Trotters triad is seen in -

• Nasopharyngeal cancer is most common in China particularly in southern states and Taiwan. • People in Southern China, Taiwan and Indonesia are more prone to this cancer. • MC tumor to produce cervical LN metastasis • MC tumor responsible for secondaries in the neck with no obvious primary malignancy • Burning of incense or wood (Polycyclic hydrocarbon), use of preserved salted fish (Nitosamines) along with vitamin C deficient diet (vitamin C blocks nitrosification of amines and is thus protective) may be other factors operative in China. Etiology • Exact etiology is not known. The factors responsible are: −− Genetic: Chinese −− Viral: Epstein-Barr virus −− Environmental: Air pollution, smoking of tobacco and opium, nitrosamines from dry salted fish, smoke from burning of incense and wood Pathology • Squamous cell carcinoma in various grades of its differentiation or its variants as transitional cell carcinoma and lymphoepithelioma, is the most common. • MC site of origin: Fossa of Rosenmuller in the lateral wall of Nasopharynx. • LN involvement is common because of rich lymphatic network in the nasopharynx. Clinical features • Age: It is mostly seen in fifth to seventh decades but may involve younger age groups. • Sex: Males are three times more prone than females. • Cervical lymphadenopathy is MC presenting symptom (60-90%). • Nasal: Nasal obstruction, nasal discharge, denasal speech (rhinolalia clausa) and epistaxis. • Otologic: Due to obstruction of Eustachian tube , there is conductive hearing loss, serous or suppurative otitis media. • Presence of unilateral serous otitis media in an adult should raise suspicion of nasopharyngeal growth. • Involvement of IX , X and XI cranial nerves may occur, constituting jugular foramen syndrome. • Can cause conductive deafness (Eustachian tube blockage), ipsilateral temporoparietal neuralgia (involvement of CN V) and palatal paralysis (CN X)-collectively called Trotter’s triad. • Cervical nodal metastases may be the only manifestation of nasopharyngeal cancer. • Nodal metastases are seen in 75% of the patients, when first seen, about half of them with bilateral nodes. • Distant metastases involve bone, lung, liver and other sites. • Jaccods’s triad: Ipsilateral ophthalmoplegia + Amaurosis + Ipsilateral neuralgia Diagnosis • CT scan: Demonstrate erosion of bone at the base of skull and the extent of tumor. • Biopsy is essential to show the exact histology of the malignancy. • In absence of nasopharyngeal lesion but with strong suspicion of malignancy, nasopharynx is exposed by transpalatal approach and a strip of mucosa and submucosa from the region of fossa of Rosenmuller should be taken and subjected to histology. Treatment • Irradiation is treatment of choice. • Chemo therapy for stage III and IV cancers