TUMOURS OF TUMOURS OF OROPHARYNXOROPHARYNX

DEPT OF OTORHINOLARYNGOLOGYDEPT OF OTORHINOLARYNGOLOGY

J J M M CJ J M M C

DAVANAGEREDAVANAGERE

BENIGN TUMOURSBENIGN TUMOURS

PapillomaPapilloma: usually asymptomatic, surgical excision is the : usually asymptomatic, surgical excision is the treatment of choicetreatment of choice

Haemangioma:Haemangioma: may be capillary or cavernous. may be capillary or cavernous. Treatment is diathermy coagulation or injection of Treatment is diathermy coagulation or injection of sclerosing agents. Cryotherapy and laser coagulation is sclerosing agents. Cryotherapy and laser coagulation is also effectivealso effective

Pleomorphic adenomaPleomorphic adenoma: mostly seen submucosally on : mostly seen submucosally on the hard or soft palate. It is potentially malignant and the hard or soft palate. It is potentially malignant and should be excised totallyshould be excised totally

Mucous cystMucous cyst: usually seen in vallecula. Surgical excision : usually seen in vallecula. Surgical excision is the treatment of choice in case of symptomatic cystsis the treatment of choice in case of symptomatic cysts

LipomaLipoma fibromafibroma

Pleomorphic adenomaPleomorphic adenoma

PapillomaPapilloma

MALIGNANT TUMOURSMALIGNANT TUMOURS

Common sites of malignancy in Common sites of malignancy in oropharynx areoropharynx are::

Base of tongueBase of tongueTonsil and tonsillar fossaTonsil and tonsillar fossaFaucial palatine arch (soft palate and Faucial palatine arch (soft palate and

anterior pillar)anterior pillar)Posterior pharyngeal wallPosterior pharyngeal wall

MALIGNANT TUMOURSMALIGNANT TUMOURS

Gross appearance:Gross appearance:Superficially spreadingSuperficially spreadingExophyticExophyticUlcerativeUlcerativeInfiltrativeInfiltrative

MALIGNANT TUMOURSMALIGNANT TUMOURS

Histological classification:Histological classification:Squamous cell carcinoma: may be Squamous cell carcinoma: may be

well/moderately/poorly differentiatedwell/moderately/poorly differentiatedLymphoepitheliomaLymphoepitheliomaAdenocarcinomaAdenocarcinomaLymphomas: both hodgkin and non-Lymphomas: both hodgkin and non-

hodgkin hodgkin

TNM CLASSIFICATIONTNM CLASSIFICATION

TREATMENTTREATMENT

Depends upon the site and extent of the Depends upon the site and extent of the disease, patients general condition, disease, patients general condition, experience of treating surgeon and experience of treating surgeon and facilities availablefacilities available

Options of treatment areOptions of treatment areSurgery aloneSurgery aloneRadiation aloneRadiation aloneSurgery+radiotherapySurgery+radiotherapyChemotherapy+surgery+radiotherapyChemotherapy+surgery+radiotherapyPalliative therapyPalliative therapy

CARCINOMA OF BASE OF TONGUE CARCINOMA OF BASE OF TONGUE (POSTERIOR 1/3(POSTERIOR 1/3RDRD OF TONGUE OF TONGUE))

Commonly seen in our countryCommonly seen in our country Patients usually presents with enlarged Patients usually presents with enlarged

neck nodesneck nodes Earlier symptoms are sore throat, feeling Earlier symptoms are sore throat, feeling

of lump in throat, discomfort on swallowingof lump in throat, discomfort on swallowing Late features include referred pain in ear, Late features include referred pain in ear,

dysphagia, bleeding from mouth, change dysphagia, bleeding from mouth, change in quality of speech (hot potato voice)in quality of speech (hot potato voice)

CARCINOMA OF BASE OF TONGUE CARCINOMA OF BASE OF TONGUE (POSTERIOR 1/3(POSTERIOR 1/3RDRD OF TONGUE OF TONGUE))

Spread: Spread: Local: spread to rest of tongue Local: spread to rest of tongue

musculature, epiglottis, pre - epiglottic musculature, epiglottis, pre - epiglottic space, tonsils, faucial pillars, hypopharynxspace, tonsils, faucial pillars, hypopharynx

Lymphatic spread: 70% of cases show Lymphatic spread: 70% of cases show cervical metastasis either unilateral or cervical metastasis either unilateral or bilateral at the time of initial consultation. bilateral at the time of initial consultation. Jugulo-digastric nodes are first to be Jugulo-digastric nodes are first to be involvedinvolved

Distant metastasis: bones, liver, lung may Distant metastasis: bones, liver, lung may be involvedbe involved

CARCINOMA OF BASE OF TONGUE CARCINOMA OF BASE OF TONGUE (POSTERIOR 1/3(POSTERIOR 1/3RDRD OF TONGUE OF TONGUE

DiagnosisDiagnosis::Indirect laryngoscopyIndirect laryngoscopyPalpation under anesthesiaPalpation under anesthesiaCT scanCT scanFNAC of neck nodesFNAC of neck nodesBiopsy Biopsy

