耳鼻喉科Otolaryngology topic three: Diseases of Nasopharynx and Related areas

Diseases of Nasopharynx and Related areas

1.  Most common site of nasopharyngeal carcinoma(NPC)= Fossa of Rosenmüller

2. Histology: 

-- epithelial
(ciliated pseudostratified >  stratified squamous epithelium)

-- lymphoid

-- salivary gland

3. Benign diseases:

Adenoid hypertrophy (inflammatory)

-- may obstruct E-tube, sinus outlet

-- adenoid face

Nasopharynx cyst- Tornwaldt’s bursa (cyst)/ bursitis  (inflammatory)

-- caudal end of notochord in communication with nasopharyngeal epithelium

-- position: midline, posterior wall of nasopharynx

-- treatment: antiobiotics, marsulpialization

Nasopharynx cyst- retention cyst  (inflammatory)

-- chronic inflammation of lymphoid tissue

Juvenile angiofibroma (tumor)

-- teenager, boy

-- unilateral epistaxis (vessels lack of intervening smooth muscle layer)

-- DO NOT perform BIOPSY!!! -->avoid massive bleeding, do imaging first

-- pre-op 24~72 hrs : perform artery embolization 

NPC

-- influenced by environment, race, gene; related to EBV

-- peak age: 40 y/o, reach plateau afterwards

-- prognosis:  Type I Keratinizing Carcinoma >  Type II Non-Keratinizing Carcinoma (more common in South-East China and Taiwan)

-- features:  cervical lymphadenopathy(jugulodigastric), unilateral nasal congestion(cp. inverted papilloma), blood-stained rhinorrhea, middle-ear effusion, hearing impairment, unilateral headache and other neurological symptoms
-- diagnosis tool: BIOPSY for both new case and recurrence!!!
                            liver sono & bone scan for metastasis, meta. LN > 6cm in distance

-- F/U: IgA toward EBV capsule antigen(VCA), early antigen(EA)/ DNA
-- treatment:
                    less sensitive to radiation and  chemo, but initial therapy still preferring chemo-->CCRT-->chemo or RT(IMRT), CCRT alone
                   in field recurrence-->surgery; metastasis at margin-->re-irradiation; metastasis at neck-->surgery

-- prognosis: good if no metastasis, local recurrence 25%, distal metastasis 20%