Tornwaldt cyst is a rare cyst in the midline of the nasopharynx that may become infected.
A Tornwaldt cyst is a rare, benign congenital cyst located in the midline nasopharynx (1). It is a remnant of the embryonal notochord superficial to the superior constrictor muscle of the pharynx and is covered by the mucous membrane of the nasopharynx. It may become infected, causing persistent purulent drainage with a foul taste and odor, eustachian tube obstruction, and sore throat.
Purulent exudate may be seen at the opening of the cyst.
This sagittal T1-weighted MR image shows a prominent Tornwaldt cyst (arrow) in the posterior nasopharynx.
Living Art Enterprises, LLC/Science Source/SCIENCE PHOTO LIBRARY
Diagnosis is based on nasopharyngoscopy supplemented by CT or MRI when the diagnosis is in doubt (2). They are often incidentally discovered on MRI performed for other reasons (3).
Treatment consists of marsupialization (sometimes via transnasal endoscopy) or excision (4). Asymptomatic cysts do not require treatment.
General references
1. Cetinkaya EA. Thornwaldt Cyst. J Craniofac Surg. 2018;29(6):e560-e562. doi:10.1097/SCS.0000000000004559
2. Ikushima I, Korogi Y, Makita O, et al. MR imaging of Tornwaldt's cysts. AJR Am J Roentgenol. 1999;172(6):1663-1665. doi:10.2214/ajr.172.6.10350312
3. Righi S, Boffano P, Pateras D, et al. Thornwaldt cysts. J Craniofac Surg. 2014;25(5):e456-e457. doi:10.1097/SCS.0000000000001004
4. Turan Ş, Gürbüz MK, Kaya E, et al. Is Transnasal Endoscopic Marsupialization Sufficient in Thornwaldt Cysts?. J Craniofac Surg. 2020;31(2):e208-e210. doi:10.1097/SCS.0000000000006120
