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Clinical Problem Solving
October 2013

Intraoral Mass Causing Obstructive Sleep Apnea

Author Affiliations
  • 1University of Texas Southwestern Medical Center, Dallas
JAMA Otolaryngol Head Neck Surg. 2013;139(10):1075-1076. doi:10.1001/jamaoto.2013.4417

A young girl presented with an intraoral mass after developing obstructive sleep apnea characterized by a 1-year history of snoring, pauses in breathing, and restless sleeping. The patient did not have a sore throat, dysphagia, dyspnea, hemoptysis, or cough. Her medical history included allergic rhinitis and asthma, which were controlled with medications. On examination, marked enlargement and bluish discoloration of the right side of the soft palate with intact mucosal lining were noted in the region adjacent to the right palatine tonsil. The bulbous region of the soft palate was soft, smooth, compressible, and without pulsation. Magnetic resonance imaging (MRI) of the soft palate and neck demonstrated a well-marginated, lobulated mass adjacent to, but separate from, the palatine tonsil on short tau inversion recovery (STIR) (Figure, A and B) and T1-weighted images (Figure, C). Multiple internal septations were noted, which were relatively hypointense on T2-weighted images without associated enhancement. The lesion appeared intermediate in signal on T1-weighted images and high in signal on T2-weighted images. There was intense but heterogeneous enhancement of the lesion (Figure, D).

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