Differential diagnosis of head and neck lesions based on their space of origin. 4. 2. About radiologypics. The infrahyoid neck is divided into 5 major anatomical compartments or spaces by the various layers of the cervical fascia (2). For proper studying of the neck it is divided into compartments and spaces: Suprahyoid neck: From skull base to the hyoid bone Infrahyoid neck: Below hyoid bone to thoracocervical junction. The superficial cervical fascia consists of the subcutaneous tissues of the head and neck. The CD-ROM version contains the entire two-volume textbook in PDF (portable document format) files, which preserves the two-column text layout of the printed textbook but integrates the text with high-resolution images. The spaces of the suprahyoid neck include the pharyngeal mucosal space (PMS), the sublingual space (SLS), the submandibular space (SMS), the parapharyngeal space (PPS), the parotid space (PS), and masticator space (MS). In the infrahyoid neck, the fascia encircles the hypopharynx, larynx, and thyroid. Head and Neck Imaging: Fourth Edition simplifies the transition to the electronic format by using the familiar Acrobat Reader. ; Lymph node If the lesion is solid the next step is to assess whether it is a lymph node or something else. It is also important to differentiate a primary PPS mass from a mass arising from the deep lobe of the parotid because nonvascular masses localized to the PPS may be resected via a submandibular cervical approach while a deep parotid lobe mass might require a total parotidectomy.1, Some of the primary PPS masses include minor salivary gland tumors arising from ectopic salivary gland tissue rests, atypical type II first branchial cleft anomaly, and lipomas. Some spaces cross the hyoid bone and course the entire neck. This paper will review the anatomy of the carotid space from the skull base to the thorax, defining its borders at multiple levels, as well as its contents. CT neck annotated; Annotated Anatomy; fff; MS-1 Mini-elective; CT; АНАТОМИЯ ШЕИ; FRCR2b; 2차 시험 ; Annotated CTs; fff; Neurorad; Neck Anatomy 2021; Anatomy neck spaces; IMPORTANTS; FRCR2b; IMPORTANTS; Anatomy; IMP. The anterior compartment extends from the skull base inferiorly to where the alar fascia fuses with the visceral fascia and the posterior compartment, the “danger space” that extends from the skull base to the diaphragm.1, 2, 4, 9 The contents of the RPS are fat and retropharyngeal lymph nodes (RPLN), sometimes referred to as the nodes of Rouviere (Figure 3A). Background Head and neck lesions are a very challenging subject for radiologist due to the complex anatomy and DR/ Wafik Ebrahim, MD Assistant Professor of Rradiodiagnosis Faculty of Medicine Alazhar University. In a neck lesion in a child, ultrasound can usually determine whether a lesion is cystic or solid. Enlarged lymph nodes are the most common pathology of the carotid sheath (Table 2). Radiologic Evaluation The radiologic evaluation of pediatric patients following physical examination usually begins with conventional and color Doppler US due to its nonionizing and noninvasive ability to depict superficial structures, often at bedside. Prevertebral Space 3. These spaces are present in the neck between the layers of cervical fascia. Meesa IR, Mukherji SK. Davis WL, Smoker WR, Hamsberger HR. Suyash Mohan, MD, PDCC, and Laurie A. Loevner, MD LEARNING OBJECTIVES 1. Dr. Meesa is a Radiologist with Synergy Radiology, LLC, Fort Wayne, IN; and Dr. Mukherji is a Professor, The Walter F. Patenge Endowed Chair of the Department of Radiology, and Chief Medical Officer and Director of Health Care Delivery, at Michigan State University Health Team, East Lansing, MI. The suprahyoid part of the neck. However, due to the complexity and confusing array of terminology used to describe the deep cervical fascia, radiologists did not commonly use it.1,2. Figure 4.1. 