Читать книгу The Esophagus - Группа авторов - Страница 165

The pharynx is irradiated when patients undergo radiation therapy for squamous cell carcinoma of the larynx or pharynx, lymphoma of the pharynx or cervical lymph nodes, or metastases to the neck. Historically, the pharynx was included in the radiation portal in patients who also underwent radiation therapy for thyrotoxicosis and tuberculous lymphadenitis. Chronic radiation injury to the pharynx is characterized by vascular damage with mucosal atrophy and fibrosis of muscle and submucosal tissue. Edema caused by lymphatic and venous obstruction is most marked in the epiglottis and mucosa overlying the muscular processes of the arytenoid cartilages. Osteomyelitis and chondronecrosis are more severe complications.

Figure 6.22 Lymphoid hyperplasia of the palatine tonsils and tongue base. (A) Frontal view of the pharynx demonstrates that the left and right palatine tonsils (arrows) protrude deeply into the oropharynx. Ovoid nodules carpet the base of the tongue. (B) Lateral view of the pharynx during phonation reveals a mass in the tonsillar fossae (white arrows) and nodules at the tongue base (black arrows).

Source: Reproduced from Rubesin [31], with permission.

Radiation edema and fibrosis is manifested on barium studies by smooth, bulbous enlargement of the epiglottis, smooth thickening of the aryepiglottic folds, and elevation of the mucosa overlying the muscular processes of the arytenoid cartilages [31, 40, 65] (Figure 6.34). Other findings include flattening of the valleculae and atrophy of the soft palate if this structure is included in the radiation portal [3]. Radiation fibrosis leads to diminished or absent epiglottic tilt and poor closure of the laryngeal vestibule with subsequent laryngeal penetration [66]. Constrictor muscle paresis may result in poor clearance from the hypopharynx with stasis and overflow aspiration. Nodularity or focal ulceration of the mucosal surface should suggest the possibility of persistent or recurrent tumor [65].