0:00

So this is a patient that has a

0:02

left glossotonsillar sulcus carcinoma.

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And so when we look at the glossotonsillar sulcus,

0:07

it's actually in a very interesting location.

0:10

So what I'm gonna do is I'm gonna outline the

0:12

normal anatomy of the glossotonsillar sulcus.

0:15

So before I begin to talk about the glossotonsillar

0:18

sulcus, I want to go over the normal anatomy.

0:20

So this area right here...

0:23

This muscle right here extends to the

0:25

genial tubercle to the tongue base.

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And when we look at the tongue base, we can see these

0:29

various transverse fibers that go from right to left.

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So this muscle is the genioglossus muscle.

0:35

So the tongue base is the tongue.

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And Greek for tongue is gloss.

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And Latin for tongue is lingua.

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So that's actually part of the confusion.

0:45

So the normal sulcus that's

0:47

located between the tongue...

0:51

And the lower pole, the tonsil is here, and

0:53

this little area that it stretches out is

0:55

referred to as the glossotonsillar sulcus.

0:58

Now, when patients present with unknown

1:00

primaries, probably one of the most likely

1:03

areas that you can have early, early carcinomas

1:06

is right here in this glossotonsillar sulcus.

1:08

So it's a subtle area, but we

1:10

have to be familiar with it.

1:12

Now on the left-hand side, what we see

1:14

is this mass right here that's involving

1:17

the left glossotonsillar sulcus.

1:19

Now this image on your left

1:21

is actually a non-contrast CT.

1:23

If you're evaluating patients that potentially

1:26

have malignancy involving the neck, and as a

1:28

result, essentially in all neck CTs, you really

1:31

should be performing contrast because when you

1:33

give contrast you can see that there's enhancement

1:37

of this mass, and I would suggest that you

1:39

can see this mass a lot easier with contrast

1:42

than you can without contrast.

1:44

So this is the classic example

1:45

of a glossotonsillar sulcus.

1:47

The other piece of anatomy that I wanna point

1:49

out is that if you look right at the tip of my

1:51

arrow right here, this is the tip of the uvula.

1:54

Everyone see that now?

1:55

Right at the tip of the uvula?

1:57

You're at the level of the circumvallate papillae.

2:00

So when we talked about the circumvallate

2:02

papillae in the introduction, we can

2:04

approximate that location by looking at the

2:07

tip of the uvula on the sagittal images.

2:10

What we have here is this mass involving

2:13

the left lateral aspect of the tongue base,

2:16

extending into the glosso-tonsillar sulcus.

2:18

So that's the cancer.

2:19

And this air right here is actually an ulceration.

2:23

So on the coronal images here, we see the

2:25

normal air right here involving the airway.

2:27

But this area right here where this air is,

2:30

is actually an ulceration extending into

2:33

this left glosso-tonsillar sulcus carcinoma.