Torbiel Tornwalda w praktyce klinicznej

Klinika Audiologii i Foniatrii Instytutu Fizjologii i Patologii Słuchu, Kierownik: dr med. Agata Szkiełkowska, Warszawa, Poland
Otolaryngologia polska. The Polish otolaryngology 05/2013; 67(3):170–175. DOI: 10.1016/j.otpol.2013.03.004

ABSTRACT AimTornwald's cyst is a recess in the midline of the nasopharynx, which is produced by persistent notochord remnants. The aim of the study was to present difficulties in diagnostic procedures in patients with Tornwald's cyst suspicion.Material and methodAuthors present 2 cases of patients being treated for Tornwald's cyst in the Audiology and Phoniatrics Clinic of Institute of Physiology and Pathology of Hearing in Warsaw.ResultsDiscussed patients complained fullness in ears, hearing disorders, tinnitus, dysphagia, occipital headaches and balance problem. Both patients underwent ENT examination with endoscopic examination of nasopharynx and hearing assessment tests(pure tone audiometry, impedance audiometry). Magnetic resonance imaging and computer tomography were also performed. Surgery of nasopharyngeal cyst and tympanotomy with drainage of middle ear were performed in one patient. Second patient was treated with TRT therapy for her tinnitus.Conclusion
Tornwald's cyst should be remembered as an uncommon cause of hearing problems, tinnitus, fullness in ears, dysphagia, occipital headaches and balance problem. Magnetic resonance imaging seems to be the most specific method in Tornwald's cyst diagnosis.

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    ABSTRACT: Thornwaldt's bursa, also known as nasopharyngeal bursa, is a recess in the midline of the nasopharynx that is produced by persistent notochord remnants. If its opening becomes obstructed, possibly due to infection or a complication from adenoidectomy, a Thornwaldt's cyst might develop. Here, we present a 53-year-old man who complained of nasal obstruction that had progressed for 1 year. Nasopharyngoscopy showed a huge nasopharyngeal mass. Thornwaldt's cyst was suspected. Magnetic resonance imaging showed a lesion measuring 3.6 x 3.4 cm, intermediate on T1-weighted and high signal intensity on T2-weighted imaging, neither bony destruction nor connection to the brain. The patient underwent endoscopic surgery for this huge mass. Afterwards, his symptoms improved significantly. We present the treatment and differential diagnosis of a nasopharyngeal cyst.
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    ABSTRACT: The purpose of this study was to assess the characteristics of Tornwaldt's cysts as revealed by routine MR studies. We retrospectively reviewed MR images of the brain in 1208 consecutive subjects who ranged in age from 3 weeks to 93 years (mean, 57.1 years). The signal intensity, shape, and size of Tornwaldt's cysts were assessed. Patients with Tornwaldt's cysts were then questioned about the presence of persistent nasal discharge, occipital headaches, and halitosis and an unpleasant taste in the mouth and about a history of adenoidectomy. Tornwaldt's cysts were found in 23 patients (1.9%) who ranged in age from 39 to 78 years (mean, 57.3 years). Of the 23 Tornwaldt's cysts, all were isointense to CSF on T2-weighted images and hyperintense to gray matter on the fluid-attenuated inversion-recovery images. The cysts showed high signal intensity compared with muscle on T1-weighted images. Nineteen cysts were round and four were oval. The mean size of the lesions was 6.0 mm in the major axis and 5.5 mm in the minor axis. Two patients with Tornwaldt's cysts had persistent nasal discharge and occipital headaches, and another patient had occipital headaches alone. None of the patients had undergone an adenoidectomy. Lesions consistent with Tornwaldt's cysts were found in 1.9% of the routine MR studies of the brain. The cysts had high signal intensity on T1-weighted, T2-weighted, and fluid-attenuated inversion-recovery images.
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    ABSTRACT: Tornwaldt's disease was first described by Tornwaldt as one of the causes of epipharyngitis, and is an inflammation or abscess of the embryonic remnant cyst of the pharyngeal bursa appearing at the posterior median wall of the nasopharynx. Although many cases are symptom-free, symptoms can often be caused by nasal tamponade, trauma, adenotomy, or other mechanical stimuli. Only a few cases have been reported in Japan between 1929 and 1992. At about the 10th week of embryonic development, the pouch, which forms by adhesion of the pharyngeal ectoderm to the notochord at the most cranial end of the notochord, becomes closed at the orifice (cystic type), or crusts adhere to the orifice without closing (crust type). Symptoms are those of upper respiratory tract infection with obstinate occipital pain, purulent choanal discharge, nasal obstruction, halitosis, feeling of ear fullness, clearing of the throat, etc. Posterior rhinoscopy, simple lateral view X-ray tomography, nasopharyngeal fiberoscopy, CT scan and MRI are useful in showing adhesion to the cervical vertebrae. While complete extirpation via a transpalatal approach is desirable, incision or excision of the cyst can also be performed.
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