Pharyngeal Recess Research Articles

Technique for guttural pouch bead removal using a novel three-dimensional (3D)-printed instrument.

The aim of the present study was to determine if a three-dimensional (3D)-printed instrument technique would improve lavage removal of plastic beads (guttural pouch [GP] chondroid mimics) through a dorsal pharyngeal recess (DPR) fenestration. We hypothesized that using a 3D-printed instrument placed through the DPR fenestration would remove more beads, reduce lavage time and incur less soft tissue damage than using a lavage tube control or instrument placement through the salpingopharyngeal ostium (SPO). Experimental cadaveric study. A total of 30 cadaveric equine heads. DPR fenestration was performed using transendoscopic laser and 50 plastic 12 mm beads were placed into one GP of horse heads. Four removal procedures using a 3D-printed instrument or lavage tube control placed through the DPR fenestration or the SPO were compared. Number of beads removed and number of 2-min lavage cycles to recover ≥96% of beads or three consecutive no-yield cycles were recorded. Endoscopic soft tissue damage was graded. Data were compared by generalized estimating equations (GEE) model and Fisher's exact test (p < .05). More beads (median 48 beads; range 0-49) were removed faster (median 24 beads/cycle; range 12-50) using the 3D-printed instrument compared to control (median 6 beads; range 0-29, 0.66 beads/cycle, range 0-49). There was no difference between total beads removed or removal speed between placement sites. There was no difference in soft tissue damage between procedures. Our 3D-printed instrument enabled efficient plastic bead removal. DPR fenestration and use of our 3D-printed instrument represents an alternative to current chondroid removal techniques, warranting investigation in clinical cases.

Predicting distant metastasis in nasopharyngeal carcinoma using gradient boosting tree model based on detailed magnetic resonance imaging reports.

Development of distant metastasis (DM) is a major concern during treatment of nasopharyngeal carcinoma (NPC). However, studies have demonstrated improved distant control and survival in patients with advanced NPC with the addition of chemotherapy to concomitant chemoradiotherapy. Therefore, precise prediction of metastasis in patients with NPC is crucial. To develop a predictive model for metastasis in NPC using detailed magnetic resonance imaging (MRI) reports. This retrospective study included 792 patients with non-distant metastatic NPC. A total of 469 imaging variables were obtained from detailed MRI reports. Data were stratified and randomly split into training (50%) and testing sets. Gradient boosting tree (GBT) models were built and used to select variables for predicting DM. A full model comprising all variables and a reduced model with the top-five variables were built. Model performance was assessed by area under the curve (AUC). Among the 792 patients, 94 developed DM during follow-up. The number of metastatic cervical nodes (30.9%), tumor invasion in the posterior half of the nasal cavity (9.7%), two sides of the pharyngeal recess (6.2%), tubal torus (3.3%), and single side of the parapharyngeal space (2.7%) were the top-five contributors for predicting DM, based on their relative importance in GBT models. The testing AUC of the full model was 0.75 (95% confidence interval [CI]: 0.69-0.82). The testing AUC of the reduced model was 0.75 (95%CI: 0.68-0.82). For the whole dataset, the full (AUC = 0.76, 95%CI: 0.72-0.82) and reduced models (AUC = 0.76, 95%CI: 0.71-0.81) outperformed the tumor node-staging system (AUC = 0.67, 95%CI: 0.61-0.73). The GBT model outperformed the tumor node-staging system in predicting metastasis in NPC. The number of metastatic cervical nodes was identified as the principal contributing variable.

