Lingual Tonsil Hypertrophy Producing Obstructive Sleep Apnea

The hypertrophy of the lingual tonsil is a rare occurrence in adults. This disorder may cause obstructive sleep apnea (OSA) and also may lead to a life-threatening obstruction of the upper airway. Diagnosis of lingual tonsil hypertrophy in patients with OSA requires a careful examination by advanced technologic methods. The sleep apnea is successfully treated by lingual tonsillectomy, with or without tracheotomy. In this study the case of an adult with OSA caused by lingual tonsil hypertrophy which was treated with lingual tonsillectomy is presented, and the diagnosis and the treatment procedure of such cases are discussed.     

Recurrent lingual tonsil hyperplasia

Clinically significant lingual tonsil hypertrophy is a rare entity in children. We describe a child, status postadenotonsillectomy, with recurrent hypertrophy of the lingual tonsil after carbon dioxide laser ablation. Workup was negative for immunodeficiency, cystic fibrosis, and allergies. The findings of examination of multiple biopsy specimens of the tissue suggested follicular hyperplasia, and cytometery showed no evidence of a lymphoproliferative disorder. Empiric treatment with a histamine2-receptor blocker after the sixth carbon dioxide laser ablation prevented lingual tonsil hypertrophy.     

Severe upper airway obstruction in children secondary to lingual tonsil hypertrophy

Lingual tonsil hypertrophy in children is a rarely reported disorder. Two cases of severe upper airway obstruction in pediatric patients secondary to marked lingual tonsil enlargement are reported. Both children were effectively treated with lingual tonsillectomy. The surgical technique, using an insulated Bovie tip, is described.     

鼻内镜下微波凝固配合养阴利咽汤治疗舌扁桃体肥大的临床观察

目的观察微波凝固配合养阴利咽汤治疗舌扁桃体肥大的临床疗效.方法门诊舌扁桃体肥大治疗患者216例,随机分成三组,一组采用微波凝固配合养阴利咽汤联合治疗(综合治疗组),二组为单纯微波凝固(微波组),三组为单纯养阴利咽汤服用(养阴利咽汤组),比较分析三组的疗效.结果综合治疗组患者微波引起的咽干、咽痛等咽部不适症状很快得到缓解,总有效率为93.1%,微波治疗组和养阴利咽汤组总有效率分别为73.6%和61.1%,综合治疗组与微波凝固组、养阴利咽汤组之间疗效差异有显著性意义(P＜0.05).结论综合治疗舌扁桃体肥大疗效显著,值得临床推广应用.     

The lingual tonsil. A neglected symptomatic structure?

Surgical treatment of the lingual tonsil is seldom performed because problems attributable to chronic lingual tonsillar hypertrophy are infrequently diagnosed. We have reviewed a series of 25 patients with symptoms from enlarged lingual tonsils. The variety of presentation of lingual tonsillar lesions and the methods of surgical treatment are discussed.     

低温等离子治疗舌扁桃体肥大所致的咽异感症

目的：探讨鼻内镜辅助下等离子射频消融术治疗舌扁桃体肥大所致的咽异感症的临床疗效。方法：应用30。鼻内镜下低温等离子射频消融术治疗307例舌扁桃体肥大患者,观察术区创面生长情况、术后疼痛、术中术后出血情况及术后疗效。结果：咽部异物感主观症状VAS评分从术前的（9．3±0．6）分降至术后的（3．7±2．4）分,差异有统计学意义（P〈0．05）。本组患者治愈率为84．4％,显效率为6．8％,有效率为4．6％,总有效率为95．8％。术后30~45d自膜脱落,无明显疼痛。术中平均出血量为（5．2±2．4）m1;术后11例（3．6％）患者继发出血;随访6～36个月无复发。结论：鼻内镜辅助下等离子射频消融术治疗舌扁桃体肥大所致的咽异感症是一种寄仝右杆的治疗青法．值得临床r椎广     

Narrow Band Imaging for lingual tonsil hypertrophy and inflammation,in laryngo-pharyngeal reflux disease

European Archives of Oto-Rhino-Laryngology - The objective of this study is to analyse the relationship between the endoscopic signs of laryngo-pharyngeal reflux, the lingual tonsil hypertrophy...     

