Unilateral palate paralysis in patients with nasopharyngeal carcinoma: imaging and clinical correlations.
OBJECTIVE
Neck masses, hearing impairment, and blood-tinged nasal discharges are three major clinical manifestations of nasopharyngeal carcinoma (NPC). Because of the relationship between the anatomic structures of the fossa of Rosenmüller and the levator veli palatini muscle, NPC arising in the fossa can invade the levator muscle, limiting movement or causing paralysis of the ipsilateral soft palate. It is well known that NPC originates commonly from the fossa of Rosenmüller. We therefore hypothesize that the clinical signs of unilateral palate paralysis in patients with NPC must be far more common than usually realized. This issue is, as yet, not fully addressed in the literature.


METHODS
A prospective study of all patients with newly diagnosed NPC.


METHODS
Two hundred sixty-four patients with newly diagnosed NPC were studied. Clinical records included the details of their clinical presentations and the results of physical and neurological examinations. The degree of elevation of the soft palate during phonation was carefully evaluated. Magnetic resonance imaging (MRI) of the head and neck region with a particular emphasis on the levator veli palatini muscles was then performed. The degree of paralysis of the palate was correlated with the degree of invasion of the levator muscles by the tumor, as seen with imaging. The incidence of paralysis of the palate in the patients with NPC was also determined.


RESULTS
At the time of diagnosis, ipsilateral paralysis of the palate was observed in 137 (52%) of the 264 patients with NPC. The results of imaging indicated that 62% (163 of 264) of the patients had radiological evidence of tumor invasion of the levator muscle. The degree of paralysis of the palate corresponded well to the extent of tumor invasion of the levator muscle. Paralysis of the palate was not evident in 26 patients with early perimuscular infiltration of the levator muscle.


CONCLUSIONS
This study revealed that ipsilateral invasion of the levator veli palatini muscle by NPC is common and typically presents with signs of unilateral palate paralysis. This subtle sign is relatively common in patients with NPC. Consequently, we think palate function should be routinely tested when diagnosing NPC, particularly when the patient has unilateral aural symptoms or a neck lump.
Su
C Y
CY
Department of Otolaryngology, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan. usgniy@adm.cgmh.com.tw
Lui
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CC
D005260:Female; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000150:complications* / Q000473:pathology; D009361:Neoplasm Invasiveness; D010156:Palatal Muscles / Q000473:pathology; D010160:Palate, Soft / Q000473:pathology; D010243:Paralysis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies