Unusual symptoms of Thornwaldt’s cyst: a case report

Abstract

Thornwaldt’s cyst also known as bursa pharyngeal embryonalis which is formed by traction of notochord at the retropharyngeal wall at the site of contact. It is present in the midline, at the junction between nasopharyngeal vault and posterior pharyngeal wall. The bursa can extend upward and backward above the limit of superior constrictor muscle fibres. This bursa when infected becomes seat of inflammation and cyst formation occurred. The well-known Thornwaldt’s cyst occurs as a result of obstruction of orifice of the bursa and is different from cyst of Rathke’s pouch. Thornwaldt’s cyst is usually asymptomatic but more than 1-2 cm may become symptomatic. Symptoms that commonly seen are halitosis, nasal discharge, nasal obstruction, epistaxis, prevertebral spasm, and rarely occipital headache and obstruction of Eustachian tube can occur. The diagnosis usually incidental as a part of a nasal endoscopic examination or radiological and endoscopic examination which is used to diagnose the cyst. On examination it appears as smooth mass with a central dimple. In this case report young female present with difficulty in swallowing, occipital headache, halitosis and fever. Initially she was managed conservatively when the cyst was resolved then it was marspupizied by transoral approach, with uneventful postoperative period. Other approaches for excision or marsupialization in symptomatic cases are endoscopic or transpalatal using powdered instrumentation.