[Polypoid space-occupying lesion of the nasopharynx. Nasopharynx tuberculosis with cervical lymph node involvement bilaterally and right hypoglossal paralysis].
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Aged↗
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[Diagnosis and therapy of juvenile fibromas of the nasopharynx. Juvenile fibroma of the nasopharynx in an atypical locaction].
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Adolescent↗
Extent of nasopharyngeal carcinoma involvement inside the nasopharynx. Lack of prognostic value on local control.
A study on the use of fiberscopic examination and multiple biopsy specimens taken from the nasopharynx in the assessment of the extent of nasopharyngeal carcinoma (NPC) involvement inside the nasopharynx found that the involvement often was more extensive than the detected with conventional methods. In the current study, 247 patients with NPC were studied with the use of fiberscopic examination, and multiple biopsy specimens were taken from the superior wall, posterior wall, and lateral wall of the nasopharynx on both sides. It was confirmed that the tumor often involved the nasopharynx extensively. Also, the extent of primary tumor involvement inside the nasopharynx was correlated with the American Joint Committee (AJC) T stage and the degree of paranasopharyngeal extension of the tumor (P = 0.0100 and 0.0009, respectively), as well as with the size of the largest node and the lowest neck level involved by the node in the ipsilateral neck (P = 0.0005 and 0.005, respectively). However, the extent of primary tumor involvement inside the nasopharynx, expressed as either the number of the six standard sites or the number of the AJC subsites that were involved, had no predictive value on the control of the primary tumor (P = 0.3773 and 0.7794, respectively) at a median follow-up time of 27 months. Except when salvage brachytherapy is contemplated for persistent or recurrent NPC, the extent of primary tumor involvement inside the nasopharynx should not be routinely studied.
Actuarial Analysis↗
Neoplasms of the nasopharynx in children.
Neoplasms of the nasopharynx are rare in children, but they threaten the child's life when they do occur. The nasopharynx tends to harbor dysontogenetic neoplasms. After classification into benign and malignant groups, nasopharyngeal neoplasms in children can be further characterized according to the age of the patients in which the clinical manifestations usually appear. Dermoids and teratomas are the most frequently encountered neoplasms of the nasopharynx in infants and may produce airway obstruction and dysphagia. Among the benign tumors of the nasopharynx in children, the juvenile angiofibroma deserves the most attention. With the onset in puberty, these neoplasms may cause recurrent massive bleeding and orbital and intracranial complications. Evaluation of the extent of the neoplasm and the source of the blood supply has been improved with bilateral selective internal and external carotid angiography. Intracranial and orbital invasion is regarded as an indication for radiotherapy. Surgery has been made somewhat safer by preoperative estrogen therapy and angiographic embolization of the major arterial supply. Patients with squamous cell carcinoma of the nasopharynx have immunologic similarities to patients with Burkitt's lymphomia and infectious mononucleosis; The etiologic role of the Epstein-Barr virus is considered. The parts played by radiation therapy, surgery, chemotherapy, and cryosurgery in the treatment of children with carcinoma of the nasopharynx are discussed. The value of radical neck dissection after radiation therapy is critically reviewed. The prognosis in patients with carcinoma of the nasopharynx is better in females than in males and better in children than in adults.
Adolescent↗
Radiologic evaluation of the normal adult nasopharynx.
Adenoid hypertrophy complicates the radiographic evaluation of the adult nasopharynx. To define the limits of normal soft-tissue thickness of the nasopharynx on the lateral film, I measured the profiles of 2 different groups of adult patients: 60 patients examined by x-ray for trauma who had no sinus disease or nasopharyngeal complaints and 30 patients examined by x-ray who had nasopharyngeal complaints necessitating biopsies. Histologic examinations of the biopsy specimens indicated benign disease, usually caused by an inflammatory process. The asymptomatic group showed a more uniform appearance of the nasopharynx than the symptomatic patients, who had a wide variation in the thickness of the nasopharynx. The symptomatic group manifested nasal and eustachian tube obstruction, frequently associated with serous otitis media. When the soft-tissue thickness of the nasopharynx was correlated with age, nasopharyngeal thickening was unusual in asymptomatic persons older than 30 years. Conversely, persons over 30 with nasopharyngeal thickening were often symptomatic and had biopsies indicating some inflammatory change in the nasopharynx.
