This document discusses tumors of the hypopharynx, including both benign and malignant tumors. It notes that malignant tumors are more common, especially squamous cell carcinomas. The three main subsites that can be affected are the pyriform sinus (60% of cases), postcricoid region (30% of cases), and posterior pharyngeal wall (10% of cases). For each subsite, it describes characteristics like prevalence, spread patterns, clinical features, diagnosis, and treatment options.

1. TUMOURS OF THE
HYPOPHARYNX
DEPT OF
OTORHINOLARYNGOLOGY
JJM M C
DAVANAGERE

2. SUBSITES OF HYPOPHARYNX
► Pyriform sinus
► Post cricoid region
► Posterior pharyngeal
wall

3. BENIGN TUMOURS
► Exceptionally uncommon: present as
smooth well defined pedunculated and
mobile mass
a) Papilloma
b) Adenoma
c) Lipoma
d) Fibroma
e) leiomyoma

4. MALIGNANT TUMOURS
► Carcinoma of the hypopharynx is very
common in our country
► Most of the tumours are squamous cell
type with various grades of differentiation
► In order of frequency
a) Pyriform sinus (60%)
b) Post cricoid region (30%)
c) Posterior pharyngeal wall (10%)

5. CARCINOMA OF PYRIFORM
SINUS
► Mostly affects male above 40 years of age
► Growth is either Exophytic, ulcerative and
deeply infiltrative
► Because of large size of pyriform sinus
growth of this region remain asymptomatic
for long time
► Metastatic neck nodes is the most common
presenting symptom

6. CARCINOMA OF PYRIFORM
SINUS
► Spread: local
 Upwards: vallecula and base of tongue
 Downwards: post cricoid region
 Medially: AE fold and ventricle
 Laterally: thyroid cartilage, thyroid gland and
may present as soft tissue mass in neck
 Lymphatic spread: upper and middle group
of jugular cervical nodes
 Distant metastasis: occur late and may be
seen in lung, liver, bone

7. CLINICAL FEATURES
► Metastatic neck nodes may be the first sign
► Sticking/pricking sensation in throat
► Referred otalgia
► Odynophagia
► Dysphagia
► Hoarseness of voice
► stridor

8. DIAGNOSIS
► Indirect laryngoscopy
► Barium swallow
► Flexible nasopharyngoscopy
► CT scan: helpful to evaluate the extent of
growth and status of nodes
► Direct laryngoscopy and biopsy

9. Treatment
► Early growth without nodes: radiotherapy
(preserves voice)
► Growth limited to pyriform fossa: total
laryngectomy and partial pharyngectomy and
pharyngeal reconstruction often combined with
neck dissection
► Growth extending to post cricoid region: total
laryngopharyngectomy with block dissection.
Pharyngo-oesophageal segment is reconstructed
with myocutaneous flap or gastric pull up
► Post operative radiotherapy

10. CARCINOMA OF POST CRICOID
REGION
► Constitutes 30% of hypopharyngeal
tumours
► Plummer-Vinson syndrome is an important
etiological factor (seen in 1/3rd of patients)
► Spread: local spread to cervical
oesophagus, arytenoids, RLN and
cricoarytenoid joint
► Lymphatic spread to paratracheal nodes,
may be bilateral due to midline nature of
lesion

11. CARCINOMA OF POST CRICOID
REGION
► Clinical features: females are usually
affected in the age group of 20-40
► Progressive dysphagia (predominant
presenting symptom)
► Voice change
► Weight loss
► Diagnosis: indirect laryngoscopy, laryngeal
crepitus will be lost, lateral soft tissue neck
x-ray, CT scan, barium swallow, direct
laryngoscopy and biopsy

12. CARCINOMA OF POST CRICOID
REGION
► Treatment: prognosis is poor with irradiation
and surgical treatment
► Radiotherapy: preserves laryngeal function
► Surgical: laryngo-pharyngo-
oesophagectomy with gastric pull up or
colon transposition for reconstruction

13. CARCINOMA OF POSTERIOR
PHARYNGEAL WALL
► Least common hypopharyngeal malignancy
► Mostly seen in males above 50 years of age
► Spread: prevertebral fascia, muscles and vertebrae
► Lymphatic: usually bilateral, retropharyngeal and deep
cervical nodes involved
► Clinical features: dysphagia, metastatic neck node
► Diagnosis: indirect laryngoscopy, lateral soft tissue
neck x-ray, CT scan, direct laryngoscopy and biopsy
► Treatment: early lesions  radiotherapy
early small lesions surgery by lateral
pharyngotomy approach
advanced lesions laryngopharyngectomy
with block dissection