Tornwaldt's disease is the inflammation or abscess of the embryonic

cyst A cyst is a closed sac, having a distinct envelope and division compared with the nearby tissue. Hence, it is a cluster of cells that have grouped together to form a sac (like the manner in which water molecules group together to form a bubble) ...

of pharyngeal bursa. It is located in the midline of the posterior wall of the

nasopharynx The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and trachea (the tubes going down to the stomach and the lungs). It is found in vertebrates and invertebrates, though its struct ...

. It is covered anteriorly by mucosa in the adenoid mass. It is bounded posteriorly by longus muscle.

Signs and symptoms

The symptoms usually appear when there is inflammation of pharyngeal bursa causing

Tornwaldt cyst A Tornwaldt cyst also spelt as Thornwaldt or Thornwald cyst is a benign cyst located in the upper posterior nasopharynx The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and tr ...

. This is caused by spontaneous drainage in the nasopharyngeal cavity or because of involvement of nervous plexus. The symptoms are occipital headache, cough, middle ear effusion, cervical myalgia, and halitosis, i.e. bad breath. When there is an enlargement of the cyst, it causes symptoms like nasal obstruction, post-nasal discharge with foul-smelling odour, blockage of the Eustachian tube causing

otalgia Ear pain, also known as earache or otalgia, is pain in the ear. Primary ear pain is pain that originates from the ear. Secondary ear pain is a type of referred pain, meaning that the source of the pain differs from the location where the pain ...

and secretory otitis media, retro-orbital pain.

Cause

Tornwaldt's disease is caused by many different causative agents of stimulus. This includes excessive alcohol and tobacco, which causes a decrease in local immune resistance so the pathogenic microbes take advantage, leading to the disease. Frequent contact with high temperature, malnutrition, chronic heart disease, kidney disease, joint disease, poor living and working conditions and contact with dust and harmful gases leads to Tornwaldt's disease.

Pathogenesis

Tornwaldt's disease is a rare benign disorder caused by persistent notochord remnants. This disease almost remains asymptomatic. At about the 10th week of embryonic development, the pharyngeal pouch forms by adhesion of the pharyngeal ectoderm to the cranial end of the notochord. This become closed at the orifice or crusts adhere to the orifice without closing. The contact between these remnants and pharyngeal ectoderm leads to the growth of respiratory epithelium. This forms Tornwaldt's bursa which drains into the nasopharyngeal cavity. This only forms a cyst when the orifice is partially or completely obstructed by infection. A Tornwaldt's cyst progresses to Tornwaldt's disease only after infection or inflammation occurs.

Diagnosis

A CT scan shows a solid mass of Tornwaldt's cyst and

MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves ...

shows a glass-shaped lesion with fluid on the upper part of the posterior nasopharyngeal wall. Additionally, a cystic mass in the upper part of the nasopharyngeal wall and mucopurulent discharge from upper part of the mass can be seen on nasal

endoscopy An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are inse ...

. Among them MRI is the best for diagnosing the Tornwaldt's cyst.

Treatment

Antibiotics are given to treat the infection. If there is a large symptomatic lesion, surgery by transnasal endoscopic marsupialisation is the treatment option because it is safe, fast and provides good visualization during surgery. For small lesions, the endonasal approach is recommended.

History

Tornwaldt's disease was noted by Mayer in 1840. He noted it in an autopsy specimen but founded as a

pathologic ''Pathologic'' ( rus, Мор. Утопия, Mor. Utopiya, ˈmor ʊˈtopʲɪjə, , More. Utopia – a pun on Thomas More's ''Utopia'' and the Russian word for "plague") is a 2005 role-playing and survival game developed by Russian studio Ice-Pic ...

entity by German physician Gustavus L. Tornwaldt in 1855. Only a few cases have been reported in Japan between 1929 and 1992. In 2008–2009, six patients were diagnosed to have

nasopharyngeal The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and trachea (the tubes going down to the stomach and the lungs). It is found in vertebrates and invertebrates, though its struct ...

bursitis, of which four were male and two female.

References

External links

{{Medical resources , ICD10 = j39.2 , ICD9 = 478.26 , ICDO = , OMIM = , DiseasesDB = , MedlinePlus = , eMedicineSubj = , eMedicineTopic = , MeSH = , GeneReviewsNBK = , GeneReviewsName = , Orphanet = Pharynx Cysts