For AJCC TNM Staging of Head and Neck cancers see here
- Stage 1 - Limited to the nasopharyngeal cavity; bone destruction negligible or limited to the sphenopalatine foramen.
- Stage 2 - Invading the pterygopalatine fossa or the maxillary, ethmoid or sphenoid sinus with bone destruction.
- Stage 3 - Invading the infratemporal fossa or orbital region without intracranial involvement
- Stage 3a - Without intracranial involvement
- Stage 3b - With intracranial extradural (parasellar) involvement
- Stage 4 - Intracranial intradural tumour
- Stage 4b - Without infiltration of the cavernous sinus, pituitary fossa or optic chiasm
- Stage 4b - With infiltration of the cavernous sinus, pituitary fossa or optic chiasm
¶ Carotid body tumours - Shamblin classification
Proposed by Shamblin et al in 1971 for the classification of carotid body tumours based on the involvement of carotid vessels.
- Grade 1 - Small tumor with minimal attachment to carotid vessels.
- Grade 2 - Large tumor with some arterial attachment but does not entirely encase the carotid vessels.
- Grade 3 - Large tumor that completely encases the carotid vessels
- Group 1 - Minor endolaryngeal hematomas or lacerations without detectable fractures.
- Group 2 - More severe edema, hematoma, minor mucosal disruption without exposed cartilage, or nondisplaced fractures.
- Group 3 - Massive edema, large mucosal lacerations, exposed cartilage, displaced fractures, or vocal cord immobility.
- Group 4 - Same as group 3, but more severe, with disruption of anterior larynx, unstable fractures, two or more fractures lines, or severe mucosal injuries.
- Group 5 - Complete laryngotracheal separation
* In general, group 2 or above warrant direct laryngo-pharyngo-oesophagoscopy in theatre to rule out injury
- Type I - Localised and discrete nodule in superior aspect of stoma without oesophageal involvement
- Type II - Recurrence in superior aspect of stoma with oesophageal involvement
- Type III - Recurrence in inferior aspect of stoma with mediastinal involvement
- Type IV - Recurrence laterally and under either of clavicles
- Grade 1 - Slight retraction over the annulus
- Grade 2 - Retraction over long process of the incus
- Grade 3 - Retraction on to promontry without adhesion
- Grade 4 - Retraction with adhesion on to the promontry
- Grade 1 - Slight retraction/dimple
- Grade 2- Retraction over the head of the malleus
- Grade 3 - Retraction with erosion of the scutum
- Grade 4 - Retraction with keratin (synonymous with cholesteatoma)
The Fisch classification of glomus tumors is based on tumour extension and correlates with the associated morbidity and mortality.
- Type A - Tumor limited to the middle ear cleft (glomus tympanicum)
- Type B - Tumor limited to the tympanomastoid area with no infralabyrinthine compartment involvement
- Type C - Tumor involving the infralabyrinthine compartment of the temporal bone and extending into the petrous apex
- Type C1 - Tumor with limited involvement of the vertical portion of the carotid canal
- Type C2 - Tumor invading the vertical portion of the carotid canal
- Type C3 - Tumor invasion of the horizontal portion of the carotid canal
- Type D - Intracranial extension
- Type D1 - Tumor with an intracranial extension less than 2 cm in diameter
- Type D2 - Tumor with an intracranial extension greater than 2 cm in diameter
A radiological grading system out of 10 based upon the presence of certain middle/external ear structures used to help decide when a middle ear implant/atresiaplasty can be considered instead of BAHA in patients with microtia. A consensus statement on VSB implantation in children and adolescents recommended against implantation when the Jahrsdoerfer score was less than 8. Atresiaplasty had up to 50% stenosis rate over grade 3 microtia.
2 points - Stapes present, 1 point - Oval window present, 1 point - Middle ear space, 1 point - Facial nerve position, 1 point - Malleus-incus complex, 1 point - Mastoid pneumatized, 1 point - Incus-stapes connected, 1 point - Round window present, 1 point - Appearance of external ear
The Cotton-Myer grading system is used to measure the severity of subglottic or tracheal stenosis and is determined with endotracheal tubes demonstrating a leak.
- Grade 1 - 0-50% obstruction
- Grade 2 - 51-70% obstruction
- Grade 3 - 71-99% obstruction
- Grade 4 - No detectable lumen
- Stage A - Tumour limited to the nasal cavity
- Stage B - Tumor limited to the nasal cavity and paranasal sinuses
- Stage C - Extends beyond the nasal cavity and paranasal sinuses (to orbit/skullbase)
- Stage D - Nodal or distant metastases (added by Chao et al in 2001)