Pseudoxanthoma-elasticum-like changes on the soft palate.

Pseudoxanthoma elasticum (PXE) is an autosomal recessive genetic disorder characterized by aberrant fragmentation and calcification of elastic fibers, leading to characteristic cutaneous, ophthalmic, and cardiovascular manifestations. PXE demonstrates significant phenotypic variability; involvement of the oral mucosa may be the only clue to the diagnosis. Reports on mucous membrane involvement in PXE are scarce. Here, we present a case of PXE-like changes in the oral cavity. A 70-year-old male patient presented with a painless leukoplakic lesion on the soft palate. Biopsy revealed numerous degenerated fibers in the lamina propria. Verhoeff-van Gieson and von Kossa staining confirmed their identity as calcified elastic fibers. A histopathological diagnosis of PXE-like changes was made; the patient was referred to ophthalmology where angioid streaks were visualized fundoscopically. PXE-like changes in the absence of the characteristic genetic mutation have also been reported with or without systemic manifestations. Furthermore, PXE-like changes have been reported in up to 10% of oral biopsy specimens undertaken without clinical suspicion for PXE. Therefore, the significance of such changes in isolation is unclear. Clinicians and pathologists should be aware of the potential oral manifestations of PXE to facilitate prompt diagnosis and subspecialist referral.

Evaluation of the clinical efficacy of nasal surgery in the treatment of obstructive sleep apnoea.

STUDY OBJECTIVES: The aim of the study was to evaluate the clinical efficacy of nasal surgery in the treatment of obstructive sleep apnoea (OSA) by comparing the improvement of subjective symptoms and objective metrics before surgery and after 6 months of surgery. METHODS: Patients with the main complaint of nasal congestion combined with habitual snoring who were hospitalized and treated were selected. Patients underwent subjective symptom tests and objective indicator monitoring both before surgery and 6 months after surgery. Comparisons between groups were performed using the independent samples t-test. RESULTS: Subjective scale evaluations demonstrated that nasal congestion, daytime sleepiness, snoring, nose-related symptoms, and sleep symptoms in patients with simple snoring or with OSA were improved after nasal surgery. Additionally, vitality was improved in all groups except for the patients with simple snoring and emotional consequence was improved in patients with simple snoring and mild OSA. Objective evaluations indicated the apnoea-hypopnoea index (AHI), the thickness of the soft palate, and the maximum cross-sectional area of the sagittal plane of the soft palate decreased after surgery in patients with mild OSA. The lowest blood oxygen concentration (LSaO2) and anteroposterior diameter of the soft palate increased after surgery in patients with mild OSA. The arousal index also significantly decreased in patients with mild and moderate OSA. The nasal cavity volumes (NCVs) and the nasal minimal cross-sectional areas (NMCAs) of all groups showed significant differences after surgery. CONCLUSIONS: Nasal surgery can effectively improve nose and sleep symptoms in patients with simple snoring or with OSA. It can significantly reduce the nasal resistance and increase the ventilation volume. STATEMENT OF SIGNIFICANCE: Obstructive sleep apnoea (OSA) is becoming a global health problem. OSA is associated with several coexisting conditions, reduced health-related quality of life, and impaired work productivity. This study performed nasal surgery on OSA patients with the main complaint of nasal congestion combined with snoring and patients with simple snoring to compare the improvement of subjective symptoms and objective metrics before and after surgery. We found that: (1) symptoms such as nasal congestion, daytime sleepiness or snoring were improved after nasal surgery; (2) the apnoea-hypopnoea index (AHI) and arousal index decreased after surgery in patients with OSA; (3) the nasal and oropharyngeal cavity volumes increased after surgery. These findings suggest that patients with OSA or with simple snoring could benefit from nasal surgery.

Reverse sneezing as a clinical manifestation of nasopharyngeal-oropharyngeal fistula in a dog.