咽腔扩大成形术治疗阻塞性睡眠呼吸暂停综合征(附49例报告)

目的：为了治疗阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ），将腭咽成形术加以改良，共行４９例手术。方法：摘除扁桃体，将腭舌弓大部分切除，保留腭咽弓，并将腭咽弓上端向外上４５°剪开，将其向外牵拉缝合；软腭前面较后面多切除约０．６ｃｍ，将后面粘膜向前上牵拉缝合，以扩大咽腔。对舌扁桃体肥大者，彻底切除三角皱襞，将舌根两侧分别向前外牵拉缝合，固定到前创缘。结果：术后咽横截面积由术前的１０３．９４±１５．４１ｍｍ２增加到３５６．２１±１６．４６ｍｍ２。呼吸暂停消失者３２例、减轻１５例，总有效率为９５．９％。结论：改良的腭咽成形术较传统的手术效果为好，尤其对舌扁桃体肥大者也有效。但其适应证仍不包括因各种鼻疾、颌部畸形等所致阻塞性睡眠呼吸暂停综合征。     

Lingual thyroglossal duct cysts--a review

Objectives

Lingual thyroglossal duct cysts (TGDC) are rare and liable to be missed in a cursory clinical examination. This study aimed to report the details of lingual TGDC from the authors’ series and review existing literature on the entity.

Methods

A 12 year retrospective survey of all cases of thyroglossal duct anomalies managed at a tertiary teaching hospital was conducted to identify those with lingual TGDC. Their clinical presentation, investigations, diagnosis and management were analysed. Case series from anecdotal published English literature were critically reviewed with particular regard to diagnosis and management.

Results

Of 78 cases of thyroglossal duct anomalies, 3 were lingual TGDC. All were females. One neonate presented with feeding difficulty and was clinically misdiagnosed as a ranula. The two older children presented with a cyst at the foramen caecum. The varied imaging and diagnostic dilemma are presented. The older children had cysts abutting the hyoid and were managed with transoral excision and a Sistrunk procedure; the neonate was managed with transoral excision only. This report also reviews the sparse literature and discusses specific issues in their treatment. The differential diagnoses encompass a wide array of developmental and neoplastic entities. Specific anatomic imaging with USG/CT/MRI and functional evaluation with radionuclide thyroid scan are essential investigative modalities. Besides a classical Sistrunk procedure and simple transoral excision, newer less invasive treatment options including marsupialisation and alcohol ablation have been reported.

Conclusions

In conclusion, the diagnosis and management of lingual TGDC needs to be individualised depending on their presentation and anatomic location. The Sistrunk's procedure is ideal for those in close proximity to the hyoid; however complete cyst excision would suffice in the rest.     

Lingual tonsillectomy: A treatment for inflammatory lesions of the lingual tonsil

Lingual tonsillectomy is a surgical treatment that is seldom performed because lingual tonsillitis is infrequently diagnosed. We have reviewed a group of patients with lingual tonsillitis or lingual tonsil hyperplasia who were treated with lingual tonsillectomy. Lingual tonsil lesions, the anatomy and histology of the lingual tonsil, and surgical approaches to lingual tonsillectomy are discussed.     

Case of cystic metastasis of lingual tonsil carcinoma diagnosed first as a branchiogenic cyst

We report a case of lingual tonsil carcinoma diagnosed first as a branchiogenic cyst. Histopathological findings showed the possibility of a malignant tumor because there was proliferation of the papillary epithelium of the cyst wall. Blind biopsy of the lingual and palatine tonsil was done and the histological findings revealed a cystic metastatic lymph node from a squamous cell carcinoma (SCC) of the lingual tonsil. The diagnosis of the primary unknown cystic metastatic cervieal SCC requires a thorough examination of the palatine or lingual tonsil when there is no evidence of any vestigial remnant of branchiogenic organ.     

