Tonsillar Area Research Articles

Carcinoma of the tonsillar area treated with external radiotherapy alone*

seventy patients with carcinoma of the tonsillar area were treated with radiation therapy alone, all with a minimum follow-up of 3 years. Seventeen patients with stages I and II developed six recurrences and three were salvaged by surgery. Fifty-three patients with stages III and IV developed 24 recurrences, and only three could be salvaged by surgery. We conclude that radiation therapy is adequate for stages I and II carcinoma of the tonsillar area. Local control rate is satisfactory and surgical salvage is acceptable. Patients with advanced disease, Stages III and IV, have a poor survival rate with radiotherapy alone. Local recurrence is high and surgical salvage is inadequate. We have decided to offer selected patients with stages III and IV tonsillar carcinoma planned combined radiotherapy and surgery, in an effort to improve the survival rate.

Bleeding as an initial sign of carcinoma of the tonsil: Report of a case

Oral bleeding is rarely the initial sign or presenting symptom in cancer of the tonsil. Persistent and repeated oral bleeding demands thorough visual and digital examination of the aerodigestive tract. A case of cancer of the tonsil in which the initial sign was oral bleeding is described. The prognosis for cancer of the tonsil localized to the tonsil is good when wide excision of the tonsillar area is accomplished.

Use of split thickness grafts in the repair of excisions of the oropharynx, base of the tongue, and larynx

Skin grafts are an important component in immediate reconstruction after extensive resection in the head and neck region. Edgerton [I] has written extensively on their use in the area of the laryngopharynx, and others [2,3] have remarked on their effectiveness in lining the tonsillar area, palate, and tongue. Most of the patients we treat with Tesions in the higher clinical stages have received 6,000 r of cobalt radiation prior to operation. Originally, we were reluctant to use skin grafts in the radiated areas and attempted to draw the structures together for primary closure wherever possible. Patients with carcinoma of the maxilla were an exception to this rule. Part of the repair in these patients for years has been the immediate lining of the defect with a split thickness graft [4]. These grafts usually take well despite high doses of preoperative radiation. Encouraged by this, we began to use skin grafts to cover extensive areas of postradiation resection in the laryngopharynx and oropharynx.

Permanent implants in the management of head and neck cancer by radiotherapy.

PERMANENT IMPLANTS IN THE MANAGEMENT OF HEAD AND NECK CANCER BY RADIOTHERAPYH. G. SEYDEL, M.D., M.S. and H. SCHOLL, M.D.Audio Available | Share

Origin and fate of lymphoid cells in the developing palatine tonsil of the rabbit. A possible mechanism of homing of lymphoid cells.

The origin of lymphoid cells in the developing palatine tonsil is a matter of controversy. Many authors assume an intrinsic origin by transformation of mesenchymal or epithelial cells of the tonsillar primordium, whereas some advocate an extrinsic haematogenous origin. To gain insight into this question a study was made of the morphology of the first appearing lymphoid cells in the developing palatine tonsil of the rabbit. Light- and electron-microscopic examination of the developmental stages at 24 hr intervals revealed the appearance of motile lymphoid cells in the tonsillar area on the 22nd day of gestation. On the 23rd day the motile cells were found to be in close contact with the cells of the condensed mesenchyme surrounding the primary tonsillar crypt. The contact between the motile lymphoid cells and the mesenchymal cells appears to be established by the formation of a number of close junctions. On the 24th day the lymphoid cells contacting the mesenchymal cells lose their motile features and differentiate into dense lymphoid cells. It is concluded that lymphoid cells of extrinsic origin migrate into the tonsillar primordium where they are immobilized by the cells of the condensed mesenchyme, after which they differentiate into dense lymphoid cells.

