FIG 6.

A 64-year-old man with secondary otalgia caused by palatine tonsil squamous cell carcinoma. Axial contrast-enhanced CT shows a right palatine tonsil mass (white arrow) with deep invasion through the superior constrictor (white arrowhead) into the parapharyngeal space. Conglomerate right level II cervical adenopathy (black arrows) with extracapsular spread displaces the carotid space and invades the parotid tail (black arrowhead). In this case, the patient’s referred otalgia may be caused by involvement of CN IX, CN X, and/or upper cervical nerve branches (great auricular or lesser occipital).