Tonsillar Area Research Articles

Primary Melanoma of the Palatine Tonsil in an Adult Filipino Patient: A Case Report

ABSTRACT Objectives: To discuss a case of primary melanoma of the palatine tonsil in a 57-year-old man presented with a dark, pigmented tonsillar mass initially managed as a case of arterio-venous malformation, and review the literature on its presentation, diagnosis, management and outcomes. Methods: Design: Case Report Setting: Tertiary Government Training Hospital Patient: One Results: A 57-year-old man presented with a pigmented, bluish-black mass (7.2 cm) on the right tonsillar area with dysphagia and odynophagia. A CT scan interpretation considered large tonsillar malignancy, right with infiltrations of the soft palate, lingual tonsils and pre-epiglottic space. The initial impression was an arteriovenous malformation and preoperative arterial embolization was followed by a tonsillectomy. The final biopsy result was mucosal melanoma. Refusing further treatment, he expired nine months later in the emergency room, after presenting with decreasing sensorium and desaturations, jaundice and abdominal distension. Conclusion: To the best of our knowledge, this is the first reported case of tonsillar melanoma in the Philippines. Primary tonsillar melanoma is rare but its diagnosis is still possible (although it is usually diagnosed in advanced stages). Despite improvement in surgical techniques and adjuvant therapies, its prognosis remains poor. Regular oral cavity screening may help in early detection.

Characterizing best practices for tonsil-oral-scrubbing (TOSc) collection for PRRSV RNA detection in sows

BackgroundA Tonsil-Oral-Scrubbing (TOSc) method was developed to sample the sow’s oropharyngeal and tonsillar area without snaring and has shown comparable porcine reproductive and respiratory syndrome virus (PRRSV) RNA detection rates with tonsil scraping in infected sows. This study investigated the effect of specific TOSc collection factors on the PRRSV RT-rtPCR results (detection rates and Ct values). Those factors include whether the sow was snared or not snared at TOSc collection (“snared” vs. “not snared”); whether the sow was laying down or standing at collection (“laying down” vs. “standing”); and type of collectors used for TOSc collection (“TOSc prototype” vs. “Spiral-headed AI catheter (SHAC)”). Volume of fluid was compared between “snared” and “not snared” groups, and collection time was compared between “laying down” and “standing” groups as well.ResultsThe effect for each factor was assessed in three independent studies following the same design: TOSc was collected twice from each studied sow, once with the baseline level for a factor (“not snared”, or “standing”, or “TOSc prototype”), and another time followed by the other level of the paired factor (“snared”, “laying down”, or “SHAC”, correspondingly). Results showed that “not snared” TOSc had numerically higher PRRSV RNA detection rate (60.7% vs. 52.5%, p = 0.11), significantly lower median Ct values (31.9 vs. 32.3, p < 0.01), and significantly higher volume of fluid than “snared” samples (1.8 mL vs. 1.2 mL, p < 0.01); “laying down” TOSc samples did not differ statistically (60.7% vs. 60.7%) in the PRRSV RNA detection rate, obtained numerically lower median Ct values (30.9 vs. 31.3, p = 0.19), but took 40% less collection time compared to “standing” TOSc samples; samples collected using the “TOSc prototype” had numerically higher PRRSV RNA detection rate (91.7% vs. 88.3%, p = 0.27) and significantly lower median Ct values (32.8 vs. 34.5, p < 0.01) than that from “SHAC”.ConclusionsUnder the conditions of this study best practices for TOSc collection aiming higher detection rate of PRRSV RNA while minimizing time for collection were suggested to be sampling TOSc without snaring, when sows are laying down, and using a prototype TOSc collector.

Correlation between sampling site and prevalence of human papilloma virus (HPV) in patients with oral cancer referred to Shiraz, Iran

AbstractIntroductionCancer is one of the leading causes of death worldwide. Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity in which there is a poor prognosis. Viruses, including human papillomavirus (HPV) play an important role in the etiology of this cancer.MethodsThis case–control study enrolled 100 individuals with diagnosed oral cancer in the case group and an equivalent number of 100 healthy individuals in the control group. Over the course of 1 year, samples were collected from Khalili Hospital in Shiraz, Iran. Tissue specimens were procured from diverse oral regions, with specimens from the healthy group exclusively sourced from the tonsillar area. Patient inclusion criteria involved manifestations like oral swelling, facial pain, tongue abnormalities, tongue paralysis, and tumors or swellings in the inner lip, gums, or chin. A questionnaire facilitated the collection of demographic data, covering variables such as age and gender. The subjects had a mean age of 53.66 ± 1.38 years, with a gender distribution of 70 individuals (34%) female and 130 (65%) males. Tissue specimens underwent molecular analysis using Nested‐PCR to detect HPV presence.ResultsAnalysis unveiled HPV identification in two cases within the control group and 14 cases within the case group, revealing a statistically significant disparity (p value = 0.008) which may be correlated to incidence of OSCC within the case group. Further exploration disclosed a predilection for HPV localization in the tongue, followed by the laryngeal region. A significant association was established between the sampling site and HPV incidence (p = 0.004).ConclusionThis investigation unveiled a compelling connection between the site of sampling and HPV infection, a phenomenon pronounced particularly among individuals grappling with oral cancer. This underscores potential relationship between the site of sampling and HPV infection within the context of oral carcinoma. The findings of this study underscore HPV's role as a significant risk factor in the initiation of oral cancer in individuals. Nevertheless, it is important to acknowledge that additional factors, including age and gender, also contribute to this intricate process.

Complete Second Branchial Cleft Fistulas: A Clinicosurgical Experience.

A complete second branchial fistula is very rare and has an internal opening at the tonsillar fossa and an external opening at the lower third of the sternocleidomastoid (SCM). Patients commonly present with persistent or intermittent mucoid or mucopurulent discharge from an external opening. The diagnosis is most often clinical and radiological investigations are rarely needed. Treatment of choice is complete surgical excision. The aim of this article is to aware young ENT surgeons of the various clinical and intraoperative surgical findings that can be encountered while dealing with these cases. This observational study was done for a period of 10years. A total of 20 cases of fistula were included which intraoperatively had a complete track from tonsillar fossa to neck. Excision of the tract was carried out via combined transcervical and transoral approach under general anaesthesia using two incisions in stepladder pattern. Each patient was seen after one year of surgery to assess for any recurrence. Different findings of patients including age/sex at surgery, initial presentation, family history, laterality of the fistula tract, Intraoperative surgical findings, complications, and recurrences. were noted. Of the 20 patients, 13 (65%) were females and 7 (35%) were Females. Most common complaint was fistulous opening with intermittent discharge(15patients; 75%).Branchial cleft fistulae more commonly affected the right neck (14 patients, 78%) among unilateral cases and 2 patients (10%) had bilateral fistulae. No patient had associated congenital anomaly/syndrome, family history or and visible opening in tonsillar area. Glossopharyngeal nerve was identified in 12 cases and track was seen passing lateral to it except in one case. The internal opening of track was seen over posterior tonsillar pillar in 15 cases (75%) while in 5 patient the track was seen entering tonsillar tissue or bed. Tonsillectomy was done in 5 cases while not done in 15 cases where track was seen entering posterior pillar. All patients were seen at one year follow up. No recurrence was seen at one year of follow up. Complete second branchial cleft fistulae are rare. They are usually right sided and unilateral. The track passes between carotid bifurcation and invariably passes lateral to both glossopharyngeal and hypoglossal nerves. Track usually ends at the posterior tonsillar pillar. Tonsillectomy is not routinely indicated. Recurrences are not typically seen.

Early presentation of complete branchial fistula with review of literature

Branchial anomalies are rarely seen in clinical practice. They arise as a result of aberrations of the branchial apparatus during fetal development. Though present since birth, they are usually diagnosed in the first or second decade of life. Second arch anomalies are by far the most common and present as a neck mass or discharging sinus that may be complicated by infection. Clinical examination often reveals the lesion to be related to the junction of the upper two thirds and the lower one third of the sternocleidomastoid muscle. Branchial fistulas often present as a discharging sinus in the neck. The fistulous tract may extend for a variable distance within the neck. However complete branchial fistula of the second cleft with an internal opening in the tonsillar area and an external opening in the skin is rare. Surgical excision using the step ladder approach was used. No recurrence was seen at one year follow up. The incidence of such lesions presenting within first two years of age is extremely rare. Surgical excision is the treatment of choice for branchial anomalies. We present the case of a two-year-old female patient with complete branchial fistula and discuss the clinical presentation and surgical management of such lesions, while reviewing the relevant literature.

Prevalence of Denture-Related Stomatitis in Edentulous Patients at a Tertiary Dental Teaching Hospital.

Oral mucosal lesions can be uncomfortable and can result in a poorer oral health related quality of life. This can be seen especially in edentulous patients who are mostly elderly and have comorbid diseases such as Diabetes Mellitus, which can impair their ability to withstand oral infections. In South Africa, one of the most unequal countries in the world, almost 50% of the population is edentulous and this prevalence increases as age increases. The aim of this cross-sectional study was to determine the prevalence of denture-related stomatitis in subjects who presented to a tertiary institution in Cape Town, South Africa for new complete dentures and to determine the risk indicators associated with it. Three hundred and ninety-six folders of participants who received complete dentures during the period 2014–2019 were included in this study. Categorical data was displayed as frequencies and percentages and a multiple adjusted logistic regression was used to determine associations between Candida and certain risk indicators. The prevalence of denture-related stomatitis was 25.76% (n = 102). Almost 75% (n = 225) females and 72.63% (n = 69) males had no denture-related stomatitis. The most common site for candidiasis in this population was the palate and tonsillar area (40.2%, n = 41) and the least common site was the upper ridge (2.94%, n = 3). Candidiasis, in edentulous patients are highly prevalent in this population and more needs to be done to prevent it.

Low Frequency of Human Papillomavirus in Strictly Site-Coded Oral Squamous Cell Carcinomas, Using the Latest NHI/SEER-ICD Systems: A Pilot Observational Study and Critical Review.

Simple SummaryThe incidence of oropharyngeal squamous cell carcinomas (OPSCCs) has increased in the last decades, and this seems to be correlated to the infectious epidemiological trend of human papillomavirus (HPV). The prevalence of HPV-positive OPSCCs is approximately 70%, with involvement mainly of the tonsillar area. On the role of HPV in oral squamous cell carcinoma (OSCC), very few studies have investigated the prevalence of HPV in strictly site-codified OSCC, excluding the base of the tongue as distinct oropharyngeal entity. As a result, an inappropriate estimation of HPV infection in OSCC has been observed. We investigated HPV status, using a combination of detection methods, in a sample of 40 subjects with OSCC coded by the latest site classifications. Moreover, we performed a critical review of the studies with the same outcomes. The main finding of our investigation was a low frequency of HPV-positive OSCC, suggesting no significant HPV role in strictly oral carcinogenesis.The aim of this study was to evaluate HPV status in oral squamous cell carcinoma (OSCC), as coded by the latest classifications and applying a combination of detection methods used in clinical practice. Forty-two patients with suspect OSCC were consecutively recruited. Patients underwent an incisional biopsy for histological OSCC diagnosis and HPV identification by PCR DNA and p16 IHC. All lesions were coded by the latest ICD-0-3.2 site/histology classifications, as proposed for OSCC by the National Cancer Institute Surveillance, Epidemiology and End Results Programs. Moreover, a comparative analysis review, critically evaluated by the same site-coded systems and HPV detection methods, was performed. In 40 confirmed cases of OSCC, the frequency of HPV infection was 10% (4/40). Among positive patients, two cases were PCR DNA/p16 IHC positive (high-risk HPV 51, high-risk HPV 67), two cases were PCR DNA positive/p16 IHC negative (high-risk HPV 31 + 68, high-risk HPV 66). Applying the latest site coding systems for OSCC, the frequency of HPV infection in this study and in similar, reviewed investigations was low (from 3.3% to 12.5%). These results suggested no significant HPV role in oral carcinogenesis, particularly where an updated site-coded classification of OSCCs (categorically excluding the base of the tongue) had been performed.

