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PubMed1988

The lateral facial approach to the nasopharynx and infratemporal fossa.

Surgical access to the nasopharynx and infratemporal fossa is restricted by the bony structures that support and define these areas. Traditional surgical approaches to the nasopharynx for removal of benign neoplasms follow three directions: (1) the anterior route via the nasal cavity and the maxillary and, if necessary, the ethmoid sinuses; (2) the inferior route through the palate; and (3) the anterolateral retromaxillary pathway via the gingivobuccal sulcus into the pterygoid space. These approaches provide fair access, but limited visibility and little technical control of the neurovascular supply. For the small- to medium-sized tumor, the experienced surgeon is able to successfully manage the majority of cases using these approaches, singly or in combination. However, in patients with larger tumors--when recurrence is more common--approaches offering greater visualization have been developed, such as Panje's facial biflap, Mann's transmaxillary, and Fisch's transtemporal. These provide better access and control at the cost of increased locoregional morbidity, long operating time, and considerable technical complexity. I have developed a simpler, more direct surgical approach that combines the exposure concepts of the head and neck surgeon with the microsurgical techniques of the otosurgeon. It has been applied to eight cases, with minimal morbidity and excellent results, and appears to be the procedure of choice for cases of angiofibroma with early intracranial extension. Subsequently, a similar approach, developed previously by Holliday, has been published in which access into the anterior temporal lobe, petrous apex, and clivus are gained.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1980

Papanicolaou test of the nasopharynx in a radiotherapy department.

Radiotherapists are often asked to irradiate patients with metastases in lymph nodes in the cervical area from an unknown primary carcinoma. In our department we use indirect mirror examination, finger palpation and cytology of smears from the nasopharynx, in case the primary is located there. The same method is used before radiotherapy of patients with nasopharyngeal carcinoma, during treatment and at their follow up examinations. We found cytology of the nasopharynx very useful in managing these patients.

Adult↗
PubMed1992

Refinement of the transpalatine exposure of the nasopharynx.

The intrasulcular incision provides excellent transpalatine exposure of the nasopharynx with a viable palatal flap. There is less chance for naso-oral fistula formation since the resulting suture line is always over underlying bone. This safely allows extensive removal of the hard palate. Additionally, the continuous sling suture allows excellent flap reapproximation using the teeth as anchors for the replaced palatal flap. Patients tolerate oral feedings within 24 hours of their operations and require minimal postoperative analgesics. The extended intrasulcular incision offers many advantages over other methods for transpalatine exposures to the nasopharynx.

Gingivectomy↗
PubMed2006

Growth of the nasopharynx and adenoidal development in Brazilian subjects.

The purpose of this research was to study the growth of the nasopharynx and adenoid development. Lateral cephalometric radiographs obtained from 320 white Brazilian subjects between 4 and 16 years of age were used. All the participants were nose breathers and none of them had previously undergone adenoidectomy. Tracings were made from the radiographs and cephalometric measurements were performed. The results showed that adenoid sagital thickness is larger in the age group 4 - 5 years and decreases progressively. There is a slight increase in the age group 10 - 11 years, but afterwards the decrease continues. However, the nasopharyngeal free airway space does not decrease in the age group 10 - 11 years, despite the increasing thickness of the adenoid. This is attributable to the downward displacement of the hard palate, resulting in an increase of the free airway space due to growth. Although the nasopharynx follows a growth pattern similar to that of the rest of the body, adenoid tissue does not. Adenoidal development seems to differ from that of other lymphatic tissues, showing a peculiar pattern that can be revealed when hypertrophy due to infections and allergies is eliminated.

Adenoids↗
PubMed1976

Perforation of the nasopharynx by nasogastric intubation: a rare cause of left pleural effusion and pneumomediastinum.

A case of nasogastric tube perforation of the posterior nasopharynx producing a left pleural effusion and pneumomediastinum is reported. Findings which led to the correct diagnosis were the rapid appearance of a left pleural effusion simultaneous with the initiation of tube feedings, the intrathoracic location of the nasogastric tube, and demonstration of perforation of the posterior nasopharynx. Potentially hazardous intubation techniques are discussed.

Female↗
PubMed2004

Evidence of allergic inflammation in the middle ear and nasopharynx in atopic children with otitis media with effusion.

