Tornwaldt's Cyst Research Articles

Anomalies of the clivus of interest in dental practice: A systematic review.

PurposeThe clivus is a region in the anterior section of the occipital bone that is commonly imaged on large-volume cone-beam computed tomography (CBCT). There have been several reports of incidental clivus variations and certain pathological entities that have been attributed to the variations. This study aimed to evaluate the effects of these variations within the scope of dentistry.Materials and MethodsMedical databases (PubMed, Scopus, and Web of Science) were searched using a controlled vocabulary (clival anomalies, cone-beam CT, canalis basilaris medianus, fossa navicularis magna, clival variation). The search was limited to English language, humans, and studies published in the last 25 years. The articles were exported into RefWorks® and duplicates were removed. The remaining articles were screened and reviewed for supporting information on variations of the clivus on CBCT imaging.ResultsCanalis basilaris medianus and fossa navicularis magna were the most common anomalies noted. Many of these variations were asymptomatic, with most patients unaware of the anomaly. In certain cases, associated pathologies ranged from developmental (Tornwaldt cyst), to acquired (recurrent meningitis). While no distinct pathognomonic aspects were noted, there were unique patterns of radiographic diagnosis and treatment modalities. Most patients had a normal course of follow-up.ConclusionInterpretation of CBCT volumes is a skill every dentist must possess. When reviewing large-volume CBCT scans, the clinician should be able to distinguish pathology from normal anatomic variations within the skull base. The majority of clivus variations are asymptomatic and will remain undetected unless incidentally noted on radiographic examinations.

Endoscopic Management of a Large Tornwaldt Cyst: A Case Report

ABSTRACT
 Objective: To report successful marsupialization of a large Tornwaldt cyst using combined transnasal and transoral endoscopic surgery in a 7-year-old girl who presented with nasal obstruction.
 Methods:Design: Case ReportSetting: Tertiary Government Training HospitalPatient: One
 Result: A 7-year-old girl presented with an 11-month history of recurrent yellowish nasal discharge gradually associated with nasal obstruction. Examination revealed a large, well encapsulated, broad-based cystic mass in the nasopharynx immediately adjacent to the posterior choanae, continuing posterior to the soft palate (pushing the uvula anteriorly) and extending inferiorly to the epiglottic area. Computerized Tomography (CT) demonstrated a well-circumscribed, midline hypodense mass with fluid attenuation obstructing the nasopharyngeal area extending inferiorly to the oropharyngeal area. Endoscopic marsupialization via transnasal and transoral approach was successful, and a respiratory epithelium-lined cyst consistent with a Tornwaldt cyst was confirmed by histopathologic examination
 Conclusion: Combined transnasal and transoral endoscopic marsupialization is possible a for a large symptomatic Tornwaldt cyst in a pediatric patient with relatively smaller and complex nasal cavities.

JOURNEY OF THE NOTOCHORD: LINKING EMBRYOLOGY TO RADIOLOGIC INTERPRETATION OF THE CRANIOCERVICAL JUNCTION

<h3>Background</h3> The notochord is a mesoderm-derived cylindrical midline structure and a defining feature found in all chordates. In vertebrates, the notochordal process represents the initial embryologic axial skeleton and plays important structural and signaling roles in the development of the vertebral column, nervous system, and skull base. Besides persisting postnatally as the nucleus pulposus of the intervertebral disks, the remaining notochord typically regresses during fetal development after completion of its principal tasks. However, remnants of the notochord can persist along its developmental path within the craniocervical region. These remnants present as a spectrum of entities, ranging from anatomic variants, benign tumors, and malignant neoplasms of notochordal origin. Radiologists who interpret imaging in the area along the embryologic path of the notochord should be knowledgeable about its development and be able to recognize its wide array of potential pathologies. <h3>Discussion</h3> This presentation will review notochord embryology and the anatomic and pathologic relevance of notochordal remnants and demonstrate the vast range of imaging features and behavioral properties of these postnatal remnants in the area of the posterior cranial base and cervical spine. We present 3 cases of inferior median clival canal, a notochordal anatomic variant typically discovered as an incidental finding. Also known as <i>canalis basilaris medianus</i>, this notochord remnant manifests as a narrow, well-defined corticated canal passing through the sagittal plane of the clivus. Depending on its course and extent, 2 groups with 6 subtypes have been described. We also present imaging features of pathologic abnormalities, including Tornwaldt cyst, benign remnant ecchordosis physaliphora, and chordoma, a notochord malignancy. Awareness of the full spectrum of pathologic consequences of persistent notochord tissue, recognition of their imaging features, and directing appropriate referral add to the value provided by an oral and maxillofacial radiologist.

