1 radio of head and neck

8/6/2019 1 Radio of Head and Neck

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RADIOLOGY OF THE HEADRADIOLOGY OF THE HEAD

AND NECKAND NECK

Maria Divina Gracia C. Macalinao, M.D.


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Head and NeckHead and Neck

y Includes the extracranial parts of the

head

y Suprahyoid neck

From skull base to hyoid bone

y Infrahyoid neck

From hyoid bone to cervicothoracic junction


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SkullSkull

y 22 bones in the skull

Bones of the calvaria

Bones of the face and mandible

y Calvaria or Cranium

Paired frontal, parietal and temporal bones

Occipital

Sphenoid and ethmoid bones


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SKULL PA STRUCTURESSKULL PA STRUCTURES

y Frontal bone

y Crista galli

y Posterior ethmoidal

air cells

y Petrous portion of

temporal bones


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SKULL PA IMAGE CRITERIASKULL PA IMAGE CRITERIA

y Demonstrate anterior and lateral walls of

cranium

y Petrous bones should fill the orbit

y Distance from lateral wall of orbit to

lateral skull margin equal on both sides

y Posterior ethmoid cells should be seen

y Crista galli should be visualized


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SKULL LAT STRUCTURESSKULL LAT STRUCTURES

y Sella turcica

y Anterior and

posterior clinoid

process

y Dorsum sellae

y Squamous portion of

parietal and temporalbone

y Sphenoid sinuses


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SKULL LAT IMAGE CRITERIASKULL LAT IMAGE CRITERIA

y Lateral walls of cranium should be

demonstrated

y Superimposition of orbital roofs,

mandibular rami,EAM, and TMJ

y Sella turcica, ant and post clinoid

processes, and dorsum sellae w/o rotation

y Sphenoid sinuses should be visualized


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Skull BaseSkull Base

y Bony undulating surface which delimits

inferior boundary of the cranial vault.

y 5 bones:

Paired bones: frontal and temporal bones

Unpaired bones: ethmoid, sphenoid and

occipital bones

y 2 surfaces: Endocranial

Exocranial


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y 3 regions:

Anterior skull base (ASB): frontal bones to

lesser wing of sphenoid and planum

sphenoidale Central skull base (CSB): up to dorsum sella

and posterior clinoid processes medially,

petrous ridges laterally

Posterior skull base (PSB): up to occipital

bone


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y Imaging best done as combination of

focused MR and bone CT


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ExocranialExocranial Skull BaseSkull Base


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SubmentoverticalSubmentovertical ViewView


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OPEN MOUTH VIEWOPEN MOUTH VIEW


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OPEN MOUTHOPEN MOUTH

y Atlas and axis seen projected through

open mouth

y Odontoid process and C1-C2 articulation

y Upper teeth and base of skull

superimposed just above T1 level

y See the ff structures: atlas, axis, odontoid

process (dens), C1-C2 articulation


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Temporal BoneTemporal Bone

y Paired bones located in posterolateral floorof the middle and posterior cranial fossaemade up of petrous pyramid and mastoidcomplex

y Major components: External auditory canal (EAC)

Middle ear- mastoid

Inner ear

Petrous apex Internal auditory canal (IAC)

Facial nerve

Petrous internal carotid artery (ICA)


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MASTOID SERIESMASTOID SERIES

yTownes view

ySchullers view

yMayers view


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TOWNES VIEWTOWNES VIEW


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SCHULLERS PROJECTIONSCHULLERS PROJECTION


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SCHULLERS VIEW IMAGE CRITERIASCHULLERS VIEW IMAGE CRITERIA

` Mastoid air cells andantrum should be welldemonstrated in center offilm

` TMJ seen anterior to EAM

` Mastoid portion ofopposite temporal boneprojected inferior and notoverlapping mastoid ofinterest

` Auricle not tosuperimpose mastoid aircells


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MAYERS PROJECTIONMAYERS PROJECTION


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Temporal Bone CTTemporal Bone CT


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Temporal Bone CTTemporal Bone CT


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TemporomandibularTemporomandibular Joint (TMJ)Joint (TMJ)

y Articulation between the temporal bone

and the mandible

y MRI is the best imaging modality


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TemporomandibularTemporomandibular Joint SeriesJoint Series