A 6-year-old spayed female Labrador retriever was evaluated for a 3-month history of intermittent reverse sneezing and gagging episodes. Pertinent findings at evaluation included frequent reverse sneezing and non-productive retching. No pathology was visible on sedated oral examination. Contrast-enhanced computed tomography of the skull revealed a gas-filled defect within the left ventral aspect of the soft palate. A non-eroded defect was present in the left caudoventral nasopharyngeal wall on nasopharyngoscopy. Surgical exploration revealed a nasopharyngeal-oropharyngeal fistula within the left palatine tonsillar fossa. The dog had a witnessed oropharyngeal stick injury (OSI) 3 months previous in the location of the fistula. The OSI had been allowed to heal by secondary intention and was treated with an oral antibiotic and NSAID. However, the dog lacked characteristic signs of a chronic OSI such as nasal discharge or abscess formation. The defect in the soft palate was surgically debrided and closed, and the left palatine tonsil was excised. The dog recovered completely with cessation of reverse sneezing and retching episodes.

Éternuements inversés comme manifestation clinique d'une fistule oropharyngée-nasopharyngée chez un chien. Une femelle Labrador stérilisée âgée de 6 ans a été évaluée pour une histoire de 3 mois d'épisodes intermittents d'éternuements inversés et d'étouffements. Les résultats pertinents lors de l'évaluation comprenaient des éternuements inversés fréquents et des haut-le-coeur non productifs. Aucune pathologie n'était visible à l'examen oral sous sédation. La tomodensitométrie à contraste amélioré du crâne a révélé une imperfection remplie de gaz dans la face ventrale gauche du palais mou. Une imperfection non érodée était présente dans la paroi nasopharyngée caudo-ventrale gauche à la nasopharyngoscopie. L'exploration chirurgicale a révélé une fistule nasopharyngée-oropharyngée au sein de la fosse amygdalienne palatine gauche. Le chien a eu une blessure oropharyngée par une branche (OSI) il y a 3 mois à l'emplacement de la fistule. L'OSI avait été laissée à guérir par seconde intention et a été traitée avec un antibiotique oral et un AINS. Cependant, le chien ne présentait pas de signes caractéristiques d'une OSI chronique comme un écoulement nasal ou la formation d'abcès. Le défaut du palais mou a été chirurgicalement débridé et fermé, et l'amygdale palatine gauche a été excisée. Le chien s'est complètement rétabli avec l'arrêt des épisodes d'éternuements inversés et de haut-le-coeur.(Traduit par Dr Serge Messier).

Zymogen-poor acinic cell carcinoma of the soft palate with high-grade transformation.

Acinic cell carcinoma is an uncommon malignant salivary gland tumour accounting for approximately 6-7% of all salivary gland neoplasms. The key diagnostic feature of acinic cell carcinoma is the presence of acinar cell differentiation characterised by cytoplasmic zymogen secretory granules. This tumour shows a variety of growth patterns, including solid, microcystic, follicular and papillary cystic patterns. Acinic cell carcinoma is typically a cytologically low-grade malignancy. Acinic cell carcinomas with high-grade transformation (HGT) are exceedingly rare and are reported to have a more aggressive clinical course than conventional acinic cell carcinoma. This is a case report of this uncommon entity with high-grade transformation arising on the soft palate in a 64-year-old woman.

Endoscopic findings in the soft palatal mucosa are associated with the risk of esophageal squamous cell carcinoma.

