Nasopharyngeal cyst

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Nasopharyngeal cyst refers to cystic swelling arising from midline and lateral wall of the nasopharynx. The commonest cyst arising from lateral wall is the nasopharyngeal branchial cyst, whereas the mucus retention cysts are the commonest to arise from the midline. [1] Sometimes nasopharyngeal cyst may directly refer to Tornwaldt cyst. [2] It arises from the midline and lies deep to the pharyngobasilar fascia which helps to distinguish it from a mucous retention cyst. The main difference lies in that nasopharyngeal branchial cyst is congenital whereas the Tornwaldt's cyst is acquired. [3]

Contents

Nasopharyngeal Branchial Cyst

These are congenital cysts often arising from the fossa of Rosenmüller located in the lateral wall of the nasopharynx. [4] [5] They represent remnants of first branchial cleft. These may extend superiorly to reach the bony confines of eustachian tube even to the skull base. [6]

Initially patients are asymptomatic but may present with aural fullness, unilateral conductive hearing loss, and serous otitis media as the cyst mass grows. [7] In even more rare cases, they may be the source for unexplained sinonasal symptoms, such as CSF rhinorrhea, visual disturbances and nasal obstruction. [8]

Diagnosis

In most of the cases incidental diagnosis happens while performing nasal endoscopy. MRI and CT scan can be helpful for further confirmation of diagnosis.

On CT scan a low density, well capsulated mass in the roof of nasopharynx is suggestive of Thornwaldt cyst. [9] [10]

Differential Diagnosis

Differential diagnosis of this cyst are branchial cleft cyst, Rathke cleft cyst, neurenteric cyst, nasopharyngeal carcinoma, adenoid retention cyst, meningocele and meningomyelocele. [11] [12]

Treatment

Surgery is performed once symptomatic using transplatatine or endonasal route with the help of nasal endoscopy. [13] [14]

Related Research Articles

Vocal fold cysts are benign masses of the membranous vocal folds. These cysts are enclosed, sac-like structures that are typically of a yellow or white colour. They occur unilaterally on the midpoint of the medial edge of the vocal folds. They can also form on the upper/superior, surface of the vocal folds. There are two types of vocal fold cysts:

  1. Sub-epithelial vocal fold cysts- located in the superficial lamina propria of the vocal folds.
  2. Ligament vocal fold cysts- located within the deeper layers of the lamina propria or on the vocal ligament.
Teratoma a tumor made up of several different types of tissue, such as hair, muscle, teeth, or bone

A teratoma is a tumor made up of several different types of tissue, such as hair, muscle, teeth, or bone. Teratoma typically form in the ovary, testicle, or coccyx.

Thyroglossal cyst

A thyroglossal cyst is a fibrous cyst that forms from a persistent thyroglossal duct. Thyroglossal cysts can be defined as an irregular neck mass or a lump which develops from cells and tissues left over after the formation of the thyroid gland during developmental stages.

Longus colli muscle

The Longus colli muscle is a muscle of the human body.

Cerebellopontine angle

The cerebellopontine angle (CPA) is located between the cerebellum and the pons. The cerebellopontine angle is the site of the cerebellopontine angle cistern one of the subarachnoid cisterns that contains cerebrospinal fluid, arachnoid tissue, cranial nerves, and associated vessels. The cerebellopontine angle is also the site of a set of neurological disorders known as the cerebellopontine angle syndrome.

Pineal gland cyst

A pineal gland cyst is a usually benign (non-malignant) cyst in the pineal gland, a small endocrine gland in the brain. Historically, these fluid-filled bodies appeared on 1-4% of magnetic resonance imaging (MRI) brain scans, but were more frequently diagnosed at death, seen in 4-11% of autopsies. A 2007 study by Pu et al. found a frequency of 23% in brain scans.

Pneumocephalus Air or gas in the cranial cavity

Pneumocephalus is the presence of air or gas within the cranial cavity. It is usually associated with disruption of the skull: after head and facial trauma, tumors of the skull base, after neurosurgery or otorhinolaryngology, and rarely, spontaneously. Pneumocephalus can occur in scuba diving, but is very rare in this context.

Odontogenic keratocyst

An odontogenic keratocyst is a rare and benign but locally aggressive developmental cyst. It most often affects the posterior mandible and most commonly presents in the third decade of life. Odontogenic keratocysts make up around 19% of jaw cysts.

