Non-brachycephalic dogs with stertor have higher nasopharyngeal collapsibility compared with dogs without stertor and foramen lacerum level is ideal for evaluating nasopharyngeal collapse on dynamic CT.

Stertor, a clinical sign associated with obstructive airway syndrome, is often observed in non-brachycephalic dogs. This prospective, case-control study aimed to compare soft palate dimensions, nasopharyngeal cross-sectional area (CSA), and nasopharyngeal collapsibility at various locations in non-brachycephalic dogs with and without stertor. A total of 50 dogs were recruited and stratified into control (n = 34) and stertor (n = 13) groups. Static and dynamic computed tomography was conducted without tracheal intubation, and the following variables were calculated: normalized soft palate length and thickness, normalized maximum and minimum nasopharyngeal CSAs (rCSAmax and rCSAmin), and nasopharyngeal collapsibility at the level of the cranial end of the soft palate, pterygoid hamulus, foramen lacerum, bony labyrinth, and caudal end of the soft palate. The stertor group demonstrated significantly lower rCSAmax and rCSAmin, as well as higher nasopharyngeal collapsibility compared with the control group, while no significant differences were noted in the soft palate dimension. Evaluating nasopharyngeal collapse at the foramen lacerum level was recommended due to the clear presence of identifiable bony landmarks and lower overlap in the nasopharyngeal collapsibility between dogs with and without stertor. Physical dimensions of the soft palate may not be the primary contributing factor to nasopharyngeal collapse and clinical signs in non-brachycephalic dogs.

Primary Nasopharyngeal Tuberculosis: A Case Report Focused on Nasopharyngoscopic Features and CT Findings.

Primary nasopharyngeal tuberculosis, defined as an isolated tuberculosis infection of the nasopharynx without systemic or pulmonary disease, is rare, even in areas endemic for tuberculosis. It is challenging for ENT specialists to diagnose primary nasopharyngeal tuberculosis at an early stage. In this report, we describe a new case of primary nasopharyngeal tuberculosis, focusing on its nasopharyngoscopic features and radiological findings that can help the understanding and aid in accurate diagnosis of this unusual disease entity. Our experience suggests that although primary nasopharyngeal tuberculosis is a relatively rare disease, it must be included in the differential diagnosis of various nasopharyngeal lesions, particularly in patients with unusual nasopharyngoscopic and computed tomography findings.

Radiation-induced nasopharyngeal ulcers after intensity modulated radiotherapy in primary nasopharyngeal carcinoma patients: A dose-volume-outcome analysis.

OBJECTIVE: This is a retrospective dose-volume-outcome analysis of radiation-induced nasopharyngeal ulcers after intensity modulated radiotherapy in primary nasopharyngeal carcinoma (NPC) patients, with the aim to determine how the radiation doses to nasopharynx influence the occurence of radiation-induced nasopharyngeal ulcer (RINU) and predict the most serious complication of radiotherapy for NPC. METHODS: Data from 6023 consecutive and nonselected histologically proven primary NPC patients treated with definitive IMRT were collected and 25 patients were diagnosed with nasopharyngeal ulcer and met the diagnosis criteria of RINU. Predictive dosimetric factors were identified by using univariate and multivariate analysis. RESULTS: Paired samples t-tests showed all dosimetric factors were significantly correlated with the development of RINU, and these factors were associated with each other closely. (P < 0.001) Multivariate analysis revealed D3cc (dose to 3 mL of the nasopharynx) was an independent predictor for RINU (P = 0.01); the area under the ROC curve for D3cc was 0.87 (P < 0.001), and the cutoff point 73.67 Gy may be the dose tolerance of the nasopharynx. The primary tumor location, distribution of high dose regions and the location of RINU were consistent. CONCLUSIONS: The study indicates that radiation-induced nasopharyngeal ulcer is consistent with primary tumor location and 'hottest spots' regions and we suggest a D3cc limit of 73.67 Gy for the nasopharynx. Physicians should be cautious of such 'hot spots' in the nasopharynxduring IMRT treatment plan optimization, review and approval to avoid the most serious complication of radiotherapy for NPC.