Adenoids↗
Acoustic rhinometry, used as a method to demonstrate changes in the volume of the nasopharynx after adenoidectomy.
Acoustic rhinometry is a method of investigating the geometry of the nasal cavity and the nasopharynx. An acoustic impulse is transferred to the nasal cavity and the reflected signal is analysed expressing the cross-sectional area in the nasal cavity and the nasopharynx as a function of the distance from the nostril. The method provides an accurate and objective measurement of the geometry of the nasal cavity and the nasopharynx in a non-invasive way. In a series of 20 children, age range 4-16 years, it has been possible to demonstrate the changes in the volume of the nasopharynx after adenoidectomy. The relation between the volume of the adenoid and the calculated change of volume in the nasopharynx is found to be proportional and highly significant (P = 0.0005). It is concluded that acoustic rhinometry, which is very easy to perform, gives a reliable, objective measurement of the amount of adenoid tissue in the nasopharynx. The results from these and future studies may help reduce the number of unnecessary adenoidectomies.
Adenoidectomy↗
Influence of biopsy on the prognosis of nasopharyngeal carcinoma--a critical study of biopsy from the nasopharynx and cervical lymph node of 649 patients.
Most of the nasopharyngeal carcinomas (NPC) are histopathologically either poorly differentiated or undifferentiated. After radiotherapy, hematogenous spread is the chief cause of failure for these patients. Biopsies taken from the nasopharynx or the enlarged neck nodes should be performed to establish diagnosis before radiotherapy. The present study was done to ascertain whether the biopsy procedure would affect the final outcome of this malignancy, and to establish certain criteria for clinicians as they endeavor to correctly diagnose and prepare the patients for treatment. Six hundred and forty-nine of 702 NPC patients treated in our hospital from March 1958 through 1972 were analyzed for this purpose and the results are as follows: For patients with fixed and partially fixed neck nodes, the interval between the first biopsy and radiotherapy, the number of times or frequency of biopsy either taken from the nasopharynx or the lymph node and the type of biopsy done on the lymph node did not influence the prognosis. For patients with or without only movable neck nodes, the interval between the first biopsy from the nasopharynx and radiotherapy influenced the final outcome. Patients who received radiotherapy within 14 days after biopsy had a five year survival of 61% (42/69), which is better than that of the patients who started their treatment beyond the 15th day (47.5%-58/122). This is statistically significant (p less than 0.05). The number of times or frequency of biopsy taken from the nasopharynx before radiotherapy did not influence the result of treatment. The interval, therefore, and not the frequency, is important in the biopsy from the nasopharynx. For patients with movable lymph nodes, partial excision of the node gave a poorer five year survival (22%-2/9) than that of patients on whom complete excision was done (50%-9/18). Therefore, complete excision of the node is advised for patients with movable neck node metastasis.
Biopsy, Needle↗
[The relationship between nasopharynx surface-active agents and otitis media effusion].
This experiment was done with a view to exploring the etiologic mechanism and new therapy of otitis media effusion (OME). The amount of lecithin, which is representative of the surfactants in the nasopharynx irrigation wash liquid, was determined by photometry in 40 cases OME and 40 normal controls. The results showed the surfactant of otitis media effusion (8.637 +/- 2.730 mg/L) was significantly lower than that of normal (39.212 +/- 2.437 mg/L) in the nasopharynx irrigation wash liquid (P < 0.01). The surfactant of child group of OME (8.062 +/- 2.925 mg/L) significantly lower than that of normal control(39.787 +/- 2.557 mg/L, P < 0.01). The surfactant of otitis media effusion in the nasopharynx irrigation wash liquid was not associated with the course of OME. These data suggest that the surfactant reduction in the nasopharynx could indirectly reflect the level of the surfactant in the eustachian tube and the middle ear and influence the eustachian tube function. Surfactant reduction may be one of the etiologic mechanisms of OME. Increasing the surfactant in the nasopharynx and eustachian tube could be beneficial to reducing the persistent otitis media effusion.
