Tumours Of: Oropharynx

TUMOURS OF
OROPHARYNX
BENIGN TUMOURS
 Papilloma: usually asymptomatic, surgical excision is hte
treatment of choice
 Haemangioma: may be capillary or cavernous.
Treatment is diathermy coagulation or injection of
sclerosing agents. Cryotherapy and laser coagulation is
also effective
 Pleomorphic adenoma: mostly seen submucosally on
the hard or soft palate. It is potentially malignant and
should be excised totally
 Mucous cyst: usually seen in vallecula. Surgical excision
is the treatment of choice in case of symptomatic cysts
 Lipoma
 fibroma
Pleomorphic adenoma
Papilloma
MALIGNANT TUMOURS
 Common sites of malignancy
n
i oropharynx are:
 B a s e of tongue
 To n s i l and tonsillar fossa

 F a u c i a l palatine arch (soft palate a
n
d
anterior pillar)
 P o s t e r i o r pharyngeal wall
MALIGNANT TUMOURS
 Gross appearance:
 Superficially spreading
 Exophytic
 Ulcerative
 I nf i lt r at iv e
MALIGNANT TUMOURS
 Histological classification:
 S q u a m o u s cell carcinoma: may be
well/moderately/poorly differentiated
 Lymphoepithelioma
 Adenocarcinoma
 Ly m p h o m a s : both hodgkin and
non- hodgkin
TNM CLASSIFICATION
TREATMENT
 Depends upon the site and extent of hte
disease, patients general condition,
experience of treating surgeon and
facilities available
 Options of treatment are
 S u r g e r y alone
 R a d i a t i o n alone
 Surgery+radiotherapy
 Chemotherapy+surgery+radiotherap
CARCINOMA OF BASE OF TONGUE
(POSTERIOR 1/3RD OF TONGUE)
 Commonly seen in our country

 Patients usually presents with enlarged
neck nodes
 Earlier symptoms are sore throat, feeling
of lump in throat, discomfort on swallowing
 Late features include referred pain in ear,
dysphagia, bleeding from mouth, change
in quality of speech (hot potato voice)
(POSTERIOR 1/3RD OF TONGUE)
 Spread:
 L o c a l : spread to rest of tongue
musculature, epiglottis, pre - epiglottic
space, tonsils, faucial pillars, hypopharynx
 Ly m p h a t i c spread: 70% of cases show
cervical metastasis either unilateral or
bilateral at the time of initial consultation.
Jugulo-digastric nodes are first to be
involved
(POSTERIOR 1/3RD OF TONGUE
 Diagnosis:
 I n d i r e c t laryngoscopy
 P a l p a t i o n under anesthesia
 C T scan
 F N A C of neck nodes
 Biopsy
(POSTERIOR 1/3RD OF TONGUE
 Treatment:
 Radiosensitive tumours such as
Lymphoepithelioma are treated by radiotherapy
to the primary and neck nodes
 T 1 , T2 squamous cell carcinoma with N0, N 1
neck  surgical excision with block dissection
with post operative radiotherapy
 T 3 , T4  surgical excision with
mandb
i ua
l r resection, neck dissection and post
operative radiation
 T 4 lesions with extension to anterior tongue and
vallecula  extensive surgery with total
CARCINOMA TONSIL AND
TONSILLAR FOSSA
 Squamous cell carcinomas are most

common
 Presents as an ulcerated lesion wtih
necrotic base
 Lymphomas present as unilateral tonsillar
enlargement and mimic Quinsy
CARCINOMA TONSIL
LYMPHOMA OF TONSIL
TONSILLAR FOSSA
 Spread:
 L o c a l : may spread to soft palate, pilars,
base of tongue, pharyngeal wall,
hypopharynx, parapharyngeal space,
mandible, pterygoid muscles
 Ly m p h a t i c : 50% patients have initial
cervical node involvement at the time of
presentation. jugulo-digastric nodes
are first to be involved
TONSILLAR FOSSA
 Clinical features: persistent throat pain,
dysphagia, ear ache, neck swelling,
trismus, fetor oris
 Diagnosis: palpation, biopsy
 Treatment:
 Radiotherapy
 S u r g e r y : excision of tonsil in early
lesions.
Commando operation for larger lesions
COMMANDO OPERATION
(Combined oro - mandibular resection with

reconstruction)
 It involves wide surgical excision of
primary tumor with hemimandibulectomy
and radical neck dissection
CARCINOMA OF PALATINE
ARCH
 Soft palate, uvula, anterior tonsillar pilar
comprise palatine arch
 Most common tumour type is squamous
cell carcinoma
 May spread locally to contiguous
structures or lymph nodes
 Patient presents with persistent throat
pain, local pain, ear ache
 Treatment is irradiation or surgery
CARCINOMA OF POSTERIOR
AND LATERAL PHARYNGEAL
WALL
 Lesions remain asymptomatic for ol ng
time
 They may spread submucosally to
adjoining areas such as tonsil, soft palate,
tongue, nasopharynx, hypopharynx
 They may also involve parapharyngeal
space and anterior spinal ligaments
 Bilateral nodal involvement is common
 Treatment is irradiation or surgery
PARAPHARYNGEAL TUMOURS
 Tumors of deep lobe of parotid

 Neurogenic tumors: neurilemmomas
 Chemodectoma: carotid body tumor,
glomus vagale
 Lipoma
PARAPHARYNGEAL TUMOURS
Tumors of deep lobe of parotid

Tumours Of: Oropharynx

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Tumours Of: Oropharynx

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TUMOURS OF

 To n s i l and tonsillar fossa

 Commonly seen in our country

 Squamous cell carcinomas are most

(Combined oro - mandibular resection with

 Tumors of deep lobe of parotid

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