Cantarella Giovanna, Pagani Davide, Biondetti Pietro
Department of Otolaryngology, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.
Dysphagia. 2006 Apr;21(2):133-6. doi: 10.1007/s00455-006-9019-6.
We report the case of a 68-year-old man affected by severe oropharyngeal dysphagia for solid food, who had undergone tonsillectomy when he was 22 years old. Videolaryngoscopy revealed a smooth-surfaced, elongated overgrowth on the left lateral pharyngeal wall that protruded toward the left pyriform fossa and impeded the transit of solid boli. A computed tomography scan showed that the solid content of the lesion was markedly inhomogeneous and denser than the surrounding soft tissues. The mass was removed by means of direct pharyngoscopy under general anesthesia. It was found that it arose from the inferior pole of the left tonsillar fossa and had a central cavity filled with caseum and multiple calculi. Histopathologic examination showed that its soft tissue component consisted of lymphoid tonsillar tissue. The operation totally resolved the swallowing disturbance. This case report highlights that tonsilloliths in a tonsillar residue should be considered in the differential diagnosis of mechanical oropharyngeal dysphagia, even in tonsillectomized patients.
我们报告了一例68岁男性患者，该患者因固体食物严重口咽吞咽困难前来就诊，其在22岁时接受了扁桃体切除术。电子喉镜检查发现左侧咽侧壁有一个表面光滑、细长的增生组织，该组织向左侧梨状窝突出，阻碍了固体食团的通过。计算机断层扫描显示，病变的固体成分明显不均匀，且比周围软组织密度更高。在全身麻醉下通过直接喉镜检查切除了肿块。发现它起源于左侧扁桃体窝的下极，有一个充满干酪样物质和多个结石的中央腔。组织病理学检查显示，其软组织成分由淋巴样扁桃体组织组成。手术完全解决了吞咽障碍。本病例报告强调，即使在扁桃体切除术后的患者中，扁桃体残体中的扁桃体结石也应在机械性口咽吞咽困难的鉴别诊断中予以考虑。
