Direction of spread Structures involved Along Glossotonsillar sulcus Base of tongue Superior Soft palate or nasopharynx Laterally (Infiltrating through the constrictor muscle) Pharyngeal space, Pterygoid musculature, Mandible Superior spread through parapharyngeal space Base of skull Inferior Lateral neck Extensive spread in parapharyngeal space Carotid artery, Carotid sheath. Metastasis to regional lymphnodes is common as the tonsil has a rich supply of lymphatics giving way to the tumor cells to metastasis to other lymph nodes (commonly the lymph nodes of neck) and cause lymphydenopathy. The cervical lyphydenopathy can be ipsilateral (70% or more patients) or bilateral (30% and fewer patients). The<unk>  of tonsil usually spreads through the cervical lymph node levels II, III, IV, V, and retropharyngeal lymph nodes. The fourth edition of WHO' s classification of head and neck tumors subdivides squamous cell<unk>  of the tonsil into two types: HPV positive or negative. HPV positive tumors arise from the deep lymphoid tissue of the tonsillar crypts and are non-keratinizing. On the other hand HPV negative tumors develop from the tonsillar surface epithelium and hence have keratinizing dysplasia. Routes of metastasis Metastasis is common in tonsillar<unk> . It largely depends on the stage of the cancer and the route through with the cancer cells metastasize. The cancer cells may spread to adjacent structures, to lymphatics or to distant locations in the body producing secondary tumors. Local The tumor may spread locally to soft palate and pillars, base of tongue, pharyngeal wall and hypopharynx. It may invade pterygoid muscles and mandible, resulting in pain and trismus. Parapharyngeal space may also get invaded. Lymphatic 50% of patients have initial cervical node involvement at the time of presentation. Jugulardigastric nodes are the first to be involved. Distant metastasis The occurrence of distant metastasis varies extensively, ranging between 4%–31% in clinical studies. Factors influencing the incidence of distant metastasis are: * Location of primary tumor. * Initial staging * Histological differentiation * Loco-regional control of the primary tumor. The records of 471 male patients with tonsillar<unk>  seen at the Veterans Administration Medical Center, Hines, Illinois, have been reviewed to establish the incidence and site of distant metastasis. All the patients were histological diagnosed and proven cases of tonsillar<unk> . 72 (15%) out of 471 patients and 33 (29%) of 155 autopsied patients were reported to have distant metastasis. Squamous cell<unk>  was the most common reported cell type (88%); cases with Lymphoepithelioma had the highest incidence of distant metastasis. The most common anatomical sites of incidence of distant metastasis include lung, liver and bones. Thorough investigation of these organs is highly recommended before treatment as well as during follow ups.
Tonsil carcinoma
Laryngeal cyst
Laryngeal papillomatosis
Laryngeal cancer
Peritonsillar abscess
Oropharyngeal cancer
Nasopharyngeal cyst
Adenoiditis