Palatine Tonsillar Epidermoid Cyst- Mimicking Cystic Tumor

Epidermoid cyst refers to the implantation of epidermal elements into the dermal and deeper tissues. In head and neck, incidence ranges from 1.6 to 7%. In the tonsillar area it is extremely rare i.e less than 0.01%. They occur in fetal period as congenital lesion or as an acquired lesion either due to a trauma or as post surgery implant. In this case report, we will discuss the epidermoid cyst, in a 46-year-old male who presented with history of pain in the throat with previous history of bilateral tonsillectomy.

Extranodal natural killer T cell lymphoma of the oropharyx: case report

BackgroundT cell lymphoma of the upper aerodigestive tract is a rare entity usually presenting as midfacial ulcerative lesion. It is extremely rare to present as non-healing erosive lesion of the oropharynx.Case presentationA 29-year-old female patient presented with odynophagia and trismus for several months. An “inflammatory” oropharyngeal ulcer was diagnosed and she was treated with repeated courses of antibiotics and corticosteroids without response. Recently, she had some blood stained saliva and vomited fresh blood. When seen, she had extensive painful ulcer eroding the right side of the soft palate and right tonsillar area. The ulcer had a whitish floor and ragged border without any tendency to heal. A second biopsy was taken and proved the lesion to be extranodal natural killer T cell lymphoma (ENKTL). The patient was treated with a modified SMILE (steroid, methotrexate, ifosfamide, l-asparaginase, and etoposide) protocol.ConclusionsExtranodal natural killer T cell lymphoma can manifest first in the oropharynx. If left untreated it may lead to deep erosive lesion and major oral bleeding. SMILE chemotherapy protocol was used in our patient with good early response.

Differences of oral cancer in men and women of West Bengal, India.

Introduction:Oral cancer constitutes a major public health problem in South East Asia, as it causes profound social and economic consequences for people in this area. Nowadays, pattern of tobacco and alcohol use among females is changing and at the same time incidence of oral squamous cell carcinoma (SCC) among females is increasing.Objectives:The aim of the study was to evaluate the possible differences between male and female patients suffering from oral SCC.Materials and Methods:One hundred and sixteen patients with oral SCC, who were diagnosed between 2017 and 2018, were evaluated retrospectively. Special attention was paid to tobacco and alcohol use, as well as to patients without the risk factors. Data obtained were entered into a Microsoft Excel Spreadsheet and then were analyzed by SPSS 24.0.Results:The men: women ratio was 2.5:1. Mean age for diagnosis of oral cancer in men was 57.5 and mean age for diagnosis of oral cancer in women was 46.33. Majority of men oral cancer patients had smoking habits (61.45%) and majority of women oral cancer patients had chewing habits (66.67%). Tongue was the most common site for women oral cancer patients and palate, retromolar area and tonsillar area were the most common site for men oral cancer patients who never used any habit products.Conclusion:Compared to earlier studies women gets diagnosis of oral cancer earlier than men in our study. Gutkha use in men and Gudaku use in women were associated with oral cancer in early age. Further studies should be performed in women tongue cancer patients and men patients with cancer of maxillary area, retromolar and tonsillar area without risk factors to find etiology.

Public Health Approach of Ayurveda and Yoga for COVID-19 Prophylaxis.

Public Health Approach of Ayurveda and Yoga for COVID-19 Prophylaxis.

Statistical Shape Analysis of Cerebellum in Patients With Chiari Malformation I.