CARCINOMA OF BASE OF TONGUE CARCINOMA OF BASE OF TONGUE (POSTERIOR 1/3(POSTERIOR 1/3RDRD OF TONGUE OF TONGUE

Treatment:Treatment:Radiosensitive tumours such as Radiosensitive tumours such as

Lymphoepithelioma are treated by radiotherapy Lymphoepithelioma are treated by radiotherapy to the primary and neck nodesto the primary and neck nodes

T1, T2 squamous cell carcinoma with N0, N1 T1, T2 squamous cell carcinoma with N0, N1 neck neck surgical excision with block dissection surgical excision with block dissection with post operative radiotherapywith post operative radiotherapy

T3, T4 T3, T4 surgical excision with mandibular surgical excision with mandibular resection, neck dissection and post operative resection, neck dissection and post operative radiationradiation

T4 lesions with extension to anterior tongue and T4 lesions with extension to anterior tongue and vallecula vallecula extensive surgery with total extensive surgery with total glossectomy and laryngectomy in addition to the glossectomy and laryngectomy in addition to the block dissectionblock dissection

CARCINOMA TONSIL AND CARCINOMA TONSIL AND TONSILLAR FOSSATONSILLAR FOSSA

Squamous cell carcinomas are most Squamous cell carcinomas are most commoncommon

Presents as an ulcerated lesion with Presents as an ulcerated lesion with necrotic basenecrotic base

Lymphomas present as unilateral tonsillar Lymphomas present as unilateral tonsillar enlargement and mimic Quinsyenlargement and mimic Quinsy

CARCINOMA TONSILCARCINOMA TONSIL

LYMPHOMA OF TONSILLYMPHOMA OF TONSIL

CARCINOMA TONSIL AND CARCINOMA TONSIL AND TONSILLAR FOSSATONSILLAR FOSSA

Spread: Spread: Local: may spread to soft palate, pillars, Local: may spread to soft palate, pillars,

base of tongue, pharyngeal wall, base of tongue, pharyngeal wall, hypopharynx, parapharyngeal space, hypopharynx, parapharyngeal space, mandible, pterygoid musclesmandible, pterygoid muscles

Lymphatic: 50% patients have initial Lymphatic: 50% patients have initial cervical node involvement at the time of cervical node involvement at the time of presentation. jugulo-digastric nodes are presentation. jugulo-digastric nodes are first to be involvedfirst to be involved

Distant metastasis: seen in late casesDistant metastasis: seen in late cases

CARCINOMA TONSIL AND CARCINOMA TONSIL AND TONSILLAR FOSSATONSILLAR FOSSA

Clinical features: persistent throat pain, Clinical features: persistent throat pain, dysphagia, ear ache, neck swelling, dysphagia, ear ache, neck swelling, trismus, fetor oristrismus, fetor oris

Diagnosis: palpation, biopsyDiagnosis: palpation, biopsy Treatment: Treatment: RadiotherapyRadiotherapySurgery: excision of tonsil in early lesions. Surgery: excision of tonsil in early lesions.

Commando operation for larger lesionsCommando operation for larger lesionsCombined therapyCombined therapy

COMMANDO OPERATIONCOMMANDO OPERATION

(Combined oro - mandibular resection with (Combined oro - mandibular resection with reconstruction)reconstruction)

It involves wide surgical excision of It involves wide surgical excision of primary tumor with hemimandibulectomy primary tumor with hemimandibulectomy and radical neck dissectionand radical neck dissection

CARCINOMA OF PALATINE CARCINOMA OF PALATINE ARCHARCH

Soft palate, uvula, anterior tonsillar pillar Soft palate, uvula, anterior tonsillar pillar comprise palatine archcomprise palatine arch

Most common tumour type is squamous Most common tumour type is squamous cell carcinomacell carcinoma

May spread locally to contiguous May spread locally to contiguous structures or lymph nodesstructures or lymph nodes

Patient presents with persistent throat Patient presents with persistent throat pain, local pain, ear achepain, local pain, ear ache

Treatment is irradiation or surgeryTreatment is irradiation or surgery

CARCINOMA OF POSTERIOR AND CARCINOMA OF POSTERIOR AND

LATERAL PHARYNGEAL WALLLATERAL PHARYNGEAL WALL

Lesions remain asymptomatic for long Lesions remain asymptomatic for long timetime

They may spread submucosally to They may spread submucosally to adjoining areas such as tonsil, soft palate, adjoining areas such as tonsil, soft palate, tongue, nasopharynx, hypopharynxtongue, nasopharynx, hypopharynx

They may also involve parapharyngeal They may also involve parapharyngeal space and anterior spinal ligamentsspace and anterior spinal ligaments

Bilateral nodal involvement is commonBilateral nodal involvement is common Treatment is irradiation or surgeryTreatment is irradiation or surgery

PARAPHARYNGEAL TUMOURSPARAPHARYNGEAL TUMOURS

Tumors of deep lobe of parotidTumors of deep lobe of parotid Neurogenic tumors: neurilemmomasNeurogenic tumors: neurilemmomas Chemodectoma: carotid body tumor, Chemodectoma: carotid body tumor,

glomus vagaleglomus vagale LipomaLipoma

PARAPHARYNGEAL TUMOURSPARAPHARYNGEAL TUMOURS

Tumors of deep lobe of parotidTumors of deep lobe of parotid