BACKGROUND: Otitis media with effusion (OME) occurs in the setting of eustachian tube (ET) dysfunction. Previous studies have demonstrated a predominance of T helper 2 (Th2) mediators in the middle ear effusions (MEEs) of atopic children, suggesting that allergy plays a role in the pathogenesis of OME. Given that the middle ear is contiguous with the upper airway, the allergic inflammation seen in the middle ear of atopic patients with OME may also have been observed in the nasopharynx. OBJECTIVE: We hypothesize that atopic children have different cellular and cytokine profiles in MEE compared with nonatopic patients and that this allergic inflammation occurs in both the middle ear and the nasopharynx. METHODS: Forty-five patients undergoing both ventilation tube placement for OME and adenoidectomy for adenoid hypertrophy were recruited. The atopic status was determined for each patient using standard skin testing. The cellular and cytokine profiles of the MEEs and the torus tubarius and adenoid tissues were investigated using immunocytochemistry and in situ hybridization. RESULTS: Our results indicate that, within the atopic patient, there is a similar cellular and cytokine profile within the three regions sampled, with a predominant expression of interleukin-4 (a Th2 cytokine) and an increased infiltration of eosinophils compared with the nonatopic patient. CONCLUSION: These findings confirm the association of allergy with MEE and support the hypothesis that the middle ear may be an integral part of the United Airway Concept.

Adenoidectomy↗
PubMed1990

The intermediate epithelium lining the nasopharynx of the Suncus murinus.

In the adult Suncus murinus, the rostral part of the nasopharynx is lined with the ciliated columnar epithelium continuing from the nasal cavity, while the laryngopharynx with the stratified squamous epithelium; i.e., the epithelium lining the caudal part of the nasopharynx forms the transitional zone between the ciliated columnar epithelium and the stratified squamous one. The epithelium shows gradations ranging from ciliated stratified low-columnar through stratified cuboidal to stratified squamous type. It is suggested that the epithelium is identical with the "intermediate epithelium (Nakano, 1986)".

Animals↗
PubMed1997

Eradication of penicillin-resistant pneumococci in the nasopharynx with antibiotic combinations including rifampicin: experiences from the South Swedish Pneumococcal Intervention Project.

39 children with prolonged nasopharyngeal carriage (48-328 days) of intermediately to highly penicillin-resistant pneumococci (PRP) were treated for 7 days with rifampicin in combination with amoxicillin (n = 18) erythromycin (n = 17) or clindamycin (n = 4), according to resistance pattern. In all children, except for 1 carrying a rifampicin-resistant strain, control cultures from the nasopharynx 1-2 weeks after the last antibiotic dosage, yielded no growth of PRP. In 2 brothers, PRP with the same serogroup and resistance pattern were found in nasopharynx 10 weeks after the antibiotic treatment. These preliminary findings indicate that antibiotic regimens including rifampicin are effective in eradicating nasopharyngeal carriage, but reappearance of the same strain may occur after several weeks. Such treatments should be given with caution due to the risk of selecting rifampicin-resistant strains. Further controlled studies are needed to determine the optimal combination of antibiotics and appropriate duration of therapy.

Amoxicillin↗
PubMed2004

IgA class switch occurs in the organized nasopharynx- and gut-associated lymphoid tissue, but not in the diffuse lamina propria of airways and gut.

Secretory IgA plays a crucial role in the host immune response as a first line of defense. A recent demonstration of in situ IgA class switching in intestinal lamina propria provided an opportunity to reconsider the model for the homing of IgA-committed B cells characterized by distinctive trafficking patterns to effector sites. Those effector sites depend on the organized mucosa-associated lymphoid tissues as their site of induction. In this report we show the preferential presence of IgM(+)B220(+) and IgA(+)B220(+) cells belonging to pre- and post-IgA isotype class-switched cells in the organized mucosa-associated lymphoid tissues, such as nasopharynx-associated lymphoid tissues, isolated lymphoid follicles, and Peyer's patches, and the defect of those populations in the diffuse effector tissues, such as the nasal passage and intestinal lamina propria. Consistent with these findings, the expressions of a series of IgA isotype class switch recombination-related molecules, including activation-induced cytidine deaminase, Ialpha-C micro circle transcripts, and Ialpha-C micro circle transcripts, were selectively detected in these organized mucosa-associated lymphoid structures, but not in the diffuse mucosal effector sites. Taken together, these findings suggest that IgA isotype class switching occurs only in the organized mucosa-associated lymphoid organs (e.g., nasopharynx-associated lymphoid tissues, isolated lymphoid follicles, and Peyer's patches), but not in the diffuse effector tissues of the upper respiratory and gastrointestinal tracts.