Cancer of the Tonsillar Area and Palatine Arch

CA: A Cancer Journal for CliniciansVolume 19, Issue 5 p. 315-317 ArticleFree Access Abridgement: Cancer of the tonsillar area and palatine arch† Justin J. Stein, Justin J. SteinSearch for more papers by this author Justin J. Stein, Justin J. SteinSearch for more papers by this author First published: September/October 1969 https://doi.org/10.3322/canjclin.19.5.315 † Presented at the Eleventh Annual Cancer Seminar sponsored by the American Cancer Society Nevada Division, Reno, Nevada, April l2-4, 1969. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References 1 American Joint Committee for Cancer Staging and End Results Reporting: Clinical Staging System for Carcinoma of the Pharynx (Nasopharynx, Oropharynx, and Hypopharynx). Chicago, 1965. 2 Scanlon, P. W., et al.: Carcinoma of the palatine tonsil. Am. J. Roentgenol. 80: 781– 786, 1958. 3 Fletcher, G. H.: The Role of Radiotherapy for Head and Neck Cancer. In: Cancer Management. Philadelphia: J. B. Lippincott Co., 1968. Pp. 323– 326. 4 Jesse, R. H.: Operative Problems in Integrated Therapy of the Oropharynx. In: B. F. Rush, and R. H. Greenlaw (eds.). Cancer Therapy by Integrated Radiation and Operation. Springfield, Illinois: Charles C Thomas, 1968. Pp. 38– 46. 5 Schulz, M. D.; Lintner, D. M., and Sweeney, L.: Carcinoma of the palatine arch. Am. J. Roent genol. 89: 541– 548, 1963. 6 Moss, W. T.: The Oral Cavity, Oropharynx, Mucous Gland, and Salivary Gland. In: W. T. Moss (ed.). Therapeutic Radiology. St. Louis: C. V. Mosby Co., 1965. Pp. 102– 103. Volume19, Issue5September/October 1969Pages 315-317 ReferencesRelatedInformation

The persistence of foot-and mouth disease virus in sheep.

Sheep infected with FMDV strains of different epizootiological origin developed a carrier state which persisted in the majority of animals for 1–5 months.The sites of virus persistence and multiplication in the convalescent animal were identified by titration of suspensions of mucosae and epithelia taken post mortem. Virus was recovered most frequently and in highest titre from the tonsillar area and less frequently from the pharynx and dorsal surface of the soft palate. No virus was found in samples taken from the nasal passages, the trachea or the rumen.

Juxtacortical chondroma of the hyoid bone. Report of a case.

THE purpose of this article is to add to the literature an instance of a chondroma appearing in an unusual location. Report of a Case A 32-year-old white woman who first noted an asymptomatic swelling in the right submandibular area one year ago. This was not associated with a concurrent upper respiratory infection, trauma, or any inflammatory process about the head or neck. She continued to watch this mass grow until it became noticeable to her family, and at their insistence she visited her attending physician. Physical examination at that time revealed a large nontender firm mass which occupied the right submandibular area. There was no evidence of inflammation, no abnormal lymph nodes were palpable. Examination of the oropharynx revealed the right tonsillar area to be displaced medially almost to the midline by an underlying mass. This mass was contiguous with that in the submandibular area and could be balloted

Chemodectoma of the Vagus Nerve

Chemodectomas are tumors of the chemoreceptive system and occur at all sites where chemoreceptor bodies are found. The author was able to find reports of only 26 cases of chemodectoma originating from the cervical portion of the vagus nerve, and of these only 6 (1–6) gave a detailed description of the radiographic and angiographic findings. Case Report A 60-year-old woman presented with the complaint of partial loss of hearing on the right side and a mass in the right upper cervical region that pushed the tonsil medially. A right common carotid arteriogram showed a well circumscribed, highly vascular lesion that extended from about 2 ern above the carotid bifurcation to the base of the skull and up to the area of the jugular foramen (Figs. 1–3). A rather acute angle of the internal carotid artery was produced at its entrance into the carotid canal, imparting to the artery a smooth, forward convex curve. The lesion took its blood supply from external carotid branches. Although the mastoid was hazy, no destruction of it could be identified. On surgical exploration the mass was seen to form an integral part of the vagus nerve. It was impossible to remove the tumor without transsecting the internal carotid artery, which was ligated proximally. Left hemiparesis developed, and the patient died twenty-four hours later. At autopsy, no residual tumor was found. Microscopically, typical elements of chemoreceptive bodies were found with clusters of cells (Zellballen) embedded in a vascular, fibrous stroma. Parts of the vagus nerve were identified (Fig. 4). Comment Clinical Features: Chemodectomas of the vagus nerve are manifested by swellings in the upper cervical region that cause displacement of the pharyngeal wall and tonsillar area. Destruction of the temporal bone and aural symptoms are infrequent in contrast to tumors that arise from the glomus jugulare complex. Some chemodectomas have metastasized. The majority have been benign. Radiological Features: Invasion of the temporal bone is rare except in advanced cases where erosion of the jugular fossa may occur. Angiographically, these lesions show a highly characteristic pattern. In all reported cases with angiograms, there was anterior displacement of the internal carotid artery below the skull, and in some a highly vascular lesion with good demarcation was demonstrated. The blood was supplied from the external carotid. Treatment: Surgery is the treatment of choice, but because of frequent intimate association of the tumor with the internal carotid artery, removal may be hazardous. Three reports in the literature mention fatal outcome after bisection of the artery. Johnson et at. (7) report successful removal in 7 of 8 patients. Symptoms of vagal dysfunction were present in all cases postoperatively.

Analysis of complications following megavoltage therapy for squamous cell carcinomas of the tonsillar area.

If carcinoma of the tonsillar area is treated aggressively, approximately one-third of the patients will develop some form of complication in the mandible. There will also be significant incidence of less severe complications. Most of the bone exposures, however, will be self-limited or will heal with conservative therapy. There appears to be a decreased incidence of severe mandibular complications when parallel opposing fields are employed.

The importance of specific sensitization of the body to the resorption of protein from the tissues

Resorption of proteins from the peritonisillar area was studied in experiments on rabbits both in normal conditions and in the state of specific sensitization. The process of resorption was studied by labeling the horse serum proteins with radioiodine and estimating its activity directly in the living organism. As shown experimentally, specific sensitization of rabbits considerably accelerates the resorption of horse serum proteins from the tonsillar area.

Epithelial Cancer of the Tonsillar Area

Tumours of the tonsillar area are defined as those arising in the tonsil proper or the tonsillar pillars and spreading to involve any part of the contiguous soft palate, tongue, buccal mucosa, and lateral pharyngeal wall. The thesis of this paper is that failure to control spread into the tongue is the most common cause of defeat in treatment of cancer of the tonsillar area. Two hundred and sixty-three cases of epithelial cancer of this region were seen at the Ontario Cancer Institute in the years 1921 to 1959 inclusive. Only the lymphomatous and recurrent cases have been excluded. Two hundred and sixteen cases are available for five-year analysis. Males are more commonly afflicted than females, by a ratio of 7 to 1. The tumour is one of later life, having a peak incidence at about sixty-five years of age. An anatomical classification has been adopted, since it is felt that this bears a closer relation to prognosis and treatment than does classification by size. Six anatomical subdivisions are recognized: 1. Tonsil proper 2. Tonsillar pillars 3. Base of tongue 4. Soft palate 5. Pharyngeal wall 6. Bilateral Cases have been allocated to one or other of these subdivisions on the basis of predominance of tumour spread. Classification of lymph node involvement has been simplified into two categories—unilateral and bilateral. Figure 1 shows graphically the tonsillar area, its various subdivisions, and the incidence of primary involvement. The incidence of lymph node invasion and distant metastases is also indicated. It is evident from this that the invasions of the base of the tongue and the lymph nodes are the salient features. In Table I, the pathological subdivisions, incidence of lymph-node involvement, and gross five-year survival rates are presented. It is interesting to note that the undifferentiated tumour is associated with a high incidence of lymph-node involvement, but carries a more favourable prognosis than the squamous-cell group. One of the two patients with salivary-gland tumours had a mixed salivary adenoma and died of extraneous causes in less than five years. The other, with a mucoepidermoid carcinoma, has survived five years, but with some doubt about the control of the disease. Since the majority of tumours of this region are squamous-cell carcinomas, and carry the most serious prognosis, the following remarks refer mainly to that type of tumour. In Table II the cases have been rearranged to show survival by site, demonstrating that, of the three most common sites or areas of involvement, invasion of the tongue carries the worst prognosis. When the problem of recurrence of the primary tumour is considered, a distinct pattern is seen. This pattern is shown in Table III for the cases in which sufficient information was available to make such an evaluation. This emphasises the problem of persistence of tumour in the tongue after initial treatment or of recurrence following apparently successful treatment.

The vagus nerve in surgical consideration of glossopharyngeal neuralgia.

G LOSSOPHARYNGEAL neuralgia is a syndrome of tic-like pain at the angle of the jaw, with radiation frequently appearing at the external audi tory canal. I t may be confused with trigeminal neuralgia 1,3 of the 3rd division of the 5th cranial nerve and with neuralgia of the superior laryngeal nerve. Cocainization of the tonsillar area ordinarily serves to relieve and thus diagnose glossopharyngeal neuralgia, and cocainization of the pyriform fossa of the larynx is said to relieve neuralgia of the superior laryngeal nerve. 2 Because of the anatomic and physiologic association of the 9th and 10th cranial nerves, it would not be surprising to find clinical association of the two in neuralgia at the angle of the jaw, but to our knowledge, this has not been reported. I t is the purpose of this paper to report involvement of the vagus nerve in so-called glossopharyngeal neuralgia, and to report an improved method of diagnosis tha t we believe essential to the recognition of the unusual case where both the 9th and 10th nerves are involved in neuralgia and so to take appropriate surgical measures for relief.

Suppurative sialadenitis produced by a foreign body in the hypopharynx; report of an unusual case.

