In the past, tonsil cancer treatment was mainly based on simple radiotherapy + chemotherapy because of the difficulty of surgical resection and the difficulty of postoperative defect repair and unsatisfactory functional reconstruction after tumor removal, which could lead to serious damage of swallowing function. Nowadays, tonsil cancer treatment tends to be a comprehensive treatment mainly based on surgical treatment, because the technology of surgery has made great progress, the level of postoperative defect repair has improved, and the functional recovery after surgery is obviously better. T stage of tonsil cancer T1: Tumor maximum diameter ≤2cm. T2: Tumor maximum diameter >2cm but ≤4cm. T3: Tumor maximum diameter >4cm. T4: Tumor invades adjacent structures, such as mandible, hard palate, nasopharynx, internal and external pterygoid muscles, tongue root, internal carotid artery, etc. T1 and T2 stage tonsil squamous carcinoma treatment methods: 1.Simple radical radiotherapy 2.Simple surgery. Both of them can achieve good treatment effect, and the 5-year survival rate is about 75-90%. Reasons for advocating radical radiotherapy for T1 and T2 tonsil squamous carcinoma: 1.Tonsil carcinoma is mostly hypofractionated carcinoma, which is sensitive to radiotherapy. 2. Surgery is more difficult and the functional reconstruction is not ideal, which can lead to serious damage of swallowing function and affect the quality of life. For T1 and T2 tonsil squamous carcinoma, the reasons for advocating surgery: 1. (1) Radiation necrosis of the mandible. Some authors have calculated that the necrosis rate reaches 12,5% after 8 years, which requires surgical removal of the mandible. (2) Pharyngeal mucosa atrophy, swallowing difficulties, not easy to swallow dry food (with soup, or water to swallow food). (3) Muscle damage and limited mouth opening. (4) Hearing damage, vagus nerve damage (vocal cord complaint rate paralysis), otitis media, etc. (5) Radioactive malignant tumors such as sarcoma, etc. For T1 and T2 tonsil squamous carcinoma, the choice of surgery or radiotherapy is up to the patient. T3, T4 tonsillar squamous carcinoma treatment principle 1, the effect of comprehensive treatment is better than radiotherapy alone, or surgery alone. 2.There is a tendency to prefer surgery as the main comprehensive treatment method. There is no significant difference in efficacy between surgery first, followed by radiotherapy, or radiotherapy first, followed by surgery. 3.Surgery first, then radiotherapy advantage: the use of forearm and other free flaps to repair the defect, the success rate is high (more than 90%), good functional recovery. If radiotherapy is used first and surgery is performed later, it is not conducive to wound healing. If free flaps such as forearm flap are used to repair the defect, the success rate is low; if pectoralis major muscle flap is used to repair the defect instead, the functional recovery is poor. Tonsil cancer surgical methods 1.Cracking of mandible to remove tumor. Intraoral surgery should be avoided to prevent damage to the internal carotid artery in the parapharyngeal space. 2.Defect repair after tonsil cancer resection. (1) Small defect-medium thickness skin piece repair to protect the internal carotid artery. (2) Large defects – forearm flap repair. (3) Very large defects (including lingual root defects) – anterolateral femoral flap repair. (4) Tumor residual or recurrence after radiotherapy, postoperative defect – pectoralis major muscle flap repair. Adenocarcinoma of the tonsil and adenoid cystic carcinoma, which are not sensitive to radiotherapy, should be given priority for surgery and supplemented with radiotherapy after surgery.