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Clinical Challenge
April 2015

Oropharyngeal Mass Causing Obstructive Sleep Apnea

Author Affiliations
  • 1Department of Otorhinolaryngology, Jeju National University School of Medicine, Jeju, South Korea
  • 2Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
JAMA Otolaryngol Head Neck Surg. 2015;141(4):393-394. doi:10.1001/jamaoto.2014.3729

A woman in her 60s presented with a 10-year history of oropharyngeal discomfort and recent episodes of snoring and obstructive sleep disturbance. Although she had been experiencing a gradually increasing lumpy feeling on swallowing for at least 6 months, she did not experience of dysphagia, dyspnea, or pain. Physical examination revealed a mass measuring approximately 4 × 3 cm and covered with normal mucosa on the posterior oropharyngeal wall. This tumor was firm, nontender, and firmly adherent (Figure, A). Computed tomography (CT) showed a segmented bony lesion located at the odontoid process and the body of the C2 vertebra (Figure, B). This mass showed high signal intensity with a hypointense rim in both T1- and T2-weighted magnetic resonance images (MRI) (Figure, C and D, respectively). Polysomnography was performed and showed an apnea-hypopnea index of 58.7/h and a minimal oxygen saturation of 76%, which led to a diagnosis of obstructive sleep apnea. The mass was considered causative of obstructive sleep apnea. Hence, we performed total excision of the mass using a per-oral approach.

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