Persistent thyroglossal duct

A persistent thyroglossal duct is a usually benign medical condition in which the thyroglossal duct, a structure usually only found during embryonic development, fails to atrophy. The duct persists as a midline structure forming an open connection between the back of the tongue and the thyroid gland. This opening can lead to fluid accumulation and infection, which necessitate the removal of the duct.

Clivus (anatomy)

The clivus is a bony part of the cranium at the skull base, a shallow depression behind the dorsum sellæ that slopes obliquely backward. It forms a gradual sloping process at the anterior most portion of the basilar occipital bone at its junction with the sphenoid bone. On axial planes, it sits just posterior to the sphenoid sinuses. Just lateral to the clivus bilaterally is the foramen lacerum, proximal to its anastomosis with the Circle of Willis. Posterior to the clivus is the basilar artery.

Nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC), or nasopharynx cancer, is the most common cancer originating in the nasopharynx, most commonly in the postero-lateral nasopharynx or pharyngeal recess, accounting for 50% of cases. NPC occurs in children and adults. NPC differs significantly from other cancers of the head and neck in its occurrence, causes, clinical behavior, and treatment. It is vastly more common in certain regions of East Asia and Africa than elsewhere, with viral, dietary and genetic factors implicated in its causation. It is most common in males. It is a squamous cell carcinoma of an undifferentiated type. Squamous epithelial cells are a flat type of cell found in the skin and the membranes that line some body cavities. Differentiation means how different the cancer cells are from normal cells. Undifferentiated cells are cells that do not have their mature features or functions

Branchial cleft cyst

A branchial cleft cyst is a cyst as a swelling in the upper part of neck anterior to sternocleidomastoid. It can, but does not necessarily, have an opening to the skin surface, called a fistula. The cause is usually a developmental abnormality arising in the early prenatal period, typically failure of obliteration of the second, third, and fourth branchial cleft, i.e. failure of fusion of the second branchial arches and epicardial ridge in lower part of the neck. Branchial cleft cysts account for almost 20% of neck masses in children. Less commonly, the cysts can develop from the first, third, or fourth clefts, and their location and the location of associated fistulas differs accordingly.

Nasopharyngeal angiofibroma

Nasopharyngeal angiofibroma is a histologically benign but locally aggressive vascular tumor of the nasopharynx that arises from the superior margin of the sphenopalatine foramen and grows in the back of the nasal cavity. It most commonly affects adolescent males . Though it is a benign tumor, it is locally invasive and can invade the nose, cheek, orbit, or brain. Patients with nasopharyngeal angiofibroma usually present with one-sided nasal obstruction with profuse epistaxis.

A vascular malformation, is a blood vessel or lymph vessel abnormality. Vascular malformations are one of the classifications of vascular anomalies, the other grouping is vascular tumors. They may cause aesthetic problems as they have a growth cycle, and can continue to grow throughout life.

Sandifer syndrome is an eponymous paediatric medical disorder, characterised by gastrointestinal symptoms and associated neurological features. There is a significant correlation between the syndrome and gastro-oesophageal reflux disease (GORD); however, it is estimated to occur in less than 1% of children with reflux.

Pharynx

The pharynx is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and trachea – the tubes going down to the stomach and the lungs. It is found in vertebrates and invertebrates, though its structure varies across species.

Dorello's Canal is the bow-shaped bony enclosure surrounding the abducens nerve and the inferior petrosal sinus as the two structures merge with the cavernous sinus. It is sometimes found at the tip of the temporal bone. The petrosphenoidal ligament or petroclinoidal ligament also known as Gruber ligament, forms the superior border of Dorello canal, the conduit for the abducens nerve.

Ectopic thymus is a condition where thymus tissue is found in an abnormal location. It is thought to be the result of either a failure of descent or a failure of involution of normal thymus tissue.

Pneumatosis Abnormal presence of air or other gas within tissues

Pneumatosis, also known as emphysema, is the abnormal presence of air or other gas within tissues.

Tornwaldt's disease is the inflammation or abscess of the embryonic cyst of pharyngeal bursa. It is located in the midline of the posterior wall of the nasopharynx. It is covered anteriorly by mucosa in the adenoid mass. It is bounded posteriorly by longus muscle.

