Introductory Head and Neck Imaging

C ontributors
	A ditya Bharatha MD
	A lan Johnson MD
	C laudia Kirsch MD
	K eng-Yeow Tay MBBS
	P eter Yang
	T imo Krings MD
	V inh Nguyen MD
F o r e w o rd
	Suresh K Mukherji MD FACR
Preface
	E ugene Yu Lalitha Shankar
C ontents
	1. Imaging techniques in head and neck
	2. Radiographic anatomy and pathology of the temporal bone
	N ormal CT and MRI anatomy of the temporal bone 16 • T he external ear
	T emporal bone pathology 37 • T he external ear 37
	3. Imaging of the orbit
	4. Imaging of the paranasal sinuses
	5. Diseases of the nasopharynx
	6. Imaging of the masti cator and parapharyngeal spaces
	P art I: The masticator space 257 • A natomy 257
	P art II: The parapharyngeal space 279
	7. Radiographic anatomy and pathology of the oral cavity
	8. Oropharynx
	9. Diseases of the parotid gland
	10. P erineural disease in the head and neck
	11. Imaging evaluation of cervical lymph nodes 421
	12. T he larynx and the hypopharynx
	13. C arotid, prevertebral, and perivertebral spaces 531
	C arotid space 531
	Retropharyngeal space 548 • A natomy 548
	P erivertebral space 555
	14. V ascular lesions of the head and neck
	15. Diseases of the thyroid gland
	16. Introduction to radiation oncology
Imaging techniques i n head and neck
	Introduction
	C omputed tomography
	Magnetic resonance imaging
	P o sitron emission tomography
	U ltrasound
	X -ray esophagram
	Summary
	References
Radiographic anatomy and pathology of the temporal bone
	Embryology
	Normal CT and MRI anatomy of the temporal bone
	The external ear (Figures 2.2A and B)
	The middle ear (Figures 2.3A to L)
	The facial nerve (Figures 2.4A to L)
	The inner ear (Figures 2.5A to I)
	Imaging of the temporal bone with CT and MRI
	T emporal bone pathology
	The external ear
		C ongenital anomalies
		Acquired diseases
	The middle ear
		C ongenital anomalies
		Neoplasm
	Facial ne r ve
		C ongenital anomalies
		Acquired diseases
		Neoplasm
	The inner ear
		C ongenital anomalies
		Neoplasm
	T r a u ma (Figures 2.34A to S)
	C o nclusion
	A cknowledgments
	Bibliography
Imaging of the orbit
	A n a t o m y of the orbit
		( F igures 3.4A and B ).
	C ongenital anomalies
		A nophthalmia
		Microphthalmia
		P ersistent hyperplastic primary vitreous
		Macrophthalmia
		Buphthalmos (Ox eye)
		S taphyloma
		C oloboma
		Dermoid and epidermoid cysts
	Orbital infections
		P reseptal cellulitis
		P o stseptal cellulitis
		Orbital abscesses
		Etiology
		C l inical presentations
		Imaging findings
		T reatment
		S pecific orbital infections
		Ocular infections
		Cavernous sinus thrombosis
	Orbital neoplasms
		Neural tumors of orbit Optic nerve glioma
			P eripheral nerve sheath tumors
			Optic nerve sheath meningioma
				( F igures 3.24 and 3.25 ).
		V a scular tumors of orbit Cavernous hemangioma
			Capillary hemangioma
			Hemangiopericytoma
		Hematological malignancies L ymphoma
			Leukemia
				( F igure 3.30 ).
			P lasma cell tumors
			Malignant neoplasms in childhood
			Rhabdomyosarcoma
			R etinoblastoma
			Intraocular tumors
			Ocular melanoma
			Metastasis of the orbit
			The lacrimal apparatus
	Inflammatory diseases of the orbit
		Idiopathic orbital inflammatory disease ( IOID or orbital pseudotumor)
		W egener granulomatosis
		Sarcoidosis
		Langerhans cell histiocytosis
		S j ö gren syndrome
		Optic neuritis
		Thyroid associated orbitopathy
	T r a u m a of the orbit
	Intraocular detachments
	Some overall thoughts about the orbit
		Organization of compartmentalizing the orbit
			Some examples: P reseptal swelling
			Optic nerve sheath complex
			Retrobulbar orbit
		F inal message
			S pecific orbit imaging comments:
	Bibliography
Imaging of the paranasal sinuses
	Normal anatomy
		Lateral wall of the nasal cavity
		The uncinate process (Figure 4.1 ‘U’)
		The bulla ethmoidalis (Figure 4.1 ‘BE’)
		The turbinates (Figure 4.1 middle MT and inferior IT turbinates)
		Drainage pathways of the paranasal sinuses
		E t h moid air cells
		Maxillary sinus
		F rontal sinus
			( F igures 4.2A and B ).
