Tornwaldt's disease

Abstract

Tornwaldt's disease was first described by Tornwaldt as one of the causes of epipharyngitis, and is an inflammation or abscess of the embryonic remnant cyst of the pharyngeal bursa appearing at the posterior median wall of the nasopharynx. Although many cases are symptom-free, symptoms can often be caused by nasal tamponade, trauma, adenotomy, or other mechanical stimuli. Only a few cases have been reported in Japan between 1929 and 1992. At about the 10th week of embryonic development, the pouch, which forms by adhesion of the pharyngeal ectoderm to the notochord at the most cranial end of the notochord, becomes closed at the orifice (cystic type), or crusts adhere to the orifice without closing (crust type). Symptoms are those of upper respiratory tract infection with obstinate occipital pain, purulent choanal discharge, nasal obstruction, halitosis, feeling of ear fullness, clearing of the throat, etc. Posterior rhinoscopy, simple lateral view X-ray tomography, nasopharyngeal fiberoscopy, CT scan and MRI are useful in showing adhesion to the cervical vertebrae. While complete extirpation via a transpalatal approach is desirable, incision or excision of the cyst can also be performed.