BACKGROUND AND AIM: We investigated endoscopic findings of the soft palatal mucosa to identify factors associated with esophageal squamous cell carcinoma (ESCC). METHODS: This study was conducted during endoscopic examinations of subjects at Osaka International Cancer Institute from January 2020 through May 2020. We took endoscopic images of the soft palate under non-magnifying and mild-magnifying observations. Subjects with ESCC or a history of ESCC were defined as the ESCC group. Two endoscopists who were blinded to subjects' clinical information interpreted 10 endoscopic findings: melanosis, brownish changes, whitish epithelium, vasodilation, circular alignment of dilated vessels, uneven surface, uneven epithelial color, uneven vessel visibility, palate ridge, and erosion. Subjects were interviewed about their alcohol use, smoking, and flushing reactions. RESULTS: Two hundred eighty-two subjects, including 151 in the ESCC group and 131 in the non-ESCC group, were included in the analysis. Univariate analyses and multivariate logistic regression demonstrated that melanosis, whitish epithelium, and vasodilation were significantly associated with ESCC. The positive likelihood ratios (PLRs) of melanosis, whitish epithelium, and vasodilation were 3.3, 4.2, and 2.8, respectively. Additionally, the PLRs for three of the endoscopic findings in subjects with drinking and smoking habits were higher than in those without these habits-PLRs ranging from 7.23 to 19.1. High PLRs for three endoscopic findings suggested a high possibility of ESCC. Interobserver agreement was substantial for whitish epithelium, moderate for melanosis, and fair for vasodilation. CONCLUSIONS: Three endoscopic findings in soft palate were considered to be useful as alarming signs that indicate ESCC risk.

Histopathological and biomechanical changes in soft palate in response to non-ablative 9.3-µm CO2 laser irradiation: an in vivo study.

The purpose of this study was to investigate in vivo the biomechanical and morphological changes in soft palates of Wistar rats from non-ablative irradiation with a 9.3-µm CO2 laser. A blinded, randomized, controlled study was designed with 45 Wistar rats categorized into treated and control sets. The treated set was exposed to 9.3-µm CO2 laser irradiation at an average power of 1.0 W and a single pulse fluence of 0.16 J/cm2 scanned using an automated system at a repetition rate of 315 Hz in a patterned area covering 0.4 cm2 in 6 s. The tissue of each animal was excised and divided into two halves. One-half was sectioned for histopathology, and the other half was used to measure tissue stiffness, which was reported as the effective Young's modulus. Measurements for both sets were taken at three time points: days 1, 21, and 35. There were no significant adverse events or changes in the behavior of the rats over the duration of the study. The treated set exhibited an order of magnitude increase in stiffness relative to the controls, which was maintained over the three time points. Histopathology showed a moderate contraction/disruption of the lamina propria collagen observed at day 1 and collagen accumulation observed at days 21 and 35 in the tissue remodeling phase. Non-ablative 9.3-µm CO2 laser irradiation can safely increase oral mucosal stiffness and can be used as an effective treatment to reduce tissue vibrations that are associated with snoring.

Expert consensus statements for Waldeyer's ring involvement in pediatric Hodgkin lymphoma: The staging, evaluation, and response criteria harmonization (SEARCH) for childhood, adolescent, and young adult Hodgkin lymphoma (CAYAHL) group.

Waldeyer's ring (WR) involvement in pediatric Hodgkin lymphoma (HL) is extremely rare and criteria for determining involvement and response to treatment are unclear. The international Staging, Evaluation, and Response Criteria Harmonization for Childhood, Adolescent and Young Adult Hodgkin Lymphoma (SEARCH for CAYAHL) Group performed a systematic review of the literature in search of involvement or response criteria, or evidence to support specific criteria. Only 166 cases of HL with WR involvement were reported in the literature, 7 of which were pediatric. To date no standardized diagnostic or response assessment criteria are available. Given the paucity of evidence, using a modified Delphi survey technique, expert consensus statements were developed by the SEARCH group to allow for a more consistent definition of disease and response evaluation related to this rare site of involvement among pediatric oncologists. The available evidence and expert consensus statements are summarized.

Mucus Retention Cyst of the Soft Palate in a Dog.

A 10 yr old 6.6 kg (14.5 lb) castrated male Chihuahua was referred to the Alta Vista Animal Hospital for evaluation of a mass of the soft palate. The cystic structure was bluntly dissected from the soft palate submucosal tissue, and the dog recovered from surgery and anesthesia without complication. Histopathology revealed salivary tissue with a large multiloculated cyst lined by a single layer of cystic and dilated cuboidal epithelium. Follow up 7 mo after surgery revealed complete resolution of clinical signs with no evidence of local recurrence. To the authors' knowledge, this is the first confirmed report of a mucus retention cyst in a dog.

