Exploring the Diagnostic Conundrum: Nasopharyngeal Branchial Cyst - A Case Report

BackgroundNasopharyngeal branchial cleft cysts arise from the 2nd branchial cleft and are classically located in the neck. Total excision is often challenging and carries with it the risk of potential vascular injury at the level of skull base.Case presentationA 40-year-old female presented to the ENT OPD with complaints of bilateral nasal obstruction, mouth breathing, snoring since three months and history of foreign body sensation in the throat since one month associated with difficulty swallowing and change in voice. Examination revealed a well circumscribed yellow globular mass in the nasopharynx which was cystic in consistency. Left ear revealed a dull and retracted tympanic membrane. Patient underwent CECT which revealed a hypodense cystic lesion involving the nasopharynx, arising from the Fossa of Rosenmuller on the left side, causing significant luminal narrowing. Patient was managed surgically- Cyst was aspirated and cyst wall was marsupialised using a microdebrider through a trans nasal endoscope. Patient was started on IV antibiotics post-surgery.ConclusionWhen a patient presents with a nasopharyngeal tumour, we should consider nasopharyngeal branchial cyst as a differential diagnosis although it is an extremely rare anomaly. It can often be confused with other nasopharyngeal cystic lesions like Rathke's pouch, intra adenoid cyst and Tornwaldt's cyst hence systematic evaluation is essential.