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Suggest Treatment For Cyst In The Removed Tonsil Area

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Posted on Sat, 5 Apr 2014
Question: my sister is 50 years old. she had her tonsils removed. after healing, she got another cyst on the left side above where the tonsil was. also, when they removed her left tonsil, they removed a large growth that went down her throat. they said it was not cancer, but now, this cyst came up. they did a cat scan, and nothing showed except her left lymph node is swollen -- but not sure if that is because they only did the ct scan was only on the left side. yesterday morning she woke up with a cluster of blisters on the back of her tongue and throat. the Doctor took a needle and remove some of the contents of the cyst which was very thick and hard to get with a needle -- the cyst is white in color and she can see her veins. do you have any idea what this is -- when she sends me pictures, it looks like she has a lot of bad stuff going on and she is feeling very tired. the fact that this came back after the 3 week after this large mass was removed is concerning to all of us. any ideas?
doctor
Answered by Dr. Vivek Chail (1 hour later)
Brief Answer: Request CT scan findings Detailed Answer: Hi XXXXXX, Thanks for writing in to us. The tonsillar region has many structures around it. It must be known if your sister always had a cyst-tumor type of lesion in the region earlier which was dormant and progressively increased in size with appearance of symptoms or if she had a bad infection in the operated region. A swollen lymphnode is typical of an infection if the doctors have ruled out cancer. The needle test is known medically as FNAC (fine needle aspiration cytology) and helps in sampling the cells in swellings to confirm what is the disease condition. There are many possibilities in the region from a congenital branchial cleft cyst which got infected to a retropharyngeal abscess.I will be glad to go through the CT scan report and provide you better clarifications on the ongoing condition. Waiting to hear an update from your end. Regards, Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Vivek Chail (29 minutes later)
thank you so much Dr. XXXXXXX Chail I am going to get the ct scan report sent to you. we have to scan it tomorrow, I cant do it at my house. she has had very bad tonsils, and the growth that was so big on the left side when the doctor operated, took him an hour to remove and he has never seen anything like it before. She is in a small region of New Mexico, and I know the doctor is good, he is and ear, noise and throat specialist, but he only sees what he sees -- he has said it is not like anything he has ever seen. I have pictures of the inside of her mouth, but not of the cyst - I am asking her to try again and take a picture of it. I will follow up with some pictures. Also, Do you normally take antibiotics with something like tonsil surgery? when I saw the huge holes in her throat, I did not know how infection could not occur. he does not seem to have ruled out cancer -- that is what is bother us all greatly, however, with things like these blisters, and membrane in the back of the throat, and on the left side it looks like ground meat - it makes me wonder if it is not an infection, or multiple infections -- also the fact that she had staph infection -- can that act up again? pictures will follow, and ct report tomorrow.
doctor
Answered by Dr. Vivek Chail (15 hours later)
Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXXX, Thanks for writing in with an update. I think it may take some more time before you can scan the report and send it across. Meanwhile, the answer to your query on antibiotics being taken after tonsil surgery is yes. Antibiotic are always given after any surgery to avoid the surgical wound from getting infected. Some infections do not get treated with usual antibiotics and these are known as resistant. The doctor may need to carefully choose an antibiotic in that case to treat the condition. There are resistant forms of staph infections which need consideration. To confirm cancer, cancer cells must be found in the mass of tissue in the area or in the lymph node. This is possible best by an excision biopsy. Please do keep me updated. Regards, Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Vivek Chail (29 minutes later)
Dr. Vivel Chail thank you for your reply. did you not have access to the report I uploaded with my note this morning? if not. I many have to do it again. The report said that the doctor was looking for a Pharyngeal Cyst. apparently, the CT scan did not detect the cyst , that is visible in my sister mouth, but this is what it said: "there is a 13x8mm noe deep to the Jugular vien slightly cephalad to the level of the calavicle" Conclusion: "Single enlarged lymph node at the neck base on the left. No Pharyngeal detected." the doctor then excreted a needle to draw fluid from the cyst - it was very thick, and it is about the size of a pencil eraser. he sent it to be checked. he said it would take 2 weeks to get the response. that seems like a very long time. given her terrible experience when she had cervical cancer that was followed by a staph infection that almost killed her, I was frightened when I found out that he gave NO medication after surgery. So, I can see infection occurring, but I really don't know -- it just did not sound right to me that with 2 big holes in your mouth you would not have some medication to prevent an infection. this is all beside the cyst, and not knowing about the lymph node that I found out yesterday when I asked her to get the report. if you need me to up load the ct report again, I will. I also uploaded pictures from inside her mouth - she has not been able to get a picture of the cyst, but she is going to try again today. what I sent was what her mouth looked like after surgery, and there was no cyst, and the cluster of blusters she has on the back of her tongue which is going down her throat that appeared this week. I am very concerned. if you can give me some advise, it will be greatly appreciated. I am ready to go get her and bring her to Houston! this sounds very scary to me.
