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Imaging in head and neck surgery
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
The anterior margin is demarcated by the posterior choanae. The posterior wall contains the adenoids as part of Waldeyer's lymphatic ring. This regresses with age. Posterolaterally, the pharyngeal recesses, also known as the fossa of Rosenmuller, can be a difficult region for clinical evaluation due to obscuration by the cartilaginous torus tubarius. However, this area can be readily reviewed by radiological cross-sectional evaluation. Anterolateral to the torus tubarius will be the opening of the Eustachian tube. Laterally are the veli palatini muscles, which are important demarcators for staging of nasopharyngeal tumours.
Nasopharyngeal Carcinoma
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Raymond King-Yin Tsang, Dora Lai-Wan Kwong
The nasopharynx is the most superior part of the pharynx with the inferior border defined as the lower level of the soft palate. Anteriorly it connects to the nasal cavities through the posterior choana. Superiorly the roof of the nasopharynx is formed by the floor of the sphenoid sinus and slopes down to become the posterior wall, which is formed by the clivus bone. The inferior outlet normally opens into the oropharynx but is closed by the soft palate during swallowing and phonation. The cartilaginous Eustachian tubes on both sides open on the lateral wall of the nasopharynx. A recess extends postero-laterally on both sides of the posterior wall of the nasopharynx to form the lateral recess of the nasopharynx, also known as the fossa of Rosenmüller. The depth of the fossa of Rosenmüller is variable. The posterior cushion of the Eustachian tube opening forms the anterior wall of the fossa of Rosenmüller. Most early stage nasopharyngeal primaries originating from the fossa of Rosenmüller are difficult to detect unless the area is carefully inspected during endoscopy.2 Cancers arising from the fossa of Rosenmüller therefore frequently invade the Eustachian tube and affect function, leading to the development of otological symptoms.
Anatomy and Embryology of the External and Middle Ear
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
The cartilaginous part of the tube is about 24 mm long and consists of a fibrocartilaginous skeleton to which are attached the peritubal muscles. At its upper border, the cartilage is bent over to resemble an inverted ‘J’, thereby forming a longer medial cartilaginous lamina and shorter lateral cartilaginous lamina. The cartilage is fixed to the base of the skull in a groove between the petrous part of the temporal bone and the greater wing of the sphenoid, which terminates near the root of the medial pterygoid plate. Thus, the back (posteromedial) wall is composed of cartilage and the front (anterolateral) wall comprises cartilage and fibrous tissue. The apex of the cartilage is attached to the isthmus of the bony portion, while the wider medial end protrudes into the nasopharynx, lying directly under the mucosa to form the torus tubarius. In the nasopharynx, the tube opens 1–1.25 cm behind and a little below the posterior end of the interior turbinate. The opening is almost triangular in shape and is surrounded above and behind by the torus. The salpingopharyngeal fold stretches from the lower part of the torus downwards to the wall of the pharynx. The levator palati, as it enters the soft palate, results in a small swelling immediately below the opening of the tube. Behind the torus is the pharyngeal recess or fossa of Rosenmüller. Lymphoid tissue is present around the tubal orifice and in the fossa of Rosenmüller and may be prominent in childhood.
Real World Presentation and Treatment Outcomes with a Predominant Induction Chemotherapy Based Approach in Nasopharyngeal Carcinoma: A Sixteen Year Report from a Teaching Hospital in India
Published in Cancer Investigation, 2023
Ramana Gogi, Aparna Sharma, Atul Sharma, BK Mohanti, Raja Pramanik, Suman Bhasker, Ahitagni Biswas, Alok Thakar, Amit Chirom Singh, Kapil Sikka, Rajeev Kumar, Sanjay Thulkar, Sudhir Bahadur
Nasopharyngeal carcinoma (NPC) is the most common tumor arising from nasopharynx (frequently from the fossa of Rosenmuller) (1). It differs widely from the other head and neck cancer (squamous cell carcinoma) in terms of epidemiology, histology, natural history and response to treatment modalities. This disease is endemic to eastern Asia. NPC is an uncommon malignancy in most parts of India, though it is common in north-eastern states of India (highest age-adjusted rate = 19.4/100,000 in Kohima district, Nagaland) (2). The risk in endemic population appears to be interplay of Epstein Barr virus (EBV) infection, environmental factors such as high intake of preserved food and smoking. The outcome of these patients has improved with time, both in terms of response and survival (3,4). Various treatment nomograms have been suggested for EBV and NPC prognosis model. DNA methylation, miRNAs, and mRNAs have also been studied for their prognostic in NPC (3).
Sinonasal Lymphoma Presenting as Cavernous Sinus Syndrome: Case Report and Review of the Literature
Published in Neuro-Ophthalmology, 2022
Noranida Abd Manan, May May Choo, Irina Effendi Tenang, Mimiwati Zahari
He was admitted to the ward due to suspicion of cavernous sinus thrombosis, likely secondary to a left nasal malignancy. A contrast-enhanced CT scan of his brain and orbits revealed a large enhancing left nasopharyngeal mass measuring 4.4 × 5.3 x 3.8 cm with intracranial extension to the cavernous sinuses and local infiltration (Figure 3). There was also extension into the oropharynx, fossa of Rosenmüller and the left retropharyngeal region associated with adjacent bony destruction involving the maxillary bone, nasal bone, greater wing and petrous part of sphenoid and clivus. There were also multiple rim-enhancing brain parenchymal lesions that likely represented intracranial abscesses. The orbital structures were otherwise preserved. CT venography showed no evidence of cavernous sinus thrombosis or arteriovenous malformations as well as patent extracranial and intracranial internal carotid arteries.
Factors associated with early diagnosis in pediatric vs adult nasopharyngeal carcinoma
Published in Acta Oto-Laryngologica, 2018
Nasopharyngeal carcinoma (NPC) is a squamous cell carcinoma (SCC) arising from the mucosal surface of the nasopharynx. The most common site is the fossa of Rosenmüller which is a recess just medial to the medial crura of the eustachian tube [1]. It is rare in most parts of the world, with age-standardized rates (ASRs) in incidence well below 1 per 100,000 person-years for both genders, but it is rather prevalent in Southern China, Southeast Asia and Northern Africa [2]. A bimodal age distribution has been suggested to exist in nonendemic areas, with an early peak of incidence at10–20 years and a second at 40–60 years [3].