.

Seven head and neck oncology cooperative groups in the Netherlands have reviewed the epidemiology, staging, treatment and survival of oropharyngeal carcinoma patients treated between 1986 and 1990. In all, 640 patients with squamous cell carcinoma (628, 98%) or undifferentiated carcinoma (12, 2%) referred for primary treatment were analyzed. The total group included 441 males (69%) and 199 females (31%), with a median age of 59 years (range, 30-92). Tumor distribution by subsite was the tonsillar region (372 patients, 58%), base of the tongue/vallecula (179, 28%), soft palate/uvula (62, 10%) and posterior oropharyngeal wall (27, 4%). Forty-four patients (7%) had stage I disease, 106 (17%) had stage II disease, 157 (24%) stage III, and 319 (50%) stage IV. Staging was unknown in 14 patients (2%). Radiotherapy was given to the primary tumor in 408 patients (64%), surgery and radiotherapy to 147 (23%), surgery alone to 42 (7%), other treatments to 14 (2%) and no treatment to 29 patients (4%). The 5-year overall survival was 28% and the 5-year disease-specific survival was 41%. This latter survival was 35% in males and 51% in females (P = 0.003). Five-year survival by subsite was 54% in the soft palate/uvula, 42% in the tonsillar region, 33% in the base of the tongue and 32% in the posterior oropharyngeal wall (P = 0.003). When analyzing survival by stage, 5-year survival in patients with stage I disease was 68% and decreased significantly to 27% in stage IV disease (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma of the soft palate and the posterior oropharyngeal wall.

Between 1966 and 1984, 14 patients with carcinoma of the soft palate and eight patients with a posterior oropharyngeal wall carcinoma were treated at the Netherlands Cancer Institute. In the soft palate group, the majority of patients (10) had small tumours T1-T2; the median patient delay was 1 month (range 0-5). Eleven patients were treated with radiotherapy and three with surgery, as single treatment modalities. Tumour control was achieved in 10 patients following initial treatment. Five-year results for tumour control and overall survival were 67% and 41%, respectively. In the posterior wall group all patients had advanced tumours (T3-T4), after a median patient delay of 4 months (range 0-6). Six patients were treated with radiotherapy, one with surgery only and one with a combination of these. Following the initial treatment, tumour control was achieved in half of the patients. Five-year tumour control was 50%, and overall survival at 5 years was 38%. In conclusion, the tumours in these two sub-sites of the oropharynx differ significantly in the extent of the primary tumour (P < 0.01), posterior wall tumours being more advanced on admission, after a significantly longer history (P < 0.01).

Prognostic factors for local control, regional control and survival in oropharyngeal squamous cell carcinoma

We have performed univariate and multivariate analysis to identify the clinical and treatment-related prognostic factors in a series of 254 patients with newly diagnosed, histologically proven, oropharyngeal squamous cell carcinoma treated with radical radiation therapy. The probabilities of local control, regional control, disease-free survival (DFS) and adjusted survival (AS) were calculated using the Kaplan-Meier method and differences between curves were evaluated by the Mantel-Cox test. The obtained significant variables in the univariate analysis were analysed using the Cox proportional hazards model. In the Cox multivariate analysis, four variables significantly influenced local control probability in the following order: tumour diameter, N stage, alcohol intake and weight loss. N stage significantly influenced the probability of regional control. Five variables influenced both DFS and AS: N stage, tumour diameter, weight loss, alcohol intake and tumour origin within the posterior oropharyngeal wall.

