OtoRhinoLaryngology Portal

The Leading Online Gallery of Otolaryngology and Head & Neck Surgery Specialty

OtoRhinoLaryngology Portal Video Collections @

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Nasopharyngeal Carcinoma Lecture Series by Lori J Wirth

Nasopharyngeal Carcinoma: Obliteration of Fossa of Rosenmüller in Early Tumour

Nasopharyngeal Carcinoma: Obliteration of Fossa of Rosenmüller

Obliteration of right fossa of Rosenmuller.  (TT - torus tubarius, X - tumour, SP - soft palate, arrow - eustachian tube opening) 


Ipsilateral middle ear effusion. 

Nasopharyngeal Carcinoma: Post-nasal Endoscopic Appearance of Tumour at Various Stages


Tumour (X) presenting as a mass involving roof-posterior wall junction of nasopharynx and spreading laterally causing obliteration of right fossa of Rosenmuller.  (V - vomer, TT - torus tubarius, arrow - eustachian tube opening).

Solitary mass arising from left fossa of Rosenmüller

as seen through left nasal cavity.

Arrow -tumour, S- nasal septum, IT- inferior tubinate

NPC presenting as a well-defined 'polyp' (X).  V - vomer, IT - tail of left inferior turbinate. 

Ulcero-fungating tumour involving right fossa of Rosenmüller (left)

and fungating type involving the roof of nasopharynx (right)..


R-roof of nasopharynx

IT- inferior turbinate

S- nasal septum

Red arrow- ulcer

Yellow arrows- tumour

Curve green arrow- eustachian tube opening


Endoscopic view of nasopharynx as seen through right nasal cavity showing tumour (T) along left left Fossa of Rosenmüller.  The corresponding CT-scan in axial cut is shown to show the tumour extension. 

[TT - torus tubarius, R - roof of nasopharynx, V - vomerine end of nasal septum arrow - nasopharyngeal opening of eustachian tube]


Watch video of nasopharyngeal carcinoma endoscopy @ YouTube

Watch video of postnasal space tumour biopsy @ YouTube



 Ipsilateral midde ear effusion of the same patient depicted in the video above which had caused conductive hearing loss, blocked ear sensation, and autophony.

Narrow Band Imaging (NBI) Technology

 Nasopharyngeal carcinoma lesion (dotted hexagon) before (above) and after NBI (below).  (FOR - fossa of Rosenmüller, R - roof of nasopharynx)

Nasopharyngeal Carcinoma: Extranasal Manifestations

             Unilateral otitis media with effusion.        Meastatic cervical

                                                                    lymphadenopathy (arrow)

Massive bilateral metastatic lymphadenopathy, the so-called bull's neck appearance.

Nasopharyngeal Carcinoma: Right Lateral Rectus Palsy

Nasopharyngeal Carcinoma: Orbital Spread

Spread of carcinoma into left orbit causing proptosis, cheimosis, ophthalmoplegia and blindness.

Nasopharyngeal Carcinoma: Mucosal Appearance after Radiotherapy [Complete Response in Remission]


These figures show the appearance of the nasopharynx months after

completion of radiotherapy treatment of nasopharyngeal carcinoma.

Mucosal atrophy resulted in dry and thinner mucosal appearance.

The eustachian tube openings appeared blunted/obliterated.

The fossa of Rossenmuller (white dots) were clear of tumour recurrence.

Another example of post-irradiation changes of the nasopharynx in a "cured" patient 10 years after successful treatment of TI lesion involving

right fossa of Rosenmuller.

Trabecular pattern of mucosal scars post-irradiation.


Watch video of nasopharyngeal appearance after radiotherapy @ YouTube

Palatal Palsy

Palatal palsy manifested as asymmetry  of the throat and absent of movement on the affected side upon saying the the word "aaaa".  The patient had NPC diagnosed 15 years ago and completed radiation and chemotherpy.  He presented with hoarse voice, difficulty in swallowing and limited tongue movements 5 years later.  His nutrition is via percutaneous gastrostomy which needs to be changed every 4 months.  Endoscopic laryngoscopy showed bilateral fixed vocal cords with phonatory gap.  The nasopharynx appeared clear of tumour with mucosal changes related to the definitive treatment given earlier.  Electronic larynx was recommended to improved his voice as medialization procedure would caused glottic obstruction and resultant stridor.

Posterior Choanal Stenosis: Acquired

These figures show the nasal endoscopy view of the posterior choana in post-irradiated nasopharynx of the same patient.  The right posterior choana

has becomes narrower as compared to the contralateral side.

However, the patient didn't complaint any obstructive symptom.