Desmin and dystrophin abnormalities in upper airway muscles of snorers and patients with sleep apnea.

BACKGROUND: The pathophysiology of obstruction and swallowing dysfunction in snores and sleep apnea patients remains unclear. Neuropathy and to some extent myopathy have been suggested as contributing causes. Recently we reported an absence and an abnormal isoform of two cytoskeletal proteins, desmin, and dystrophin, in upper airway muscles of healthy humans. These cytoskeletal proteins are considered vital for muscle function. We aimed to investigate for muscle cytoskeletal abnormalities in upper airways and its association with swallowing dysfunction and severity of sleep apnea. METHODS: Cytoskeletal proteins desmin and dystrophin were morphologically evaluated in the uvula muscle of 22 patients undergoing soft palate surgery due to snoring and sleep apnea and in 10 healthy controls. The muscles were analysed with immunohistochemical methods, and swallowing function was assessed using videoradiography. RESULTS: Desmin displayed a disorganized pattern in 21 ± 13% of the muscle fibres in patients, while these fibers were not present in controls. Muscle fibres lacking desmin were present in both patients and controls, but the proportion was higher in patients (25 ± 12% vs. 14 ± 7%, p = 0.009). The overall desmin abnormalities were significantly more frequent in patients than in controls (46 ± 18% vs. 14 ± 7%, p < 0.001). In patients, the C-terminus of the dystrophin molecule was absent in 19 ± 18% of the desmin-abnormal muscle fibres. Patients with swallowing dysfunction had 55 ± 10% desmin-abnormal muscle fibres vs. 22 ± 6% in patients without swallowing dysfunction, p = 0.002. CONCLUSION: Cytoskeletal abnormalities in soft palate muscles most likely contribute to pharyngeal dysfunction in snorers and sleep apnea patients. Plausible causes for the presence of these abnormalities is traumatic snoring vibrations, tissue stretch or muscle overload.

Late Occurrence of Raccoon Eyes: The Role of the Ligature.

This case represents a planned complex suicide in which the victim combined gunshot to the head and hanging. The most interesting finding in the presented case was pale face, but without any visible injury to it at the time the body was found (more than 24 hours after death), whereas at autopsy (20 hours later), black eyes were prominent. The removal of the ligature led to the decompression of the neck and its blood vessels with consequential blood redistribution, which, alongside the liquid state of blood, resulted in the aforementioned finding. Considering the described postponed appearance of periorbital ecchymosis, this kind of finding suggests that great caution is necessary when interpreting hematomas in terms of their vitality.

Comparison of carbon dioxide laser versus bipolar vessel device for staphylectomy for the treatment of brachycephalic obstructive airway syndrome.

Carbon dioxide (CO2) laser and bipolar vessel sealing device (BSD) are industry standards for soft palate resection. No studies exist to directly compare these 2 techniques in a clinical setting. The purpose of this study was to describe and compare clinical outcomes for dogs that underwent CO2 laser versus BSD staphylectomy. Medical records of brachycephalic dogs that underwent CO2 laser (Group-L) or BSD staphylectomies (Group-B) between September 2013 and September 2017 were reviewed retrospectively. Of 60 dogs that met the inclusion criteria, 26 dogs (43%) were designated Group-L and 34 (57%) Group-B. Techniques did not differ in procedure or anesthetic time (P = 0.52 and P = 0.19, respectively) or major complication rates [intraoperative (P = 1.00), post-operative (P = 0.72), short-term (P = 1.00), and long-term (P = 0.68)]. This study suggests that patient outcomes are similar for dogs undergoing staphylectomy performed by CO2 laser and BSD.