Animals↗
PubMed2002

[Adenoid cystic carcinoma (cylindroma) of the nasopharynx with extension into the cavernous sinus].

INTRODUCTION: The adenoid cystic carcinoma or cylindroma of the nasopharynx is a rare tumour characterised by its slow progression, high risk of local recurrence and prolonged survival, even in the locally advanced and/or metastatic forms. Treatment is pluridisciplinary. OBSERVATION: In a 30 year-old man consulting for right retroauricular pain, hypoacousia and epistaxis, diagnosis of a nasopharyngeal cylindroma was made in 1994. Treatment consisted first line surgery combined with loco-regional radiotherapy. Twenty-six months after complete remission had been obtained, a loco-regional relapse was revealed, combined with pulmonary metastases. The treatment combining radiotherapy, surgery and chemotherapy led to the stabilisation of the disease. COMMENTS: The adenoid cystic carcinoma of the nasopharynx a rare neoplasia of the head and neck, characterised by its slow progression over time, a high risk of relapse and the progression of metastases at distance. The corner stone of its therapeutic management is surgery. Radiotherapy improves the local control of the disease and chemotherapy is helpful in treating the metastatic disease.

Adult↗
PubMed1992

[The shape of the nasopharynx in youth: statistical study].

The particular shape of the nasopharynx in the child can influence morphology and physiopathologic behaviour of the mucosa. In such a perspective, it appeared interesting to evaluate the kind and the entity of its variations by means of nuclear magnetic resonance (NMR) in 50 patients (age range: 2 months-16 years). The results show that the nasopharyngeal shape (represented either by bending radius and shape factor) varies in a statistically significant way during the considered age range, while the dimension of the pharyngeal tonsil remains constant in the studied cases. The statistically significant shape variation of the tonsil appears, so, related to its involvement in the shape variation of the whole nasopharynx.

Adolescent↗
PubMed1976

[Indication for operation in the area of the nasopharynx and the middle of the base of skull (author's transl)].

For the treatment of malignancies of the nasopharynx and the middle of the base of skull the high voltage irradiation is the therapy of first choice. It can also be used in combination with cytostatic drugs or in the form of synchronization. The indication for operative procedure with functional lesions is given only in few cases. Today, operative approach is only indicated for benign pathological changes. The removal of small benign tumors, posterior conchotomy or hyperplastic tubal elevations can be performed perorally directly looking through a nasopharyngeal endoscope. The same is true for the removal of cicatricial stenoses or mucosal scars. With deformations (choanal atresia) the transpalatinal way of approach is preferred to others. This method is also convenient for large tumors of the nasopharynx, the choanas and middle of the base of skull. If this topographic region is exceeded a large combined operation (transmaxillary, paralateronasal, transpterygoidal, transcygomatical, retro-submandibular) will be necessary. With plastic reconstruction a good functional result can be obtained. This is shown with own examples.

Adolescent↗
PubMed2006

[The prevention of the ear barotrauma by positive pressure on nasopharynx].

OBJECTIVE: To explore if the ear barotrauma could be prevented or not if the provided nasopharyngeal pressure is higher than the Eustachian tube resistance during the pressure increases in the hyperbaric chamber. METHOD: Eight volunteers of healthy men were divided into 4 groups, with 2 persons in each group who were the tested and the control for each other. The positive pressure of 6kPa was given via mask to the nasopharynx of the tested, while the control took normal breath. The pressure in the hyperbaric chamber was increased by 5kPa with the velocity of 0.5kPa/s. No positive or negative measurement to open Eustachian tube was allowed for both tested and controls. The pressure within the tympanic cavity was measured. Similarly, the pressure in the hyperbaric chamber was increased by 20kPa with the same velocity. The tested were not allowed to adjust the Eustachian tube, while the controls could do so. The pressure within the tympanic cavity was measured once again. RESULT: When 5 kPa in the hyperbaric chamber was reached, the pressure within the tympanic cavity of the tested and the control was -11.2 daPa and -168.6 daPa (P < 0.01), respectively. When 20 kPa was reached, the pressure within the tympanic cavity of the tested and the control was -8.3 daPa and -7.6 daPa (P > 0.05), respectively. Ear barotrauma could be prevented by providing positive pressure which is higher than the Eustachian tube resistance through mask to the nasopharynx.

