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 Pharyngeal
mucosal space

Adenoids
 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
• 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
• 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
• Masseter
• Temporalis
• Medial pterygoid
• Lateral pterygoid
– Mandibular division, trigeminal nerve (V3)
• 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
Masticator
Temporalis Space
muscle

Lateral
pterygoid
muscle

Medial
pterygoid
muscle
Axial T1 MR
 Masticator Space
• Clinical Implications
– Trismus
– Differential diagnosis of masticator space lesion
• 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
Parotid
Retromandibular space
vein

Parotid gland
Axial T1 MR
 Parotid Space
• Clinical Implications
• Parotid Tumors benign mixed tumor (75%)
• Warthin tumor (5%)
• Adenoid cystic carcinoma (5%)
• Mucoepidermoid carcinoma (5%)
• Other (10%)
– Other masses in parotid space
• 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
• 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 Carotid

artery space

Internal jugular
vein
 Carotid Space
• Clinical implications
– Differential diagnosis of carotid space lesion
• 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
• 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
• 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
• 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
• 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