Sagittal mandibulectomy provided safe oncologic margins and functional and esthetic advantages in the surgical treatment of tonsillar cancers that abut but do not infiltrate the mandible.
Mandible ; Tonsillar Neoplasms*

Four consecutive patients underwent composite resection of tonsillar cancer and reconstruction with a microvascular radial forearm free flap. Three patients had postoperative assessments of speech at six to nine months respectively. One patient could not attend for the postoperative assessment. The speech assessment was examined by same speech therapist. All the patients had an good postoperative speech assessment. Compared to conventional local or regional myocutaneous flaps, the thin forearm free flaps offers better postoperative articulatory recovery.
Forearm* ; Free Tissue Flaps* ; Humans ; Myocutaneous Flap ; Tonsillar Neoplasms

Female ; Humans ; Middle Aged ; Sarcoma, Myeloid ; Tonsillar Neoplasms

Transoral robotic system (TORS) is performed by positioning at least 3 robotic arms through the oral cavity that are operated by the surgeon bimanually. The elaborate movements of the operating tools and high resolution endoscopic images provided by the robot can overcome the shortcomings of transoral radical lateral oropharyngectomy, thus enabling wide and effective surgery. Also, it preserves postoperative functions and improves the quality of life, thereby decreasing postoperative morbidity. In this study, the possibility of TORS as a novel surgical method in managing tonsillar carcinoma has been identified. However, a long term observation regardingpostoperative swallowing, phonation, quality of life and oncologic safety in using TORS is further required.
Arm ; Deglutition ; Mouth ; Phonation ; Quality of Life ; Tonsillar Neoplasms

Humans ; Lung Neoplasms ; pathology ; Male ; Middle Aged ; Palpation ; Tonsillar Neoplasms ; diagnosis ; secondary

PURPOSE: The aim of this study was to determine the incidence and malignant rate of incidental asymmetric palatine tonsillar uptake (ATU) on (18)F-FDG PET/CT in various clinical indications and to evaluate the clinical and PET/CT findings suggesting malignancy. MATERIALS AND METHODS: We retrospectively reviewed a total of 2,901 patients (58.4+/-12.3 yrs, range 20~88 yrs, M:F=1,841:1,060) who underwent (18)F-FDG PET/CT during an 1-year period with various indications except primary tonsillar cancer and lymphoma evaluation. On (18)F-FDG PET/CT, metabolic abnormality of the palatine tonsil and cervical lymph node were visually assessed. ATU was defined as increased palatine tonsillar uptake with diffuse, focal, or irregular pattern compared to contralateral side. The incidence and malignant ratio of ATU were evaluated according to clinical and PET/CT findings. RESULTS: Of 2,901 cases, 290 (10.0%) showed ATU. The incidence of ATU showed seasonal variation and was high in the winter (12.1%). Of 209 cases with ATU confirmed pathologically and/or clinically, five (2.4%) were malignant lesions. ATU with irregular uptake pattern (2/2) and in cases referred for cervical lymph node metastasis of unknown origin (3/5) were frequently associated with malignant lesion (p<0.05). CONCLUSION: ATU was not infrequently observed on (18)F-FDG PET/CT, and the malignant risk of ATU was low. However, ATU with cervical lymph node metastasis or with irregular pattern on PET/CT would be further evaluated by the histopathologic examination.
Humans ; Incidence ; Lymph Nodes ; Lymphoma ; Neoplasm Metastasis ; Palatine Tonsil ; Retrospective Studies ; Seasons ; Tonsillar Neoplasms

PURPOSE: We wanted to present the preliminary results of intensity-modulated radiotherapy (IMRT) for the treatment of tonsillar cancer. MATERIALS AND METHODS: We retrospectively analyzed 12 patients who underwent IMRT for tonsillar cancer at Asan Medical Center between November 2002 and February 2007. Seven patients (58%) received definitive treatment, and five (42%) were treated in the postoperative setting. Among the definitively treated patients, 6 patients received cisplatin-based chemotherapy regimens. Simultaneous modulated accelerated radiation therapy (SMART) was used in nine patients. The prescribed dose was 72 Gy at 2.4 Gy/fraction for the definitively treated cases and 61.6 Gy at 2.2 Gy/fraction for the postoperative cases. The median follow-up period was 34 months. RESULTS: All twelve patients completed treatment without interruption, and eleven showed a complete response. One patient had persistent loco-regional disease after treatment. The three-year estimates of loco-regional control, disease-free survival and overall survival were 91.7%, 91.7%, and 100%. The worst acute mucositis was Grade 1 in four patients, Grade 2 in five patients, Grade 3 in two patients and Grade 4 in one patient. Grade 3 xerostomia was observed in six patients. CONCLUSION: Intensity-modulated radiotherapy was shown to be a safe and effective treatment modality for tonsillar cancer. Further studies with a larger number of patients and a longer follow-up period are needed to evaluate the ultimate tumor control and late toxicity of IMRT for treating tonsillar cancer.
Disease-Free Survival ; Follow-Up Studies ; Humans ; Mucositis ; Radiotherapy, Intensity-Modulated ; Retrospective Studies ; Tonsillar Neoplasms ; Xerostomia

The use of a myomucosal flap from the buccinator muscle is a valuable reconstruction method for intraoral defects. In this paper, we report the clinical advantages of using a buccinator myomucosal flap for the treatment of partial mandibular defects caused by osteoradionecrosis. We implemented a buccinator myomucosal flap for the reconstruction of a partial mandibular defect in a 55-year-old man with tonsil cancer and partial mandibular defects caused by osteoradionecrosis. The total operating time was 90 minutes. Twelve months after the reconstruction, the patient remains free of disease. A buccinator myomucosal flap can be used for the reconstruction of partial mandibular defects caused by osteoradionecrosis. It is a reliable method for reconstructing small mandibular defects.
Humans ; Mandible* ; Mandibular Reconstruction ; Middle Aged ; Myocutaneous Flap ; Osteoradionecrosis* ; Reconstructive Surgical Procedures ; Tonsillar Neoplasms

Adult ; Airway Obstruction ; etiology ; Anesthetics ; adverse effects ; Humans ; Male ; Polyps ; complications ; Tonsillar Neoplasms ; complications ; Young Adult

BACKGROUND: The soft palate functions as a valve and helps generate the oral pressure required for normal speech resonance. Speech problems and nasal regurgitation can result from a soft palatal defect. Reduction of the size of the velopharyngeal orifice is required to compensate for the lack of mobility in a reconstructed soft palate. We suggest a large volume folded free flap for reduction of the caliber and a palmaris longus tendon sling for suspension of the reconstructed palate. METHODS: Six patients had total soft palate resection for tonsillar cancer and reconstruction with a large volume folded radial forearm free flap combined with a palmaris longus sling. A single surgeon and speech therapist examined the patients with three standardized speech assessment tools: nasometer test, consonant articulation test, and speech acuity test performed for speech evaluation. RESULTS: Mean nasalance score was 76.20% for sentences with nasal sounds and 43.60% for sentences with oral sounds. Hypernasality was seen for oral sound sentences. The mean score of the picture consonant articulation test was 84% (range, 63% to 100%). The mean score of the speech acuity test was 5.84 (range, 5 to 6). These mean ratings represent a satisfactory level of speech function. CONCLUSIONS: The large volume folded free flap with a palmaris longus tendon sling for total soft palate reconstruction resulted in satisfactory prognosis for speech despite moderate hypernasality.
Forearm ; Free Tissue Flaps ; Humans ; Palate, Soft ; Prognosis ; Tendons ; Tonsillar Neoplasms