2.To revisit the anatomy of spaces in the neck as demonstrated by cross-sectional imaging. The program provides an in-depth study of anatomy, physiology, and pathology related to head and neck radiology. The visceral space or compartment is a deep compartment of the head and neck that contains the thyroid gland, larynx, trachea, upper esophagus, hypopharynx and, in some definitions, oropharynx and nasopharynx. Pollei SR, Harnsberger H. The radiologic evaluation of the parotid space. Frank Pameijer, Erik Beek, Frank Joosten and Robin Smithuis. The carotid space in the suprahyoid neck. « CT of the Chest Soft Tissue Windows Axial … The advent of CT and MRI allowed radiologists to better visualize the complex anatomy and pathology of the suprahyoid neck. Specific approaches for using the imaging modalities are provided in each chapter. Carotid Sheath Space. Approximately 75% percent of all TDCs are located in the midline, with 25% within 2 cm of midline. Many people have used Adobe Acrobat Reader to read electronic journals, including RadioGraphics, which are provided in PDF files as well as in Web-based format (HTML). sublingual space; T2-weighted sequences are useful in demonstrating these tracts which usually pass around the mylohyoid muscle. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, Peter M. Som, MD, Hugh D. Curtin, MD, editors. 3. If the address matches an existing account you will receive an email with instructions to reset your password. Subsequent chapters provide an extensive discussion of pathologic conditions encompassing pertinent dysplasias, neoplasms, inflammatory diseases, trauma, postoperative complications, and radiation-induced changes. Lateral neck radiography may show extensive soft-tissue swelling between C1 through C4 with amorphous calcific deposits anterior to C1 and C2. The retropharyngeal or retrovisceral space (RS) spans the suprahyoid and infrahyoid neck as contiguous retropharyngeal and retroesophageal spaces (Figure 1). A simplified approach to the spaces of the suprahyoid neck, Indu Rekha Meesa, MD, MS, and Suresh K. Mukherji, MD, MBA, FACR. Each anatomic section has an introductory chapter that reviews anatomy and embryology. CD-ROM; $329.00. The differential diagnoses for primary retropharyngeal processes include edema, cellulitis and abscess (Figures 3B and 3C). The contents of the SLS include muscles, the hypoglossal nerve, the lingual nerve, lingual artery and vein, sublingual gland and ducts, the deep portion of the submandibular gland and duct and lymph nodes.1 The differential diagnoses for the contents are as follows: SCC from the epithelial lining, minor salivary gland tumors, ranula, obstructed submandibular duct, abscess, ludwig’s angina, neurogenic tumor, lingual thyroid, thyroglossal duct cyst, hemangioma, lymphangioma, dermoid/epidermoid (Figures 15B and C).1, The submandibular space (SMS) is located below the mandible, inferior to the mylohyoid muscle and the inferior margin is the hyoid bone (Figure 15A). St Louis, Mo: Mosby, 2003. The deep layer (prevertebral) is posterior to the visceral fascia and defines the contents of the prevertebral space (PVS).9, In the suprahyoid neck, the contents of the visceral space are the naso- and oropharynx, which have an epithelial lining (Figure 1A). Rather, a proper understanding of the anatomical spaces of the neck can aid considerably in formulating a differential diagnosis of pathologic processes involving the contents of that space and providing better care for our patients. Unique to the CD-ROM version is the option to magnify the image in a separate viewer. Diagnostic approach. 1. Normal Neck Anatomy and Method of Performing Ultrasound Examination. Tryhus MR, Smoker WR, Harnsberger HR. Fruin ME, Smoker WR, Harnsberger HR. CD-ROM versions of other textbooks have many different, unique interfaces that the user must first master before being able to peruse the text efficiently. The traditional approach to neck CT analysis is focused on an understanding of the fascial spaces of the neck (2–4). 2017;46(4):6-14. Many of these spaces could as well be inconsequential. It is separated from the subcutaneous tissues of the face by the plane formed by the superficial muscle of facial expression and the investing fascia1 (Figure 14A). Harnsberger HR, Osbom AG. Appl Radiol. Parotid space | Radiology Reference Article | Radiopaedia.org Anatomy Suprahyoid neck- a) Parotid space b) Para-pharyngeal space c) Masticator space d) Carotid space e) Retropharyngeal space f) Peri-vertebral space Infrahyoid neck- a) Anterior cervical space b) Posterior cervical space c) Visceral space +inferior extension of the peri-vertebral, carotid and retropharyngeal spaces. Often more than one lymph node is enlarged. IMAIOS and selected third parties, use cookies or similar technologies, in particular for audience measurement. The in-depth text provides a useful reference for the general radiologist who is researching a specific case and for the neuroradiologist who desires an extensive