Recurrent thyroglossal duct cysts: a 23-year experience and a new method for management

OBJECTIVES: We present an experience in the management of primary and recurrent thyroglossal duct cysts (TGDCs) and describe a novel method for recurrent TGDC removal. METHODS: We performed a retrospective review of TGDC surgery at Children's Hospital in Seattle from 1980 to 2003. The surgical techniques for primary and recurrent TGDCs and the factors associated with TGDC recurrence were evaluated and analyzed. RESULTS: During the study period, 231 patients underwent 296 TGDC surgeries. Thirty-four of the 231 patients (15%) underwent a total of 88 procedures for recurrent TGDCs. Successful procedures used for secondary TGDC management included central neck dissection with directed base of tongue (BOT) excision in 6 of 9 patients (67%), secondary Sistrunk operation with limited BOT resection in 12 of 27 patients (44%), revision Sistrunk operation with BOT dissection in 7 of 11 patients (64%), and suture-guided transhyoid pharyngotomy in 8 of 8 patients (100%). Ten of the 231 patients (4%) had initial TGDC incision and drainage and then underwent a total of 21 procedures, excluding the incision and drainage. The factors associated with TGDC recurrence were inaccurate initial diagnosis (17 of 34 or 50%), infection (5 of 34 or 15%), unusual TGDC presentation (5 of 34 or 15%), and lack of BOT musculature removal (7 of 34 or 20%). The level of surgeon training affected the surgical outcome. CONCLUSIONS: Successful TGDC treatment requires consideration of factors associated with recurrence. Recurrent TGDCs can be treated by several methods, including suture-guided transhyoid pharyngotomy.     

Pathological characteristics of the epiglottis relevant to acute epiglottitis

Objective

The characteristic swelling of acute epiglottitis is thought to be caused by histological factors in the epiglottis. We investigated the relationships between histological findings and the pathology of acute epiglottitis.

Methods

We examined 23 autopsy cases. For 16 of these, histological assessments were performed. In the remaining 7 subjects, physiological saline was injected at the lingual tonsil.

Results

These histological findings revealed abundant laryngeal glands on the laryngeal surface compared with the lingual surface. With regard to the blood vessels and lymphatic vessels, more of these vessels tended to be apparent on the lingual surface compared with the laryngeal surface. In each of the physiological saline injected subjects, almost no swelling of the lingual tonsil occurred, but the lingual surface of the epiglottis was swollen, and morphological changes had occurred that resembled those in acute epiglottitis.

Conclusion

Periepiglottic tissues are rich in lymphatic tissues, and it appears easy for inflammation to spread to the epiglottis itself via the gland's own rich networks of blood and lymphatic vessels. In addition, according to the video observation, it appeared that the liquid ingredient that exudes at the inflamed the lingual tonsil may cause swelling the lingual surface of the epiglottis.     

Cryosurgical treatment of the lymphoid tissue of Waldeyer's ring

The role of cryosurgery in the treatment of tonsil disease is an unresolved issue. Initial favorable reports failed to provide the necessary incentives for larger well-controlled studies. Bacteriologic and immunologic response to the cryosurgical treatment of tonsils remains unclear. Without appropriate studies, cryosurgery has been relegated to a backup status for conventional tonsil surgery. At present, cryogenic treatment of lymphoid tissue is generally limited to tonsillectomy in patients with blood dyscrasias; elimination of palatine tonsil regrowth and posterior pharyngeal lymphoid hyperplasia; and occasional laryngeal and lingual tonsillectomy.     