Know Your Notochord: A Pictorial Review of Notochord Remnants

Notochord formation begins between the third and fourth weeks of embryonic development. As the axial skeleton develops, the notochord regresses and eventually contributes to the formation of the nucleus pulposus of the intervertebral disks. Notochord regression can be variable, especially at the 2 poles of the skeleton, which results in the persistence of ectopic notochordal remnants. These remnants include benign entities (eg, ecchordosis physaliphora, benign notochordal cell tumor, Tornwaldt cyst, canalis basilaris medianus, fossa navicularis) or malignant lesions (eg, chordoma). We present a review of these lesions, their clinical presentations, and their typical radiographic appearances. Notochord remnants may have overlapping features in terms of their location and appearance; however, differentiation is crucial because the proper treatment and management may differ drastically. Familiarity with notochord development aids in understanding the characteristic locations of notochordal remnants. Noting the unique imaging findings of notochordal remnants can often help narrow the differential diagnoses.Learning Objective: To describe notochord development, normal regression during fetal life, and notochord remnants that give rise to anatomic variants, including benign and malignant lesions.

PARAPHARYNGEAL AND RETROPHARYNGEAL SPACES: NORMAL ANATOMY AND CASE DISCUSSION

<h3>Background</h3> An appreciation of the complex anatomy of potential spaces and fascial planes of the neck is vital to understanding lesions and their potential complications. The involvement of the parapharyngeal space (PPS) and the retropharyngeal space (RPS) poses significant diagnostic and therapeutic problems. The PPS extends from the skull base to the superior cornu of the hyoid bone, connecting posteromedially with the retropharyngeal space, inferiorly with the submandibular space, and laterally with the masticator space. The carotid sheath courses through this space into the chest. RPS lies between the visceral division of the middle layer of the deep cervical fascia around the pharyngeal constrictors and the alar division of the deep layer of deep cervical fascia posteriorly. PPS contains mainly fat and the pterygoid venous plexus, whereas the RPS contains retropharyngeal lymphatics. <h3>Clinical and Radiologic Findings</h3> We outline the normal anatomy of the PPS and the RPS on images derived from cone beam computed tomography (CBCT), medical computed tomography (CT), and magnetic resonance imaging (MRI) data sets. Then we present unique case studies exhibiting pharyngeal retention cyst in the tonsil, Tornwaldt cyst in the nasopharynx, nasopharyngeal carcinoma with invasion of the PPS, incidental retropharyngeal internal carotid arteries that can be mistaken for a pseudomass, large goiter with retropharyngeal extension, retropharyngeal air in barotrauma, and retropharyngeal lymphadenopathy occupying the PPS. <h3>Discussion/Conclusions</h3> Displacement of the PPS laterally implicates a lesion in the pharyngeal mucosa posteriorly, the masticator space anteriorly, and the carotid space anterolaterally. Medial displacement implies that the lesion resides in the parotid space. Infection may enter the retropharyngeal airspace directly, as with traumatic perforations of the posterior pharyngeal wall or esophagus, or indirectly, from the parapharyngeal space A fundamental skill set is required for the diagnosis and management of these potentially life-threatening illnesses.

The Tornwaldt cyst

We report the case of a patient who presented otological and neurological symptoms; an endoscopic examination has objectified formation of the nasopharynx and the imaging has confirmed the cystic nature of this formation compatible with a Tornwaldt cyst. This lesion is quite rare, benign and often asymptomatic, its knowledge is important to eliminate other malignant causes and invasive management.

