3 to 4 days after the onset of acute tonsillitis, the fever continues/gets worse; the sore throat on one side is obvious, especially when swallowing, and may radiate; in severe cases, there may be slurred speech and difficulty opening the mouth (involvement of the medial pterygoid muscle)

With an acute appearance, the head is tilted to the affected side. Patients often use their hands to support the affected neck to relieve pain.

In the early stage of peripheral inflammation, significant congestion of the palatoglossal arch on one side can be seen; in the anterosuperior type, the uvula on the affected side is red and swollen, deflected to the opposite side, the top of the palatoglossal arch is bulged, and the tonsils are covered and pushed inward and downward; in the posterosuperior type, It can be seen that the tonsils are pushed forward and downward; the lymph nodes in the ipsilateral mandibular angle are swollen

There may be pus when punctured at the protuberance.

Parapharyngeal abscess, laryngitis/laryngeal edema, internal jugular vein thrombosis, purulent cervical lymphadenitis, sepsis

Treat as acute tonsillitis: adequate antibiotics, infusion; appropriate amount of glucocorticoids

Puncture and pus aspiration: can determine whether an abscess has formed and the location of the abscess

Incision and drainage: In the anterosuperior type, the incision is made at the highest point of the abscess; in the posterosuperior type, the incision is made at the velopharyngeal arch.

Tonsillectomy: performed 2 weeks after inflammation subsides

Systemic symptoms: fever, chills, sweating, headache, loss of appetite

Local symptoms: severe parapharyngeal/neck side pain, difficulty swallowing, slurred speech, difficulty opening mouth (violating the medial pterygoid muscle)

Acute appearance; neck movement is limited, swollen, hard to touch, and tender; there is a sense of fluctuation when an abscess is formed; the pharyngeal wall on the affected side is bulging and congested, and the tonsils are pushed toward the midline but there is no redness or swelling.

Pharyngeal CT, diagnostic puncture and pus aspiration

Peripheral extension: retropharyngeal abscess, laryngeal edema, mediastinitis

Erosion of the internal carotid artery: fatal haemorrhage

Erosion of the internal jugular vein: thrombophlebitis

Adequate systemic antibiotics; appropriate glucocorticoids

Immediate incision and drainage of pus (external cervical approach); continue to prevent and treat infection after surgery

Bleeding: Mostly the first complaint, manifesting as paroxysmal nasal/oral bleeding, which may be bright red blood; often accompanied by anemia. Nasal obstruction: accompanied by runny nose, obliterative nasal sound, and hyposmia.

Others: tinnitus, auricularia, hearing loss; exophthalmos, vision loss; cheek bulge; headache, cranial nerve palsy

Anterior rhinoscopy: There are inflammatory changes in one/both sides of the nasal cavity; after retracting the inferior turbinate, a light red tumor in the back of the nasal cavity can be seen. Indirect nasopharyngoscopy: A red tumor in the nasopharynx, with a smooth surface and rich blood vessels.

Imaging: shows the location, size, shape, extent of involvement, degree of bone destruction, and surrounding anatomical relationships of the tumor; enhanced CT has diagnostic value

DSA: Understand tumor feeding arteries and perform embolization to reduce intraoperative bleeding

Biopsy is contraindicated before surgery

Nasal symptoms: Sniffles with blood may appear in the early stage; nasal obstruction may occur after the tumor increases (unilateral → bilateral). Ear symptoms: tinnitus, auricularia, hearing loss, tympanic effusion; easily misdiagnosed as secretory Otitis media

Cervical lymphadenopathy: more common, even accounting for 60% of the first symptoms; characterized by progressive enlargement of deep and upper cervical lymph nodes, which are hard, inactive, and non-tender

Cranial nerve symptoms: often invade V and VI first (related to the involvement of rupture holes), followed by II, III, and IV, resulting in headache, facial numbness, limited eyeball abduction, and ptosis; IX, X, and XI may also be involved. , XII (related to swollen affected lymph nodes), paralysis of the soft palate, choking, hoarseness, and deviation of the tongue.

Difficulty opening your mouth: seen in late stages

Distant metastasis: bone, lung, liver

Nasopharynx: Indirect nasopharyngoscopy/nasopharyngolaryngoscopy/nasal endoscopy can show that tumors tend to occur on the anterior wall of the nasopharynx roof and pharyngeal recesses. They appear as small nodules/granuloma-like bulges with rough and uneven surfaces and are prone to bleeding. ; Early manifestations may be atypical, such as mucosal congestion, vasodilation, or fuller pharyngeal recesses on one side.

Neck: palpable lymph nodes, cranial nerve examination: involved

Epstein-Barr virus serological test: auxiliary diagnostic indicators

Videography

Nasopharyngeal puncture biopsy: confirmed diagnosis

The preferred treatment method; radiotherapy alone for T1 and T2 stages, and radiotherapy and chemotherapy for T3 and T4 stages

Indications: ① Residual primary tumor in the nasopharynx 3 months after radical radiotherapy and localized disease; ② Residual cervical lymph nodes/local recurrence after radical radiotherapy

Can enhance radiotherapy sensitivity

Early stage: pharyngeal discomfort, foreign body sensation; sore throat on one side, obvious when swallowing

Late stage: worsening sore throat, difficulty swallowing, unclear speech, and difficulty breathing

Early stage: throat discomfort, swallowing infarction

Middle and late stages: pain in swallowing, ipsilateral reflex earache; progressive dysphagia, salivation, and blood in sputum; dyspnea and hoarseness may occur when the laryngeal cavity is involved.

Indirect laryngoscopy, fiberoptic laryngoscopy; neck examination; imaging examination