European Annals of Otorhinolaryngology, Head and Neck diseases 131 (2014) 321–322

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Letter to the Editor

Nasopharyngeal locations are extremely rare in branchial cyst,

Nasopharyngeal branchial cyst
which is usually located on either the anterior edge or the deep
side of the sternocleidomastoid muscle, and generally originates
Kyste nasopharyngé branchial (origine)
in the 2nd branchial cleft [1]. Nasopharyngeal locations are pos-
sible, if unusual, and are classified as type IV according to Proctor
A 70 year-old male without previous medical history was
[2]; there are only a few dozen reports in the literature, mainly
referred for right nasal obstruction associated with a sensation of
in Asian populations [3,4]. Clinical presentation is polymorphic,
fullness of the right ear.
associating rhinorrhea, nasal obstruction, ear fullness or sero-
Nasal endoscopy found a well-delineated smooth-surfaced
mucous otitis; location is lateral [1]. Nasal endoscopy shows a
cystic-like mass in the right superolateral nasopharynx, obstruct-
well-delineated smooth-surfaced cystic-like mass attached to the
ing the right choana and projecting into the contralateral choana
lateral wall of the nasopharynx. Radiological diagnosis is mainly
(Fig. 1A). MRI found a high-intensity 22.4 × 23.7 × 32 mm cystic
founded on MRI, which usually shows a low-intensity signal on T1
mass with a thickened wall showing slight gadolinium uptake,
and a high-intensity on T2-weighted sequences, without periph-
obliterating the Rosenmüller fossa in the right nasopharynx, with-
eral contrast uptake; signals may, however, be high-intensity on
out parapharyngeal extension (Fig. 1B). Marsupialization was
both sequences in protein-rich cysts [4]. Differential diagnosis
performed under general anesthesia by an endonasal approach, fol-
mainly involves nasopharyngeal carcinoma, which is very frequent
lowed by regularization of the marsupialization site edges, without
in Mediterranean lands, or Thornwaldt’s cyst, although this diagno-
bleeding or neurovascular damage (Fig. 1C and D). Histopathology
sis is confirmed by a medial location and the absence of lymphoid
diagnosed branchial cyst (Fig. 2). At 3 years’ follow-up, the patient
tissue on histology [4]. Treatment consists in complete surgical
was asymptomatic, without recurrence.

Fig. 1. A. Cyst-like formation originating in the superolateral nasopharynx and obstructing the right choana. B. High-intensity 22.4 × 23.7 × 32 mm cystic mass, with thick-
ened wall showing slight gadolinium uptake, obliterating Rosenmüller’s fossa in the right nasopharynx, without parapharyngeal extension. C. Cyst marsupialization. D.
Regularization of marsupialization site edges.

http://dx.doi.org/10.1016/j.anorl.2014.01.007
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322 Letter to the Editor / European Annals of Otorhinolaryngology, Head and Neck diseases 131 (2014) 321–322

Disclosure of interest

The authors declare that they have no conflicts of interest con-

cerning this article.

References

[1] Marom T, Russo E, Ben Salem D, et al. Int J Pediatr Otorhinolaryngol

2009;73:1063–70.
[2] Proctor B. Lateral vestigial cysts and fistulas of the neck. Laryngoscope
1955;65:355–61.
[3] Chen P-S, Lin Y-C, Lin Y-S. Nasopharyngeal branchial cleft cyst. J Chin Med Assoc
2012;75:660–2.
[4] Chen YA, Su JL, Hao SP. Nasopharyngeal branchial cleft cyst. Otolaryngol Head
Neck Surg 2007;136:144–6.
[5] Kim YW, Baek MJ, Jung KH, et al. Two cases of nasopharyngeal branchial cleft
cyst treated by powered instrument assisted marsupialisation. J Laryngol Otol
2013;127:614–8.

B. Hemmaoui ∗
Fig. 2. The cyst wall was bordered by cylindrical epithelium surrounding abundant M. Sahli
lymphoid tissue compatible with branchial cyst. A. Jahidi
F. Benariba
resection. Various approaches are feasible: endonasal, transpala- Service d’ORL et chirurgie cervico-faciale, hôpital
tine, transoral or transmandibular [1,3]; but an endonasal approach d’instruction militaire Mohamed V, BP 1018, Hay
is to be preferred, being easier and showing less associated morbid- Riad, Rabat, Morocco
ity, the only restriction being in case of parapharyngeal extension;
∗ Corresponding author. Tel.: +212 66 10 69 73 4.
the alternative approaches incur a risk of severe complications such
as hemorrhage or velopharyngeal insufficiency. Kim reported 2 E-mail address: hemmaouibouch@yahoo.fr
cases of nasopharyngeal branchial cyst, managed in 1 case on a tran- (B. Hemmaoui)
soral approach and in the other endonasally by the microdebrider;
there was no recurrence in either case. Given the small number of
cases, however, and the rare implementation of this technique, a
larger long-term study would be useful to assess this attitude [5].