Tornwaldt Cyst: A Case Report Of Unusual Dental Symptoms

Introduction: Tornwaldt's (Thornwaldt's) or nasopharyngeal cyst is an uncommon developmental benign cyst located in the midline postero-superior wall of nasopharynx. Incidence reported in general population is 0.06%. It occurred in the potential space due to outpouching of ectoderm into the pharyngobasilar fascia at the site where notochord attached to pharyngeal ectoderm. The cyst developed when the epithelial lining of the pouch secrets mucous following recurrent infection or trauma of the nasopharynx. Although majority of the cases are asymptomatic, patients may present with clinically-significant nasal, ear or cervical symptoms. Thus, most of Tornwaldt cyst cases were reported under otorhinolaryngology (ORL)-associated journals. However, patient presented with dental symptoms has never been reported before. This case is the first one as such to be reported.

Nasopharyngeal Cystic Lesions

Nasopharyngeal cystic lesions are commonly encountered on magnetic resonance imaging with significantly overlapped imaging characteristics. The purpose of this study was to determine the prevalence and distinguishing imaging features of cystic lesions in the nasopharynx in the largest patient series to date. After institutional review board approval, consecutive head magnetic resonance images of 3000 patients performed at 1.5 T between June 2010 and April 2011 were retrospectively reviewed for cystic nasopharyngeal lesions. Location, size, and signal characteristic of cystic lesions were recorded. Electronic medical records were reviewed for patient demographics, symptoms, and underlying conditions. Among 3000 patients, 6% had Tornwaldt cysts (peak prevalence, 51-60 years old) and 10% had mucous retention cysts (peak prevalence, 41-50 years old). A significant correlation between human immunodeficiency virus infection and mucous retention cysts was observed (P < 0.001). The prevalence of Tornwaldt cysts was slightly higher than previously described in the literature. Additionally, younger and older patients had the lowest prevalence of Tornwaldt cyst, suggesting these lesions are acquired and subsequently involute with time. A significant correlation was observed between human immunodeficiency virus infection and mucous retention cysts.

Paroxysmal Nocturnal Hemoglobinuria and Magnetic Resonance Imaging

Paroxysmal Nocturnal Hemoglobinuria (PNH) is a rare and complex disease characterized by a severe prothrombotic state caused by a complement system mediated hemolysis. The introduction of the anti-C5 antibody, Eculizumab, has been conducted in many Hematology units worldwide to adopt new diagnostic tools to evaluate new and old PNH patients in order to consider the adequacy of the adoption of this new drug in each case.Magnetic Resonance Imaging (MRI) allows a more adequate and profitable approach in PNH that other radiology techniques used for this purpose. In the last four years Hematology and Radiology units in our Hospital have collaborate in the clinical evaluation of PNH patients performing MRI (cranioencephalic, thoracic and/or abdominal) in acute complications of PNH patients (9 patients) or as a programmed protocoled evaluation previous to consider Eculizumab treatment (14 patients).The protocoled evaluation consists in thoracic and abdominal MRI evaluations in all cases, and cranioencephalic MRI (with independence of the presence of neurological symptoms) in 9 cases. The PNH patients were examined with 1.5 Teslas magnet for cranioencephalic,thoracic and abdominal MRI and with 3.0 Teslas magnet for some cranioencephalic MRI (Achieva Magnets; Philips Healthcare, Best, The Netherlands).Different protocols designed for the study of this pathology, using morphological sequences with different empowerment, functional sequences and angiographic studies after administration of intravenous contrast (gadobutrol) have been used. In the abdominal explorations had been performed calculations of T2 * for the quantification of deposit of iron in liver and kidney.The first group of patients (incidental studies in acute/chronic situations) included Classical and with other bone marrow failure syndrome (BMFS) Parker's types. The second group (protocoled studies previous consideration of Eculizumab therapy) consisted on 11 Classical Parker's type patients with active hemolysis (LDH increased 3-13 times over normal levels) and elevated PNH clone (73-99% negative GPI granulocytes by FLAER cytometry); and 3 with BMFS Parker's type patients (LDH increased 2-6 times over normal levels) with lower PNH clone (43-50% negative GPI granulocytes by FLAER cytometry). Thrombosis was found in four cases, one in the inferior cava and and three arterial (two cerebral and one in descendent aorta). In three patients this finding implied to initiate Eculizumab therapy. Minor ischemic brain changes were displayed by three patients. None of the eighteen patients explored with thoracic MRI, displayed pulmonary hypertension signs despite the elevation of pro-BNP in eight of them. Iron overload in the liver and/or kidneys were very frequent. The finding of a reversal of the normal cortical and medullary intensities on T1 and T2 weighted images of both kidneys was evident in the majority of patients with severe PNH types. Interestingly, one patient with a chronic PNH severe form displayed no renal iron cortical after two years on Eculizumab therapy. This finding was also evident in patients with active hemolysis in the past but with very low PNH clones and clinical remission of the disease.Many other incidental discoveries includes cholelithiasis, splenomegaly, kidney arterial vessel constriction, vascular anomalies, kidney and vesical stones, adrenal adenoma, atheromatosis at different levels, Tornwaldt cyst, hamartoma, hemangiomas and abnormal bone marrow signal.MRI is the best imaging technique to diagnose thrombosis in PNH patients and to control evolution. Moreover, in the cerebrovascular setting allows a more fine and precise diagnosis of the minor pathologic thrombotic changes. MRI is the only imaging technique that permits to evaluate the iron overload that in some PNH cases could be underestimated and needs quelation therapy. In our opinion all new patients with classical severe hemolytic PNH must be evaluated prospectively with MRI. The collaboration of the Radiology team with the Hematologist is fundamental to acquire expertise in this rare disease. Disclosures:Pastrana:Alexion Pharmaceuticals: Speakers Bureau. Ojeda:Alexion Pharmaceuticals: Consultancy, Speakers Bureau.

