At the level of the hyoid bone, intraoral finger pressure was applied to the right tonsillar fossa
to enable further dissection superiorly.
Asymmetry is usually apparent rather than real and may be the result of asymmetry of the depth of the tonsillar fossa
or of the tonsillar pillars.
The adenoidectomy was uneventful, but during the tonsillectomy, the patient's right superior constrictor muscle dehisced near the center of the tonsillar fossa
, resulting in fat herniation.
They are particularly evident with second arch anomalies, which typically occur as cysts, sinus tracts, or fistulae along a course from the tonsillar fossa
, internally, to the skin anterior to the sternocleidomastoid muscle, externally.
Clinically, almost all of the internally opening branchial cysts are derived from the second branchial cleft, and their ducts enter the lower portion of the lateral wall of the tonsillar fossa
or the adjacent vallecula.
As is evident in figure 1, the lesion in our patient appeared to arise from the posterolateral oropharyngeal wall, from whence it grew anteriorly into the tonsillar fossa
A right-sided tonsillectomy was performed, and the tonsillar fossa
was inspected for an internal opening, which was found near the inferior pole.
2) Previously published data by our group indicated that patients who underwent local infiltration of bupivacaine into the tonsillar fossa
immediately following tonsillectomy did not have less pain than did placebo controls.
On examination, a large, firm, nontender submucosal mass was noted in the right tonsillar fossa
A suspected diagnosis of Eagle syndrome can be confirmed in the office setting; the diagnosis is established if an injection of lidocaine into the tonsillar fossa
provides relief of symptoms within minutes.
Bilateral fistulography demonstrated complete branchial tracts and extravasations of contrast material in each tonsillar fossa