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From: Significant Invasion of the Pharyngeal Constrictor Muscle in Early Squamous Cell Carcinoma of the TonsilPrediction of Multiple Regional Metastasis Arch Otolaryngol Head Neck Surg. 2012;138(11):1034-1039. doi:10.1001/2013.jamaoto.467 Figure Legend: Figure 1. Relationship between squamous cell carcinoma of the tonsil and the pharyngeal constrictor muscle. A, No invasion (normal tissue remained between the tumor and the pharyngeal constrictor muscle). B, Attachment (no normal tissue remained between the tumor and the medial surface of the pharyngeal constrictor muscle, but no cancer cells were seen in the pharyngeal constrictor muscle tissue). C, Invasion (cancer cells were seen in the pharyngeal constrictor muscle tissue but not in the lateral surface of the pharyngeal constrictor muscle). D, Penetration (cancer cells were seen in the lateral surface of the pharyngeal Date of download: 4/28/2017 constrictor muscle). From: Significant Invasion of the Pharyngeal Constrictor Muscle in Early Squamous Cell Carcinoma of the TonsilPrediction of Multiple Regional Metastasis Arch Otolaryngol Head Neck Surg. 2012;138(11):1034-1039. doi:10.1001/2013.jamaoto.467 Figure Legend: Figure 2. Possible patterns of lymph node spread according to the presence or absence of extratonsillar invasion of the pharyngeal constrictor muscle. A, Tumor confined to the tonsil can spread only via the lymph vessels perforating to the cervical lymph nodes. B, Tumor with extratonsillar invasion can spread to the cervical lymph node network directly and then spread more easily to the cervical lymph nodes. Date of download: 4/28/2017