The case to be reported is unique in my experience, and I am unable to find any such case to date reported in the literature. Furthermore, I am unable to explain the chain of events leading to involvement of the submaxillary glands. Whether the foreign body first entered Wharton's duct and then penetrated to the tonsillar fossa, or whether it entered the peritonsillar area, thus setting up an inflammatory process which dissected through to the gland, is a point of controversy. In view of the history of the case, the latter explanation is the more plausible. <h3>REPORT OF CASE</h3> A man aged 26, a lieutenant in the United States Army, was first seen at an overseas station in June 1945 with the complaint of a prickling sensation in the left tonsillar area. At this time nothing could be seen or felt on examination. A few weeks later he noticed a

Carcinoma of the Tonsil

The tonsillar area is a relatively uncommon site for cancer. Because of this fact, the medical literature contains few reports covering a large number of cases. From the material which has been published (3, 5, 9, 10, 11), it is apparent that the pattern of management of patients with this disease has been fairly uniform for the past fifteen years. Since progress depends on a periodic evaluation of the results of any treatment, it has seemed worth while to review at this time a group of cases with the diagnosis of carcinoma of the tonsil treated with irradiation during the past ten years. Material Studied This study is based on all the patients with carcinoma of the tonsil irradiated at the Collis P. Huntington Memorial Hospital from 1936 through 1941 and at the Massachusetts General Hospital from 1936 through 1945. Since the primary site of an extensive tumor in the mesopharynx is often impossible to determine, only those cases in which it was reasonably certain that the lesion was located at the palatine tonsil, the tonsillar fossa, the tonsillar pillars, or in the triangular fold have been considered. Excluding one case in which the tumor later proved to be a Kaposi sarcoma, 90 cases were found and analyzed. In the series, there were 76 (84 per cent males and 14 (16 per cent) females. The median age was sixty-five, the oldest patient being eighty-seven and the youngest twenty-nine years. These figures correspond with those reported by Schall (9) and Lierle (5), and confirm the common belief that cancer of the tonsil occurs most frequently in males in the seventh decade of life. Because of the insidious onset of malignant disease, patients almost universally procrastinate in seeking medical advice. The median delay in treatment in this group was three months. The duration of disease (symptomatically) at the time treatment was instituted ranged from one day (?) to over two years. The most frequent presenting complaint was soreness of the throat, which was noted in 54 per cent of the group. Swelling of the neck was the first sign in 46 per cent, difficulty in swallowing in 16 per cent, bleeding in 15 per cent, weight loss in 4 per cent, and hoarseness in 2 per cent. A noteworthy fact is that in only 9 per cent was a growth in the mouth observed. Lymph-node metastases are often the first indication to the patient that he has the disease. Sixty per cent of the group presented enlarged nodes when they were first seen, and in two-thirds of these the “lump in the neck” was the first subjective sign to be observed. Of those who had no palpable metastases at the time of first examination, 8 per cent later showed cervical lymph node involvement. No attempt has been made to correlate the metastatic spread of the cancer with the grade of malignancy of the lesion, but the evidence suggests that tumors classified as Grade I (Broders) did not metastasize early, although they were locally recalcitrant in responding to irradiation.

CEPHALOSPORIOSIS

A patient recently came under our observation with a gumma-like lesion involving the left side of the soft palate and the left tonsillar area. It was acute in onset, and within a short time caused a perforation of the soft palate. Its similarity to a syphilitic and a malignant lesion necessitated considerable pathologic study and the empiric use of arsphenamine intravenously even in the absence of a positive history or serologic indications. The ultimate isolation of a delicate mycelial organism resembling Sporotrichum gave the first information as to the possible cause of the disorder. The culture and photomicrographs of the organism were shown to Dr. Fred D. Weidman. He tentatively classified it as a Cephalosporium . Further studies apparently confirmed this classification. The organism has been described in the recent foreign literature as a pathogenic agent in human lesions. We have been unable to find any mention of it in

TRACHEAL ABSCESS: Review of the Literature and Report of a Case

Having found a paucity of references in the literature on tracheal abscess, I wish in this paper to review the literature and to present the report of a case. In 1913, Richards 1 reported a case of phlegmon which had its origin in a peritonsillar abscess. The patient gave a history of sore throat for several days followed by difficulty in breathing and swelling of the entire left side of the neck. He had paroxysms of dyspnea and coughing. On examination, the tonsillar area was swollen, the patient was cyanotic, and the pulse rate was 124. The skin of the neck was very tense, and there was no fluctuation. The author incised the supratonsillar fossa for abscess. Pus was obtained. At the same time the patient had a paroxysm of coughing. When the opening was enlarged, there was cessation of breathing. An emergency tracheotomy was done, and artificial respiration