Comparaison du laser au gaz carbonique par rapport au dispositif de coagulation bipolaire lors de la staphylectomie pour le traitement du syndrome de brachycéphalie d'obstruction des voies respiratoires. Le laser au gaz carbonique (CO2) et le dispositif de coagulation bipolaire sont des normes de l'industrie pour la résection du palais mou. Aucune étude n'existe afin de comparer ces deux techniques dans un milieu clinique. Le but de cette étude consistait à décrire et à comparer les résultats cliniques pour les chiens qui ont subi une opération au laser CO2 par rapport à une staphylectomie à l'aide d'un dispositif de coagulation bipolaire. Les dossiers médicaux de chiens brachycéphales qui ont subi des staphylectomies au laser CO2 (Groupe-L) ou à l'aide d'un dispositif de coagulation bipolaire (Groupe-B) entre septembre 2013 et septembre 2017 ont été examinés rétrospectivement. Parmi les 60 chiens qui satisfaisaient aux critères d'inclusion, 26 chiens (43 %) ont été désignés dans le Groupe-L et 34 (57 %) dans le Groupe-B. Les techniques n'ont pas différé pour la durée de l'intervention ou de l'anesthésie (P = 0,52 et P = 0,19, respectivement) ou les taux de complications majeures [intra-opératoires (P = 1,00), postopératoires (P = 0,72), à court terme (P = 1,00) et à long terme (P = 0,68)]. Cette étude suggère que les résultats des patients sont semblables pour les chiens subissant une staphylectomie réalisée par laser au CO2 et à l'aide d'un dispositif de coagulation bipolaire.(Traduit par Isabelle Vallières).

Soft palate cephalometric changes with a mandibular advancement device may be associated with polysomnographic improvement in obstructive sleep apnea.

PURPOSE: It is unclear whether soft palate-associated changes in cephalometry associated with a mandibular advancement device (MAD) are independently associated with improvements in polysomnography (PSG) respiratory parameters in obstructive sleep apnea (OSA). METHODS: This retrospective review aimed to identify the association between soft palate-associated changes in cephalometry and PSG changes after application of an MAD. Korean patients diagnosed with OSA who underwent cephalometry with or without an MAD were enrolled. All the patients were evaluated after undergoing full-night PSG twice: once with an MAD and once without. Cephalometric findings were measured using an image analyzer. RESULTS: Mean apnea-hypopnea index significantly decreased with an MAD from 36.4/h to 14.7/h (p < 0.001). Retropalatal airway space significantly increased with an MAD from 6.6 to 7.3 mm (p = 0.013). Soft palate length also significantly decreased with an MAD from 43.6 to 42.3 mm (p = 0.02). Although these findings were shown by responders (patients with a reduction of apnea-hypopnea index by more than 50%), there were no significant changes in non-responders. However, retroglossal airway space did not significantly increase with an MAD even in responders. CONCLUSIONS: Improvement of OSA with an MAD can be predicted with soft palate-associated upper airway changes shown in cephalometry.

Myoepithelioma of the Soft Palate.

Myoepitheliomas are extremely rare salivary gland tumors. Myoepithelioma of salivary glands comprised only 1% of all salivary tumors, most commonly occurring in the parotid gland followed by the minor salivary glands in the oral cavity. Involvement of the soft palate is a rare occurrence. This tumor is usually benign, and its treatment is total lesion excision. Here, the author reports a case of myoepithelioma of the soft palate in a 42-year-old Turkish man. The mass was removed by local excision under general anesthesia. There was no recurrence during the follow-up period of 10 months.

A Man With Asymptomatic Ulcerated White Plaques on the Soft Palate.

A man in his 60s had irregular gray-white ulcers with a surrounding erythema on the soft palate, uvula, and tonsils that did not improve with oral cefuroxime. He reported sexual contact with 1 male partner over the prior 6 months; history and physical examination findings were otherwise unremarkable. What is the diagnosis and what would you do next?