Squamous carcinoma of the posterior pharyngeal wall

We present 70 patients with tumours of the posterior pharyngeal wall, considering tumours of the posterior hypopharyngeal and posterior oropharyngeal wall as one unit. Almost half (45%) of the patients were in poor general condition at the time of presentation, and 60% had Stage III or IV tumours. One-third of the patients were untreated, and surgery was mainly reserved for patients with Stage I and II tumours. The larynx could be preserved in two-thirds of those undergoing surgery. The best current method of repair of the posterior pharyngeal wall after partial pharyngectomy appears to be a revascularized radial forearm flap. The median survival for patients with Stage I tumours was 236 weeks, but for patients with Stages II-IV tumours was only 33 weeks. There was no significant difference between the survival for II-IV stage groups, but there was between Group I and the rest. We identify 2 defects in the UICC classification system: lack of definition of the lateral limit of the posterior pharyngeal wall, and a gross discrepancy between size and T staging of tumours arising primarily from the posterior wall of the hypopharynx.

Transoral Repair of a Rare Basioccipital Meningocele in a Neonate: Case Report

Abstract An extremely rare case of a basioccipital meningocele causing obstruction of the upper airway in a neonate is described. A transoral approach was used to remove the meningocele and repair the dural fistula. Bilateral posterior lateral pharyngeal releasing incisions were made to allow mucosal and muscle coverage over the dural repair. This report demonstrates and emphasizes the use of lateral pharyngeal releasing incisions to cover midline full thickness defects in the posterior oropharyngeal wall that might be encountered during transoral transclival operations.

Management of severe caustic stenosis of the hypopharynx and esophagus by ileocolic transposition via suprahyoid or transepiglottic approach. Analysis of 18 cases.

Eighteen cases of severe chronic caustic stenosis of the hypopharynx and esophagus are presented. Restoration of digestive continuity was accomplished by retrosternal ileocolic transposition. The cervical approach and the position of anastomosis depended on the status of the hypopharynx. When one pyriform sinus remained open (type I, N = 4), an anterior suprahyoid approach was used in conjunction with lateral hypopharyngotomy because it facilitated the anastomosis and additional minor surgical procedures. When the hypopharynx was completely stenosed (type II, N = 14), a transepiglottic approach consisting of partial horizontal laryngectomy was used because it allowed excision of the supraglottic stricture, restoration of the oropharyngeal cavity, anastomosis to the posterior oropharyngeal wall, management of an eventual laryngotracheal stenosis, and elevation of the laryngeal inlet above the digestive anastomosis. After operation, several endoscopic examinations were required, sometimes combined with reoperation. Return of deglutition assuring normal nutrition was obtained in 61% of patients: 3 of 4 type I and in 8 of 14 type II.

咽喉頭異常感症患者の咽頭所見

Recurrent sore throats are common in patients with abnormal sensation in the throat, perhaps because abnormal sensation is caused mainly by local inflammatory changes.In order to test this hypothesis, the authors evaluated clinically the inflammatory changes of the palatine tonsils, posterior oropharyngeal wall, lateral pharyngeal band and lingual tonsils in 208 patients (85 males and 123 females, 17 to 84 years of age) with abnormal sensation in the throat (AST group) and compared them with 350 patients (167 males and 183 females, 14 to 85 years of age) who had never complained of abnormal sensation (control group).1. AST group had a significantly higher incidence of recurring sore throat.2. Tonsillitis, hyperemic palatine tonsils, hyperemic posterior oropharyngeal wall and hyperemic lateral pharyngeal band were found somewhat or significantly more often in the AST group.3. Hypertrophy of the palatine and lingual tonsils was not significantly different in the two groups.These results indicate that chemical stimulation by unknown substances produced in inflamed tissues may be more important in eliciting the abnormal sensations in the throat than mechanical stimulation by hypertrophic organs.

Sensation Elicited by Mechanical Stimuli to the Oropharyngeal Mucosa

An inaccurate localization of the site of stimulus, a higher two-point threshold for touch than those at lower lip or soft palate mucosae, and reference of touch sensation to the submaxillary cervical region following mechanical stimuli to the posterior oropharyngeal wall or lateral pharyngeal band were observed in the present study on otolaryngologists, medical students and patients with abnormal sensations in the throat. These results indicated that not only the somatic but also the visceral nervous system might contribute to the elicitation of sensation from the oropharyngeal structures behind the soft palate.