[Nasopharyngeal tuberculosis: report 2 cases and review of the literature].

Nasopharyngeal tuberculosis is a noteworthy disease and it should be differentiated from with nasopharyngeal carcinoma,especially in southern China,because of both having similar clinical presentations such as cervical lymph node enlargement and lesions in nasopharynx. Here we report 2 middle-aged patients of nasopharyngeal tuberculosis;between them,one was male, another was female. They came to hospital with the symptoms of pharyngeal pain and neck node, respectively. The former patient was accompanied by repeated fever. His chest radiographic displayed suspected active lesions; and nasopharyngeal examination inspected irregular mucosa with white patch covering the nasopharyngeal area; and magnetic resonance imaging (MRI) presented diffuse thickening of the mucosal wall of nasopharynx; moreover, the biopsy specimen pathological results showed ulceration with mucosal squamous papillary hyperplasia.Finally,acid-fast staining of nasopharyngeal secretions disclosed acid-fast bacilli was positive. However, the latter patient was completely different from the former in clinical presentations, while MRI finding was almost the same. In addition, the endoscopy depicted that characteristic of nasopharyngeal lesion was smooth, congested and swelling, and the pathological result revealed granulomatous inflammation with epithelioid histiocytes and multinucleated giant cells of Langerhans type.Combined their clinical manifestations with various laboratory and imaging examinations, both of the two patients were eventually diagnosed as nasopharyngeal tuberculosis.

Masses of the Nose, Nasal Cavity, and Nasopharynx in Children.

A wide range of masses develop in the nose, nasal cavity, and nasopharynx in children. These lesions may arise from the nasal ala or other structures of the nose, including the mucosa covering any surface of the nasal cavity, the cartilaginous or osseous portion of the nasal septum, the nasal turbinates, and the nasal bones. Lesions may also arise from the nasopharynx or adjacent structures and involve the nose by way of direct extension. The causes of nasal masses in children include congenital and developmental disorders such as congenital nasolacrimal duct mucocele, dermoid cyst, cephalocele, and nasal neuroglial heterotopia; inflammatory and infectious processes such as mucocele, polyp, and pyogenic granuloma; benign neoplasms such as infantile hemangioma and juvenile nasopharyngeal angiofibroma; malignant lesions such as rhabdomyosarcoma and nasopharyngeal carcinoma; and masses related to prior trauma such as septal hematoma. Although direct visualization, without imaging, is frequently sufficient to diagnose pediatric nasal conditions, in many cases imaging has a key role in the treatment of the affected child. Some of these lesions have characteristic computed tomography and/or magnetic resonance imaging findings, some of them are diagnosed on the basis of the location and imaging findings combined, and others demonstrate nonspecific imaging findings. However, imaging is important for better defining the total extent of the lesion and guiding the clinician in determining whether medical and/or surgical intervention is required. In this article, the authors review the imaging findings of the most common causes-and many of the not-so-common causes-of nasal masses encountered in the pediatric population. ©RSNA, 2017.

Localized nasopharyngeal amyloidosis mimicking malignancy: A case report.

RATIONALE: Nasopharyngeal amyloidosis is a benign, slowly progressive disease that is characterized by extracellular eosinophilic deposition. PATIENT CONCERNS: We report a rare case of localized nasopharyngeal amyloidosis. DIAGNOSES: The initial chief complaint of this patient was frequent epistaxis and right aural fullness. The initial diagnosis was nasopharyngeal tumor. INTERVENTIONS: There is no universally effective medical treatment for nasopharyngeal amyloidosis but surgery can be an option. We performed careful observation with regular follow-up by nasopharyngoscopy and radiologic study. OUTCOMES: The patient reported no further complaints at 1-year follow-up and the lesion from nasopharyngeal amyloidosis was still present. LESSONS: Although it is rare, nasopharyngeal amyloidosis should be considered in the differential diagnosis of epistaxis, nasal obstruction, and otitis media with effusion, which are the main symptoms of nasopharyngeal carcinoma. In the absence of systemic disease, localized nasopharyngeal amyloidosis may be treated conservatively.

