Non-calcified retropharyngeal tendonitis-What is this?

• Published in: Japanese Journal of Headache Vol. 49; no. 1; pp. 223 - 228
• Main Author: Kitami, Koichi
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Headache Society 2022; 一般社団法人 日本頭痛学会
• Subjects: chronic epipharyngitis; ICHD classification; non-calcified retropharyngeal tendonitis; 国際頭痛分類; 慢性上咽頭炎; 非石灰沈着性後咽頭腱炎
• ISSN: 1345-6547; 2436-1577
• DOI: 10.50860/jjho.49.1_223

Thirty-seven consecutive cases of non-calcified retropharyngeal tendonitis（NCRT）were reported and clinical symptoms, signs and labo results were analyzed together with head/cervical CT scans. Symptoms and signs were consistent with the ICHD-3 diagnostic criteria of 11.2.2 retropharyngeal tendonitis. CT scans revealed retropharyngeal edema at the epipharyngeal level more prominently than at the insertion level of longus colli tendons. WBC and CRP were normal in 13 cases. Treatment by oral medication of diclofenac 37.5mg twice a day was continued for 2 weeks. Clinical outcome showed excellent or good result in 19 cases, moderate recovery in 8, unchanged/worthen in 3, and missing in 9. One unchanged case was consulted to an otolaryngologist and was given epipharyngeal abrasive therapies, which made his symptoms alleviated. Symptomatology and CT findings showed that NCRT might be caused by chronic epipharyngitis due to over-reaction of the immune system, which activated pro-inflammatory cytokine production at the epipharyngeal tonsil and consequently retropharyngeal fluid collection emerged. CT findings showed that pathogenesis of NCRT was not tendonitis but chronic epipharyngitis. This pathology should be differentiated from calcified retropharyngeal tendonitis, which also called calcified longus colli tendinitis. From time course of NCRT, this pathology might be diagnosed as acute episodic tension-type headache, and if treatments in acute phase failed, then it could be diagnosed as new daily persistent headache. On these standpoints, further study should be required for the investigation of the pathogenesis of NCRT．