The surgical procedure is viewed as a typical treatment choice for patients with Chiari malformation (CM). Decompression is the preferred method for surgery, but it is not always possible to understand whether decompression has been successful especially in an early period. The present study focuses on investigating the shape differences in the cerebellums of Chiari patients compared with healthy controls, and to assess the clinical application of this situation whether if present. The MRI scans were reviewed retrospectively. Cerebellar data were obtained from the digital images and 9 anthropometric landmarks were marked on each image. Shape difference was assessed by performing Generalized Procrustes analysis. The cerebellar shape deformation from control to the patient was evaluated performing the Thin Plate Spline approach. There is a statistically significant cerebellar shape difference between groups. Highest deformation was determined at the cerebellar tonsillar inferior area, posterior of the uvula, and anterior of inferior medullary velum. The present study demonstrated cerebellar shape differences in CM I patients using a landmark-based geometric morphometric approach, considering the topographic distribution of cerebellum for the first time.

Quantification of Cerebellar Crowding in Type I Chiari Malformation.

This study was focused on a semi-automated morphometric analysis of the cerebellum in the mid-sagittal plane as an alternative to tonsillar descent alone in the evaluation of Chiari malformation type 1 (CMI) patients. Morphometric analyses of posterior fossa structures were performed on mid-sagittal MRI images of 375 individuals (females, > 18years, 235 CMI and 140 healthy controls). Twenty-six parameters including linear, angular and area measurements together with non-dimensional ratios were calculated. Eighteen parameters were found to be significantly different between CMI and control subjects. Smaller posterior cranial fossa (PCF) area in CMI subjects was attributed to a smaller PCF area anterior to the brainstem. The cerebellar area was found to be larger in CMI subjects as compared to controls (15.1%), even without inclusion of the tonsillar area below the foramen magnum (FM) (8.4%). The larger cerebellar area in CMI subjects was due to cranial-caudal elongation of the cerebellum, predominately below the fastigium. The cerebrospinal fluid spaces below the FM were smaller in CMI subjects as compared to controls. Overall, greater cerebellar crowding was identified in CMI subjects relative to healthy controls. These observations may improve our understanding of the pathophysiology of CMI in adult female patients.

MRI features of presumed normal palatine tonsils in dogs.

To describe the MRI characteristics of normal palatine tonsils in dogs. Retrospective study of 95 dogs with presumed normal tonsils. Tonsillar margination, shape and signal intensity in pre- and postcontrast studies were assessed and the cross-sectional area was measured at the point of maximal size on transverse images. In all cases the tonsils were located with their largest transverse cross-section at the level of the temporomandibular joints. Their margins were well-defined in all dogs; in 57 (60%) the borders were smooth and in 38 (40%) slightly irregular. The majority (96%) of the tonsils were rounded to oval in cross-section and the remainder were elongated. All tonsils were hyperintense to the medial pterygoid muscles in T1-weighted, T2-weighted, FLAIR and T2* gradient echo images and they showed either homogeneous (53%) or heterogeneous (47%) signal intensity. Contrast enhancement was marked (65%) or moderate (33%) in the majority of animals. Median tonsillar cross-sectional area was approximately 29 mm2 (90% confidence interval: 10.0 to 64.4 mm2 ). There was significant positive correlation between bodyweight and tonsillar cross-sectional area and a weak negative correlation between age and tonsillar cross-sectional area. MRI is of value in assessing normal palatine tonsils in dogs. This study could be used as a baseline for the investigation of the value of MRI in assessment of tonsillar disease in dogs.

Steroid pulse therapy transiently destroys the discriminative histological structure of tonsils in IgA nephropathy: Tonsillectomy should be performed before or just after steroid pulse therapy

