Mahboobe Asadi et al: Hypoplasia of the maxillary, sphenoid and frontal sinus www.jrmds.

in

Case Report

Hypoplasia of the maxillary, sphenoid and frontal sinus in the patient

with nasopharyngeal branchial cyst: Case Report
*
Matin Ghazizade, Mahboobe Asadi and Pouyan Darbani

Faculty of medicine, Department of otolaryngology and head and neck surgery, ShahidBeheshti University of Medical
Sciences, Tehran, Iran

Received on: 18/10/216

Accepted on: 8/12/2016

ABSTRACT

Cystic lesions of the nasopharynx are typically benign and often found incidentally. The authors report a case of
nasopharyngeal branchial cyst in a patient with hypoplastic maxillary, sphenoid and frontal sinuses. The patient
underwent transnasal endoscopic resection of the cyst.Results showed that in the management of nasopharyngeal
branchial cyst it is important to clarify the anatomic details of the paranasal sinuses with Computed tomography (CT)
scan respect to correct diagnosis and appropriate surgical planning. Nasopharyngeal branchial cysts and paranasal
sinus hypoplasia may have the same developmental cause.

Keywords: Hypoplasia, branchial cyst, maxillary, sphenoid, frontal sinus.

was cystic in its consistency.It was compressible with

INTRODUCTION no extension in to the nose and oropharynx.
Otological examination showed normal appearance
Cystic lesions of the nasopharynxusually found tympanic membrane with no middle ear effusion.
casually [1].There is no specific microscopic feature The paranasal sinus CT scans showed a well-
that conclusively identifies them. However, the circumscribed low-density mass 1 cm in diameter in
specific site in the nasopharynx can provide helpful the nasopharynx at the right side and normal-
clues[2].Cysts arising from the nasopharynxmay be appearing nasal septum and conchae. The notable
midline or lateral based on their natural origin[3]. finding wasbilateral hypoplasia ofmaxillary, frontal and
Differing from Tornwaldt cysts, nasopharyngeal sphenoid sinuses (Figure1). The patient underwent
branchialcysts present laterally and arise from the transnasal endoscopic resection of the mass
fossa of Rosenmuller and may track superiorly within .Histopathology revealed a squamous lined epithelial
the bony confines of the Eustachian tube wall with lymphoid aggregation, which confirmed
[4].Embryogenic cysts of the pharyngeal bursa and branchial cleft cyst.It has had no evidence of
Rathke's pouch are usually located in the midline [2]. recurrence for 1 years following surgery (Figure 2).

DISCUSSION
CASE REPORT
The second branchial cleft accounts for 95% of
A 35-year-old male was referred because of snoring, branchial anomalies [5]. They can be termed cyst,
mouth breathing and intermittentright side nasal sinus and fistula according to maintain their
obstruction since childhood. Nasal endoscopy connection with skin or pharynx. Cyst is the most
revealed a well-circumscribed mass in the commonamong such abnormalities. It almost always
nasopharynx. The submucosal mass located in the present as a neck mass along with the anterior border
right side of nasopharynx. It was attached to the of sternocleidomastoidmuscle [6]. Nasopharyngeal
lateral nasopharyngeal wall. On palpation, the mass branchialcysts are uncommon. They are mostly

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 Mahboobe Asadi et al: Hypoplasia of the maxillary, sphenoid and frontal sinus www.jrmds.in

asymptomatic and infrequently found during routine additional cause of midline acquired nasopharyngeal
endoscopies and imaging studies. Rarely they maybe cysts.Branchiogenic cysts are the most common
the source for unexplained sinonasal symptoms, such cause of lateral nasopharyngeal cysts [8]. They have
as CSF rhinorrhea, visual disturbances and nasal been reported in only a limited number of
obstruction [7]. literatures.Mucus retention cysts and Oncocytic cysts
(Warthin's tumor) are additional rare causes of
The most common midline nasopharyngeal cysts are acquired lateral nasopharyngeal cysts [9].
mucus retention cysts. They are distinguished from
Tornwaldt cysts in that they originate superficial to the
pharyngobasilar fascia. Intra-adenoid cysts are an

Figure 1: bilateral hypoplasia of maxillary, frontal and sphenoid sinuses

Figure 2: No evidence of recurrence for 1 years surgery

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The association between nasopharyngeal consideration is necessary. Because both conditions

