Head and Neck Anatomy Jake Pickering MS IV

Head and Neck Anatomy
Jake Pickering MS IV
Suprahyoid Neck
• Skull Base to Hyoid Bone (the different spaces)
– Parapharyngeal Space
– Pharyngeal Mucosal Space
– Masticator Space
– Parotid Space
– Carotid Space
– Retropharyngeal Space
– Perivertebral Space
– Posterior Cervical Space
Suprahyoid Spaces
Suprahyoid Spaces
Suprahyoid Spaces
Lateral Neck
CT of Suprahyoid Spaces
CT of Suprahyoid Spaces
CT of Suprahyoid Spaces
CT of Suprahyoid Spaces
Parapharyngeal Space
• Internal structures
– Fat
– Minor salivary glands
– Internal maxillary artery
– Ascending pharyngeal artery
– Pterygoid venous plexus
Parapharyngeal Space
Parapharyngeal
space
Parapharyngeal
Space
Parapharyngeal Space
• Clinical implications
– Direct extension from neoplasm
• From pharyngeal mucosal space (see neoplasm differential
for pharyngeal mucosal space)
• From masticator space (see neoplasm differential)
• From parotid space (see neoplasm differential)
– Direct extension from abscess
• Tonsillar abscess
• Acute Parotiditis
– Primary lesion
• Lipoma
• Venolymphatic malformation
Pharyngeal Mucosal Space
• Internal structures
– Minor salivary glands
– Torus tubarius: Cartilaginous end of eustachian tube
– Muscles
• Superior, middle and inferior constrictor muscles
• Salpingopharyngeus muscle
• Levator palatini muscle
– Lymphatic ring (Waldeyer ring)
• Nasopharynx: Adenoids
• Oropharynx: Palantine tonsil
• Oropharynx: Lingual tonsil
Pharyngeal Mucosal Space
Torus tubarius
Adenoids
Pharyngeal
mucosal space
Lingual tonsil
Pharyngeal
muscoal space
Palantine tonsil
Axial T1 MR
Nasopharyngeal
mucosal space
Oropharyngeal
mucosal space
Hypopharyngeal
mucosal space
Pharyngeal Mucosal Space
• Clinical Implications
– Differential diagnosis of lesion in Nasopharyngeal
space
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Adenoid inflammation
Tornwaldt cyst
Retention cyst
Nasopharyngeal carcinoma
Non-Hodgkin lymphoma
Benign mixed tumor (uncommon)
Post-radiation mucositis (uncommon)
Minor salivary gland malignancy (rare)
Rhabdomyosarcoma (rare)
Extraosseous chordoma (rare)
Pharyngeal Mucosal Space
• Clinical implications
– Differential diagnosis of lesion in oropharynx space
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Squamous cell carcinoma
Non-hodgkin lymphoma
Retention cyst
Palantine tonsil abscess
Tonsillar inflammation
Thryoglossal duct cyst (uncommon)
Post-radiation mucositis (uncommon)
Vallecular cyst (uncommon)
Minor salivary gland malignancy (uncommon)
Rhabdomyosarcoma (rare)
Masticator Space
• Internal contents
– Muscles of Mastication
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Masseter
Temporalis
Medial pterygoid
Lateral pterygoid
– Mandibular division, trigeminal nerve (V3)
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Masticator nerve branch
Mylohyoid nerve branch
Lingual nerve
Inferior alveolar nerve branch
– Ramus and posterior body of mandible
– Pterygoid venous plexus
Masticator Space
Masseter
muscle
Temporalis
muscle
Lateral
pterygoid
muscle
Medial
pterygoid
muscle
Masticator
Space
Axial T1 MR
Masticator Space
• Clinical Implications
– Trismus
– Differential diagnosis of masticator space lesion
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Abscess
Benign masticator muscle hypertrophy
Metastasis
Sarcoma
Osteosarcoma
Chondrosarcoma (uncommon)
Perineural tumor CNV3 (uncommon)
Schwannoma (uncommon)
Odontogenic keratocyst (uncommon)
Osteoradionecrosis (uncommon)
Pigmented villonodular synovitis (rare)
Synovial chondromatosis (rare)
Dentigerous cyst (rare)
Parotid Space
• Internal structures
– Parotid Gland
– Facial Nerve (CN7)
– External carotid artery
– Retromandibular vein
– Intraparotid lymph nodes
– Parotid Duct
– Accessory parotid glands (20% of population)
Parotid space (green)
Parotid Space
External carotid
artery
Retromandibular
vein
Parotid gland
Parotid
space
Axial T1 MR
Parotid Space
• Clinical Implications
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Parotid Tumors benign mixed tumor (75%)
Warthin tumor (5%)
