Unilateral palate paralysis in patients with nasopharyngeal carcinoma: Imaging and clinical correlations

Objective: Neck masses, hearing impairment, and blood-tinged nasal discharg es are three major clinical manifestations of nasopharyngeal carcinoma (NPC ), Because of the relationship between the anatomic structures of the fossa of Rosenmuller and the levator veli palatini muscle, NPC arising in the fo ssa can invade the levator muscle, limiting movement or causing paralysis o f the ipsilateral soft palate, It is well known that NPC originates commonl y from the fossa of Rosenmuller, 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 i n the Literature. Study Design: A prospective study of all patients with ne wly diagnosed NPC, Methods: Two hundred sixty-four patients with newly diag nosed NPC were studied. Clinical records included the details of their clin ical presentations and the results of physical and neurological examination s. The degree of elevation of the soft palate during phonation was carefull y evaluated. Magnetic resonance imaging (MRI) of the head and neck region w ith a particular emphasis on the levator veli palatini muscles was then per formed. The degree of paralysis of the palate was correlated with the degre e of invasion of the levator muscles by the tumor, as seen with imaging. Th e incidence of paralysis of the palate in the patients with NPC was also de termined. Results: At the time of diagnosis, ipsilateral paralysis of the p alate was observed in 137 (52%) of the 264 patients with NPC, The results o f imaging indicated that 62% (163 of 264) of the patients had radiological evidence of tumor invasion of the levator muscle. The degree of paralysis o f the palate corresponded well to the extent of tumor invasion of the levat or muscle. Paralysis of the palate was not evident in 26 patients with earl y perimuscular infiltration of the levator muscle. Conclusion: This study r evealed that ipsilateral invasion of the levator veli palatini muscle by NP C is common and typically presents with signs of unilateral palate paralysi s. 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.