A huge Thornwaldt's cyst causing hearing loss in an adult patient.

Nasopharynx (NP) is anatomically difficult to explore adequately. The pharyngeal bursa (PB) is a recess lined with respiratory epithelium along the posterior wall of the nasopharynx between the longus capitis muscles. If the opening through which the bursa drains into the nasopharynx becomes obstructed, a Thornwaldt's cyst (TC) might develop. Small-sized cysts are mostly asymptomatic, whereas large-sized cysts may lead to various nasal and otologic symptoms depending on their localization. In this report, we present a 71-year-old case with a huge TC who presented to our clinic with the complaints of snoring, nasal obstruction, periodic halitosis, postnasal drip, headache, and hearing loss in the left ear and underwent total excision of the cyst through transnasal endoscopy. The diagnosis and treatment characteristics of the case are presented with the review of the literature.

Head and neck inflammatory pseudotumor: Case series and review of the literature.

Inflammatory pseudotumor (IP) is an uncommon idiopathic lesion that often imitates malignancy clinically and radiologically. Inflammatory pseudotumors have been found to occur in various sites but rarely in the head and neck. The histopathology, imaging, and treatment of three unique cases of head and neck inflammatory pseudotumors are described in this case series. Patients in Cases 1 and 2 presented with right level II neck mass and left parotid tail mass, respectively. The patient in Case 3 presented with otalgia, jaw pain and trismus, and a left parapharyngeal space mass. The tumors in Cases 1 and 3 significantly decreased in size with tapered courses of oral corticosteroids. The tumor in Case 2 was surgically excised without disease recurrence. Malignancy must be ruled out with incisional or excisional biopsy. Treatment includes surgical excision, oral corticosteroids, or both. The literature shows that radiotherapy and small-molecule inhibitors may be promising alternatives.

MRI of nasopharyngeal adenoid hypertrophy.

Nasopharyngeal adenoid hypertrophy (NAH) is a typical benign lesion. Due to involution, nasopharyngeal lymphatic tissue usually is not found in adults beyond the 30th to 40th year of life. However, occasionally NAH has been recognized after the 50th or 60th year. The aim of this study is to identify the frequency of NAH and to analyze its MRI findings in different age groups. From 2007 to 2011, 6693 MR investigations of the head were performed at our institution. MRI was obtained with a 1.5 T MRI device. NAH was identified in 18.0% of the patients. The frequency of NAH varied from 60.3% to 1.0% in the different age groups. The mean size of NAH was 23.2 ± 4.5 mm in cranio-caudal, 31.1 ± 5.2 mm in left-right, and 14.2 ± 4.1 mm in the anterior-posterior direction. The left-right and cranio-caudal sizes of NAH were largest in the 0-9 age group and decreased with age. On T1-w images most lesions (95.4%) were hypointense in comparison to the adjacent musculature. On T2-w fat-saturated images 82.4% of the lesions were hyperintense. After intravenous administration of contrast medium most lesions showed a slight enhancement (58.6%). Moderate enhancement was seen in 32.4% and a marked enhancement was identified in 9.0%. In the 0-9 age group most lesions showed a slight enhancement. Cysts within NAH were identified in 433 cases (35.9%). The frequency of cysts increased continuously with age, namely from 10.9% to 65.2%.

Correlation between adenoidal nasopharyngeal ratio and symptoms of enlarged adenoids in children with adenoidal hypertrophy.

