Tornwaldt's cyst: Clival erosion with reconstitution after treatment

Tornwaldt's cyst is an uncommon midline nasopharyngeal cyst that arises from the pharyngeal bursa (pouch of Luschka) on the posterior nasopharynx. The pharyngeal bursa is the remnant of a communication between the nasopharynx and the notochord. Occlusion of this communication results in the formation of Tornwaldt's cyst. Development of these cysts has been linked to scarring from prior adenoidectomy and nasopharyngeal inflammation (Boucher et al, 1990 [1]). Often these cysts are found incidentally on rhinoscopy, computerized tomography (CT) or magnetic resonance imaging (MRI). However Tornwaldt's cysts, like other nasopharyngeal cysts, may become symptomatic once they become large or infected. Clinical symptoms of nasopharyngeal cysts may include fullness in the ear, tinnitus, nasal obstruction, dysphagia, dysarthria, dysphonia, odynophagia, halitosis, cephalgia, or stiffness of cervical muscles (Weissman, 1992 [2]; Miyahara and Matsunaga, 1994 [3]). This case report of a 6-year-old female with severe cephalgia and a Tornwaldt's cyst serves as a reminder that these cysts can be a cause of many symptoms seen in daily clinical practice. An unusual finding of cortical destruction of the clivus was noted in this case and thought to be associated with the Tornwaldt's cyst. Upon literature review, no prior cases of cortical destruction from a Tornwaldt's cyst have been noted.