NASOPHARYNGEAL CARCINOMA—– DANIEL W TODD, MD
ANATOMY
TRANSITION SPACE BETWEEN THE NC AND OP
WIDEST PORTION OF THE PHARYNX
ABOUT A 3 X 3 CM CUBE SHAPED CHAMBER
PHYSIOLOGY
A RESPIRATORY CONDUIT
VP FUNCTION TO ALLOW NASO-ORAL SEPARATION
VPI—-NASAL REGURGE, HYPERNASAL SPEECH “RHINOLELIA APERTA”
VP STENOSIS—-INADEQUATE SINONASAL DRAINAGE, HYPONASAL SPEECH “RHINOLELIA CLAUSA”
STERTOR = NP TURBULENCE
HISTOLOGY
LYMPHOID TISSUE–PRIMARY NON-THYMUS RELATED B-CELLS (GERMINAL CENTERS OF GOODSIR)
PRIMARILY FUNCTIONS IN 1ST YEARS OF LIFE (NO DECREASED IGA FOLLOWING ADENOIDECTOMY)
EPITHELIAL LINING–METAPLASIA
ANATOMY
TRANSITION SPACE BETWEEN THE NC AND OP
WIDEST PORTION OF THE PHARYNX
ABOUT A 3 X 3 CM CUBE SHAPED CHAMBER
LYMPHATIC DRAINAGE
EXTENSIVE
VARIABLE
OFTEN BILATERAL
PROMINENT DRAINAGE TO THE RP LYMPH NODES—CANNOT BE PALPATED
ANT/SUP BORDER
POST CHOANAE (2ND ONLY TO ANT CHOANAE IN AIRWAY RESISTANCE–NOSE AS A WHOLE PROVIDES 50% OF RESP. TRACT RESISTANCE)
VOMER
POST/SUP BORDER
CLIVUS
(FORNIX “ROOF” PHARYNGEOUS) = BASISPHENOID AND BASIOCCIPUT
BODY OF C1 (ATLAS) AND C2 (AXIS)
ADENOID
= PHARYNGEAL TONSIL = LUSCHKA’S TONSIL (CONTAINS GERMINAL CENTERS OF GOODSIR)
BURSA PHARYNGEUS = DEPRESSED REMNANT OF MIDLINE NOTOCHORD–INFXN=THORNWALD’S Dz
POST BORDER
STRAT SQUAMOUS MUCOUS MEMBRANE
PHARYNGEAL CONSTRICTORS
BUCCOPHARYNGEAL FASCIA
ALAR FASCIA
RP SPACE
PREVERTEBRAL FASCIA
ANT LONG LIG
VERTEBRAL BODIES
RP SPACE
REALLY A POST EXTENSION OF THE RETROSTYLOID PORTION OF THE PARA(NASO)PHARYNGEAL SPACE
CONTAINS RP LN’S “GLANDS OF HENLE” MOST LATERAL PROMINENT IS NODE OF ROUVIERE
RULE OF 7’S
INF BORDER
SOFT PALATE = VELUM PALATI
LINED BY PSEUDOSTRAT CILIATED COLUMNAR EP ON NASAL SIDE AND BY STRAT SQUAM EP ON ORAL SIDE
PASSAVANT’S RIDGE (PAD) = PROMINENCE OF INF MOST SUP CONSTRICTOR
LATERAL BORDER
TORUS TUBARIS (FIBROCARTILAGE  ORIGIN OF CARTILAGENOUS ET–AN INFERIORLY INCOMPLETE ARCH)
ANT–TVP, SALPINGOPALATINE MUSCLE AND MEMBRANE, LVP, AND SALPINGOPHARYNGEAL MUSCLE AND MEMBRANE–POST
LAT BORDER
FOSSA OF ROSENMULLER (PHARYNGEAL RECESS)
TUBAL TONSIL (GERLACH’S TONSIL)
WALDEYER’S RING
A QUASI-CIRCLE OF LYMPHOID TISSUE SURROUNDING THE OP INLET
ADENOID/PHARYNGEAL TONSIL OF LUSCHKA
TUBAL (GERLACH’S) TONSIL
LAT PHARYNGEAL BANDS
PALATINE (FAUCIL) TONSILS
LINGUAL TONSIL
OTHER ENTITIES
NPC
WHO CLASSIFICATION OF NON-GLANDULAR/ NON-LYMPHOMATOUS EPITHELIAL MALIGNANCIES
NPC
EPIDEMIOLOGY
HIGH INCIDENCE IN GUANGDONG PROVINCE IN S.E. CHINA
MALE 3:1
MEAN AGE 50 (YOUNGER THAN MOST H&N CA)
ETIOLOGY
EBV (STRONG RELATIONSHIP WITH WHO TYPES I AND II)
NITROSAMINES (DRY SALTED FISH)
POLYCYCLIC HYROCARBONS
CHRONIC RHINOSINUSITIS?
GENETICS
CLINICAL MANIFESTATION
PRIMARILY PRESENT AS A HIGH PAINLESS NECK MASS (50% B METS AT TIME OF Dx)
ETD–OME WITH CHL
NAO, STERTOR, EPISTAXIS, RHINOLELIA
TRISMUS
DIPLOPIA, CRANIAL NEUROPATHY
TROTTER SYNDROME
TROTTER SYNDROME (SINUS OF MORGAGNI SYNDROME)
W. TROTTER 1911
TUMOR AT THE SKULL BASE INVOLVING THE SINUS OF MORGAGNI—SUP CONSTRICTOR APONEUROSIS WHERE THE E.T. PASSES
TROTTER’S SYNDROME
ETD—CHL
PAIN IN DIST. OF VIII (INF. ALVEOLAR NEURALGIA)
IPSI SOFT PALATE AKINESIA (RHINOLELIA CLAUSA OR APERTA)
TRISMUS—PTERYGOID INVOLVEMENT
PREAURICULAR EDEMA
PTERYGOPALATINE SYNDROME
POSSIBLE BLINDNESS
VII PAIN (INFRA-ORBITAL AND MAXILLARY TOOTH PAIN)
PALATAL ANESTHESIA
TRISMUS
NO ETD
DIAGNOSIS
DIRECT EXAMINATION
ENDOSCOPY
IMAGING
BIOPSY
SEROLOGY
STAGING
TREATMENT