		S phenoid sinus
	P aranasal sinus imaging anatomy
		F unctional endoscopic sinus surgery a nd anatomic variants
		A n a t omic variants
		Hazardous variants
		Inflammatory diseases A c ute rhinosinusitis
			Orbital complications
		Intracranial complications
		C h ronic rhinosinusitis
		C h ronic rhinosinusitis without nasal polyposis
		C h ronic rhinosinusitis with nasal polyposis
		A l lergic fungal sinusitis
		S inochoanal polyp
		Mucous retention cyst
		Mucocele
		S i lent sinus syndrome
		F ungal sinusitis
		Noninvasive fungal sinusitis
		Invasive fungal sinusitis
		A c ute fulminant invasive fungal sinusitis
		C h ronic invasive fungal sinusitis
		Granulomatous sinusitis
		S inonasal tumors
		P a tterns of tumor spread
		Imaging
		A ppearance of tumor
		Bone involvement
		S kull base and intracranial extension
			4.85 and 4.86 ).
		Orbital invasion
		P erineural tumor spread
		T umor subtypes
			Malignant lesions
				Squamous cell carcinoma
			A denocarcinoma
		Melanoma
		Olfactory neuroblastoma (Esthesioneuroblastoma)
		S inonasal undifferentiated carcinoma
	Benign lesions
		Inverted papilloma
		A ngiofibroma
		F ibro-osseous lesions
		F ibrous dysplasia
			4.105 and 4.106 ).
			C ongenital disorders C ongenital frontonasal masses
		Nasal dermal sinus
		Nasal gliomas
		F rontoethmoidal encephaloceles (Figure 4.109)
		C hoanal atresia (Figures 4.110A and B)
	Bibliography
D i s e a s e s of the nasopharynx
	Anatomy
	Imaging of the nasopharynx
		Nasopharyngitis
	Nasopharyngeal cysts
		Retention cysts
	Diseases of the nasopharynx
		T ornwaldt cysts
	L ymphoid hyperplasia/hyperplastic adenoid
	Juvenile angiofibroma
	Nasopharyngeal tuberculosis
	Nasopharyngeal carcinoma
		( F igures 5.20 and 5.21 ).
		Nasopharyngeal carcinoma staging (Table 5.1)
	L ymphoma
		( F igures 5.25A to E ).
	Other rare nasopharyngeal disorders
	C onclusion
	Bibliography
Imaging of the m a sti cator a nd parapharyngeal spaces
	P a rt I: The masticator space
	Anatomy
	Imaging anatomy
		Masticator space: superior (Figure 6.I.1)
		Masticator space: mid (Figure 6.I.2)
		Masticator space: inferior (Figure 6.I.3)
		Masticator space: anterior (Figure 6.I.4)
		Masticator space: mid section coronal (Figure 6.I.5)
		Masticator space: posterior (Figure 6.I.6)
	Muscles of mastication
	Mandible
	Odontogenic tumor
		( F igures 6.I.19A and B ).
	Neurogenic lesions
		( F igures 6.I.27A to C ).
	Summary
	Bibliography
	P art II: The parapharyngeal space
	A n a t o m y (Figures 6.II.1A and B)
		P arapharyngeal space: superior (Figure 6.II.2)
		P a r a pharyngeal space: inferior (Figures 6.II.3A and B)
		P arapharyngeal space: anterior (Figure 6.II.4)
		P arapharyngeal space: posterior (Figures 6.II.5 and 6.II.6)
		P restyloid parapharyngeal space
	P a tterns of parapharyngeal f a t displacement (Figures 6.II.7 to 6.II.11)
	Infection
	T umors
		( F igures 6.II.14A to E ).
	Retrostyloid parapharyngeal space
		Tu m o r s
	Summary
	Bibliography
Radiographic anatomy and pathology of the oral cavity
	C ross-sectional anatomy of the oral cavity
		The lips and gingiva
		The floor of mouth
		The oral tongue
		The hard palate
		Maxilla and mandible
		Imaging of the oral cavity with CT and MRI
	Pathology
		V ascular
		Infectious
			( F igures 7.9A to C ).
		Neoplastic
		Neoplastic — critical imaging findings
		L ip carcinoma
		F loor of mouth carcinoma
		U pper and lower alveolus and g i ngiva and buccal mucosa
		Oral tongue
		Hard palate
		R etromolar trigone
			( F igures 7.19 and 7.20 ).