ObjectiveTonsillectomy combined with steroid-pulse therapy is a widely accepted method for the treatment of IgA nephropathy (IgAN) in Japan. However, the indication of tonsillectomy for IgAN is still controversial, and the timing of tonsillectomy is not clearly defined for the protocol of this therapy. Based on the results of a randomized control trial in Japan, the Evidence-Based Clinical Practice Guidelines for IgA nephropathy 2014 (edited in Japan) recommended tonsillectomy combined with steroid-pulse therapy for Grade C1. However, this is not widely accepted worldwide. To clarify the validity and timing of tonsillectomy, we evaluated how the three-consecutive steroid-pulse therapy method affects the tonsil tissues of IgAN patients. MethodsWe examined tonsil specimens from 35 IgAN patients and 8 chronic tonsillitis patients. We compared the proportion of follicular area to total tonsillar area and the number of germinal centers between each group on hematoxylin and eosin stained pathological specimens to clarify the histopathological characteristics of tonsils from IgAN patients. Based on these findings, we examined the tonsils of patients after three-consecutive steroid-pulse therapy treatments (n=34) to determine the influence of this therapy on the tonsil tissues of IgAN patients. Moreover, we observed chronological changes in tonsil tissues after steroid-pulse therapy. ResultsThe extrafollicular area was enlarged in IgAN patients before steroid-pulse therapy compared with chronic tonsillitis patients. Just after steroid-pulse therapy, the follicles became very small with blurry outlines, and the number of germinal centers was remarkably decreased. With a gradual decrease in oral prednisolone, the tonsil tissue structure was gradually restored. ConclusionTonsillectomy combined with steroid-pulse therapy is considered a reasonable treatment for IgAN. Steroid-pulse therapy-induced histological changes in tonsils were transient, indicating tonsillectomy should be performed before or just after steroid-pulse therapy.

Use of Selective Serotonin Reuptake Inhibitor and Midodrine in a Patient With Autonomic Instability 2/2 Compressive Squamous Cell Carcinoma and Pain.

A rare cause of reflex syncope is metastatic cancers involving the head and neck. These can irritate the glossopharyngeal nerve and lead to glossopharyngeal neuralgia with associated syncope. This type of syncope is difficult to treat since it commonly involves both a vasodepressor and cardioinhibitory response, and typically requires removal of the irritative focus. We report a case of a 52-year-old male who presented from home with syncope. He endorsed a 5-week history of progressively worsened positional headaches and dramatic 40-pound weight loss with night sweats over 6 months. In the emergency department, his heart rate was noted to drop into the 20s with associated hypotension 60/31 mm Hg. Heart rate and blood pressure increased with intravenous atropine. Physical examination revealed a large ulcerative lesion in the left tonsillar area. After biopsy of the lesion, a diagnosis of stage IV squamous cell carcinoma of the neck was made; computed tomography angiogram and positron emission tomography/computed tomography confirmed involvement in the posterior tongue extending to the left palatine tonsil in addition to the left jugular chain. The patient was started on cisplatin and radiation therapy, but continued to have episodes of syncope associated with bradycardia and hypotension. After a failed trial of benztropine, the patient was started on sertraline and midodrine with resolution of syncope. This could be a potential treatment option in those with compressive mixed syncope who are not candidates for surgery or chemotherapy or are awaiting definitive treatment.

Transoral Oropharyngeal Resection Classification: Proposal of the SCORL Working Group

Introduction and goalsThere has been a very significant increase in the use of minimally invasive surgery has in the last decade. In order to provide a common language after transoral surgery of the oropharynx, a system for classifying resections has been created in this area, regardless of the instrumentation used. MethodsFrom the Oncology Working Group of the Catalan Society of Otorhinolaryngology, a proposal for classification based on a topographical division of the different areas of the oropharynx is presented, as also based on the invasion of the related structures according to the anatomical routes of extension of these tumours. ResultsThe classification starts using the letter D or I according to laterality either right (D) or left (I). The number of the resected area is then placed. This numbering defines the zones beginning at the cranial level where area I would be the soft palate, lateral area II in the tonsillar area, area III in the tongue base, area IV in the glossoepiglottic folds, epiglottis and pharyngoepiglottic folds, area V posterior oropharyngeal wall and VI the retromolar trigone.The suffix p is added if the resection deeply affects the submucosal plane of the compromised area. The different proposed areas would, in theory, have different functional implications. ConclusionProposal for a system of classification by area to define different types of transoral surgery of the oropharynx, and enable as sharing of results and helps in teaching this type of technique.

