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Lau AS, Milinis K, Roode M, Williams SP, Cook C, Walijee H, Zammit M, Siau R, Emerson H, Wright R, Hampton T. The prevalence of oropharyngeal squamous cell carcinoma in patients admitted with symptoms of peritonsillar abscess or cellulitis: A retrospective multicentre study. Clin Otolaryngol 2021; 46:1362-1367. [PMID: 34407287 DOI: 10.1111/coa.13851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/08/2021] [Accepted: 08/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Anecdotal evidence suggests that oropharyngeal squamous cell carcinoma (OPSCC) should be suspected in patients presenting with symptoms of peritonsillar abscess (PTA) or cellulitis (PTC). The aim of this study was to estimate the prevalence of OPSCC in patients presenting with symptoms of PTA/PTC. METHOD, SETTING AND PARTICIPANTS We retrospectively identified all adults with a coded diagnosis of PTA or PTC who presented between 2012 and 2016 inclusive, across six ENT units in Merseyside. Records were compared to that of the centralised regional head and neck cancer database. The clinical records of a subset of patients were reviewed for the purposes of data validation. RESULTS A total of 1975 patients with PTA/PTC were identified. Three patients were subsequently diagnosed with OPSCC. None of the three actually had an objective underlying diagnosis of PTA/PTC on the same side. The prevalence of OPSCC in patients admitted with symptoms of PTA/PTC was 0.15% or approximately 1:650 admissions. The records of 510 patients who presented over a one-year period (2016) were reviewed in even greater detail. There were 298 patients with PTA (59.4%) and 151 with PTC (29.1%) and 61 had an alternative diagnosis (11.9%). High-risk features (age ≥40, tonsillar asymmetry or tonsillar lesion) were present in 106 patients (24%). Urgent follow-up was expedited for 77 patients (73%). CONCLUSION This study estimates the risk of OPSCC in patients with peritonsillar symptoms. The prevalence is low, even in a region with a relatively heavy disease burden. Clinicians should, however, retain a high level of suspicion in patients with persistent symptoms.
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Affiliation(s)
- Andrew S Lau
- Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Mersey ENT Research Collaborative, Liverpool, UK
| | - Kristijonas Milinis
- Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Mersey ENT Research Collaborative, Liverpool, UK
| | - Mila Roode
- Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Mersey ENT Research Collaborative, Liverpool, UK
| | - Stephen P Williams
- Mersey ENT Research Collaborative, Liverpool, UK.,Arrowe Park Hospital, Wirral University Teaching Hospitals NHS Foundation Trust, Wirral, UK
| | - Colette Cook
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Hussein Walijee
- Mersey ENT Research Collaborative, Liverpool, UK.,Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK
| | - Matthew Zammit
- Mersey ENT Research Collaborative, Liverpool, UK.,Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Richard Siau
- Mersey ENT Research Collaborative, Liverpool, UK.,Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Hannah Emerson
- Mersey ENT Research Collaborative, Liverpool, UK.,Warrington Hospital, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
| | - Rosanna Wright
- Mersey ENT Research Collaborative, Liverpool, UK.,Warrington Hospital, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
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Deep Parotid Lobe Abscess Presenting with Dysphagia and Trismus. Case Rep Otolaryngol 2019; 2019:2931015. [PMID: 30918736 PMCID: PMC6409038 DOI: 10.1155/2019/2931015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/04/2019] [Indexed: 11/18/2022] Open
Abstract
An abscess of the deep parotid lobe is an uncommon complication of acute parotitis. Characterized by warm erythematous facial skin and ipsilateral cheek swelling, parotid abscesses have often been associated with decreased saliva production and immunodeficiency. We offer a case of a large deep parotid lobe abscess presenting similarly to a peritonsillar mass, causing significant odynophagia and difficulty swallowing. Computed tomography scan revealed an infected deep parotid lobe sialocele which was surgically drained transorally and treated expectantly with antibiotics.
