Tornwaldts Cyst

A Tornwaldt's cyst (or pharyngeal bursitis; named after Gustav Ludwig Tornwaldt, 1843-1910) is a dilatation of a persistent pharyngeal bursa in the posterior median wall of the nasopharynx above the superior pharyngeal constrictor muscles and at the lower end of the pharyngeal tonsil caudally and posteriorly to where Rathke's cleft cysts arise [128]. The cysts arise at the site of embryonic communication between the notochord and the roof of the pharynx and can be detected in up to 7% of adults at routine autopsies [86]. Tornwaldt's cysts are typically less than 1 cm in size and asymptomatic [92]. Obstruction of the bursal orifice results in a cystic dilatation. The cysts may become infected and inflamed with subsequent abscess formation. Symptomatic disease, termed Tornwaldt's disease, may present with nasal obstruction and nasopharyngeal drainage, dull occipital headaches, pain in the ears and neck muscles and occasionally neck muscle stiffness [130]. Tornwaldt's cysts are lined with tall, columnar, ciliated respiratory epithelium, but inflammation and infection induces squamous metaplasia and fibrosis of the walls. Tornwaldt's cyst may contain varying amounts of lymphoid tissue (Fig. 6.1). Most surgical specimens of symptomatic Tornwaldt's cysts are either devoid of an epithelial lining or lined with squa-mous epithelium.

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