A Case of Atlanto-Axial Joint Subluxation Following Tonsillectomy in Patient of Tonsillar Cancer with Preoperative Radiotherapy: Grisel's Syndrome / 대한이비인후과학회지

Grisel's syndrome, defined as the atlanto-axial joint subluxation not associated with a trauma or bone disease, is a rare complication following operative procedure and/or infections of the upper aerodigestive tract. Pathogenetically, it may occur in association with any condition that results in hyperemia and pathological relaxation of the transverse ligament of the atlanto-axial joint. When an inflammation heals, Grisel's syndrome can probably result in a fixation in the rotated position. It is diagnosed by physical and radiological findings. Early management, consisting of cervical immobilization and medical treatment, is considered a key factor for satisfactory outcome. Inappropriate treatment can result in a catastrophic consequence. Recently, we experienced a case of Grisel's syndrome following tonsillectomy in a patient with left palatine tonsillar cancer with preoperative radiotherapy. We report this case with a literature review.

A Case of Transoral Robotic Radical Lateral Oropharyngectomy in Tonsilar Cancer / 대한이비인후과학회지

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.

The Preliminary Results of Intensity-Modulated Radiotherapy for Tonsillar Cancer / 대한방사선종양학회지

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.

A Case of Tonsillar Cancer in a Patient with Systemic Lupus Erythematosus Treated with Immunosuppressive Agents / 대한류마티스학회지

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by disturbance in immune surveillance and has an increased risk of cancers. However, no case of tonsillar cancer in SLE has been reported. We report a case of tonsillar cancer in a patient with SLE treated with immunosuppressive agents. A 43-year-old woman with SLE who had been treated with hydroxychloroquine, prednisolone, and azathioprine was admitted because of a palpable mass on her right neck. The patient was diagnosed to have a tonsillar cancer with cervical lymph node metastasis. She received a wide tonsillectomy, right radical neck dissection and radiation therapy.

Sagittal mandibulectomy in tonsillar cancer

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.

Results of Coventional Radiotherapy for Carcinomas of the Tonsillar Region / 대한치료방사선과학회지

PURPOSE: To evaluate the roles of conventional radiotherapy alone or with neoadjuvant chemotherapy for tonsillar carcinomas and any prognostic factors affecting survivals by retrospective analysis. MATERIALS AND METHODS: Thirty four patients received radical radiotherapy for tonsillar carcinomas from Nov. 1985 to Dec. 1993. Of them, 16 patients were treated by conventional radiotherapy alone and the other 18 patients were received radiotherapy with 1 to 3 cycles of neoadjuvant chemotherapy of cisplatin and 5-fluorouracil or pepleomycin. Radiotherapy was performed by 6MV X-ray with daily fraction of 1.8Gy and the range of primary tumor doses was 55.0-86.4Gy(median 66.6Gy), and that of clinically positive nodal doses was 55.8-90Gy(median 69.7Gy). RESULTS: Overall 5-year actuarial survival rate (5YSR) was 32%. The 5YSRs in stage I+II(n=8), III(n=13) and IV(n=13) were 47%, 29% and 25%, respectively(p=0.33). The 5YSRs in T2(n=13), T3(n=10) and T4 (n=7) were 38%, 27% and 0%, respectively and 3 of 4 patients of T1 are alive with NED at 25, 45, 53 months respectively with statistical significance of the trend in survivals among the four T-stages(p=0.01), and those of node negative(n=14) vs node positive patients(n=20) were 31% vs 32%, respectively(p=0.85). There was no significant survival difference between radiotherapy alone group and with neoadjuvant chemotherapy group(22% vs. 38%, p=0.24). The 5YSRs of 21 patients of primary tumor extension to adjacent sites and the other 13 patients of tonsillar proper site were 28% and 38%, respectively but the difference was not significant statistically(p=0.62). There was a statistically significant difference in 5YSRs between the groups of the patients who received radiotherapy in less than 61days vs more than 60days(60% vs. 18%, p=0.027). All living patients without any tumor progression(n=11) had suffered from serious late sequelae such as xerostomia, edentia, dental caries and one patient had the osteoradionecrosis of mandible. On univariate analysis, the duration of radiotherapy and T-stage were the significant prognostic factors affecting 5YSR. On multivariate analysis, also the duration of radiotherapy was the only significant prognostic factor(p=0.01). CONCLUSION: There was no survival difference between the radiotherapy alone and with neoadjuvant chemotherapy groups. Although it was a retrospective study, the role of conventional radiotherapy alone could be effective as the local treatment modality only for the early stage of tonsillar carcinomas. But for the purpose of more improved survivals and better quality of lives of living patients, other altered fractionation such as hyperfractionated radiotherapy with shorter treatment time and smaller fraction size rather than conventional radiotherapy might be beneficial and these prospective studies are needed.