References

  1. ↑ Flis, Daniel W.; Wein, Richard O. (February 2013). "Nasopharyngeal Branchial Cysts—Diagnosis and Management: A Case Series". Journal of Neurological Surgery. Part B, Skull Base. 74 (1): 50–53. doi:10.1055/s-0032-1331020. ISSN   2193-6331. PMC   3699168 . PMID   24436888.
  2. ↑ Ng, WSJ; Sinnathuray, AR (2012-08-31). "Nasopharyngeal (Tornwaldt's) Cyst: Rare Finding in a Habitual Snorer". Malaysian Family Physician. 7 (2–3): 39–41. ISSN   1985-207X. PMC   4170436 . PMID   25606255.
  3. ↑ Flis, Daniel W.; Wein, Richard O. (February 2013). "Nasopharyngeal Branchial Cysts—Diagnosis and Management: A Case Series". Journal of Neurological Surgery. Part B, Skull Base. 74 (1): 50–53. doi:10.1055/s-0032-1331020. ISSN   2193-6331. PMC   3699168 . PMID   24436888.
  4. ↑ Flis, Daniel W.; Wein, Richard O. (February 2013). "Nasopharyngeal Branchial Cysts—Diagnosis and Management: A Case Series". Journal of Neurological Surgery. Part B, Skull Base. 74 (1): 50–53. doi:10.1055/s-0032-1331020. ISSN   2193-6331. PMC   3699168 . PMID   24436888.
  5. ↑ Gleeson, Michael; Clarke, Ray (2008-04-25). Scott-Brown's Otorhinolaryngology: Head and Neck Surgery 7Ed: 3 volume set. CRC Press. ISBN   9781444109832.
  6. ↑ Gleeson, Michael; Clarke, Ray (2008-04-25). Scott-Brown's Otorhinolaryngology: Head and Neck Surgery 7Ed: 3 volume set. CRC Press. ISBN   9781444109832.
  7. ↑ Flis, Daniel W.; Wein, Richard O. (February 2013). "Nasopharyngeal Branchial Cysts—Diagnosis and Management: A Case Series". Journal of Neurological Surgery. Part B, Skull Base. 74 (1): 50–53. doi:10.1055/s-0032-1331020. ISSN   2193-6331. PMC   3699168 . PMID   24436888.
  8. ↑ Marom, Tal; Russo, Eyal; Ben Salem, Douraied; Roth, Yehudah (2009-08-01). "Nasopharyngeal Cysts". International Journal of Pediatric Otorhinolaryngology. 73 (8): 1063–1070. doi:10.1016/j.ijporl.2009.01.004. ISSN   0165-5876. PMID   19211159.
  9. ↑ Flis, Daniel W.; Wein, Richard O. (February 2013). "Nasopharyngeal Branchial Cysts—Diagnosis and Management: A Case Series". Journal of Neurological Surgery. Part B, Skull Base. 74 (1): 50–53. doi:10.1055/s-0032-1331020. ISSN   2193-6331. PMC   3699168 . PMID   24436888.
  10. ↑ Gaillard, Frank. "Tornwaldt cyst | Radiology Reference Article | Radiopaedia.org". Radiopaedia. Retrieved 2019-10-02.
  11. ↑ Baisakhiya, Nitish; Deshmukh, Prasad; Pawar, Vinod (July 2011). "Tornwaldt Cyst: A Cause of Neck Pain and Stiffness". Indian Journal of Otolaryngology and Head & Neck Surgery. 63 (Suppl 1): 147–148. doi:10.1007/s12070-011-0185-y. ISSN   2231-3796. PMC   3146685 . PMID   22754868.
  12. ↑ Gaillard, Frank. "Tornwaldt cyst | Radiology Reference Article | Radiopaedia.org". Radiopaedia. Retrieved 2019-10-02.
  13. ↑ Flis, Daniel W.; Wein, Richard O. (February 2013). "Nasopharyngeal Branchial Cysts—Diagnosis and Management: A Case Series". Journal of Neurological Surgery. Part B, Skull Base. 74 (1): 50–53. doi:10.1055/s-0032-1331020. ISSN   2193-6331. PMC   3699168 . PMID   24436888.
  14. ↑ Gleeson, Michael; Clarke, Ray (2008-04-25). Scott-Brown's Otorhinolaryngology: Head and Neck Surgery 7Ed: 3 volume set. CRC Press. ISBN   9781444109832.
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