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ParanasalParanasal SinusesSinuses

y Frontal

y Maxillary

y Ethmoid

y Sphenoid


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ParanasalParanasal SinusesSinuses

y Imaging

PNS series

PNS screening (CT)

x Presurgical work-up and follow-up of inflammatory

sinonasal disease

MRI

x If enhanced scan needed to define complex

inflammatory or neoplastic disease


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PARANASAL SINUS SERIESPARANASAL SINUS SERIES

yCaldwells view

yWaters view

ySkull lateral


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CALDWELL PROJECTIONCALDWELL PROJECTION


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CALDWELL IMAGE CRITERIACALDWELL IMAGE CRITERIA

` Frontal sinuses welldemonstrated abovethe frontonasal suture

and without rotation` Anterior ethmoid

sinuses seen inferiorto frontal sinuses and

on each side of nasalfossae

` Petrous bones filllower 1/3 of orbits


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WATERS PROJECTIONWATERS PROJECTION


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WATERS IMAGE CRITERIAWATERS IMAGE CRITERIA` Maxillary sinuses

demonstrated` Petrous ridges seen

below maxillary

sinuses` Maxillary sinuses and

orbital cavitieswithout rotation

` Frontal and ethmoidsinuses distorted

` Sphenoid sinuses notshown


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LATERAL PROJECTIONLATERAL PROJECTION


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SKULL LATERAL IMAGE CRITERIASKULL LATERAL IMAGE CRITERIA

`All paranasalsinuses shouldbe visualized

(thoughsuperimposed)

`Orbital roofs

and mandibularrami seensuperimposed


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Mandible ObliqueMandible Oblique


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Panoramic viewPanoramic view

y Shows the nasal area, maxillary sinus, TMJ,

teeth, maxilla, and mandible.

y Shows the entire mandible

y Used for:

Orthodontic assessments

Diagnosis of wisdom teeth impaction

Diagnosis of advanced periodontal disease

Diagnosis of mandibular fracture


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PanorexPanorex


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NeckNeck

y Suprahyoid neck

Spaces from skull base to hyoid boneincluding parapharyngeal, pharyngeal mucosal,masticator, parotid, carotid, buccal,retropharyngeal and perivertebral spaces

y Infrahyoid neck

Spaces below hyoid bone with some

continuing into mediastinum including visceralspace, posterior cervical space, anteriorcervical space, carotid space, retropharyngealand perivertebral spaces


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NeckNeck

y Suprahyoid neck

Nasopharynxx sits atop the upper aerodigestive tract as a midline,

tubular structure functioning as a conduit for air and

secretions from the nose and sinuses. Oropharynxx region of the upper aerodigestive tract that is visible

posteriorly through the open mouth

Oral Cavityx Anterior to the oropharynx and separated from it by a

ring of structures including the soft palate, anteriortonsillar pillars and the circumvallate papillae


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SuprahyoidSuprahyoid NeckNeck


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SuprahyoidSuprahyoid NeckNeck Oral CavityOral Cavity

y Area of suprahyoid neck below sinonasalregion and anterior to oropharynx

y Separated from the oropharynx by soft

palate, anterior tonsillar pillars andcircumvallate papillae

y 4 distinct regions:

Oral mucosal space/surface

Sublingual space

Submandibular space

Root of tongue - made up of genioglossus-geniohyoid complex and lingual septum


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y Internal Structures-Critical Contents

Oral tonguex Oral tongue: anterior 2/3 of tongue

x Base of tongue: posterior 1/3 of tongue (lingual tonsil of

oropharynx)x Root of tongue: deep muscles of oral tongue

(genioglossus and geniohyoid) + lingual septum

x Extrinsic tongue muscles

x Genioglossus

xHyoglossus

x Styloglossus and palatoglossus

x Mylohyoid muscle

x Forms floor of mouth


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Oral mucosal space/surfacex Lines entire oral cavity including buccal (cheeks), gingival

(gums), palatal and lingual surfaces

x Minor salivary glands

Sublingual spacex Lingual nerve

x Distal CN9 and CN12

x

Lingual artery and veinx Sublingual glands and ducts

x Deep portion of submandibular gland and submandibulargland duct


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Submandibular spacex Large superficial portion of submandibular gland

x

Submental and submandibular lymph node groupsx Facial vein and artery

x Inferior loop of CN12

x Anterior belly of digastric muscles

Pterygomandibular raphe fibrous bandextending from posterior mandibularmylohyoid line to medial pterygoid platehamulus


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Oral CavityOral Cavity


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Oral CavityOral Cavity


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InfrahyoidInfrahyoid NeckNeck

y 5 major spaces

Visceral

x only space unique to the infrahyoid neck

Carotid Posterior cervical

Retropharyngeal

Perivertebral


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y Visceral Space

Contents

x Thyroid gland

x Parathyroid glandsx Larynx

x Trachea

x Esophagus

x Recurrent Laryngeal Nerves

x Lymph nodes


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y Trachea

CT scan

y Esophagus

Barium swallow is the primary diagnostic tool

CT scan for tumor staging


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Barium SwallowBarium Swallow


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Thank you!Thank you!

1 radio of head and neck

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