By Tim Price, Paul Montgomery, Martin Birchall, Patrick Gullane

Fresh advances in versatile endoscopy have ledto the advance of the Trans-Nasal FlexibleLaryngo-Esophagoscope (TNLE) which makes visualisation,identification, biopsy and therapy of stipulations of theupper aero-digestive tract more straightforward and attainable underlocal anaesthesia in an outpatient setting.A precise and important source for oncologists, otolaryngologists,gastroenterologists, respiration physicians, and ENT Read more...

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5 Axial postcontrast CT through the base of the tongue and tonsillar fossae. A large mass in the right base of tongue extending into the floor of the mouth and tonsillar fossa. Bilateral level 2 lymphadenopathy. 3 Same lesion as the one above being biopsied under local anesthetic. 6 Postcontrast axial CT level of hyoid. Base of the tongue tumor extending into the right vallecula. Enlarged level 2/3 lymph nodes on the right. A mildly enlarged left submandibular lymph node. Arrows = tumor involving the right vallecula.

CLINICAL APPEARANCE The oropharynx is assessed by direct vision through the mouth, palpation via the mouth, and a pharyngoscopy either via a fiberoptic nasendoscope in clinic or pharyngoscope under general anesthetic (Figs. 2). 2 The same lesion as the one above, seen from the level of the soft palate. The lesion is spreading inferiorly to involve the posterior pharyngeal wall. com by Nyu Medical Center on 03/24/12 For personal use only. 3 A left tongue base lesion seen from the level of the soft palate.

The lymphatic vascularity is denser in the supraglottis accounting for a higher incidence of nodal metastases. Up to 70% of patients can have advanced disease at presentation and the incidence of occult cervical lymph-node metastases is linked to T stage and can range from 20% in T1/T2 tumors to 50% in T3/T4 tumors. The primary echelons of nodal drainage of supraglottic tumors are of levels II, III and IV. node involvement but this may be underestimated clinically. Clinical examination should include palpation of the tongue base.

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