Managing a patient with a huge intraoral mass is always challenging. Manipulation or even a simple biopsy of the mass may lead to hemorrhage and further compromise the airway. An examination under anesthesia is not without risk. The method of securing the airway itself may become an issue if the mass is fully occupying the airway before intubation. Usually a tracheostomy is indicated. We share a gentleman presented with a huge intraoral mass occupying the oropharynx, which initially necessitates tracheostomy. We utilized the ultrasonic scalpel-assisted instrument to biopsy by debulking the tumour, thus avoiding the tracheostomy while waiting for the definitive treatment.
Oropharynx

Herein, we report an unusual case of large tonsillolith presented with acute otalgia. Since the tonsils and tonsillar fossa are supplied by the glossopharyngeal nerve, any irritation or pain can be referred to the ear along the tympanic branch of the glossopharyngeal (Jacobson's) nerve. Also, it is worth re-emphasizing that normal otoscopy must be followed by inspection of the nasal cavities, oral cavity, and oropharynx, with particular note given to the floor of mouth, teeth, tongue, and tonsils because the identification of a causative etiology is necessary to successfully treat referred otalgia.
Ear ; Earache ; Glossopharyngeal Nerve ; Mouth ; Mouth Floor ; Nasal Cavity ; Oropharynx ; Otoscopy ; Palatine Tonsil ; Tongue ; Tooth

OBJECTIVES: Obstructive sleep apnea (OSA) syndrome is diagnosed through history, physical examination, imaging studies and polysomnography. Clinical examination of this condition may point to hypertrophic tonsils and crowded oropharynx. The objective of this study is to investigate the usefulness of modified Mallampati grade (MMG) and tonsil grade (TG) in predicting the severity of obstructive sleep apnea. METHODS: MMG and TG were divided into 4 and 5 groups, respectively, according to their severity. Medical records were collected from 94 patients who had received polysomnography and otorhinolaryngologic examination for snoring and sleep apnea at Keimyung University Dongsan Medical Center from March 2002 through April 2004. Patients were divided into two groups according to the apnea-hypopnea index (AHI) : control (n=24), and patients with sleep apnea (n=70). RESULTS: Patients with higher MMG and TG had higher AHI, and MMG and TG proved to have a statistically significant correlation with AHI (p< 0.05) CONCLUSION: MMG and TG were reliable predictors of OSA and helpful parameters in deciding treatment method.
Humans ; Medical Records ; Oropharynx ; Palatine Tonsil ; Physical Examination ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Snoring

Tonsillar carcinoma is the most common cancer of oropharynx. Panendoscope guided biopsy has been estabilished as a diagnostic and therapeutic procedure for patients with cervical nodes from metastasis of unknown origin. There is a controversy about regarding bilateral tonsillectomy as the standard procedure. In studies where bilateral tonsillectomy are routinely performed for diagnosis of unknown primaries, the rates of occult tonsillar carcinoma could be as high as 40%. On the other hand, the incidence of synchronous tonsil carcinoma is exceedingly rare with less than 15 reports in the English literature although synchronous, metachronous carcinomas are more common in head and neck carcinomas than in other sites because the risk factors for the development of carcinomas are shared between the two. We report two cases of bilateral tonsillar carcinoma with literature reviews. In these particular cases, they present an aggressive clinical feature despite small size of the primary lesion. A careful, systemic work up should be performed in bilateral tonsillar carcinoma.
Biopsy ; Hand ; Head ; Humans ; Incidence ; Neck ; Neoplasm Metastasis* ; Oropharynx ; Palatine Tonsil ; Risk Factors ; Tonsillectomy

Patient, 30-year-old, male,was admitted to our hospital because of discontinuously spit fresh blood without any inducing factors for three days. In the course, the patient suffered mild dry sensation of pharyngeal, poor spirit condition, fatigue, poor sleep, poor appetite and was with black stool 2 times. Physical examination: T36. 6°C, R 21/min, P98/min, BP135/90 mmHg (1 mmHg = 0.133 kPa). Bilateral tonsils were III hypertrophy and with scar shape surfaces. The left tonsil's surface had longitudinal small blood vessels markedly dilated. His oropharynx, laryngopharynx and laryngeal did not be find any obvious bleeding sites. Laboratory findings: WBC 13.82 x 10(9)/L, N 0.8084, L 0.1632, Hb 81.00 g/L, HCT 25.20; PT 9.60 s, APTT 25.50 s, TT 15.80 s, FIB 1.900 g/L. After 3 hours of admission,the patient spit out fresh blood again,checked the body to see:the left peri-tonsil with fresh blood and found a slowly bleeding site at the 1/3 junction of the middle lower part of left tonsil's rear surface, the size was about 0.5 cm x 0.6 cm. We finally diagnosed spontaneous tonsillar hemorrhage and successfully managed with low-temperature radiofrequency technology.
Adult ; Catheter Ablation ; Hemorrhage ; therapy ; Humans ; Hypertrophy ; Hypopharynx ; Larynx ; Male ; Oropharynx ; Palatine Tonsil ; pathology ; Temperature

Most lymphoma occurs within the lymph node. A small portion of the lymphoma can have extranodal involvements such as the oral cavity, oropharynx, nasopharynx, paranasal sinuses, and larynx, etc. Especially, Hodgkin's lymphoma with primary manifestation in the palatine tonsil is an extremely rare entity and seldom documented in the literature. Recently, we experienced a case of palatine tonsil mass as a first symptom of Hodgkin's lymphoma. The patient underwent a surgical excision and radiotherapy. The authors report the first case of Hodgkin's lymphoma of the palatine tonsil in Korea with a review of literature.
Hodgkin Disease* ; Humans ; Korea ; Larynx ; Lymph Nodes ; Lymphoma ; Mouth ; Nasopharynx ; Oropharynx ; Palatine Tonsil* ; Paranasal Sinuses ; Radiotherapy

No abstract available.
Oropharynx* ; Tongue*

No abstract available.
Mouth* ; Oropharynx*

BACKGROUND: Laser uvulopalatopharyngoplasty(Laser UPPP) is a modified operative procedure of UPPP using laser for the patient of obstructive sleep apnea syndrome. It is based on the progressive enlargement of the airspace in the oropharynx, to eliminate or reduce obstruction that occurs during sleep, by successive vaporization of the soft palate, wide posterior tonsil pillars and redundant posterior mucosa and resection of hypertrophied palatal tonsils. OBJECTIVES: The objectives of this study were to evaluate the success rate of the operation and to access the value of predictors of outcome in patients with obstructive sleep apnea syndrome. MATERIALS AND METHODS: Laser UPPP was performed in 23 patients with obstructive sleep apnea syndrome based on preoperative polysomnography and preoperative and postoperative polysomnography were compared to evaluate the success rate of operation. Each patient underwent preoperative fiberoptic nasopharyngoscopy with Mueller maneuver. RESULTS: 73.9% of patients had greater than 50% reduction in apnea index and the improvement of snoring was obtained in 69.5% of patients. No polysomnography parameter could accurately predict the changes in sleep after laser UPPP. There was no significant difference between responder and nonresponder group concerning the body mass index(BMI). But there was a significant difference between two groups in severity of obstruction during Mueller maneuver. CONCLUSION: The results of this study suggest that laser UPPP may be effective treatment for the obstructive sleep apnea syndrome with a high success rate and Mueller maneuver would be beneficial in selecting the candidates for laser UPPP by its high predictive efficacy.
Apnea ; Humans ; Mucous Membrane ; Oropharynx ; Palate, Soft ; Palatine Tonsil ; Polysomnography ; Sleep Apnea, Obstructive ; Snoring ; Surgical Procedures, Operative ; Volatilization

BACKGROUND AND OBJECTIVES: Uvulopalatopharyngoplasty (UPPP) is one of the surgical methods used to cure obstructive sleep apnea (OSA). It is designed to relieve of oropharyngeal obstruction and to enlarge the potential air space in the oropharynx by removing the excessive soft tissues involved in the free margin of the soft palate, uvula, tonsils and the pharyngeal wall. Although laser-assisted uvulopalatoplasty (LAUP) has been recently popular for the treatment of snoring and some OSA, UPPP remains the best choice of treatment for moderate to severe OSA. The criteria for selecting patients for this procedure, however, are obscure and factors that can predict successful responses are not well established. The purpose of this study was to evaluate the success rate of UPPP and to determine the factors that can predict the response to UPPP. MATERIALS AND METHODS: We report our experience on 27 OSA patients who underwent UPPP. We evaluated their preoperative cephalometric radiograph readings as well as body mass index (BMI). Each patient also underwent polysomnography before and after UPPP. RESULTS: Defining surgery to be successful when the postoperative apnea index (AI) was reduced by more than 50%, the success rate of the surgery was 74%. The mean AI decreased from 32 to 4, and the mean lowest oxygen saturation increased from 79% to 89% in good responders. Snoring was reduced in 67% of the patients. However, no single parameter could be used to predict good responses to UPPP. CONCLUSION: We found that UPPP is an effective treatment for OSA, but we could not identify a single parameter which can invariably predict the success of the operation.
Apnea ; Body Mass Index ; Humans ; Oropharynx ; Oxygen ; Palate, Soft ; Palatine Tonsil ; Polysomnography ; Reading ; Sleep Apnea, Obstructive* ; Snoring ; Uvula