Nasopharyngeal cyst of branchiogenic origin: a rare case report

Nasopharyngeal branchial cysts present laterally as well as ascend from the fossa of Rosenmuller and trace superiorly inside the bony immures of the pharyngotympanic tube. Other commonly related disease conditions with respect to nasopharyngeal cyst include the Rathke’s pouch cyst, Thornwaldt cyst from the pharyngeal bursa along with the branchial cleft cyst. Here in our study, we report a case of a 25-year-old male presented with symptoms of snoring for the past 2 years. On zero-degree endoscopic examination, a nasopharyngeal mass was seen arising from the lateral wall of the nasopharynx extending to the oropharynx. Further based on his radiological investigations, a localized non-enhancing nasopharyngeal cystic mass was seen extending from the left lateral wall of nasopharynx to oropharynx and was diagnosed as nasopharyngeal cyst. Thus, the surgical removal of the nasopharyngeal cyst has been performed through a transoral endoscopic technique with no remnants at the surgical site. The histopathological findings revealed stratified squamous epithelium with subepithelial infiltration of lymphoid follicles, thus confirming the diagnosis as branchial cleft cyst. The patient was discharged with no complications and have been periodically advised for a follow-up. Conclusively, the cyst of 2nd branchiogenic origin in the nasopharynx is extremely sporadic and till date, only a small number of cases have been reported.

Lymphoepithelial Carcinoma of the Parotid Gland: A Rare Malignant Tumour

Primary lymphoepithelial carcinoma of the parotid gland is a rare salivary gland tumour which is more common in women with an ethnic predilection. Association of Ebstein-Barr Virus with the tumour in endemic areas suggested a role of tumorigenesis in susceptible population. We report a case of 67-year-old woman who presented with a long standing, painless right parotid region swelling. The diagnosis of lymphoepithelial carcinoma of the parotid gland was made based on histopathological examination after parotidectomy and neck dissection. Metastatic nasopharyngeal carcinoma was ruled out by targeted biopsies of bilateral fossa of Rosenmuller. Surgical resection followed by postoperative radiotherapy was essential to achieve local control of disease.

Endonasal endoscopic nasopharyngectomy for nasopharyngeal malignancies: a survival analysis

IntroductionNasopharyngeal cancer has a global incidence of less than 1.0 per 100,000 person-years. It originates from nasopharyngeal mucosa with the Fossa of Rosenmuller being the most common site. Radiation therapy with or without chemotherapy is an established first-line treatment modality given the sensitivity of the tumor.ObjectivesThe aim of our study was to report survival outcomes amongst patients undergoing endonasal endoscopic nasopharyngectomy at a tertiary care referral center.MethodsWe conducted a retrospective longitudinal cohort study. We collected data on age, gender, prior treatment, histology, extent of surgery, post-operative adjuvant therapy, and recurrence and reported the survival along mean survival time using Kaplan–Meier curves and log-rank test.ResultsA total of six patients, three males and three females with a mean age of 43.7 years were included in our study. Of the six, three patients underwent a salvage procedure whereas three patients received upfront definitive surgical resection. Three patients developed recurrence with a mean survival time of 19.3 months. The disease-free survival at 1 and 2 years of surgery was 88.3% and 66% respectively.ConclusionEndonasal endoscopic nasopharyngectomy is an effective surgical procedure that can be undertaken for both salvage and primary cases. Our survival results are comparable to the literature.

Initial evaluation and external validation of 68Ga-PSMA-11 PET/CT in tubarial gland characterization

IntroductionRadiotracer 68Ga-PSMA-11 used in PET/CT scans allows for identification and localization of gland tissue. It allows for their consideration in clinical scenarios and to design further and stronger research to answer pertinent questions regarding their function and implications. We aimed to externally validate first reported findings of location, size, and ligand uptake of the tubarial glands using 68Ga-PSMA-11 PET/CT. Materials and MethodsA cross-sectional study was performed with 68Ga-PSMA-11 PET/CT studies of patients with prostate cancer confirmed diagnosis from the database of the Radiology Department from 2018 to 2022. The maximum cephalocaudal length (CCL) in the tubarial glands and the Maximum Standardized Uptake Value (SUVmax) of major glands were recorded. ResultsA total of 202 patients were included (mean age 67.43 ± 8.5). The mean CCL of the tubarial glands was 37.38 ± 9.84 and a SUVmax of 6.56 ± 2.14. The rest of the glands were as follows: parotid 15.12 ± 4.43, submandibular 16.82 ± 5.43 and sublingual 5.84 ± 3.24. No differences were found between laterality. A weak correlation between age and SUVmax of tubarial glands was identified. Tubarial glands had a similar 68Ga-PSMA-11 uptake to that of sublingual glands. ConclusionThis study corroborates the existence of a conglomerate of glands in the nasopharynx roof, near the posterolateral pharyngeal recess. It serves as validation in a different population with similar results in previous research. Without 68GA-PSMA-11 PET/CT the abundance, configuration and potential clinical relevance of these glands would probably not have been identified. Radiotracer uptake was similar amongst the major salivary glands, with a more similar uptake to that shown by the sublingual gland.

