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Adult Thornwalt Cyst: A Rare Case Report.

Sachin Gandhi¹, Shradha Saindani¹, Renuka Mundalik¹

¹Department of E. N. T, Deenanath Mangeshkar Hospital, Pune, India.

Indian Journal of Otolaryngology and Head and Neck Surgery : Official Publication of the Association of Otolaryngologists of India

|October 8, 2024

Summary

Thornwaldt cysts, rare congenital nasopharyngeal masses, can cause obstructive symptoms in adults. Surgical excision via transnasal marsupialization effectively relieved symptoms in a 35-year-old male patient.

Keywords:

Benign nasopharyngeal cyst MRI-scan Marsupialisation Nasal obstruction Thornwaldt cyst

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Area of Science:

Otolaryngology
Head and Neck Surgery
Radiology

Background:

Nasopharyngeal cysts, particularly Thornwaldt cysts, are rare benign entities.
Typically asymptomatic and incidentally found on MRI, larger cysts can cause obstructive symptoms.
Thornwaldt cysts arise from notochord remnants in the midline nasopharynx.

Purpose of the Study:

To report a unique case of a large Thornwaldt cyst presenting with diverse symptoms in an adult male.
To highlight the diagnostic utility of diagnostic nasal endoscopy (DNE) and MRI.
To describe the successful surgical management and follow-up of this rare condition.

Main Methods:

A 35-year-old male presented with nasal blockage, discharge, snoring, ear pain, and neck pain/stiffness.
Diagnostic nasal endoscopy (DNE) and Magnetic Resonance Imaging (MRI) were used for preoperative evaluation.
Transnasal marsupialization and excision of the cyst using powered instruments were performed.

Main Results:

DNE and MRI revealed a large cystic mass measuring 2.8 cm × 3 cm.
Postoperative follow-up showed marked improvement in obstructive symptoms.
No recurrence was observed during a 2-year follow-up period.

Conclusions:

Thornwaldt cysts, though rare in adults, should be considered in the differential diagnosis of cervical pain and neck stiffness.
Transnasal endoscopic marsupialization is an effective treatment for symptomatic Thornwaldt cysts.
Early diagnosis and surgical intervention can significantly improve patient outcomes.