Tumours of the tonsil (扁桃體腫瘤)

Benign cysts (良性囊腫)

Clinical features:

Mucous retention cysts, tonsilloliths or cysts of inspissated epithelial debris may occur. They are smooth and localized to one portion of the tonsil.

Management:

Symptomatic cysts may be helped by tonsillectomy.

Lymphoma (淋巴瘤)

Clinical features:

Unilateral tonsillar swelling with an intact overlying mucosa may cause dysphagia and is suspicious of a lymphoma. The tonsil feels rubbery. Excision biopsy confirms the diagnosis.

Management:

After staging the disease, treatment involves radiotherapy for localized disease, with chemotherapy being added in more advanced cases.

Carcinoma (癌)

Clinical features:

Squamous carcinoma of the tonsil presents as otalgia, sore throat or dysphagia in heavy drinkers and smokers. More than 50%of cases have involved neck nodes ipsilaterally: this may be the mode of presentation. The tonsil is hard and ulcerated.

Management:

After full endoscopy and biopsy small primaries without nodes are best treated by radiotherapy. Surgery (which involves a block dissection of neck, partial mandibulectomy and excision of the primary) is reserved for radiation failures and large primaries.