Nasopharyngeal cyst

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]

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]

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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