		Mandible and maxilla
		AJCC staging
		TNM definitions
			P rimary tumor (T)
			Regional lymph nodes (N)
			Distant metastasis (M)
		AJCC Stage Groupings Stage 0
			Stage I
			Stage II
			S tage III
			St a g e IVA
			Stage IVB
			Stage IVC
		Degenerative
			7.27A and B ).
		Inflammatory
		Congenital
		T raumatic
	C onclusion
	Bibliography
Oropharynx
	Radiologic anatomy
		Tu m o r
		Inflammatory
		Congenital
	Miscellaneous
	Bibliography
D i s e a s e s of the parotid gland
	Embryology
	Anatomy
	Imaging overview
		P lain radiographs
		Ultrasound
		C omputed tomography
		Magnetic resonance imaging
		Digital subtraction sialography
		Nuclear medicine
	Normal variants
		A c c essory parotid tissue
	Pathology
		Developmental
			F irst branchial cleft cyst
			C ongenital absence or hypoplasia
			Infective S ialolithiasis
			Viral sialadenitis
			Pyogenic sialadenitis
	A utoimmune/inflammatory/infiltrative
		S j ö gren’s syndrome
			( F igure 9.6B ).
		Sarcoidosis
		Sialosis
			( F igures 9.8A and B ).
		Radiation-induced sialadenitis
	T r a u m a
		P a rotid laceration, duct laceration and sialocele
	Benign neoplasms
		P leomorphic adenoma (benign mixed tumor)
		W a rthin’s tumor (adenolymphoma)
		Benign lymphoepithelial lesions
		Oncocytic neoplasms
		V a scular malformations
		L ymphatic malformations
		Nerve sheath tumors
	Malignant neoplasms
		Salivary gland epithelial malignancies (Tables 9.1 and 9.2) Mucoepidermoid ca
		A denoid cystic carcinoma
		Carcinoma ex-pleomorphic adenoma
		L ymphoma
		Metastatic disease to the parotid gland
		P erineural spread
	Bibliography
P erineural disease i n the head and neck
	chapter
	Introduction
		T ypes of tumors
		Nerves most commonly involved
		S i t es and routes
		S ymptoms and signs
		C l inical features of possible PNS
		T rigeminal/5th cranial nerve (CN V)
	Anatomy
		F acial nerve/7th cranial nerve (CN VII)
		Hypoglossal nerve
		S pinal nerves
		C onnections between the facial and trigeminal nerves
			Vidian nerve
			A uriculotemporal nerve (ATN)
		Pterygopalatine fossa
	Imaging considerations: techniques a n d features
	Normal variants and differential diagnosis
	Bibliography
Imaging evaluation of cervical lymph nodes
	P h y s i o l ogy and radiologic anatomy of c ervical nodes
		Basic organization and function of the lymphatic system
	Introduction
		Radiologic anatomy and classification of cervical lymph nodes
			Historical overview and rationale for cervical lymph node classifications
			Overview of classic anatomic and level based lymph node classifications
			Imaging-based lymph node classification Overview and technique
				Nodal chain classification, landmarks, and approach to interpretation
	Pathology
		Overview
		Imaging criteria for characterization of pathologic lymph nodes
			Normal nodes
			Reactive or inflammatory nodes
			Neoplastic nodal pathology
				Imaging criteria for assessment of metastatic nodes
				A dvanced nodal imaging and future prospects
		Etiologies and clinical syndromes presenting a s cervical lymphadenopathy
			Infectious and noninfectious inflammatory/reactive lymphadenopathies
				General
				Viral lymphadenitis
			Human immunodeficiency virus (HIV) infection
			Infectious mononucleosis
			Other viral infections
				Bacterial lymphadenitides
			Routine suppurative lymphadenitis
			Lemierre’s syndrome
			Cat-scratch disease and bacillary angiomatosis
			M y c obacterial lymphadenitis
				F ungal and protozoan lymphadenitis
				Other causes of reactive lymphadenopathy
				C l inical syndromes associated with cervical lymphadenopathy
			Kimura’s disease
			Kikuchi-Fujimoto disease
			S inus histiocytosis with massive lymphadenopathy
			Sarcoidosis
			Dermatopathic lymphadenopathy
			A ngiofollicular lymph node hyperplasia ( Castleman’s disease)
			Kawasaki’s syndrome
			T u mor-reactive lymphadenopathy
		Other miscellaneous causes of cervical lymphadenopathy on imaging V a scul
			F oreign body lymphadenopathies
			L ymph node inclusions
			Neoplastic causes of cervical lymphadenopathy Metastatic lymph nodes
			S pecific neoplastic nodal pathologies
				Metastatic thyroid carcinoma
		L ymphoproliferative disorders
		P roliferative histiocytic disorders
		Other nodal neoplasms
	C onclusion
	A cknowledgments
	Bibliography
The larynx and the h ypopharynx
	Introduction
	The role of imaging
	Imaging anatomy—larynx
		Laryngeal cartilages
		Intrinsic laryngeal musculature
		Mucosal surfaces of the endolarynx
			( F igure 12.7 ).