Airway volume analysis: is there a correlation between two and three-dimensions?

Objectives: No consensus exists on the assessment of airway in CBCT scans. Two-dimensional measures remain the standard in the cephalometric analysis. This research aimed to evaluate linear and area measurements in two-dimensional views from specific airway regions of interest and compare these to the correspondent volume in CBCT exams. Materials and Methods: 250-selected CBCT scans were retrospectively analyzed. A trained and calibrated examiner performed the linear, area and volume measurements in specific sites for nasal cavity, nasopharynx and oropharynx compartments. Dolphin Software was used for the analysis. The correlations were performed using Pearson coefficient. Results: The highest positive correlations were observed in the nasopharynx and oropharynx sagittal areas and the most constricted area in the oropharynx. Nasopharynx linear measures and nasopharynx coronal area did not present correlation with whole volume. Two-dimensional measurements in the soft palate (width and sagittal area) showed very low positive correlations. Although nasal cavity presented highest volume means, changes in oropharynx contributed more to variations in total volume, compared with the other two sections. Conclusion: Airway sagittal areas, as well as the most constricted axial area in oropharynx remains a useful guide to correlate with airway volume in two-dimensional images.

Recurrent oral squamous papilloma in a pediatric patient: Case report and review of the literature.

Squamous papillomas are common lesions of the oral mucosa. They are benign proliferating lesions often painless, slow growing and with a cauliflower appearance. However, its clinical appearance which sometimes mimics exophytic carcinoma, verrucous carcinoma or condyloma acuminatum raises concern when it occurs in the oral cavity. Squamous papilloma occurs predominantly in 30- to 50-year old's. However, they may be seen in children <10 years and accounted for 8% of all oral tumors in children. There is no sex predilection. It has a predilection for the tongue and soft palate, but may occur on any other surface of the oral cavity. Oral squamous papillomas have been associated with infection by the human papilloma virus (HPV). The present report is a case of a recurrent squamous papilloma of the hard palate in a 5-year-old patient with a review of the literature.

Soft palatal melanosis, a simple predictor for neoplasia in the upper aerodigestive tract in Japanese alcoholic men.

Soft palatal melanosis can be detected by visual inspection during routine physical examination or even personally in a mirror. The aim of this study was to evaluate the association between squamous cell neoplasia in the upper aerodigestive tract (UAT) and soft palatal melanosis. We reviewed digitized records of high-quality endoscopic images of the soft palate of 1786 Japanese alcoholic men who underwent endoscopic screening. Soft palatal melanosis was observed in 381 (21.3%) of the subjects (distinct, 6.3%). Older age, an inactive heterozygous aldehyde dehydrogenase-2 genotype, smoking, and a high mean corpuscular volume were positively associated with the presence of soft palatal melanosis. The age-adjusted odds ratio (95% confidence interval) for UAT neoplasia was 1.92 (1.40-2.64) in the group with melanosis and 2.51 (1.55-4.06) in the group with distinct melanosis, compared with the melanosis-free group. A multivariate analysis showed that the presence of soft palatal melanosis was independently associated with a high risk of UAT neoplasia. We calculated the individual number of risk factors out of four easily identifiable and significant factors: age ≥55 years, current/former alcohol flushing, mean corpuscular volume ≥106 fL, and distinct soft palatal melanosis. Compared with the risk-factor-free condition, the odds ratio (95% confidence interval) values of UAT neoplasia for one, two, three, and four risk factors were 1.49 (0.97-2.30), 3.14 (2.02-4.88), 4.80 (2.71-8.51), and 7.80 (2.17-28.1), respectively. The presence of soft palatal melanosis provides a simple new strategy for identifying heavy drinkers with a high risk for UAT neoplasia.

Soft Palate Ulcer: An Unusual Presentation of a Posttransplant Lymphoproliferative Disorder.

Posttransplant lymphoproliferative disorder (PTLD) is a serious complication of solid organ transplantation. It has several clinical manifestations, including infectious mononucleosis-like syndrome, lymphadenopathy, and other organ involvement. Soft palate ulcer is a rare manifestation of PTLD. The aim of this study is to present a 17-year-old girl with liver transplantation due to metastatic liver disease. After transplantation, she presented with a painful whitish ulcerative lesion accompanied by central necrosis in the right soft palate area measuring about 3 cm×3.5 cm. Histopathologic evaluation of the lesion showed monomorphic B-cell-type PTLD. She received 6 courses of CHOP chemotherapy plus rituximab. In the follow-up, the lesion disappeared with scar formation. Therefore, PTLD has different clinical presentations and may involve any part of the body. Therefore, when an unusual oral lesion after solid organ transplantation is observed, PTLD should be considered in addition to other differential diagnoses.

Single Z-Plasty Versus Double-Opposing Z-Plasty: A Cadaveric Study of Palatal Lengthening.

OBJECTIVE: The double-opposing Z-plasty is an effective method of repairing the cleft palate due to its reorientation of the palatal musculature and lengthening of the soft palate. A technique for lengthening the palate with a single oral Z-plasty has also been described. The authors hypothesize that these 2 techniques have equivalent effects on palate length. METHODS: A cadaver study was performed. Ten fresh adult cadaver heads were used.All palates were divided in the midline. In 5 specimens, a modified double-opposing Z-plasty technique was used; 5 other specimens underwent an oral Z-plasty with a straight-line repair of the nasal mucosa. In both groups, the levator veli palatini muscles were separately dissected and reapproximated with an intravelar veloplasty. The velar length, defined in this study as the distance from the posterior nasal spine to the tip of uvula, was measured before and after the surgical procedure. RESULTS: The double-opposing Z-plasty produced a mean increase of 1.0 ±â€Š0.6 cm in velar length (P = 0.023). The single Z-plasty repair resulted in a mean gain of 1.1 ±â€Š0.3 cm (P = 0.001). There was no difference in change in palate length between the 2 procedures (P = 0.941), and no difference in the percentage of soft palate lengthening (24% vs 29%, respectively; P = 0.565). CONCLUSIONS: A single oral Z -plasty provides palatal lengthening equivalent to that of a double-opposing Z-plasty procedure.

Radiotherapy alone or combined with chemotherapy as definitive treatment for squamous cell carcinoma of the tonsil.

This study is aimed at updating our institution's experience with definitive radiotherapy (RT) for squamous cell carcinoma of the tonsil. We reviewed 531 patients treated between 1983 and 2012 with definitive RT for squamous cell carcinoma of the tonsil. Of these, 179 patients were treated with either induction (n = 19) or concomitant (n = 160) chemotherapy. Planned neck dissection was performed on 217 patients: unilaterally in 199 and bilaterally in 18 patients. Median follow-up was 5.2 years for all patients (range 0.1-31.6 years) and 8.2 years for living patients (range 1.9-31.6 years). The 5-year local control rates by T stage were as follows: T1, 94 %; T2, 87 %; T3 79 %; T4, 70 %; and overall, 83 %. Multivariate analysis revealed that local control was significantly influenced by T stage and neck dissection. The 5-year cause-specific survival rates by overall stage were as follows: I, 94 %; II, 88 %; III, 87 %; IVA, 75 %; IVB, 52 %; and overall, 78 %. Multivariate analysis revealed that cause-specific survival was significantly influenced by T stage, N stage, overall stage, fractionation, neck dissection, sex, and ethnicity. Of 77 patients treated with ipsilateral fields only, contralateral neck failure occurred in 1 %. The rate of severe complications was 12 %. Definitive RT for patients with tonsillar squamous cell carcinoma provides control rates equivalent to other modalities with a comparatively low incidence of late complications. Patients with anterior tonsillar pillar or tonsillar fossa primaries that are well lateralized with no base of tongue or soft palate extension may be treated with ipsilateral fields.