BACKGROUND: Adenoid hypertrophy is one of the most common health problems affecting the paediatric population. This study aims to correlate adenoidal nasopharyngeal ratio (ANR) with symptoms of enlarged adenoids in children with enlarged adenoids. MATERIALS AND METHODS: It was a year, cross-sectional, hospital-based study conducted at Lautech Teaching Hospital, Osogbo. ANR was determined by dividing adenoidal depth with nasopharyngeal depth on the plain lateral radiographs. RESULTS: A total of 90 consecutive children consisting of 61 males and 29 females were included in the study with M:F ratio of 2.1:1. Their ages ranged from 8 months to 11 years. All the patients presented with nasal obstruction, mouth breathing and noisy breathing. Majority (64.5%) had severe obstructions with preponderance among children of 3-5 years (39.9%). Linear regression analysis showed significant association between age and ANR (t = 10.447, P < 0.001). There was high significant association (P < 0.05) between presenting symptoms and degree of nasopharyngeal airway obstruction; for snoring (r = 0.251, P = 0.000), sleep apnoea (r = 0.594, P = 0.000), nasal discharge (r = 0.314, P = 0.001), excessive daytime sleepiness (r = 0.219, P = 0.019) and failure to thrive (r = 0.240, P = 0.011). CONCLUSION: Lateral X-ray of the nasopharynx is an effective tool to evaluate children with suspected adenoid hypertrophy. It correlates well with patients' symptoms and provides objective measures of adenoid hypertrophy.

Intensity-modulated radiotherapy for localized nasopharyngeal amyloidosis : Case report and literature review.

BACKGROUND: Primary localized amyloidosis is characterized by the deposition of amyloid proteins restricted to one organ, without systemic involvement. Primary nasopharyngeal amyloidosis is an exceedingly rare condition, for which the standard treatment remains unknown. Because of its challenging anatomical position, surgery alone hardly results in complete resection of the localized amyloidosis. Therefore, an interdisciplinary planning board to design optimal treatment is of particular importance. PATIENT AND METHODS: A 39-year-old man presented with a several-week history of nasal obstruction and epistaxis. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of a retro-odontoid nonenhancing soft tissue mass. RESULTS: The endoscopic biopsy demonstrated that the mass was amyloid in nature. An extensive systemic workup revealed an absence of inflammatory process, systemic amyloidosis, or plasma cell dyscrasia. The patient was treated with a combination of surgery and radiotherapy, showing no evidence of recurrence or progression at his 1­year follow-up. CONCLUSION: Primary solitary amyloidosis is a rare form of amyloidosis. To the best of our knowledge, this is the first report of a nasopharyngeal amyloidosis case treated with excision and radiation leading to complete remission. Because of the difficulty for surgeons to achieve radical resection with such lesions, radiotherapy proved to be an excellent adjuvant treatment in this case.

PATHOLOGIC BASIS FOR RIM ENHANCEMENT OBSERVED IN COMPUTED TOMOGRAPHIC IMAGES OF FELINE NASOPHARYNGEAL POLYPS.

In postcontrast computed tomographic (CT) images, feline nasopharyngeal polyps typically demonstrate enhancement of the peripheral rim. Computed tomographic images and histologic specimens of a case series of 22 cats with surgically removed nasopharyngeal polyps were reviewed retrospectively in an attempt to elucidate the origin of rim enhancement. Polyps were present in the tympanic cavity in 15 (68%) cats (three with extension into the nasopharynx), only in the nasopharynx in four (18%) cats, and only in the external ear canal in the remaining three (14%) cats. All polyps had variable degrees of epithelial injury. Hemorrhage and inflammatory infiltration were significantly more marked in the superficial stroma whereas edema was significantly more marked in the core stroma. In noncontrast CT images (n = 22), the tympanic bulla was thickened in all 15 cats with a polyp in the tympanic cavity and enlarged in eight (53%) of these cats. In postcontrast CT images (n = 15), an outer zone of relatively increased attenuation compatible with a rim was observed in 11 (73%) polyps. The magnitude and extent of rim enhancement in CT images was positively correlated with the histologic grade of inflammation in the superficial stroma and negatively correlated with the grade of edema in the superficial stroma. It appears that inflammation is the major determinant of contrast medium accumulation in feline nasopharyngeal polyps, and the tendency for inflammation to affect predominantly the superficial layers explains the frequent observation of a rim in postcontrast CT images.

[Current status of diagnosis and treatment of Thornwaldt cyst].

