Unilateral Nasal Obstruction Caused by a Large Nasopharyngeal Cyst.

A 40-year-old man presented with left-side nasal obstruction for the past nine months. He had been treated for allergic rhinitis with nasal steroids for a long time. An anterior rhinoscopic examination was normal. Endoscopic examination revealed a nodulary mass in the nasopharynx, partially obstructing the left choana (Figure 1A). An endoscopic examination of the right nasopharynx revealed regular mucosal thickening of the right lateral and posterior walls of the nasopharynx. There were no otological symptoms. Magnetic resonance (MRI) of the nasopharynx revealed a left nasopharyngeal cyst measuring 18×15 mm (Figure 1B). The patient selected to undergo endoscopic marsupialization of the nasopharyngeal cyst. First, punch biopsies were performed from the mass and bilateral hypertrophic nasopharyngeal tissue for histopathological evaluation; the mass was found to be a lateral nasopharyngeal cyst containing seromucinous fluid. Then, the cystic mass was marsupialized using a microdebrider via a transnasal endoscopic approach (Figure 1C). Histopathological examination of the thickening nasopharyngeal mucosa revealed reactive lymphoid hyperplasia and identified the cystic specimen as a branchial cyst. The patient’s postoperative period was uneventful. He was free of all symptoms nine months after the surgery, and an endoscopic examination did not detect any signs of recurrence.