The s.c. 'hairy polyp' or 'dermoid' of the nasopharynx. (An unusual observation in older age)

Naso-oropharyngeal choristoma (hairy polyps): an overview and current update on presentation, management, origin and related controversies

This review presents a comprehensive and updated overview of bigerminal choristomas (hairy polyps) of naso-oropharynx/oral cavity, and discusses the controversies related to nosology and origin from a clinico-embryologic perspective. English-language texts of the last 25 years (January 1989-January 2014) were collected from the PubMed/MEDLINE database using the given keywords. Of the 330 records, 64 full-text articles (mostly case reports/series) were selected, incorporating clinical data from 78 patients, after screening through duplicates and the given exclusion criteria. With the available evidence, hairy polyps appear more common than generally believed, and are increasingly being recognized as an important, often-missed cause of respiratory distress and feeding difficulty in neonates and infants. Such a child without any apparent cause should be examined with flexible nasopharyngoscope to specifically look for hairy polyps which might be life-threatening, especially when small. The female preponderance as believed today has been found to be an overestimation in this review. These lesions are characteristically composed of mature ectodermal and mesodermal tissue derivatives presenting as heterotopic masses, hence termed choristoma. However, little is known about their origin, and whether they are developmental malformations or primitive teratomas is debatable. Involvement of Eustachian tube and tonsils as predominant subsites and the speculated molecular embryogenesis link hairy polyps to the development of the first and second pharyngeal arches. They are exceptionally rare in adults, but form a distinct entity in this age-group and could be explained as delayed pluripotent cell morphogenesis or focal neoplastic malformations, keeping with the present-day understandings of the expanded "teratoma family".

Caught on camera: hairy polyp of the posterior tonsillar pillar

BACKGROUND

Hairy polyps are rare congenital growths of the head and neck, mainly found in the nasopharynx and oropharynx. They are made up of two germ cell layers: the ectoderm and mesoderm.

METHODS

This paper reports a four-month-old who presented with breathing and feeding difficulties. Clinical examination was unremarkable, but a video taken by the patient's mother on her smartphone showed a mass protruding from the infant's mouth. Laryngoscopy performed in the operating theatre showed that the mass emanated from the left posterior tonsillar pillar.

RESULTS

The mass was removed transorally with no complications. Pathological examination showed a skin-covered pedunculated structure characteristic of a hairy polyp. The patient's follow up was unremarkable.

CONCLUSION

To the best of our knowledge, this is the second English-language case report of a patient with a hairy polyp emanating from a posterior tonsillar pillar. This paper also highlights the growing usage of smartphones by patients to help physicians with their diagnosis and management.

Combined transoral and nasendoscopic resection of an eustachian tube hairy polyp causing neonatal respiratory distress

Hairy polyps are rare congenital malformations that can arise in the nasopharynx. It is rarer for them to originate from the eustachian tube. They present with intermittent airway obstruction and respiratory distress. A thorough ear, nose, and throat examination can be required to identify these lesions. We present a case of eustachian tube hairy polyp causing neonatal respiratory distress in a 1-month baby successfully removed by a combined transoral and nasendoscopic resection.

Dermoid cyst of the eustachian tube

We report a case of dermoid cyst of the Eustachian tube in a 2 1/2 -year-old-girl with CT and MRI imaging. This is the 12th described case of such a pathology. Most of the reviewed previous 11 cases affected females on the left side. The surgical approach and the contribution of CT and MRI are discussed.

Congenital teratoid tumour of nasopharynx with cleft palate

A case of congenital nasopharyngeal teratoid tumour presenting since birth projecting into oral cavity through the palatal cleft & gradually increasing in size thus causing breathing & feeding difficulty in a four months old female child is presented here for its rarity. A brief review of literature and management of such patients is also discussed here.

Congenital teratoid tumour of nasopharynx with cleft palate

A case of congenital nasopharyngeal teratoid tumour presenting since birth projecting into oral cavity through the palatal cleft and gradually increasing in size thus causing breathing and feeding difficulty in a four months old female child is presented here for its rarity. A brief review of literature and management of such patients is also discussed here.

Bilateral hairy polyp of the oropharynx

Hairy polyp of the nasopharynx is an unusual but well-recognized entity, generally presenting as a single mass at birth or in the first year of life. We describe the clinico-pathological features of a previously unreported bilateral hairy polyp in an adult and briefly discuss the pathogenesis of this condition.

Hairy polyp of the tonsil

Hairy polyps or dermoids of the oro- and naso-pharynx are benign lesions containing elements of both ectodermal and mesodermal origin. We report a case of a hairy polyp arising from the tonsil in a three-week-old infant. This presented as an intermittent swelling in the mouth, which was successfully removed under general anaesthesia. To our knowledge this is only the third case of a hairy polyp arising at this site to be reported. We discuss the terminology applied to these lesions and review the literature.

Hairy polyp of the oropharynx: an unusual cause of intermittent neonatal airway obstruction

Oropharyngeal hairy polyps are rare benign congenital tumours that usually present at birth or shortly afterwards with acute upper airway obstruction or feeding difficulties. We describe a case of intermittent airway obstruction in a neonate caused by a mobile hairy polyp of the tonsil. This rare benign lesion proved difficult to diagnose because of its tendency to prolapse into the nasopharynx.

A pharyngeal hairy polyp causing neonatal airway obstruction: a case study

A case of neonatal respiratory distress due to an oropharyngeal hairy polyp is reported with its MRI assessment. The place of hairy polyps in the differential diagnosis of upper respiratory tract obstruction is discussed. Early and rapid diagnosis and treatment may be lifesaving for the newborn.

Nasopharyngeal teratoma in the neonate

Nasopharyngeal teratomas are rare neoplasms, often presenting as neonatal airway obstruction. A case is presented of a full-term neonate with a mass which filled the oropharynx, nasopharynx and the entire left nasal cavity and extended through the left nares. Airway obstruction necessitated orotracheal intubation immediately after delivery. Cerebrospinal fluid rhinorrhea was suggested and computerized tomography was initially interpreted as a nasoethmoidal encephalocele. After a craniotomy failed to reveal a dural defect, the mass was completely removed via the nose and nasopharynx. The infant was extubated and had an uneventful recovery. This case illustrates the problem of confusing a teratoma for an encephalocele and demonstrates a pitfall in the interpretation of computerized tomography of these lesions.