	Imaging anatomy—hypopharynx
	A n a tomic details
		Innervation of the larynx and hypopharynx
		L ymph node drainage
	Pathology
		Squamous cell carcinoma
		Laryngocele
		V ocal cord paralysis
			( F igure 12.14 ).
		Medialization thyroplasty
		S u bglottic stenosis due to Wegener’s granulomatosis
		T r a c heal enchondroma due to Maffucci syndrome
		Laryngeal papillomatosis
			( F igures 12.18A to C ).
		C hondrosarcoma of the larynx
		Pyriform sinus perforation
	C onclusion
	Bibliography
Carotid, p r e v ertebral, and perivertebral spaces
	C a rotid space
	Anatomy
	P seudolesions
		R etropharyngeal carotid artery
		Asymmetric size of internal jugular veins
	V a scular diseases
		Large artery vasculitis
		Idiopathic carotiditis
		Carotid artery dissection
		F ibromuscular dysplasia
		Internal jugular vein thrombosis
	Neoplastic
		P a r agangliomas
		Carotid body tumor (Figures 13.7 and 13.8)
		Glomus vagale tumor (Figures 13.9 and 13.10)
		Glomus jugulare tumor (Figures 13.11A to D)
	Nerve sheath neoplasms
		Carotid space schwannoma
		Neurofibroma (Figure 13.14)
		L ymphadenopathy (Figure 13.15)
		Direct spread of malignancy to the carotid space
	Retropharyngeal space
	Anatomy
	Infectious or inflammatory
		Retropharyngeal abscess
	Neoplastic
		Benign neoplasms
		L ymphadenopathy (Figures 13.21A and B)
		Direct spread of malignancy
		P o stradiation changes
		Multinodular goiter
		V ascular
	Infectious or inflammatory
		A c u t e calcific tendinitis of longus colli
	P e r i v e rtebral space
	Anatomy
		P erivertebral abscess
	Neoplastic
	Bibliography
V ascular lesions of t he head and neck
	V ascular malformations
		Low flow vascular malformations
			L ymphatic or venolymphatic malformations
			V enous vascular malformations
		High flow vascular malformations
			A rteriovenous malformations
		F a l se maxillofacial vascular malformations
			S inus pericranii
			F acial venous dilations associated to intracranial vascular lesions
			Idiopathic facial vascular dilations
		T r a u matic dissections
	T r a umatic vascular lesions
		T raumatic aneurysms
		T r a umatic AV fistula
	Other vascular diseases
		F ibromuscular dysplasia
		Large and medium vessel arteritis
		C ervical septic thrombophlebitis (Lemierre’s syndrome)
	V a scular tumors
		Infantile hemangiomas
		Kasabach-Merritt syndrome
		A d u l t orbital hemangiomas
		Nasopharyngeal angiofibroma ( j uvenile nasal angiofibroma)
		P a r agangliomas
		A ngiosarcoma
		Hemangiopericytoma
		Kaposi’s sarcoma
	Hypervascular lymphadenopathies
		Castleman’s disease
		A ngioimmunoblastic T-cell lymphoma
		Hypervascular metastasis
	Bibliography
D i s e a s e s of the t h yroid gland
	Embryology
	Anatomy
	Imaging overview
		Ultrasound
		Nuclear medicine
		C omputed tomography and magnetic resonance imaging
			Developmental Thyroglossal duct anomalies
		L i ngual thyroid
			( F igures 15.7A and B ).
	Inflammatory
		Branchial apparatus anomalies
		A u t oimmune disease and thyroiditis
		Graves’ disease
		Hashimoto thyroiditis
			( F igures 15.11A and B ).
		Thyroid goiter
		Malignant neoplasms
			( F igures 15.14 and 15.15 ).
		Differentiated thyroid carcinoma
		Medullary carcinoma
		A n a plastic carcinoma
		L ymphoma
	Bibliography
Introduction to r a d i a t i o n oncology
	T ypes of radiation
	Introduction
		Biologic effects of radiation
			( F igure 16.1 ).
		Mechanism of radiation damage
		Radiation damage, repair, and dose rate effect
		C oncept of fractionation
	C linical radiation oncology
		L inear accelerators
	C linical radiotherapy planning
		Follow-up
	C onclusion
	Bibliography
Index