Nasopharyngeal Branchial Cleft Cysts

Nasopharyngeal branchial cleft cysts and fistulas are located in the lateral nasopharyngeal wall and can extend to the base of the skull through the parapharyngeal space. They occur unilaterally or bilaterally and have a postulated second pharyngeal arch origin. Most naso-pharyngeal branchial cleft cysts are clinically silent during childhood and discovery may be delayed into early adulthood, when chronic inflammation induces proliferation of the lymphoid tissues. This produces a mass resulting in respiratory difficulties and nasal obstruction. The cysts are lined with respiratory epithelium. Chronic irritation and inflammation induces squamous metaplasia. Surgical specimens of nasopharyngeal cysts removed for symptomatic disease may therefore show exclusively squamous epithelium and lymphoid hyper-plasia in a fibrosed cyst wall [143, 177, 185].

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