Tornwaldt Cyst: A Cause of Neck Pain and Stiffness

Abstract

Nasopharyngeal cysts are rare, small in size and asymptomatic, usually diagnosed as in incidental finding on MRI. Large cyst commonly presents with obstructive symptoms. Tornwaldt cysts occur in the midline bursa of the nasopharynx above the upper border of the superior constrictor muscle. They represent as a communication between notochord remnants and the pharyngeal endoderm. We report this case because of its presentation and size (2.5 × 2 cm). It was presented as intermittent cervical pain, stiffness and vertigo because of prevertebral cervical muscle spasm due to cyst and nasal symptoms were not predominant. Although rare, it should be kept as a differential diagnosis for cervical myelgia and stiffness.

Nasopharyngeal Cystic Lesions

“…As reported in the literature, large or superinfected cysts can present with symptoms such as persistent nasopharyngeal drainage, halitosis, and fullness of the ears secondary to Eustachian tube obstruction. [2][3][4][5][8][9][10][11][12][13]17 No additional symptoms that could be attributed to sequela of these types of cystic nasopharyngeal lesions were documented within the remaining 429 patients. Prior studies describe symptoms associated with Tornwaldt cyst including halitosis, neck pain, nasopharyngeal discharge, and Eustachian tube dysfunction for which treatment and potentially lesion resection is recommended.…”

“…Prior studies describe symptoms associated with Tornwaldt cyst including halitosis, neck pain, nasopharyngeal discharge, and Eustachian tube dysfunction for which treatment and potentially lesion resection is recommended. 2,10 In contrast to the Tornwaldt cyst, mucous retention cysts remain asymptomatic irrespective of their size. 2 There was a statistically significant correlation between mucous retention cysts and a diagnosis of HIV infection.…”

“…2,3 Both cystic lesions are benign and typically asymptomatic unless infected. 2,3,[8][9][10][11][12][13] Histopathologically, lesions are distinguished by location within the nasopharynx in addition to cystic wall structure. 14 The Tornwaldt cyst is lined by a columnar epithelium, whereas the mucous retention cyst contains a rim of granulation tissue and inflammatory cells, residual lymphoid tissue, and mucous.…”

5 years follow up after transnasal endoscopic surgery of Thornwaldt's cyst with powered instrumentation

“…It is present in about 4% of autopsied patient with age incidence between 15 and 30 years. There is no sex predilection [4,5].…”

Clinical presentation of Thornwaldt’s cyst

“…Thornwaldt's cyst is a benign nasopharyngeal lesion found in the midline, formed as a result of the retraction of the notochord at the point 2 . It has an autopsy prevalence of 4% with no apparent gender bias 4 .The usualage at presentation of symptomatic cysts are from 15 to 30 8 .…”