A Thornwaldt cyst is a type of cyst located in the nasopharynx, the upper part of the throat behind the nose. Many people discover them incidentally during imaging scans for other conditions. This article clarifies what a Thornwaldt cyst is and whether it poses a danger to health.
Understanding Thornwaldt Cysts
A Thornwaldt cyst is a non-cancerous, fluid-filled sac found in the midline of the nasopharynx, specifically on its posterior wall. This cyst develops from a remnant of an embryonic structure known as the notochord. If the opening of a small recess in this area, called the pharyngeal bursa, becomes blocked, a Thornwaldt cyst can form. They are considered congenital, meaning present from birth, though they often become apparent in adolescence or early adulthood.
Thornwaldt cysts are typically small. The majority are asymptomatic, meaning they do not cause any noticeable symptoms. Due to their small size and lack of symptoms, many individuals may never know they have one unless it is found incidentally during an imaging test or endoscopic examination.
Are Thornwaldt Cysts Dangerous?
Thornwaldt cysts are not considered dangerous. They are benign, non-cancerous growths that do not spread to other parts of the body. In most instances, these cysts remain small and cause no health problems. Their discovery is frequently an incidental finding during imaging studies like MRI or CT scans of the head or neck.
The reported incidence varies, with many going undiagnosed due to their asymptomatic nature. Thornwaldt cysts rarely lead to significant health issues or life-threatening complications. Their presence typically does not indicate a serious underlying condition.
When a Cyst Becomes Problematic
While generally benign, a Thornwaldt cyst can, in rare circumstances, become problematic and cause symptoms. This occurs if the cyst grows large enough to obstruct nearby structures within the nasopharynx. Such enlargement might interfere with the Eustachian tube, which connects the middle ear to the nasopharynx, potentially leading to ear fullness, hearing changes, or recurrent ear infections. Nasal obstruction or post-nasal drip could also occur.
A cyst can also cause symptoms if it becomes infected or inflamed. This happens if the cyst’s opening becomes blocked, trapping fluid and creating an environment for bacterial growth. Symptoms of an infected cyst may include bad breath (halitosis), a foul taste in the mouth, or drainage of pus. Headaches, particularly in the back of the head, and stiffness in the neck muscles have also been reported in symptomatic cases.
Diagnosis and Management
Thornwaldt cysts are frequently diagnosed incidentally during medical imaging, such as MRI or CT scans of the head or neck. MRI is often considered the preferred imaging modality for detecting and characterizing these cysts, as it provides detailed views of soft tissues. A diagnostic nasal endoscopy, where a flexible viewing tube is inserted through the nose, can also directly visualize the cyst.
For asymptomatic cysts, medical observation is typically the recommended approach, and no active treatment is usually necessary. If a cyst becomes symptomatic, surgical intervention may be considered. The most common surgical procedures involve marsupialization, which creates a permanent opening in the cyst to allow drainage, or complete surgical excision. These procedures are generally straightforward and can resolve the symptoms in most patients. Individuals experiencing any concerning symptoms should consult a healthcare professional for an accurate diagnosis and appropriate guidance.