review of evaluating head and neck pathologic conditions. Then in the late 1980s and early 1990s, the spaces concept in the neck was reintroduced from a radiologic perspective, which enabled the radiologists to better understand the spaces of the neck and their components (Table 1).2 - 8 This article will present a discussion of each of the various spaces of the suprahyoid neck, along with a list of differential diagnoses pertinent to that space based on its anatomical contents. Suprahyoid Spaces of the Head and Neck David M. Yousem W rHEN ONE refers to the deep spaces of the neck, one includes all of the tissue outside the aerodigestive system mucosal and submucosal structures. These spaces are important from the point of view of clinician because of the propensity of infections to involve this space and to spread along these spaces to involve other areas like the mediastinum. Anatomy; Session Week 13; FRCR2b; Learning-SectionalAnatomy; Neck … Differential diagnoses for secondary extension into the RPS include direct extension from squamous cell carcinoma, tortuous carotid artery, lipoma, hemangioma, diskitis and osteomyelitis from the prevertebral space. For the lymph nodes, differential diagnoses include reactive adenopathy, suppurative adenitis, metastatic adenopathy, and lymphoma (Figure 4).1. Cyst In cystic lesions the diagnosis can frequently be made based on the location of the lesion (see next figure). To recognize and describe the relevant radiologic characteristics of a cystic lesion in the head and neck on computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) 2. Some of the main pathologic processes arising from or involving the PVS contents include: benign and malignant mesenchymal tumors, calcific tendinitis, osteophytes, osteomyelitis, primary bone tumors, metastases, diskitis, anterior disk herniation, aneurysm, lymphoma, and direct extension of carcinoma of the nasopharynx (Figures 5B and 5C).2, 5 The most common PVS malignancy in children is a rhabdomyosarcoma. With the epithelial lining, the most common malignancy in the visceral space is squamous cell carcinoma (SCC).2, 5, 10, 11 The lymphatic tissue in the Waldeyer’s ring can give rise to non-Hodgkin’s lymphoma, the second-most common malignancy in the PMS.2 The minor salivary glands can also give rise to both benign and malignant tumors. The program runs on Microsoft Windows 95 through Windows XP operating systems, Pentium processor computers with 32-Mbyte RAM, 10-Mbyte hard-drive space, and an 8x or faster CD-ROM drive. Corpus ID: 16780620. 2. The normal and diseased masticator space. The program provides an in-depth study of anatomy, physiology, and pathology related to head and neck radiology. The parotid space (PS) contains the parotid gland and is divided into superficial and deep lobes by the facial nerve which is located just lateral to the retromandibular vein (Figure 12).2 - 4, 9,16 The contents include gland parenchyma, facial nerve, retromandibular vein, external carotid artery, and intra parotid lymph nodes. Buccal space, retromaxillary fat padSuperficial layer, deep cervical fasciaMiddle layer, deep cervical fasciaRetropharyngeal spacePerivertebral space, prevertebral componentDeep layer, deep cervical fasciaPerivertebral space, paraspinal componentMasticator spacePharyngeal mucosal space/surfaceParapharyngeal spaceParotid spaceCarotid spaceAxial graphic depicts the spaces of the suprahyoid neck. Differential diagnosis of head and neck lesions based on their space of origin. The infrahyoid portion of the neck. In addition, the bibliography for each chapter has links to display the abstract references from PubMed if the user has an Internet connection. The SLDCF splits to … Cookies allow us to analyze and store information such as the characteristics of your device as well as certain personal data (e.g., IP addresses, navigation, usage or geolocation data, unique identifiers). These advanced features include links in the table of contents and chapters to navigate the text, options to search the text and a compiled index, and the ability to export chapters to a PDA (personal digital assistant). Some of the pathological processes that can occur within this space include malignant tumors, inflammatory lesions, infectious causes (tonsillar or peritonsillar abscess) and musculoskeletal tumors (Figures 1B, 2). The parapharyngeal space (PPS), also known as the prestyloid PPS, is next to the pharynx and