Page 92 - Portuguese Journal - SPORL - Vol 61. Nº2
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are risk factors for the development of OSAS, Figure 1
probably due to neuromuscular damage, Preoperative examination of the oropharynx
shows asymmetry of the palatine tonsils, with an
xerostomia, and subsequent instability of the enlarged right tonsil. Note: the right anterior tonsil
airway. 4,5,6,7 pillar was retracted posteriorly to the upper pole of
However, the prevalence of snoring and the tonsil for better exposure
sleep apnea in patients with neoplasms of
the upper aerodigestive tract is not well
known. Reports of head and neck neoplasms
7
presenting with snoring and OSAS are rare in
the literature. Nevertheless, there has been a
recent increase in the number of clinical case
reports on this issue.
Clinical evaluation performed by an
otorhinolaryngologist, with or without
imaging methods, is often necessary to
identify a tumor causing OSAS. Although
polysomnography quantifies the severity of
the disease, it does not aid in the identification
of its etiology. Furthermore, an improvement
in symptoms due to the initiation of ventilation fixation to the pharyngeal wall. The left
therapy may contribute to a delay in the tonsil was classified as Friedman grade I.
diagnosis. 8 Nasopharyngolaryngoscopy did not show any
Here, we report the cases of two adult patients other lesions in the upper aerodigestive tract.
who attended the Snoring and Sleep Apnea Computed tomography (CT) of the neck
clinic of Hospital CUF Tejo due to snoring showed a tumor originating in the palatine
and symptoms suggestive of OSAS and who tonsil with a transverse diameter of 30 mm
were eventually diagnosed with palatine and antero-posterior diameter of 22 mm,
tonsil cancer (squamous cell carcinoma and without changes in the permeability of the
follicular lymphoma). parapharyngeal space or presence of cervical
adenopathy (Figure 2).
Description of the cases Diagnostic unilateral tonsillectomy using
Clinical case 1: the LigaSure (BiZact ) technique was
TM
®
A 48 year-old man presented to the Snoring performed. Intraoperatively, there was no
and Sleep Apnea clinic complaining of snoring macroscopic evidence of extracapsular
for the last one month, which was gradually involvement (Figure 3).
worsening, along with episodes of apnea and Histopathological analysis showed a B-cell
awakenings with gasping, witnessed by his lymphoma, namely grade 3B follicular
spouse. He also reported daytime sleepiness lymphoma (WHO 2017)/follicular large cell
and, more recently, globus sensation in the lymphoma (WHO 2022) (Figure 4).
oropharynx. After the surgery, there was complete
A septoplasty performed in 2005 stood out resolution of the sleep-related symptoms. The
in his medical history. On objective physical patient was then referred to the hematology
examination, he had a body mass index (BMI) clinic where he underwent evaluation
of 28.1 kg/m and marked tonsillar asymmetry. with positron emission tomography, upper
2
The right tonsil extended across the midline gastrointestinal endoscopy, and bone
and exhibited a smooth, shiny, and pinkish marrow analysis, which excluded systemic
surface with prominent superficial vessels involvement. He started chemotherapy with
and an elastic consistency, without apparent rituximab, cyclophosphamide, doxorubicin,
234 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery
