Surgical Consultation for Benign Lateral Pharyngeal Tumors: What to Expect

Surgical Consultation for Lateral Pharyngeal Tumors

I am 29 years old and about five years ago, I discovered a tumor near the lower part of my right neck, close to the earlobe.
It is not visible under normal circumstances, but it becomes quite prominent when I swallow or eat.
When I open my mouth, it is evident that the right side of my throat is swollen, almost filling the entire throat.
Over the past five years, aside from experiencing some difficulty in breathing, which causes me to snore loudly at night, I have not had any other issues or discomfort.
Recently, I felt that I could no longer ignore it, so I visited an ENT specialist at a nearby hospital.
The doctor initially diagnosed it as a relatively rare "benign lateral pharyngeal tumor" and strongly recommended that I undergo surgery at a medical center.
He also mentioned some alarming details, such as the tumor being deep in the pharynx, which would result in a long surgery time, certain risks and potential complications, a lengthy incision, and possibly skin grafting, all of which made me feel the seriousness and anxiety of the situation.

I searched online using the keyword "lateral pharyngeal tumor" and found very little information, only the introduction by Dr.
Yu-Hsing Lu from Mackay Memorial Hospital and surgical reports from Chang Gung Memorial Hospital, which further increased my anxiety and fear regarding this tumor, especially concerning the surgical methods, which were similar to what the doctor had described, leaving me feeling overwhelmed.

Here are my questions for the doctor:
1.
The tumor has been present for over five years, but aside from some difficulty in breathing leading to loud snoring at night, I have not experienced any other discomfort.
Does this mean the likelihood of it being malignant is lower? Is it possible to perform a "fine needle aspiration" before surgery to determine if it is benign or malignant? (I am really worried it could be nasopharyngeal cancer or something worse.)
2.
If surgery is performed on my neck, will the incision be large, and will there be a noticeable scar afterward? After all, I am still young, and having a large surgical scar on my neck would make me feel very self-conscious.
3.
Is it absolutely necessary to have the surgery at a medical center, or could I have the surgery at a hospital like Hsinchu Mackay Memorial Hospital or Chiayi Christian Hospital? Could you recommend any doctors in Taiwan who have more experience with this type of surgery?
4.
Lastly, should I take the risk of surgery and the associated pain to remove a tumor that only affects my breathing and causes snoring? So far, I have not experienced any other discomfort, and I suspect that I might have sleep apnea.
Is there a possibility that this could lead to sudden death? If so, that would be very serious, and removal would be necessary.
I apologize for the lengthy message and the numerous questions, but these concerns weigh heavily on my mind.
I hope the doctor can provide some answers and advice to help me prepare mentally, as this is likely not a minor surgery and could significantly impact my future life.
I just want to feel more at ease.
Thank you once again.

xiao, 20~29 year old female. Ask Date: 2005/12/16

Dr. Ye Dawei reply Otolaryngology

1.
The cyst located below the earlobe is a sebaceous gland cyst.

2.
The enlargement in the throat is due to tonsillar hypertrophy.

3.
The physician's explanations regarding benign lateral pharyngeal tumors are all correct.

4.
The likelihood of it being a malignant tumor is low.

5.
Surgery will result in scarring.

6.
It is more appropriate to have the surgery at a medical center rather than at a district or regional hospital.

7.
You can consult Dr.
Hou Sheng-Bo at the ENT department of Linkou Chang Gung Memorial Hospital.

8.
The risk of sudden cardiac death is very low.

Reply Date: 2005/12/16

More Info

When facing a diagnosis of a benign lateral pharyngeal tumor, it is understandable to feel anxious and uncertain about the next steps. Here’s a comprehensive overview of what to expect during surgical consultation and considerations regarding your situation.

1. Nature of the Tumor
Given that you have had this tumor for approximately five years without significant symptoms other than mild breathing difficulties and snoring, it is likely that the tumor is benign. Benign tumors typically grow slowly and do not invade surrounding tissues or metastasize. However, the only definitive way to determine the nature of the tumor (benign vs. malignant) is through histopathological examination after surgical removal. While needle aspiration (fine-needle biopsy) can sometimes be used to assess tumors, it may not always provide a clear diagnosis, especially for deep-seated tumors like those in the pharyngeal area. Therefore, surgical excision is often recommended.

2. Surgical Considerations
Surgery for a lateral pharyngeal tumor can be complex due to the anatomical location. The surgeon will likely discuss the potential risks, which may include bleeding, infection, and damage to surrounding structures such as nerves or blood vessels. The size of the incision and the resulting scar will depend on the tumor's size and location. Generally, surgeons aim to minimize scarring, but larger tumors may require more extensive incisions. Discussing your concerns about scarring with your surgeon can lead to strategies for minimizing visible scars, such as placing incisions in less noticeable areas.

3. Choosing the Right Surgical Center
It is advisable to have the surgery performed at a medical center with experience in head and neck surgeries, particularly those involving the pharynx. While hospitals like Hsinchu Mackay Memorial Hospital or Chiayi Christian Hospital may have qualified surgeons, a medical center often has more resources and specialists available for complex cases. If you have concerns about the specific surgeon's experience, it is reasonable to ask about their previous cases and outcomes related to lateral pharyngeal tumors.

4. Weighing Risks and Benefits
Deciding whether to proceed with surgery involves weighing the risks of the procedure against the potential benefits. If the tumor is causing significant breathing issues or could lead to complications such as sleep apnea, surgical removal may be warranted. Sleep apnea can lead to serious health issues, including cardiovascular problems and increased risk of accidents due to daytime sleepiness. If you suspect that your breathing difficulties could lead to more severe consequences, it is essential to discuss these concerns with your healthcare provider.

Conclusion
In summary, while the benign nature of your tumor seems likely given its long-standing presence without significant symptoms, surgical removal remains the best approach for definitive diagnosis and treatment. It is crucial to have an open dialogue with your surgeon about your concerns, including the surgical approach, potential scarring, and the necessity of performing the procedure at a specialized center. Ultimately, the goal is to ensure your health and well-being while addressing any fears you may have about the surgery and its implications for your future. Seeking a second opinion or consulting with a specialist in head and neck surgery may also provide additional reassurance and clarity.

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