Of Thornwaldt cyst is a congenital disease,nasopharyngeal top and posterior wall of the center of the infected cyst,which is rare in clinic,a lower incidence is a benign lesion,most cases have no symptoms,mostly through electronic endoscopic imaging system or radiological examination have been sent.Domestic reports about Thornwaldt cysts are also less,so this paper refer to the domestic and foreign literatures about the Thornwaldt cyst in recent years,the diagnosis and treatment of this disease is reviewed.

[The effect of orthodontic treatment on the change of oropharynx features in patients with dentoalveolar anomalies and nasopharyngeal tonsil hypertrophy].

The paper presents the results of comprehensive survey and orthodontic treatment of 40 children with dentoalveolar anomalies and nasopharyngeal tonsil hypertrophy aged 7-9 years. The linear parameters obtained by cone beam CT and TWH in the lateral projection were analyzed. The study revealed changes, indicating that the presence of nasopharyngeal tonsil hypertrophy, leads to pathology of the dental system and estimated the efficiency of muscle training and combined use of functional devices and elastopositioner «Corrector¼ for the treatment of anomalies of dentition and the formation of physiological occlusion in the process of permanent teeth eruption.

Pneumoparotid in "puffed cheek" computed tomography: incidence and relation to oropharyngeal conditions.

Pneumoparotid is common in patients with lesions of the oral cavity who have diagnostic computed tomography (CT) with the "puffed cheek" technique. Although such observations are often noted, we could find few papers about the incidence in relation to oropharyngeal conditions. We present a retrospective series of 47/300 patients who developed pneumoparotid during multidetector CT examination of the oropharyngeal region to assess the incidence and any possible correlation with regional disease. Patients were followed up for any symptoms and also for complications. In 14 patients the pneumoparotid was right-sided, in 17 left-sided, and in 16 it was bilateral. There was a significant association between the incidence of pneumoparotid and the site of disease, it being stronger (p<0.001) with lesions in the oral cavity than with those in the oropharynx and hypopharynx. Apart from brief discomfort, none of the patients had any symptoms after the procedure. In summary, pneumoparotid developed in 47/300 (16%) of our patients after multidetector CT when the "puffed cheek" technique was used, and was more common in patients with lesions of the oral cavity and anterior tongue than among patients with lesions of the oropharyngeal, nasopharyngeal, and hypopharyngeal regions. Few patients experienced transient fullness immediately after the procedure. None of our patients had lasting or infective symptoms.

The accuracy of diagnostic tests for adenoid hypertrophy: a systematic review.

BACKGROUND: Adenoid hypertrophy may cause sleep-disordered breathing and altered craniofacial growth. The authors conducted a study to gauge the accuracy of alternative tests compared with nasoendoscopy (reference standard) for screening adenoid hypertrophy. METHODS: The authors conducted a systematic review that included searches of electronic databases, hand searches of bibliographies of relevant articles and gray literature searches. They included all articles in which an alternative test was compared with nasoendoscopy in children with suspected nasal or nasopharyngeal airway obstruction. RESULTS: The authors identified seven articles that were of poor to good quality. They identified the following alternative tests: multirow detector computed tomography (sensitivity, 92 percent; specificity, 97 percent), videofluoroscopy (sensitivity, 100 percent; specificity, 90 percent), rhinomanometry with decongestant (sensitivity, 83 percent; specificity, 83 percent) and clinical examination (sensitivity, 22 percent; specificity, 88 percent). Lateral cephalograms tended to have good to fair sensitivity (typically 61-75 percent) and poor specificity (41-55 percent) when adenoid size was evaluated but excellent to good specificity when airway patency was evaluated (68-96 percent). CONCLUSIONS: No ideal tool exists for dentists to screen adenoid hypertrophy, owing to access constraints, radiation concerns and suboptimal diagnostic accuracy. Research is needed to identify a low-risk, easily acceptable, highly valid diagnostic screening tool. PRACTICAL IMPLICATIONS: Although lateral cephalograms (which have good to fair sensitivity) and a thorough medical history (which has good specificity) are imperfect individually, when they are used together, they can compensate for each others weaknesses. This combined approach is the best tool available to dentists for screening adenoid hypertrophy.