The feasibility of pediatric TORS for lingual thyroglossal duct cyst

A six-year-old boy who presented with symptoms of obstructive sleep apnea was found to have a midline tongue mass suspicious for lingual thyroglossal duct cyst (TGDC). Surgery was scheduled after workup confirmed the presence of functional, orthotopic thyroid tissue. The surgical robot was used to excise the mass endoscopically without removing any hyoid. He was extubated at the conclusion of the case. The child tolerated a soft diet and was discharged after an uneventful overnight stay in the ICU. Pathology confirmed TGDC. There have been no reported issues in eleven months of follow-up. Our report adds to the scarce literature on performing such a surgery in a child and demonstrates that with the correct circumstances, prompt extubation, discharge, and prolonged remission are possible.     

Laser surgery in lingual tonsil hyperplasia

Modern techniques have reduced the long existing reluctance to perform lingual tonsillectomy. The results of treatment of hyperplasia of the lingual tonsil with the carbon dioxide laser in 32 patients are presented. After exposure with a special endoscope the lingual tonsil can be vaporized or excised under microscopic control with promising results, far superior to the results obtained with other surgical techniques. Since the success rate of the surgery depends on the diagnostic criteria for applying this therapy, a careful selection of patients is essential.     

扁桃体腺样体肥大患儿术前术后血气分析

目的探讨儿童病理性扁桃体腺样体肥大低通气对血气的影响。方法对已确诊的12例扁桃体肥大、8例腺样体肥大及21例扁桃体合并腺样体肥大患儿手术前的动脉血气分析进行检则并与术后对比。结果所有患儿术前均出现不同程度的动脉氧分压降低,二氧化碳升高,部分伴有低氧血症、高碳酸血症。比较术前、术后动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)均有统计学意义。结论扁桃体腺样体肥大可导致儿童长期慢性缺氧影响内环境平衡及生长发育,建议积极治疗。     

Abscess of the lingual tonsil.

Abscess of the lingual tonsil is an unusual entity that may cause diagnostic difficulty. The pathophysiologic mechanism of formation was correlated with normal posterior tongue histology in a case of lingual tonsillar abscess.     

Doxycycline: A sclerosant agent to treat a case of recurrent thyroglossal duct cyst

Thyroglossal duct cyst (TGDC) is one of the most common congenital anterior midline neck masses in children. Sistrunk operation is considered as the cornerstone in TGDC removal. Nevertheless, 5% to 7 % of patients have been reported to show a recurrence even after adequate resection. This necessitates at times multiple resections with potential complications. One interesting emerging technique is sclerotherapy of TGDC remnants post resection. We present here a case of a child who had a successfully treated recurrent TGDC using sclerotherapy with doxycycline.     

Grade 4 tonsillar hypertrophy associated with decreased retronasal olfactory function: a pilot study

Tonsillar hypertrophy is common in children, but it can also be present in adults. Enlarged tonsils, a significant anatomical barrier, may affect the flow of odor molecules from the oral cavity to the nasal passages, which has not yet been studied. Thus, we aimed to investigate the mass effect of palatine tonsillar hypertrophy on retronasal olfaction. This study was carried out in 146 subjects, with a mean age of 22.1 ± 2.2 years, ranging 20–29 years. An oropharyngeal examination of the participants was completed, and tonsillar hypertrophy was graded according to the subjective tonsil size scale. The participants were divided into four groups according to their tonsil size grading; then, each subject’s orthonasal olfactory and retronasal olfactory functions were assessed using “Sniffin’ Sticks” and retronasal olfactory testing. There were no differences observed between the groups in terms of age, gender, cigarette smoking, or alcohol consumption. In addition, there was no difference between the groups in terms of “Sniffin’ Sticks” subtests and TDI scores. It was determined that the retronasal olfactory scores of the participants with grade 4 tonsil size were significantly lower than the retronasal olfactory scores of the participants with grade 1 tonsil size. The current investigation demonstrates that grade 4 tonsillar hypertrophy has significant negative effects on the retronasal route of olfactory sensing, when compared with grade 1 tonsillar hypertrophy.