Clasificación de las resecciones transorales en la orofaringe: propuesta del grupo de trabajo de la Sociedad Catalana de Otorrinolaringología

Introduction and goalsThere has been a very significant increase in the use of minimally invasive surgery has in the last decade. In order to provide a common language after transoral surgery of the oropharynx, a system for classifying resections has been created in this area, regardless of the instrumentation used. MethodsFrom the Oncology Working Group of the Catalan Society of Otorhinolaryngology, a proposal for classification based on a topographical division of the different areas of the oropharynx is presented, as also based on the invasion of the related structures according to the anatomical routes of extension of these tumours. ResultsThe classification starts using the letter D or I according to laterality either right (D) or left (I). The number of the resected area is then placed. This numbering defines the zones beginning at the cranial level where area I would be the soft palate, lateral area II in the tonsillar area, area III in the tongue base, area IV in the glossoepiglottic folds, epiglottis and pharyngoepiglottic folds, area V posterior oropharyngeal wall and VI the retromolar trigone.The suffix p is added if the resection deeply affects the submucosal plane of the compromised area. The different proposed areas would, in theory, have different functional implications. ConclusionsProposal for a system of classification by area to definedifferent types of transoral surgery of the oropharynx, and enable as sharing of results and helps in teaching this type of technique.

Ipsilateral radiotherapy for squamous cell carcinoma of the tonsil

The purpose of this study is to update our institution's experience with ipsilateral radiation therapy (RT) for squamous cell carcinoma of the tonsillar area. Outcome study of 76 patients treated between 1984 and 2012 with ipsilateral RT for squamous cell carcinoma of the tonsil. Patients had either cT1 (n=41, 54%) or cT2 (n=35, 46%) primaries and cN0 (n=27, 36%), cN1 (n=15, 20%), cN2a (n=8, 11%), or cN2b (n=26, 34%) nodal disease. Of these, 32 (42%) patients underwent a planned neck dissection and 21 (28%) patients received concomitant chemotherapy. Median follow-up for all patients was 7.1years (range 0.1-27.2) and 7.8years (range 2.1-27.2years) for living patients. The 2- and 5-year control and survival rates were as follows: local control, 98.6 and 96.9%; local-regional control 95.8 and 92.6%; cause-specific survival 95.9 and 93.1%; and overall survival, 92.1 and 83.8%. One patient failed in the contralateral, non-radiated neck 3years after primary treatment. Univariate analysis revealed that overall survival was significantly influenced by whether the patient had a primary tumor in the anterior tonsillar pillar versus the tonsillar fossa with the latter performing better. The incidence of severe late complications was 16%. Ipsilateral RT for patients with squamous cell carcinoma of the anterior tonsillar pillar or tonsillar fossa with no base of tongue or soft palate extension is an efficacious treatment that provides excellent control rates with a relatively low incidence of late complications.

Effects of Oral Prednisolone on Recovery after Tonsillectomy

Objectives: Evaluate the effects of postoperative steroids compared with no steroids following tonsillectomy. Methods: This study was a prospective double-blinded, randomized trial from April 2013 to September 2013. Forty patients age 5 years or older who were scheduled for elective tonsillectomy with or without adenoidectomy were enrolled. Patients were randomly assigned to receive a postoperative course of prednisolone powder or tablet over 7 days (dosage: 0.25 mg/kg/d). The primary outcomes of this study were comparing degree of postoperative pain using a validated pain scale and estimation of healing process based on the percentage of total area of reepithelization of tonsillar area. The second day outcomes were comparing bleeding rate, presence and severity of nausea and vomiting, returning to a normal diet, returning to normal daily activity, and sleep disturbance. Results: Mean ages were 23.55 (prednisolone group) and 25.25 (control group). Postoperative pain score showed no difference at day 1 and 14, but much less pain in the prednisolone group at day 7 ( P = .056). Mean percentage of reepithelization area was higher in the prednisolone group ( P &lt; .001). There were significant differences in the bleeding rate, severity of nausea and vomiting, and sleep disturbance. But there was a significant difference in the rate of return to eating a normal diet and normal daily activities. Conclusions: Oral prednisolone may offer improvement in the recovery phase from tonsillectomy without serious complications.