Quantitative Assessment of the Pharyngeal Recess Morphometry in Anatolian Population Using 3D Models Generated from Multidetector Computed Tomography Images

Aim: It was aimed to analyze the detailed morphometry of the pharyngeal recess (PR) using three-dimensional (3D) models reconstructed from multidetector computed tomography (MDCT) images.&#x0D; Material and Methods: This study was a retrospective analysis and performed on MDCT images of 97 patients (43 males, 54 females). 3D models of the PR were reconstructed using 3D Slicer software, enabling morphometric measurements according to established protocols. Measurements included PR depths, distances between the posterior nasal spine and torus levatorius (PNS-TL), distances between right and left TL (RTL-LTL) distances between the PNS and posterior wall of the nasopharynx (PNS-PWN), the angle (α) between the centerline of the PR and the sagittal plane. The morphologies of the PR classified into three types.&#x0D; Results: The average measurements for the parameters were as follows: PR depth - 10.42 mm, distance between PNS and TL - 10.40 mm, distance between RTL and LTL - 19.13 mm, distance between PNS and PWN - 19.92 mm, and the angle (α) - 53.65°. The prevalence of PR types was 20.62%, 47.42% and 31.96% for type 1, type 2 and type 3, respectively.&#x0D; Conclusion: Variations in reported measurements of the pharyngeal recess can be attributed to imaging techniques, patient positioning, anatomical differences, and sample sizes. The use of 3D models generated from MDCT datasets offers a high-resolution and comprehensive approach to understanding the PR's morphometry and spatial relationships, enabling accurate measurements and advancing our knowledge of this anatomical region.

A Case Report of an Atypical Situation Arising During Typical Ryle's Tube Removal Procedure.

Placement of Ryle's tube is a rather blind outpatient procedure which has documented minor and major complications during insertion like nasal irritation, epistasis, pharyngeal trauma, tracheal trauma, intravascular penetration, intracranial penetration etc. However, removal of Ryle's tube is a rather straightforward procedure with rarely any complication. In this case report, we encountered an unusual situation of Ryle's tube being kinked and stuck at Left Fossa of Rosenmuller, near the skull base with subsequent erosion, emphasising the fact that forceful removal should not be attempted. Thorough examination and meticulous removal are necessitated in a stuck/kinked Ryle's tube to prevent dreaded complications.

Overexpression of RRBP1 correlates with shorter survival time of nasopharyngeal carcinoma after radiotherapy

Nasopharyngeal carcinoma (NPC) is a kind of head and neck cancer rare in most of the world but common in some parts of the globe, including China. NPC is a common disorder in which malignant cells develop in the pharyngeal recess of the nasopharynx. However, the study aims to identify potential biomarkers or prognosis factors for detecting NPC patients with poor prognoses. In this retrospective study, we recruited 137 NPC patients who were admitted and enrolled on the Shanghai Pudong New Area Zhoupu Hospital and received radiotherapy and chemotherapy from July 2013 to December 2015. We collected samples from 137 NPC patients and performed immunohistochemical analysis. We evaluated the expression levels of Ribosome-binding protein 1 (RRBP1) in tissues of nasopharyngeal carcinoma (NPC) and non-tumor tissues by immunohistochemistry. High RRBP1 was closely related to tumor size, lymphatic invasion, distant metastasis, and TNM stage. The RRBP1 expression level significantly correlated with decreased overall survival (OS) and progression-free survival (PFS) of NPC patients. RRBP1 expression levels correlate with the progression and prognosis of NPC patients after radiotherapy. Therefore, RRBP1 could be a potential biomarker for NPC patients with a higher risk of poor prognosis.