MR imaging of the Tornwaldt's cyst: retrospective study of 1300 patients

Tornwaldt's cyst is a benign developmental lesion of the nasopharynx, most of all midline located, originating from an outpouching of the pharyngeal mucosa caused by notocord retraction. Usually, the cyst represents an incidental finding of magnetic resonance study. The purpose of this study is to investigate the differential diagnostic aspects of Tornwaldt's cysts, making a comparison with other diseases of nasopharynx on the basis of morphological characteristics and signal, contributing to the previous statistical works.

Embryologic Association of Tornwaldt's Cyst with Cerebral Artery Abnormalities and Infarction: A Case Report.

Background and Purpose. Tornwaldt's cysts are rare nasopharyngeal lesions that develop from remnants of the embryonic notochord. Summary of Case. We reported a twelve-year-old female stroke patient with Tornwaldt's cysts, whose father also suffered a stroke at age fifty two with the presence of an abdominal aortic aneurysm, suggesting a genetic influence in this case. Conclusions. This paper suggests an etiologic connection between Tornwaldt's cysts and cerebral vasculature abnormalities by way of notochordal dysfunction during development, likely the result of perturbation of notochord-derived molecular cues during development or biogenesis.

Not the typical Tornwaldt's cyst this time? A nasopharyngeal cyst associated with canalis basilaris medianus

We report a patient with a cystic structure in the nasopharynx mimicking a Tornwaldt's cyst, which was felt to represent a different entity owing to the lack of the distinct features of a typical Tornwaldt's cyst. It was associated with a bony cleft in the basiocciput that was considered to be a canalis basilaris medianus (CBM), thought to represent an embryological vestige of the cephalic end of the notochord along its course within the basiocciput.

Tornwaldt Cyst: A Cause of Neck Pain and Stiffness

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 (2.5×2cm). 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 bursitis: from embryology to clinical presentation

Nasopharyngeal bursitis is a relatively rare syndrome characterized by a collection of symptoms that multidisciplinary specialists should be aware of. Here we present an audit of cases presenting to a rhinology clinic over a two-year period, as well as an overview of the relevant embryology and different clinical presentations of nasopharyngeal bursitis. For 2008–2009, six patients were diagnosed to have nasopharyngeal bursitis, including four males and two females, of mean age 54 years. Two distinct pathologic types were observed, comprising three patients with classical Tornwaldt’s cyst and three with crust-type bursitis. This audit highlights the importance of recognition of the crust-type of nasopharyngeal bursitis and its anatomic and clinical features. A combined endonasal and transoral endoscopic approach is a minimally invasive procedure and an effective method of treating both types of the disease. Our findings are discussed in relation to the embryology of the disorder, with a clinical emphasis on crust- type nasopharyngeal bursitis.