Adenoid cystic carcinoma (5%)
Mucoepidermoid carcinoma (5%)
Other (10%)
– Other masses in parotid space
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Salivary gland malignancies (uncommon)
Non-Hodgkin lymphoma (uncommon)
Schwannoma (uncommon)
Infantile hemangioma (uncommon)
Lipoma (uncommon)
Oncocytoma (rare)
Venous malformation (rare)
Lymphatic malformation (rare)
1st Branchial cleft cyst (rare)
Rhabdomyosarcoma (rare)
Carotid Space
• Internal structures
– Suprahyoid
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Internal carotid artery
Internal jugular vein
Cranial nerves 9-12
Sympathetic plexus
Carotid Space
Carotid Space
External carotid
artery (not in
carotid space)
Internal carotid
artery
Internal jugular
vein
Carotid
space
Carotid Space
• Clinical implications
– Differential diagnosis of carotid space lesion
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Reactive lymph nodes
Atherosclerosis of carotid artery
Thrombosis of jugular vein
Squamous cell carcinoma
Dissection of carotid artery
Paraganglioma of carotid body
Schwannoma
Neurofibroma (uncommon)
Hodgkin and Non-Hodgkin lymphoma (uncommon)
Meningioma (rare)
Pseudoaneurysm of carotid artery (rare)
Metastases (rare)
Acute Idiopathic carotidynia (rare)
– CN 9-12 neuropathy
• Vagus Nerve injury- vocal cord paralysis
Retropharyngeal Space
• Internal Structures
– Suprahyoid
• Fat
• Lymph nodes (none below hyoid)
– Lateral group (nodes of Rouviere)
– Medial group
Retropharyngeal
space
Retropharyngeal
space
Retropharyngeal Space
• Clinical Implications
– Differential diagnosis of focal lesion
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Reactive adenopathy
Suppurative adenopathy
Squamous cell carcinoma
Metastatic node
Non-Hodgkin lymphoma
Tortuous carotid artery
Multinodular goiter (uncommon)
Lipoma (uncommon)
Schwannoma (rare)
Ectopic parathryoid adenoma (rare)
Retropharyngeal Space
• Clinical Implications
– Differential diagnosis of diffuse space lesion
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Abscess
Effusion
Longus colli tendonitis (uncommon)
Venous malformation (uncommon)
Lymphatic malformation (uncommon)
Multinodular goiter (uncommon)
Lipoma (rare)
Perivertebral Space
• Internal structures
– Prevertrebral muscles-longus colli and capitis
– Scalene muscles
– Phrenic nerve
– Vertebral artery and vein
– Vertebral body
– Paraspinal muscles
– Brachial plexus
Perivertebral Space
Perivertebral
space
Prevertebral
portion of the
perivertebral
space
Paraspinal portion
of the
perivertebral
space
Perivertebral Space
Perivertebral Space
• Clinical implications
– Differential diagnosis of perivertebral space lesion
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Vertebral body metastasis
Infection
Schwannoma of brachial plexus
Longus colli tendinitis
Chordoma (uncommon)
Venous malformation (uncommon)
Lipoma (uncommon)
Non-Hodgkin lymphoma (uncommon)
Lymphatic malformation (rare)
Fibromatosis (rare)
Hemangiopericytoma (rare
Posterior Cervical Space
• Internal structures
– Fat is primary occupant
– Accessory nerve (CNII)
– Spinal accessory lymph node chain
– Pre-axillary brachial plexus
– Dorsal scapular nerve
Posterior Cervical Space
Posterior Cervical Space
Posterior
cervical
space
Posterior Cervical Space
• Clinical implications
– Differential diagnosis of cervical space lesion
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Reactive lymph nodes
Squamous cell carcinoma
Non-hodgkin lymphoma
Suppurative lymph node
Thyroid carcinoma
Abscess (uncommon)
Metastases (uncommon)
Sarcoidosis (uncommon)
Tuberculosis (uncommon)
Lipoma (uncommon)
Venous Malformation (uncommon)
Schwannoma (rare)
Liposarcoma (rare)
Sinus histiocystois
3rd Branchial cleft cyst
Giant lymph node hyperplasia
References
• Harnsberger HR, Osborn AG, Ross JS. Diagnostic and Surgical Imaging
Anatomy: Brain, Head and Neck, Spine. 1st edition. Salt Lake City:
Amirsys, 2006.
• Harnsberger HR, Koch BL, Phillips CD. EXPERTddx: Head and Neck. 1st
edition. Salt Lake City: Amirsys, 2009.
• Neck CT. Retrieved Sept 11 2012. http://headneckbrainspine.com