No abstract

The management of salivary gland neoplasms continues to be a challenging clinical problem. Despite recent advances in histopathological classification, agreement among head and neck surgeons concerning optimum treatment is lacking. In attempts to eradicate the more malignant varieties of these tumors, surgeons have performed radical and multilating surgery. Radiation therapy has not been considered efficacious in many centers. A review of 93 maligant salivary gland tumors from 1955 to 1973 at the University of California, San Francisco, suggests that these tumors may be more radiosensitive than once thought. Radiation therapy combined with conservative surgical procedures may be as successful and perhaps more rational treatment than radical surgery alone.

Cystic lesions of the nasopharynx are typically asymptomatic and are often discovered incidentally with imaging or endoscopic examination. The etiology of these lesions can be either congenital or acquired. Acquired lesions, such as mucoceles, salivary duct cysts, oncocytic (Warthin) cysts, intraadenoid cysts, and abscesses, occur throughout the nasophar-ynx and are associated with local trauma, such as surgery, radiation, or neoplastic or infectious processeses. 1 Given their natural history, bilateral acquired lesions are an exceedingly uncommon presentation. 2 Mucoceles are mucus-filled pseudocysts commonly occurring in the oral cavity, including the buccal mucosa, lips, and tongue. The pathophysiologic mechanism relates to trauma of minor salivary glands allowing extravasation of mucin and subsequent cyst formation. 1 When infected by pathogens, mucoceles are referred to as mucopyoceles. 3 Untreated mucopyoceles can erode soft tissue and bone and extend into adjacent cavities. Critical structures, such as the brain and orbit, are separated from the sinuses by only a thin layer of mucosa and bone. For this reason, in patients with sinonasal mucopyocele, surgical treatment is indicated to avoid the potentially catastrophic sequelae, including spontaneous cerebrospinal fluid rhinorrhea, orbital, and intracranial infections. 4 To our knowledge, there have been no reported cases of bilateral mucopyoceles of the nasopharynx. Herein, we describe the unusual presentation and clinical course of a patient with refractory headaches with incidental bilateral nasopharyngeal cysts, appearing to arise from the torus tubarius on brain magnetic resonance imaging (MRI), later confirmed to be mucopyoceles.