Adolescent↗
[Rapid construction of directional cDNA library from human nasopharynx].
OBJECTIVE: To construct a directional cDNA library from human adult nasopharynx by SMART (switching mechanism at 5' end of RNA transcript) technique. METHODS: The total RNA was separated from human adult nasopharynx epithelial tissue and the first-strand cDNA was synthesized through reverse transcription by a modified oligo(dT) primer(contained sfi IB site) while the SMART oligonucleotide(contained sfi IA site) was utilized as a template so that the first-strand cDNA could be extended over the 5' end of mRNA. The double-strand cDNA was amplified by LD-PCR(long-distance PCR) with the above two primers and then digested by sfi I (IA & IB) restriction enzyme. After cDNA size fractionation through CHROMA SPIN column, the double-strand cDNA was ligated into the sfi I-digested lambda TripIEx2 vector and then the recombinant DNA was packaged in vitro. RESULTS: The unamplified human adult nasopharynx cDNA library consists of 1.5 x 10(6) independent clones in which the percentage of recombinant clones is about 100%. The titer of the amplified cDNA library is 3.8 x 10(9) pfu/ml and the average exogenous inserts of the recombinants is 1.5 kb. CONCLUSION: These results shows that the human adult nasopharynx cDNA library has an excellent quality and lays solid foundation for screening and cloning new tumor suppressor genes of nasopharyngeal carcinoma(NPC) and tissue-specific genes of human nasopharynx.
Adult↗
Nonepithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx. A clinicopathologic study. XIV: Chordomas.
Twenty cases of a rare tumor, chordoma involving the nasal cavity, paranasal sinuses, or nasopharynx, are reported. Patients most often had localized headache, nasal obstruction, decreased hearing, or symptoms related to cranial nerve involvement, especially diplopia. A mass bulging into the nasopharynx, posterior nasal cavity, or pharynx was found on physical examination in 13 of these 20 patients, and in another 6 patients on radiologic examination. Paralysis of one or more cranial nerves was identified in the majority of patients who had tumors involving the upper nasopharynx. On radiologic examination, bone destruction was frequently identified in the clivus and sphenoid areas, and less commonly in the cervical vertebrae. Each patient had biopsy-proven tumor in the nasopharynx or sphenoid areas. Patients usually were treated by combinations of surgery and radiotherapy, in some cases leading to prolonged periods of apparent tumor control. Radiotherapy frequently resulted in regression of symptoms, sometimes lasting many months or years. A few tumors that involved mainly the lower nasopharynx were more amenable to surgical resection, in one case leading to apparent tumor control. In those cases with adequate follow-up information, most patients had either died of their disease or were living with recurrent or persistent inoperable tumor. Some patients lived for many months or years between recurrences or with known tumor, indicating that chordomas often are slowly growing neoplasms. The histologic features of these chordomas are described and illustrated, and the histopathologic differential diagnosis is discussed.
Adolescent↗
[Relationship between expression of P16 protein and prognosis in carcinoma of nasopharynx].
We observed the relationship between p16 gene and the occurrence, development and prognosis of carcinoma of nasopharynx by means of LSAB immunohistochemistry method and investigated the expression of protein P16 in 73 cases of carcinoma of nasopharynx and 10 cases of epithelia of chronic inflammation of nasopharynx. The results showed that P16 positive rate was 100% for the epithelia of chronic inflammation of nasopharynx. It was significantly higher than the P16 positive rate for the carcinoma of nasopharynx (38.4%, P < 0.01). There was significant difference of P16 positive expression in differentiation of nasopharyngeal carcinoma (poor differentiation versus undifferentiation), clinical staging (I-II versus IV) and grading of tumor (T1-T2 versus T3, T4) (P < 0.01). There was no correlation between P16 expression and metastatic lymph node (P > 0.05). The 3-year survival rates were 88.9% and 72.9% in P16 expression (+) and (-) patients respectively (P < 0.05). These findings suggested that P16 might play an important role in the process of carcinogenesis and development of nasopharyngeal carcinoma, and P16 might be used as a valuable marker for assessment of the biological behavior and prognosis of nasopharyngeal carcinoma.