Tubarial Salivary Gland – The New Member of Nasopharynx

Tubarial Salivary Gland – The New Member of Nasopharynx

Imaging Recommendations for Diagnosis, Staging, and Management of Nasopharynx Carcinoma

AbstractNasopharyngeal carcinoma (NPC) is an epithelial carcinoma originating from lining of the nasopharyngeal mucosa usually at the fossa of Rosenmuller (pharyngeal recess). An early detection on endoscopy can be rewarding, however, often difficult as the tumor at the pharyngeal recess is hidden from the endoscopic view. Magnetic resonance imaging and positron emission tomography–computed tomography form the backbone of detection and spread of the carcinoma into local and distant regions. These modalities help further characterize the precise locoregional infiltration and lymph nodal involvement which aids in the planning of the surgery/chemoradiotherapy. They also help in the follow-up evaluation and further management strategies. Many research and treatment groups namely American Joint Committee on Cancer, National Comprehensive Cancer Network, American Society of Clinical Oncology, American College of Radiology, Radiological Society of North America, European Society of Radiology (iGuide), Indian Radiological &amp; Imaging Association/Indian College of Radiology and Imaging, National Cancer Grid, etc. have devised guidelines for the optimal assessment and treatment of NPC. The present document aims at providing a comprehensive review of the clinicoradiological recommendations for the diagnosis and management of NPC based on these guidelines as well as personalized experience of the contributors.

Nasopharynx evaluation in children of unilateral cleft palate patients and normal with cone beam computed tomography.

This study aimed to examine the morphological characteristics of the nasopharynx in unilateral Cleft lip/palate (CL/P) children and non-cleft children using cone beam computed tomography (CBCT). A retrospective study consisted of 54 patients, of which 27 patients were unilateral CL/P, remaining 27 patients have no CL/P. Eustachian tubes orifice (ET), Rosenmuller fossa (RF) depth, presence of pharyngeal bursa (PB), the distance of posterior nasal spine (PNS)-pharynx posterior wall were quantitatively evaluated. The main effect of the CL/P groups was found to be effective on RF depth-right (p < 0.001) and RF depth-left (p < 0.001). The interaction effect of gender and CL/P groups was not influential on measurements. The cleft-side main effect was found to be effective on RF depth-left (p < 0.001) and RF depth-right (p = 0002). There was no statistically significant relationship between CL/P groups and the presence of bursa pharyngea. Because it is the most common site of nasopharyngeal carcinoma (NPC), the anatomy of the nasopharynx should be well known in the early diagnosis of NPC.

Efficacy and safety of a treatment in patients with locoregionally advanced nasopharyngeal carcinoma (LANC) involving carotid artery invasion.

Locally advanced nasopharyngeal carcinoma (LANC) often invades the parapharyngeal space and internal carotid artery. Are patients with LANC invading carotid artery are at risk of massive neck hemorrhage after radiotherapy? This retrospective study included 130 LANC patients with carotid artery invasion admitted to our hospital between January 2012 and September 2019. All patients were treated with induction chemotherapy followed by concurrent chemoradiotherapy (CCRT) ± epidermal growth factor receptor (EGFR) inhibitor. Univariate and multivariate analysis of risk factors were conducted for the prognosis and the occurrence of massive neck hemorrhage of LANC patients with carotid artery invasion. The 5-year progression-free survival (PFS), distant metastasis-free survival (DMFS), local nodal recurrence-free survival (LNRFS), local recurrence-free survival (LRFS), nodal recurrence-free survival (NRFS) and overall survival (OS) of the 130 patients were 75.2%, 76.8%, 90.0%, 93.9%, 95.8% and 87.2%, respectively. The incidence of fatal bleeding after radiotherapy was 2.3% (3/130). The primary site of the three cases were all the pharyngeal recess, with more than 270° carotid artery invasion, suffering nasopharyngeal necrosis after radiotherapy (2 of which were diabetics and 1 received re-radiation after recurrence). Univariate analysis showed that clinical stage was negatively correlated with DMFS and PFS (P < 0.05). The induction chemotherapy TP regimen, platinum-based concurrent chemotherapy and EGFR inhibitors (Nituzumab/Cetuximab) significantly improved PFS and DMFS (P < 0.05). Patients with hemoglobin levels > 110g/L had significantly inferior PFS, DMFS and OS than those with hemoglobin levels ≤ 110g/L (P < 0.05). Multivariate analysis showed that the EGFR inhibitor was an independent risk factor for PFS and DMFS, while the lowest hemoglobin level was an independent risk factor for OS. In LANC patients whose carotid artery invasion was < 270°, induction chemotherapy (IC) followed by helical tomotherapy (HT) and concurrent chemoradiotherapy (CCRT) with EGFR (epidermal growth factor receptor) inhibitor had mild and tolerable side effects, better PFS and DMFS, with no massive hemorrhage. In patients whose primary tumor was pharyngeal recess with carotid artery invasion ≥ 270°, poorly controlled diabetes or re-radiotherapy led to a higher risk of massive hemorrhage after radiotherapy.