extends from the skull base to the hyoid bone.1 - 4, 12 The contents of the PPS includes fat, vascular structures, small branches of the fifth cranial nerve, lymph nodes and ectopic rests of minor salivary gland tissue1 (Figure 6A). With its combined ease of use and interactive options not possible in printed material, Head and Neck Imaging: Fourth Edition CD-ROM version will be a useful addition for physicians upgrading their reference library. Head and Neck Imaging: Fourth Edition, edited by Peter M. Som and Hugh D. Curtin, is a well-established textbook with outstanding quality of information and excellent graphics. The prevertebral space (PVS) is posterior to the retropharyngeal space and is enclosed by the prevertebral fascia.1 The anatomic components of the PVS in the suprahyoid neck include the following: Prevertebral muscles (longus colli capitus), vertebral body, cervical disk, spinal canal, vertebral artery and phrenic nerve (Figure 5A). 6. Davis WL, Smoker WR, Hamsberger HR The normal and diseased infrahyoid retropharyngeal, danger, and prevertebral spaces. Although many diseases of the neck are not space specific, we discuss and illustrate examples of diseases related to specific spaces. Computed tomography of the buccomasseteric region. Braun IF, Hoffman JC. These spaces are well recognized in the axial plane and therefore suited for analysis on axial CT or MR. Visceral space 18 Likewise, CT will demonstrate the same findings along with prevertebral edema – a finding that must be distinguished from that found within retropharyngeal space infection (Figure 13). I am a radiology physician from California, USA. The contents of the SMS are: anterior belly of the digastric muscle, superficial portion of the submandibular gland, submandibular and submental lymph nodes, facial artery and vein, fat, and the inferior loop of the hypoglossal nerve.1 The differential diagnoses for the contents are as follows: metastatic disease, lymphoma, adenitis, obstructed submandibular duct, salivary gland tumors, abscess, Ludwig’s angina, thyroglossal duct cyst, hemangioma, lymphangioma, dermoid/epidermoid, diving ranula (complex), second branchial cleft cyst (more common in children) (Figure 16).1. The most common lesions in the PPS result from secondary extension of pathologic processes arising from the adjacent spaces and the most pathology is deep extension of SCC arising in the tonsillar region.1, The carotid space, also known as the post styloid PPS or the carotid sheath, is located posterior to the styloid process and lateral to the RPS and PVS.2, 3, 9, 13 Its sheath extends superiorly to the jugular foramen and inferiorly to the aortic arch and is bordered anteriorly by the styloid process and PPS, laterally by the anterior belly of the digastric muscle and the PS and medially by the lateral margin of the RPS. Parker GD, Hamsberger HR, Jacobs JM. New to the fourth edition are chapters covering ultrasound of the neck; genetics of tumor development and metastasis; and new imaging techniques, including advances in positron emission tomography (PET), magnetic resonance spectroscopy, and thallium-201 imaging. Secondary PPS masses include deep spread of malignant tumor from adjacent spaces, SCC from the visceral space, sarcoma from the MS (masticator space), minor salivary gland tumor from PS or PPS abscess (odontogenic infection from the MS, or tonsil infection).1 Primary PPS masses are unusual and the most common primary lesion of the PPS is a minor salivary gland tumor (Figure 6B and 6C). The complex anatomy of the carotid space within a small confined area is unique to the head and neck and allows for a vast array of pathology. In this article we will focus on: a 3-step approach on how to analyze pathology of the infrahyoid neck on cross-sectional imaging.. Cervical fascial planes. The entire neck (suprahyoid plus infrahyoid) spaces include the carotid space (CS), retropharyngeal and danger space (RPS), and the perivertebral space (PVS). The major lesions of the aerodigestive mucosal space (AMS) are surface epithelium neo- plasms. The middle layer (visceral or pharyngomucosal) encloses the pharynx, which includes the oropharynx and the nasopharynx. A simplified approach to the spaces of the suprahyoid neck. The CD-ROM version of the textbook employs many advanced Acrobat Reader features that provide greater mobility through the information.
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