Adolescent↗
PubMed1981

[Role of Streptococcus salivarius in maintaining the ecologic balance of the human nasopharynx].

Most of Str. salivarius strains isolated from the nasopharynx of healthy persons suppressed the growth of meningococci in vitro. Their antagonistic activity varied within a wide range, which suggested that different strains were unequal in their capacity for protection from meningococcal infection. The monthly comparison of the activity of various strains also allowed revealing considerable differences. These results confirm the earlier hypothesis on the decisive role of Str. salivarius in the protection of the nasopharynx from colonization by meningococci.

Antibiosis↗
PubMed1975

[Condition of microflora of the nasopharynx in immunization with live influenza vaccine for oral administration].

The authors present data concerning the state of the microflora of the nasopharynx in the immunization of adults and schoolchildren with the living influenza vaccine for oral administration. During the vaccinal process there occurred qualitative changes in the microbial pattern of the nasopharynx and a reduction in the level of the salivary lysozyme. The most pronounced changes were seen after the first vaccination, when the seeding efficiency of the pathogenic staphylococcus the E. coli and the Pr. mirabilis increased considerably. At the same time the incidence of isolation of the pathogenic staphylococcus, neisseria, and hemolytic streptococcus was decreased. The mentioned changes in the microbial flora directly depended on the dynamics of the survival of the vaccine influenza virus.

Administration, Oral↗
PubMed1993

[AgNORs staining of exfoliated cells in the nasopharynx for diagnosis of nasopharyngeal cancer].

AgNORs were investigated in exfoliated cell smears from nasopharynx and in sections of biopsied tissues of NPC patients. It showed increased tendency of AgNOR activity that was significantly higher in carcinomas than in benign tumors, chronic nasopharyngitis, and normal nasopharyngeal tissues. This suggests that AgNOR technique of exfoliated cells might be useful for NPC diagnosis, follow-up of NPC patients, and identification of precancerous lesions of the nasopharynx.

Carcinoma, Squamous Cell↗
PubMed1997

Schwannomas of the sinonasal tract and nasopharynx.

Approximately 45% of benign peripheral nerve sheath tumors occur in the head and neck region. Of these, schwannomas (neurilemomas) arising from the nasal cavity and paranasal sinuses account for less than 4%. Pathologic features of this subset are not well documented. We report a series of five cases of sinonasal schwannoma and one in the nasopharynx. The male-to-female ratio was equal, and the age at presentation ranged from 38 to 65 years of age (median, 52 yr). Four of the lesions were located within the nasal cavity, one arose from the maxillary sinus, and one originated in the nasopharynx, with extension into the Eustachian tube. Two cases showed local bony destruction, with intracranial extension. Presenting clinical symptoms included nasal obstruction, epistaxis, rhinorrhea, anosmia, facial swelling, headache, and serous otitis media; the two cases with intracranial spread also presented with visual disturbances. All of the six cases were treated by surgical excision. Clinical follow-up in five cases ranged from 6 to 48 months (median, 27 mo). Histologically, all of the lesions shared many cytomorphologic features common to schwannomas arising at other sites, and all of the six cases showed strong, diffuse immunoreactivity for S-100 protein. Four cases showed features of the cellular variant, and one showed focal granular cell change. An unusual and previously poorly documented histologic feature, distinct from schwannomas arising at most other anatomic sites, was a lack of encapsulation, which, when combined with hypercellularity, often raised suspicion of malignancy. Because none of the cases in this series has shown either local recurrence or postoperative metastasis to date, lack of encapsulation and locally destructive growth in an otherwise histologically typical schwannoma arising at this site should not suggest malignant potential.

Adult↗