Recent Trends in the Management of Thornwaldts cyst: A Case Report

Abstract

A 28-year-old man presented with nasal obstruction since 10-years. Nasal obstruction used to aggravate during episodes of cold. He also had history of episodic dull moderate occipital headache. He had no otologic symptoms like hearing difficulty, otorrhea, ear fullness etc. Neurological examination was normal.On examination, anterior rhinoscopy and otoscopic findings were normal. Diganostic nasal endoscopy using 0 0 rigid endoscope [Table/ Fig-1] showed a large well encapsulated lesion arising from the posterior wall of the nasopharynx which was covered by smooth mucosa. The lesion was oval shaped, non tender and immobile. Magnetic resonance imaging (MRI) [Table/ Fig-2] showed a welldefined oval thick fluid filled cystic lesion measuring 2.2 x 1.6 cm attached to roof of nasopharynx. The lesion was hyperintense on T 1 W images and hypointense on T2 W images.The patient underwent successful marsupialisation using endonasal endoscopic approach using rigid endoscopes and powered instrumentation. Cheesy material was aspirated from the cyst. Histopathology revealed a respiratory lined epithelial cyst. Based on the clinical, radiological and histopathological findings a diagnosis of Tornwaldt's cyst was made. The patient was relieved of nasal obstruction and headache following surgery. The patient was on a regular followup till two years and was symptom free. DisCussionTornwaldt's cyst is a benign developmental nasopharyngeal midline cyst covered by mucosa anteriorly and bounded by longus muscles posteriorly. It was first noted by Mayer in 1840 in autopsy specimens [1]. It was established as a pathologic entity by Tornwaldt in 1885 [2]. It is also known as Nasopharyngeal bursa, Pharyngeal bursa or Thornwaldt cyst. Huber later described how irregular notochord regression in the sixth week of gestation leads to its formation [3]. Tornwaldt's cyst may be totally asymptomatic or can have a myriad of presentations. We present a case of Tornwaldt's cyst who presented with nasal obstruction which was successfully managed ear, nose and throat Section Tornwaldt's cyst is a benign cyst located in the upper posterior nasopharynx. It is a relatively rare lesion and most are small and asymptomatic whereas some cause nasal obstruction, postnasal drip, occipital headache or eustachian tube dysfunction. In our case a 28-year-old man presented with nasal obstruction since 10-years whose diagnostic nasal endoscopy showed a large well-encapsulated lesion arising from the posterior wall of the nasopharynx. A magnetic resonance imaging (MRI) was performed which was suggestive of a fluid filled cystic lesion. The patient underwent successful marsupialisation using endonasal endoscopic approach using rigid endoscopes and powered instrumentation. Histopathology of the aspirate revealed a respiratory lined epithelial cyst. Based on the clinical, radiological and histopathological findings a diagnosis of Tornwaldt's cyst was made. We report this case to highlight the role of MRI in diagnosis and use of endoscopic assisted powered instrumentatio...

Thornwaldt’s cyst: diagnostics and treatment

“…В типичных случаях при риноэндоскопии в задневерхнем отделе носоглотки определяется плотное, округлое образование с четкими контурами, содержащее воспалительный экссудат [13]. При рентгенологическом исследовании (компьютерная и магнитнорезонансная томографии) киста выглядит как округлое гиперэхогенное образование правильной формы с четкими контурами, не связанное с мышцами глотки [14,15].…”