Tornwaldt's cyst

Abstract

Background: Tornwaldt's cyst results from obstruction of the orifice of the pharyngeal bursa and subsequent accumulation of secretions, debris, or infected material within the bursa. During the sixth week of fetal life, notochordal remnants in the posterior wall of the nasopharynx may communicate with the pharyngeal epithelium. This connection allows ingrowth of respiratory epithelium, which creates the formation of pharyngeal bursa. The detection and evaluation of Tornwaldt's cyst are frequently complicated by the variability and complexity of its clinical presentations. Methods: There were seventeen cases of Tornwaldt's cysts all of which underwent surgical treatment in the Department of Otorhinolaryngology of VGH, Taipei between May 1982 and June 1995. The incidence, clinical features, and treatment of these cases are presented in associated with a review of the literature. Results: No sex predilection was noted. There were two peak incidences in the ranges 55 to 70 years and 15 to 30 years. Clinical features included related nasopharyngeal symptoms in 10 cases, middle ear effusion in 3 cases, cervical lymphadenitis in 1 case, and headache and cranial nerve palsy in 2 cases. One case was detected incidentally without corresponding symptoms or signs. All cases were discovered by mirror or endoscopic examination of nasopharynx, and the diagnoses were all confirmed by pathological studies. Surgical Management contained marsupialization in 15 cases and total excision in 2 cases. Complete relief of the symptoms without recurrence was obtained in all cases. Conclusions: Tornwaldt's cyst should not be misdiagnosed as chronic paranasal sinusitis, and it is essential to consider the possibility of nasopharyngeal malignancy. The various types of nasopharyngeal cysts may be differentiated from Tornwaldt's cyst by anatomical site and pathological findings. Marsupialization or complete excision is the preferred treatment with low incidence of recurrence.