Head & Neck Pathology Flashcards
Lymph node assessment
When assessing nodes related to primary tumour.
- size
- shape (round suspicious. oval = reactive)
- morphology (heterogenous suspicious)
- clustering (are they clustered together suggesting they are reactive to a process such as cancer)
- extranodal tumour is most specific sign of malignancy (where tumour extends beyong capsule of a lymph node) - LN will have a ‘hairy’ appearance. See pic
Firstly look at tumour and figure out where tumour should drain to. e.g. tonsillar tumour to Level II.
Level I - 15mm
Level IIA - 11mm
Retropharyngeal - 8mm
Rest - 10mm
MR Bone Lesions in H&N
Tips
Low T2 signal on MR - think fibro-osseous
Fat signal on MR - favours benign lesion
Enhancement is common in benign bone lesions including oesseous venous malformations.
Benign fatty lesions of sphenoid bone
**Benign bonyvenous malformation **
Bone lesions to keep in mind at skull base that can mimic pathology
Both of above can be seen in skull.
Arrested pneumatisation of sphenoid sinus. See picture. Bubbly, adjacent to spehnoid sinus. This is a do not touch lesion
Lesions at jugular foramen
Name 4
Perineural spread in the head and neck
There are many neurotropic tumours in H&N
- SCC
- melanoma
- Adenoid cystic
- NHL
If patient hx is Bells palsy - LOOK FOR PERINEURAL SPREAD
Look for:
- nerve enlargement
- foraminal enlargement
- loss of fat around nerve
V1 - superior orbital fissure
V2 - foramen ovale into PPF
Vidian canal - greater superficial petrosal nerve and sympathetic branches of carotid to form the vidian nerve. Goes into PPF.
Pterygomaxillary fissure - extends into masticator soft tissues lateral to PPF.
Greater palatine canal - travels inferiorly from PPF (best seen on coronal and sag - looks like tunnel) carrying V2 down to hard palate.
Perineural spread - Ophthalmic V1
Perineural spread Maxillary V2
-
Perineural spread - Mandibular V3
Goes straight down through foramen ovale. Does not enter cavernous sinus
Motor nerves
- masticator branch for muscles of mastication
- mylohyoid nerve
Sensory branches
- inferior alveolar nerve
- lingual nerve **(will pick up chorda tympani from facial nerve). ** supplies oral tongue and floor of mouth as well as submandubular and sublingual glands
- inf alveolar (supplies teeth)
- buccal nerve (buccal mucosa)
- auriculartemporal nerve (2 branches that emerge. courses posterolaterally through partotid gland and TMJ)
Perineural spread
Important communications 1
2 main communications between 5th and 7th cranial nerves
Vidian and GSPN
Greater superficial peterosal nerve (arises from geniculate ganglion of facial nerve) picks up carotid sympathetics to form vidian nerve
Vidian nerve meets other nerves like V2 of trigeminal at the pterygopalatine ganglion.
Perineural Spread
Important communications 2
V3 and auriculotemporal nerve
V3 arises from ovale and gives off 2 branches one of which is auriculotemporal nerve and courses through parotid gland.
Whilst in parotid gland it forms communications with facial nerve branches.
Auticulotemporal supplies sensation to ear, EAM, skin over partotid gland and temple
Lymph node size cut off
Level II is only one allowed 15mm
Rest are 10mm cut off
