NPC

Question 1

CTV 59.4-60 consist

Answer 1

1. CTV70 + 5mm2. Entire nasopharynx3. Skull base foramen ovale, rotundum (upore 3ta structure)4. Cavernous sinus5. Inferior sphenoidal sinus6. Pterigoid fossa (laterally 3ta structure)7. Parapharyngeal space8. Retrostyloid space9. Posterior 1/4th of nasal cavity/maxillary sinus (anteriorly)10. Anterior 1/3rd of clivus (uninvolved), entire clivus (involved) (posteriorly)11. Inferior soft palate (inferiorly)

Question 2

boundary: anterior

Answer 2

posterior nasal chonae/ septum

Question 3

boundary lateral

Answer 3

eustachian tube, torus tubarius, fossa of rossenmuller, superior pharyngeal constrictor, medial pterygoid plate

Question 4

boundary posterior

Answer 4

clivus, c1-2

Question 5

boundary superior

Answer 5

sphenoid bone/sinus,

Question 6

inferior boundary

Answer 6

roof of soft palate

Question 7

spread: anterior

Answer 7

nasal fossae, posterior ethmoid and maxillary sinuses, infiltration of orbital apex through inf orbital fissure

Question 8

spread posterior and superior

Answer 8

base of skull, sphenoid sinus, clivus through foramen lacerum: cavernous sinus, middle cranial fossa than CN II to VI
through foramen ovale: middle cranial fossa, petrous part of temporal boneinvasion of prevertebral muscle

Question 9

spread inferior

Answer 9

oropharynx

Question 10

spread laterally

Answer 10

parapharyngeal space
levator and tensor veli palateni
direct/retropharyngeal space: CN IX to XI through jugular foramen
CN XII through hypoglossal canal middle ear

Question 11

CN most commonly involve

Answer 11

V VI

Question 12

less commonly involved cn in npc

Answer 12

I, VII, VIII

Question 13

How cavernous sinus is involved in nasopharynx

Answer 13

From fossa of rosenmuller -> foramina lacerum->than involve cavernous sinus, middle cranial fossa,

Question 14

What are the structures in cavernous sinus

Answer 14

Cranial nerve: CN III (oculomotor nerve)CN IV (trochlear)CN (IV) abducent nerveV1, V2 involvedInternal carotid artery

Question 15

Foramina ovale allows access to which structures

Answer 15

V3 nerve
Middle cranial fossaPetrous part of temporal boneInvasion of prevertebral muscle (longus capitis)

Question 16

Common involved lymph nodes

Answer 16

Common involved lymph node:
II-94%,
III—85%,
Va: -46%,
VB: 17%

Question 17

Metastatic lymph node character

Answer 17

Lymph node metastases character:-
Presence of central necrosis- Extracapsular spread-
Shortest axial diameter ≥10mm (11 mm for jugulodigastric and 5 mm for retropharyngeal node)- Cluster of ≥3 lymph nodes that are borderline in size.

Question 18

Histopathological type

Answer 18

Type I: keratinizing
Type II: non keratinizing
Type III: non keratinizing undifferentiated
Basaloid
Other nasopharynx tumors: lymphoma, minor sali- vary gland, plasmacytoma, melanoma, chordoma,
rhabdomyosarcoma

Question 19

Bimodal age distribution found in

Answer 19

OS, HL,, medulloblastoma, ALL, npc

Question 20

What is petro sphenoidal syndrome of jacod

Answer 20

Petrosphenoidal syndrome of Jacod
• unilateral trigeminal type neuralgia,
• unilateral ptosis,
• complete ophthalmoplegia, and
• amaurosis results from CN II–VI by direct IC ext

Question 21

What is villarets syndrome?

Answer 21

Villaret’s syndrome / retroparotid synd
• Direct ext to jugulr foramen through PPS
• Involving CN IX, X XII & sum chain
• dysphagia
• Taste problem, salivation problem
• Unilateral weakness of SCM, trapezius
• Horner’s syndrome