A study was conducted to determine gross and microscopic tissue changes in the nasopharynx of black-tailed deer (Odocoileus hemionus columbianus) infected with nasal bot fly larvae (Cephenemyia spp.). Paired retropharyngeal recesses were the preferred sites for the growing second and third stage larvae of two species of Cephenemyia (C. apicata and C. jellisoni). Retropharyngeal recesses distended into “pouches” that harbored up to 30 larvae. Pouches were oriented caudal laterally toward the basisphenoid bone of the cranium. Lateral support of the pouch mass was provided by the stylohyoid bone. The laryngeal orifice was never occluded by the enlarged recesses. The distal pouch wall was relatively thin and remained uniform in thickness as expansion progressed. Occasionally, aberrant larvae were found protruding through the distal wall of the pouch. Disruption of the epithelium and submucosa by larval mouth hooks and integumentary spines were examined by scanning electron microscopy. Histological examination of infected recesses revealed substantial loss of epithelium and mucous glands. Enlargement of recesses into pouches resulted from fibrosis. Healing occurred after larvae egressed from the pouches. Degenerating mucous glands, epithelial metaplasia, epithelial desquamation, and intense inflammation were found near larvae. An eosinophilic exudate with a mixture of macrophages and erythrocytes was present in the lumen of the pouch. The presence of larvae within the pouch inhibited secondary bacterial infection and suppuration. Infection by larvae caused severe local trauma and intense tissue response.