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Tonsillar malignancy in adult patients with peritonsillar abscess: retrospective study of 275 patients and review of the literature. Eur Arch Otorhinolaryngol 2014; 272:2439-44. [PMID: 25001851 DOI: 10.1007/s00405-014-3186-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 06/27/2014] [Indexed: 10/25/2022]
Abstract
Unsuspected tonsillar malignancy in routine tonsillectomy specimens is rare. A potentially increased risk of unsuspected tonsillar malignancy in adult patients presenting with peritonsillar abscess (PTA) was noted in a recent review. Furthermore, a literature search revealed several case reports concerning tonsillar malignancy presenting as PTA. Thus, the aim of the current study was to explore the prevalence of tonsillar malignancy in adult patients with PTA. A retrospective review of all adult patients undergoing tonsillectomy due to PTA from January 2001 to December 2012 at the Ear-Nose-Throat Department was performed. In 275 consecutive adult patients with PTA (median age 40 years, range 30-89 years), we identified one patient with unsuspected tonsillar malignancy (prevalence 0.3 %); a 40-year-old, previously healthy, male was diagnosed with acute myeloid leukaemia. Reviewing the literature, we identified 13 cases of tonsillar malignancy presenting as PTA (median age 49 years, range 2-66 years). Our data represents the only series of histological examined tonsillectomy specimens from PTA patients reported in the literature. We identified one case of unsuspected tonsillar malignancy in this relatively small series. We find it important to stress, that we had no knowledge of this patient before designing the study. Hence, the prevalence of 0.3 % is unbiased in this respect. More, and preferably, larger studies are needed to determine the prevalence with greater certainty. At present, no definitive conclusions can be made, but clinicians should be aware that PTA infrequently masquerade tonsillar malignancy.
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Kallel S, Hadj Taieb H, Makni S, Ghorbel A. Lymphoma presenting as a peritonsillar abscess. Eur Ann Otorhinolaryngol Head Neck Dis 2013; 130:337-9. [PMID: 23562230 DOI: 10.1016/j.anorl.2012.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 08/29/2012] [Accepted: 09/10/2012] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Peritonsillar abscess is generally seen as a complication of acute tonsillitis in young subjects. It may, however, in rare cases reveal a malignant tumor of the tonsil: most often squamous cell carcinoma or, more rarely, lymphoma. We report a rare case of tonsillar lymphoma revealed by a peritonsillar abscess. CASE REPORT A 66-year-old woman, without history of recurrent tonsillitis, was admitted for right peritonsillar abscess with fever. She underwent incision-drainage of the abscess with 10 days' intravenous antibiotics. As tonsillar hypertrophy persisted, tonsillectomy was performed; histology with immunohistochemical examination found tonsillar lymphoma. DISCUSSION/CONCLUSION Possible tumoral etiology should be considered in any peritonsillar abscess occurring in an atypical subject. Acute-stage tonsillectomy enables early diagnosis.
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Affiliation(s)
- S Kallel
- Service ORL et chirurgie cervico-faciale, CHU Habib-Bourguiba, route El Ain km 0,5, 3029 Sfax, Tunisia.
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Jho DH, Spiliopoulos K, Stein TD, Williams Z. Concomitant Presentation of a Glioblastoma Multiforme With Superimposed Abscess. World Neurosurg 2011; 75:126-31; discussion 50-3. [DOI: 10.1016/j.wneu.2010.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 09/13/2010] [Indexed: 11/15/2022]
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Abstract
BACKGROUND Peritonsillar abscess (PTA) is the most common deep neck space infection treated by otolaryngologists affecting predominantly young adults. Children present a challenge owing to the difficulty in obtaining an exact history and adequate physical examination. Particularly for the pediatric age group controversy surrounds the question of optimal treatment. This study was undertaken to evaluate bleeding complications following immediate tonsillectomy (TAC) in a pediatric population (<16 years) of age and to compare our management protocol with the current status in the literature. MATERIAL AND METHODS The data of 218 children who had undergone TAC between January 1988 and January 2003 in our clinic were enrolled in a retrospective study. The youngest patient was 18 months, the oldest 15.9 years of age (mean: 14.53; median: 14; STD: 12.11 years). 95 patients were male (43.6%), 123 female (56.4%). Various treatment protocols of the current literature are addressed. RESULTS Postoperative hemorrhage (all from the opposite side) requiring surgical treatment under general anesthesia occurred in 4 children (1.8%). Repeated hemorrhage did not occur, blood transfusions were not required, there was no case with lethal outcome. Several reports indicate that needle aspiration (NP) or incision and drainage (ID) may suffice for the majority of cases but do not distinguish between different treatments for children and adults. More recently, conscious sedation has become a great support for pediatric treatment protocols. CONCLUSIONS The initial success rates of NP or ID are both very high (>90%) and the overall recurrence rate is low, particularly in children. Only for selected subgroups, patients may profit from TAC, which was clearly not associated with an increased risk of bleeding in our pediatric population.
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Affiliation(s)
- J P Windfuhr
- Klinik für Hals-, Nasen-, Ohren-Krankheiten, Kopf-, Hals- und Plastische Gesichtschirurgie, Malteser Krankenhaus St. Anna, Duisburg.
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