Thornwaldt Cyst

tornwaldt cyst

Also known as Tornwaldt cysts ( no ‘H’ ) these incidental midline nasopharyngeal mucosal cysts are remnants of where embryologic notochord and endoderm of primitive pharynx come into contact. They are rounded, immediately beneath the mucosa, and anterior to the longus colli muscles. When formed they are initially diverticula but inflammation can cause obliteration of the mouth, resulting in a cyst, which is lined by respiratory epithelium and filled with fluid of variable proteinaceous content.

TCs are common, found in around 5% of MRIs and usually asymptomatic. If superinfected they can produce halitosis or periodic discharge of foul tasting fluid into the mouth.

Treatment, if required, is with deroofing (marsupialization) or complete excision.

There is usually no real differential, however adenoidal / mucosal masses can sometimes have cystic components.

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Credit: Dr Frank Gaillard