Comparative braincase morphology of Trilophosaurus buettneri and the early evolution of the pan-archosaurian neurocranium

ABSTRACT The relative scarcity of well-preserved fossils from the earliest history of stem lineages often limits our ability to establish robust, broad-based evolutionary patterns. This is certainly the case for the pan-radiation of archosaurs whose earliest stem taxa remain poorly understood relative to the crownward archosauriforms. Trilophosaurus buettneri is a North American Triassic stem archosaur that lies near the base of this expansive pan-radiation. We used CT to study the Trilophosaurus braincase with the goal of elucidating the early pan-archosaur neurocranium and its evolution. Results clarify several problematic characters including variable fusion of the exoccipital, absence of contralateral exoccipital contact, lack of a semilunar depression, and several others. These novel scorings fail to alter most currently accepted tree topologies, but the results are detailed. These data also include the phylogenetically earliest evidence of neurocranial pneumatization among pan-archosaurs, including a parabasisphenoid cavity that is positionally homologous to the median pharyngeal recess of crown archosaurs. These data are not without their problems, but they do allow us to hypothesize the earliest transformations in what became a much more extensive character system in crown archosaurs. Multiple autapomorphies suggest Trilophosaurus was capable of a derived behavioral repertoire, but details remain unclear. For example, Trilophosaurus bears a theropod-like elongation of the anterior semicircular canal but lacks the associated expansion of the lateral canal thought to facilitate bipedality in that group. Our data clarify plesiomorphic conditions for later archosaurian transformations while promoting the hypothesis that pan-archosaurs achieved marked structural and behavioral disparity early in their history.

Nasopharyngeal Carcinoma with Dural Metastasis Masquerading as Meningioma

Nasopharyngeal carcinoma (NPC) is one of the commonest head and neck malignancies in South East Asia. The tumor arises from epithelial layer of the nasopharynx, found most frequently at the Fossa of Rosenmuller (FOR). NPC can spread to its adjacent structures and cause distant metastasis. However, the occurrence of dura metastasis is uncommon despite being closely located. Consequently, a lesion of the dura may be misdiagnosed as meningioma, especially when it presents with a dural tail sign in the Magnetic Resonance Image (MRI). We reported a case of a 48-year-old lady with progressive right eye diplopia and blurry of vision which later on MRI noted an extensive base of skull mass at the petroclival, suprasellar and orbital apex with adural tail Meningioma was the primary diagnosis until tissue biopsy of the nasopharynx and posterior part of inferior turbinate later revealed as nasopharyngeal carcinoma, non-keratinizing type.

Applicability of Transnasal Echography for Identification of Internal Carotid Artery.

To study the applicability of transnasal echography for the internal carotid artery (ICA) imaging during endoscopic procedures, primarily nasopharyngectomy. Non-randomized controlled cohort. The tip of a pediatric transducer for transesophageal echography was inserted into each nostril under endoscopic control and placed in the ipsilateral Rosenmuller's fossa. The ICA's internal diameter and distance between the nasopharyngeal wall and the artery's closest point were measured on each side. Two independent examiners measured the same parameters on the axial plane of the skull base computer tomography (CT). Agreement between CT and echography measurements was estimated by the Bland-Altman approach. Twenty-seven ICAs (sides) were available for the echography-CT agreement analysis. Inter method agreement for both parameters was similar to the inter examiner agreement for the CT measurements. Our first study on endoscopic echography demonstrated that this method is applicable, potentially allowing safer transnasal surgery in the ICA vicinity. 3 Laryngoscope, 132:1184-1188, 2022.