Adolescent↗
[Measurement of surfactant in-irrigating fluid from the nasopharynx of patients with secretory otitis media].
OBJECTIVE: Dysfunction of the eustachian tube is believed to play a role in the pathogenesis of secretory otitis media (SOM). In the animal model, previous investigators have found that surfactant in the eustachian tube could decrease the eustachian tube opening pressure and improve eustachian tube functions. Because the nasopharynx is anatomically adjacent to the eustachian tube and the membrane of the nasopharynx continues to the middle ear via the eustachian tube, we hypothesized that the surfactant could also present in the nasopharynx and then designed the following experiment to confirm this hypothesis. METHODS: The concentrations of surfactants in the nasopharyngeal irrigating fluid were measured in normal control and SOM patients. RESULTS: (1) The surfactant from the SOM patients were significantly lower than that from the normal control (8.637 +/- 2.730) mg/L vs. (39.212 +/- 2.437) mg/L. (2) The concentration of surfactant from child SOM was also significantly lower than that of the normal control (8.062 +/- 2.925) mg/L vs. (39.787 +/- 2.557) mg/L. (3) The concentration of surfactant of SOM was not associated with the course of SOM. CONCLUSION: Surfactant reduction in the nasopharynx could indirectly reflect the level of the surfactant in the eustachian tube and the middle ear and influence the eustachian tube function. So surfactant reduction is one of the causative factors in SOM. The strategy of increasing surfactant in the nasopharynx and eustachian tube should be beneficial to reducing persistent secretory otitis media.
Adolescent↗
Resurfacing of the nasopharynx after nasopharyngectomy using a free radial forearm flap.
BACKGROUND: Nasopharyngectomy is emerging as an important treatment option for salvaging locally recurrent nasopharyngeal carcinoma (NPC). After nasopharyngectomy, resurfacing the nasopharynx and covering the internal carotid artery is important to minimize the risk of infection, osteoradionecrosis, and carotid rupture. Previous authors have advocated the use of free grafts of skin and mucosa for this purpose but have also described significant rates of partial and total graft failure. METHODS: We believe that the best and most reliable way to resurface the nasopharynx is with vascularized tissue, and our preference is for the use of a free radial forearm flap. To illustrate our approach, we present two patients who underwent nasopharyngectomy by means of a maxillary swing approach and who had resurfacing of the surgical defect with a free radial forearm flap. RESULTS: Both patients had complete en bloc resection of tumor followed by the insetting of a free radial forearm flap to reline the surgical defect. Both flaps remained completely viable, and both patients achieved successful resurfacing of the entire nasopharynx. The morbidity of surgery was minimal, and there were no perioperative complications. On assessment 1 year later, the free radial forearm flap continues to reline the entire neonasopharynx, and the long-term functional recovery after surgery is excellent. CONCLUSION: Resurfacing the nasopharynx after nasopharyngectomy with a free radial forearm flap aids healing and minimizes the risk of complications. The morbidity of surgery is minimal and the functional recovery is excellent.
Humans↗
Breast carcinoma metastatic to the nasopharynx.
A case report of a patient with adenocarcinoma of the breast with metastasis to the nasopharynx is described. The patient presented initially with pulmonary metastasis followed later by metastasis to the left jugulo-digastric lymph nodes. A prominent but asymptomatic nasopharyngeal mass was concomitantly discovered on head and neck examination. Three months later, symptoms of panhypopituitarism developed. Invasion of the base of the skull and pituitary were documented. Patients with adenocarcinoma of the breast and high cervical node metastasis should have a thorough otolaryngologic and head and neck evaluation. Metastatic carcinoma to the nasopharynx is an extremely rare occurrence. Only two cases of bronchogenic carcinoma of the lung and two cases of hypernephroma metastatic to the nasopharynx have been reported in the literature (Bernstein et al., 1966). We present what we believe to be the first case of metastatic adenocarcinoma of the breast to the nasopharynx.
Adenocarcinoma↗
[A simple method for the demonstration of the bacterial spectrum in the nose and the nasopharynx in the infection-free interval in children with adenoid hypertrophy].