branchialcysts with paranasalsinus hypoplasia is an are rare diagnose requirement,a larger long-term
interesting finding in these patients. Hypoplasia of the study will be useful to assess this attitude.
paranasal sinuses is a rare event that frequently
involved The frontal and sphenoid sinuses [10- REFERENCES
11].Hypoplasia of the maxillary sinus israre than
sphenoid and frontal sinuses that occurred because 1. Ali MY, Pathogenesis of cysts and crypts in
of the acquired or congenital causes. Among the the nasopharynx. The Journal of
acquired reasons Trauma, Thalassemia, cretinism, Laryngology & Otology, 1965;79(05):391-
Wegener's gralauloma (inflammatory osteitis) 402.doi: http://dx.doi.org/10.1017/S0022215
Neoplasms (that cause osteitis) can be mentioned. 100063854
2. Chen PS, Lin YC, Lin YS. Nasopharyngeal
On the other hand it can happen because of the branchial cleft cyst. Journal of the Chinese
congenital reason such as: Medical Association, 2012; 75(12):660-662,
2012.doi: 10.1016/j.jcma.2012.09.001.
Arresting of the development because of infection, 3. Nicolai P, Luzzago F, Maroldi R, Falchetti M,
injuries and irradiation,Congenital first arch syndrome Antonelli, AR. Nasopharyngeal cysts: Report
and Developmental anomalies such as of seven cases with review of the literature.
craniosynostosis, osteodysplasia, and Down Archives of OtolaryngologyHead & Neck
syndrome [12]. Surgery, 1980;115(7):860-864,
1989.doi:10.1001/archotol.1989.0186031009
Development of paranasal sinuses begins in the 3rd 8032.
week of gestation but their expansion continues after 4. Flis DW, Wein RO. Nasopharyngeal
birth throughout early adulthood [13].The branchial Branchial CystsDiagnosis and
arches develop between the fourth and seventh week Management: A Case Series. Journal of
of gestation and form the embryological precursors of Neurological Surgery Part B: Skull Base,
the muscles, blood vessels, bones, cartilage and 2013;74(01):50-53, 2013.doi: 10.1055/s-
mucosal lining of the face, neck and pharynx [14]. 0032-1331020
synchronism of this two condition in our patient 5. Drumm AJ, Chow JM. Congenital neck
maycomment a common pathology affect the fetus at masses. Am Fam Physician 1989;39(1):159-
the same time. 63.PMID:2643275
6. Mitroi M, Dumitrescu D, Simionescu C,
Management of bronchogenic nasopharyngeal cysts Popescu CA, Mogoant CA, Cioroianu LU,
varied from a simple endonasal approach to powered Surlin C, Cpitnescu AL, Georgescu M.
instrument assisted marsupialization.Although Management of second branchial cleft
Electivetransoral excision under general anesthesia is anomalies. Rom J MorpholEmbryol. 2008;
the treatment of choice[15]. Before surgery It is 49(1):69-74.PMID: 18273506.
important to clarify the anatomic details of the 7. Maroma T , Russoa E, Ben Salemb D, Rotha
paranasal sinuses with respect to correct diagnosis Y, Cysts N. International Journal of
and appropriate surgical planning .Computed Pediatric Otorhinolaryngology.2009;
tomography (CT) scan is an excellent tool used for 73(8):10631070.
this purpose [16]. 8. Rickles NH, Little JW. The histogenesis of
the branchial cyst. II. A study of the lining
CONCLUSION
epithelium. The American journal of
Although paranasal sinus hypoplasia and pathology, 1967; 50(5):765.PMCID:
nasopharyngeal branchial cyst are reported in PMC1965270
separate cases in the literature, to our knowledge 9. Salem DB, Duvillard C, Assous D, Ballester
there is no case similar to ours, with the sphenoid, M, Kraus D,Ricolfi F. Imaging of
maxillary and frontal sinus hypoplasia concomitant nasopharyngeal cysts and bursae. European
with nasopharyngealbranchialcyst. With the advent radiology, 2006; 16(10):2249-2258.doi:
endoscopic technology and modern imaging 10.1007/s00330-006-0238-x.
techniques, nasopharyngeal cysts and 10. Thiagarajan B, Narashiman S. Hypoplasia of
paranasalsinus hypoplasiarecognition is more all paranasal sinuses A case series and
common than previous times and appropriate

Journal of Research in Medical and Dental Science | Vol. 4 | Issue 4 | October-December 2016 29
 Mahboobe Asadi et al: Hypoplasia of the maxillary, sphenoid and frontal sinus www.jrmds.in

literature review. Otolaryngology online edn. Churchill Livingston, New York,

journal, 2012;2(2):20-25. Edinburgh, 2009.
11. Erdem T, Aktas D, Erdem G, Miman MC, 15. Fageeh NA, Etwadi H, Alqarni M, Alsharif S.
Ozturan O. Maxillary sinus hypoplasia. Nasopharyngeal branchial cleft cyst.
Rhinology,2002;40(3):150-153.PMID: National Journal of Otorhinolaryngology and
12357716. Head & Neck Surgery, 2015;3(12): 30-31.
12. Jafari-Pozve N, Sheikhi M, Ataie-Khorasgani 16. Korkmaz H, Korkmaz M. Total aplasia of the
M, Jafari-Pozve S. Aplasia and hypoplasia of paranasal sinuses. Allergy &
the maxillary sinus: A case series. Dental Rhinology,2013; 4(2):e105.doi:
research journal, 2014;11(5):615.PMCID: 10.2500/ar.2013.4.0056
PMC4241618
13. Hengerer AS.Embryologic development of
the sinuses. Ear, nose, & throat journal,
1984;63(4):134-136.
14. Schoenwolf GC, Bleyl S, Brauer P, Francis-
West P. Larsens Human Embryology, 4th

Journal of Research in Medical and Dental Science | Vol. 4 | Issue 4 | October-December 2016 30