Endoscopic Drainage of Tornwaldt's Cyst

Endoscopic Drainage of Tornwaldt's Cyst

Tornwaldt's cyst: Clival erosion with reconstitution after treatment

Tornwaldt's cyst: Clival erosion with reconstitution after treatment

Tornwaldt's cyst: Clival erosion with reconstitution after treatment

Tornwaldt's cyst is an uncommon midline nasopharyngeal cyst that arises from the pharyngeal bursa (pouch of Luschka) on the posterior nasopharynx. The pharyngeal bursa is the remnant of a communication between the nasopharynx and the notochord. Occlusion of this communication results in the formation of Tornwaldt's cyst. Development of these cysts has been linked to scarring from prior adenoidectomy and nasopharyngeal inflammation (Boucher et al, 1990 [1] ). Often these cysts are found incidentally on rhinoscopy, computerized tomography (CT) or magnetic resonance imaging (MRI). However Tornwaldt's cysts, like other nasopharyngeal cysts, may become symptomatic once they become large or infected. Clinical symptoms of nasopharyngeal cysts may include fullness in the ear, tinnitus, nasal obstruction, dysphagia, dysarthria, dysphonia, odynophagia, halitosis, cephalgia, or stiffness of cervical muscles (Weissman, 1992 [2] ; Miyahara and Matsunaga, 1994 [3] ). This case report of a 6-year-old female with severe cephalgia and a Tornwaldt's cyst serves as a reminder that these cysts can be a cause of many symptoms seen in daily clinical practice. An unusual finding of cortical destruction of the clivus was noted in this case and thought to be associated with the Tornwaldt's cyst. Upon literature review, no prior cases of cortical destruction from a Tornwaldt's cyst have been noted.

Tornwaldt's Cyst Presenting Only As Occipital Headache: A Case Report

Tornwaldt's cyst (sometimes called Thornwaldt's cyst) is a rare cause of occipital headache. Owing to the rare occurrence of occipital headache as a symptom of Tornwaldt's cyst, if the patient presented only with occipital headache, this clinical symptom may be falsely perceived as a sign of neurologic disease leading to time-consuming diagnostic examinations that delay the establishment of a correct diagnosis.

Tornwaldt's Cyst: Incidence and a Case Report

Tornwaldt's cyst is an uncommon type of nasopharyngeal cyst that may cause clinically significant symptoms. We reviewed reports of 31,855 computed tomography (CT) scans and 21,158 magnetic resonance imaging (MRI) scans to ascertain how many Tornwaldt's cysts were discovered incidentally. These images had been obtained between Jan. 1, 1994, and Dec. 31, 1999, at the University of Virginia Health Sciences Center. We found that 32 Tornwaldt's cysts had been incidentally detected in 20 women and 12 men. Four of these cysts had been found on CT (0.013%; mean size: 0.66 cm3) and 28 on MRI (0.13%; mean size: 0.58 cm3). The overall rate was 0.06% (32/53,013). The most common indications for imaging in these patients were headache, seizures, dizziness/vertigo, and pharyngeal symptoms. We also report the case of a patient with a symptomatic Tornwaldt's cyst whose symptoms resolved after treatment with endoscopic marsupialization. Tornwaldt's cyst should be remembered as an uncommon but potentially treatable cause of many symptoms seen in a typical otolaryngology practice.

Tornwaldt's cyst formation after concurrent chemoradiotherapy for nasopharyngeal carcinoma

The complications of concurrent chemoradiotherapy for nasopharyngeal carcinoma include dryness of mouth, sensorineural hearing loss, dental caries, trismus, pituitary dysfunction, myelitis, paralysis of cranial nerves IX-XII, massive neck fibrosis and pharyngeal wall necrosis. Tornwaldt's cyst formation after concurrent chemoradiotherapy for nasopharyngeal carcinoma has not been reported previously in the world literature. Tornwaldt's cyst, a persistent pharyngeal bursa, is found in about 3 per cent of the adult population, although the majority of these are asymptomatic. We describe the previously unreported complication of Tornwaldt's cyst formation after concurrent chemoradiotherapy for nasopharyngeal carcinoma.