The implications of bacterial colonization and distribution patterns in the nasopharynx and nasal cavities of children with adenoidal hypertrophy without clinical signs of acute infection are to be determined. We examined the spectrum and distribution of the facultative pathogenic bacterial flora in nasal cavities and nasopharynx of children with clinical apparent symptoms or signs of adenoid hypertrophy in an infection free interval. Compared with the nasal cavity we found an accumulation of pathogenic bacteria in the nasopharynx. A transnasal single swab from the nasopharynx showed to be the most effectively practical way to detect clinically relevant pathogenic bacteria. A thin flexible calcium-alginate swab was used in our experiments. Swabbing from the anterior nasal cavities proved to be a minor successful diagnostic method.
Adenoids↗
[MRI of the nasopharynx with Gd-DTPA: its value and differential diagnostic criteria].
81 patients with masses in the nasopharynx were examined by MRI and CT. In cases of primary lesions of the nasopharynx (such as carcinomas and fibromas), MRI with Gd-DTPA was superior to CT. Secondary tumors involving the nasopharynx were visualized equally well with MRI with Gd-DTPA and CT. The results show that MRI should be the primary method of examination in lesions of the nasopharynx. CT is a secondary procedure useful for showing small areas of bone erosion. MRI with the paramagnetic contrast medium Gd-DTPA permits differentiation between inflammatory, cystic and neoplastic masses.
Angiography↗
Bacteriological findings in nasopharynx specimens from patients with a clinical diagnosis of acute sinusitis.
OBJECTIVE: To study results from bacteriological specimens from nasopharynx in patients with a clinical diagnosis of acute sinusitis in relation to CT findings. DESIGN: Prospective study. SETTING: Patients from general practice in Vestfold county, Norway. PATIENTS: 427 patients 15 years and older from two studies with a clinical diagnosis of acute sinusitis, and who were examined with coronal CT scans of the paranasal sinuses. Fluid level or total opacification of any sinus was taken as a hallmark of sinusitis. MAIN OUTCOME MEASURES: Bacteriological findings in nasopharynx specimens and proportions of various sinus pathogens in patients with and without sinusitis confirmed by CT. RESULTS: In the study, 252 patients had acute sinusitis and 175 patients did not. In the sinusitis groups, 27% of the patients had Streptococcus pneumonia, 12% had Staphylococcus aureus and 10% had Haemophilus influenzae in their nasopharynx specimens. Forty-five percent of the patients had normal nasal flora or no growth. The strains of Streptococcus pneumonia and Haemophilus influenzae showed high sensitivity to PcV, while the Moraxella strains were resistant to it. CONCLUSION: Streptococcus pneumoniae and Haemophilus influenzae were the most frequent sinus pathogens found in the nasopharynx specimens, and they were significantly more frequent in the group with confirmed sinusitis. The proportion of specimens with normal nasal flora or no growth was significantly higher in the non-sinusitis group.
Acute Disease↗
Phase variation of lic1A, lic2A and lic3A in colonization of the nasopharynx, bloodstream and cerebrospinal fluid by Haemophilus influenzae type b.
The role of phase variation of lic1A, lic2A and lic3A in the ability of Haemophilus influenzae type b to colonize the nasopharynx, bloodstream and cerebrospinal fluid (CSF) of infants was investigated. This was achieved by using PCR to determine the number of 5'-CAAT-3' repeats present in each gene, which is indicative of whether each ORF can be expressed. Multiple PCR products of different intensities were amplified from all three genes at each site sampled. This indicated that the nasopharynx, bloodstream and CSF were colonized by a heterogeneous population of organisms, expressing different combinations of lic genes. At each site however, a predominant PCR product was amplified from each gene, indicating that organisms with this genotype were the most abundant. The number of 5'-CAAT-3' repeats in this predominant product varied depending upon whether organisms were isolated from the nasopharynx, bloodstream or CSF. These observations suggest that the expression of different combinations of lic genes may influence the efficiency with which H. influenzae colonizes the nasopharynx, bloodstream and CSF of infant rats.
Animals↗