A Stony Coincidence in the Nose Mimicking Nasopharyngeal Carcinoma

The number of adult cases of rhinolith is uncommon. Rhinoliths are hard stony mass that are found in the nose that can progress over a long period of time leading to nasal symptoms and sometimes ear symptoms. This is a case report of a 40-year-old lady that came with unilateral tinnitus and blood stained rhinorrhea, but on further investigation was found to have rhinolith mimicking symptoms of nasopharyngeal carcinoma due to the position of the rhinolith in the fossa of Rosenmuller.

An extremely rare malignant tumour of nasopharynx: primary nasopharyngeal non salivary type adenocarcinoma

&lt;p&gt;Adenocarcinoma is commonly found in lung, prostate and gastrointestinal tract. Nasopharyngeal part contributes a very small percentage of adenocarcinoma as the most common histopathology found here is squamous cell carcinoma. We present a case of nasopharyngeal adenocarcinoma which is a very rare clinical presentation. This is 35 years old Iban gentleman, with underlying retroviral disease, hepatitis B on treatment, presented with right neck swelling for 3 months associated with right ear fullness. Examination showed unilateral right level II neck swelling and nasal endoscopy showed mass arising from right fossa of Rosen muller (FOR). The investigation done includes biopsy of right FOR and biopsy of right neck swelling with contrast enhanced computed tomography of neck, thorax and abdomen. The result of right FOR biopsy is non intestinal type adenocarcinoma, and biopsy of right neck swelling is reported as metastatic undifferentiated carcinoma. CECT NTAP showed asymmetry with fullness of right FOR associated with right level II cervical lymphadenopathy. Our centre managed this case with surgical intervention and patient underwent endoscopic nasopharyngectomy, and planned for right modified radical neck dissection (MRND). Patient defaulted our follow up after operation and was not keen for neck dissection surgery. He presented the second time with bilateral neck swelling and underwent chemotherapy and defaulted the follow up thereafter again. In conclusion the approach in treatment for nasopharyngeal carcinoma (NPC) and sino-nasal adenocarcinoma differs whereby the cornerstone management for the latter one is surgical intervention compared to the former which is radiotherapy. Hence early detection and treatment is essential.&lt;/p&gt;

THE ANATOMICAL AND MEASUREMENT STUDY OF ROSENMÜLLER FOSSA AND OROPHARYNGEAL STRUCTURES USING CONE BEAM COMPUTED TOMOGRAPHY.

The objective of this study was to assess Rosenmüller fossa (RF) anatomy and neighboring structures using cone beam computed tomography (CBCT). A total of 1000 patients were analyzed using CBCT. The reference points were based on the spina nasalis posterior (Snp) and basion. The length between RF and neighboring structures were measured.The mean distance from Snp to the posterior pharyngeal wall was 17.7 mm. The mean distance from right to left torus levatorius was 25.69 mm. The mean depth of right RF was 5.54 mm while the mean depth of left RF was 5.26 mm. RF, also described as the lateral pharyngeal recess, is a source location of nasopharyngeal carcinoma development. Its location is on the lateral pharyngeal wall posterior to the cartilaginous part of the eustachian tube, the torus tubarius. The knowledge of RF is important to diagnose and perform treatment planning of nasopharyngeal carcinoma.

Nasopharyngeal carcinoma: A new synthesis of literature data (Review).

Nasopharyngeal carcinoma (NPC) is an epithelial tumor, which develops most frequently from the lateral pharyngeal recess and holds some complex epidemiological characteristics. Its unusual race and geographic distribution suggests that not only the environmental factors are a contributing factor to the development of this rare cancer type, but also the genetic traits play an important role, along with nitrosamine-containing food consumption and Epstein-Barr virus infection. The signs and symptoms which a patient can present and suffer from are various and include nasal, otic, neurological as well as general ones; the way this tumor manifests being dependent on the stage of the tumor. The therapeutic management applicable in NPC needs to be established according to the case of the patient and include radiotherapy, chemotherapy, surgery, immune therapy, targeted therapy or combined treatment. The main objective of the treatment is local and regional tumor control; relapse is an important factor for future development of distant metastases. New therapeutic concepts are always sought of, current research focusing on precision medicine, meaning systemic treatment with a personalized radiotherapy approach according to the characteristics of the tumor.