doctor
Answered by Dr. Vivek Chail (7 hours later)
Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXX, Thanks for writing in with an update. I had not received any CT scan report details in your earlier messages except in the last one mentioning the presence of a 13 x 8 mm lymph node deep to the jugular vein. At 13 x 8 mm it is small and possibly infective. However it must be observed for further changes in size and other nodal enlargement in the area. The doctor has aspirated the cyst contents and sent it for cytology and bacterial culture examinations. This may take time and two weeks should be enough to get a complete report. There are antibiotic medications which are given as injections and I am not sure if your sister is getting that. Please do ask your sister about other instructions given by her doctor regarding oral hygiene and proper fluid intake. I have not received any pictures from you till now. However the description suggests something in the parapharyngeal or retropharyngeal region (sides and back of throat). Can I make a request to you to please scan the CT scan report and attach it so that I know the disease is confined to a certain part of the throat and not involving any important structure deep in the neck. I re assure you that if the doctor is seeing her and CT scan is done then there is not much to worry. It is important though to follow instructions on fluid intake and diet as she should not get dehydrated which is a problem situation. Healing of wounds in the throat takes a while and is surely associated with a lot of discomfort. Please do keep me updated. Regards, Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Vivek Chail (13 hours later)
Dear Dr XXXXXXX thank you so much for your reply, it makes me feel better. I wlll tell my sister what you have suggested. I am not sure she has gotten any specifics regarding oral hygiene, but surly she has! I will ask, I know she is not taking any meds. The doctor is concerned that he can not handle her situation, but we will know when the report returns. I have a friend in Houston that is one of the best reconstruction surgeons , and other connections into the Houston medical community - so if it comes to it, I can get access to the best for her. I am relieved that the node in her lymph might be related to infection - she certainly has that. I have tried again to upload pictures of her mouth to you, and the CT scan - it shows that is it on this site as part of this conversation --- I must be doing something wrong it you still can not be seeing it -- I can. if you can not, I will call the help deck to help me be sure of what to do so you can see it. I have asked my sister to ask the doctor about the mass he removed from her left side and what he thinks the blisters are. I will send that when I receive it. Thank you so much XXXXXXX
doctor
Answered by Dr. Vivek Chail (1 hour later)
Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXX, Thanks for writing in with an update. This time I have been able to see both pictures and the CT scan neck report. Thanks for sending that across. From the CT scan, there appears to be no mass or cyst in the throat. The doctor was aware of your sister's problems and has confirmed the presence of a lymph node but no other mass as thought earlier. So I think we can stop thinking about a mass/ cyst after reading the CT scan report. Speaking of the blisters, they could be due to formation of granulation or healing tissue. However secondary bacterial infection may be present and that is confirmed once the test results come and then antibiotics can be given. Oral hygiene must be kept in mind and pain killer may be taken after food if there is significant pain. A talk with your friend who is a reconstructive surgeon will surely help. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek
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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Vivek Chail

Radiologist

Practicing since :2002

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Suggest Treatment For Cyst In The Removed Tonsil Area

Brief Answer: Request CT scan findings Detailed Answer: Hi XXXXXX, Thanks for writing in to us. The tonsillar region has many structures around it. It must be known if your sister always had a cyst-tumor type of lesion in the region earlier which was dormant and progressively increased in size with appearance of symptoms or if she had a bad infection in the operated region. A swollen lymphnode is typical of an infection if the doctors have ruled out cancer. The needle test is known medically as FNAC (fine needle aspiration cytology) and helps in sampling the cells in swellings to confirm what is the disease condition. There are many possibilities in the region from a congenital branchial cleft cyst which got infected to a retropharyngeal abscess.I will be glad to go through the CT scan report and provide you better clarifications on the ongoing condition. Waiting to hear an update from your end. Regards, Dr.Vivek