Suprahyoid neck

Question 1

What is within the parotid space?

Answer 1

1. Parotid gland
2. Lymph nodes (within gland)
3. Facial nerve
4. Retromandibular vein (medial to CN VII)

Question 2

What are the important features of a pleomorphic adenoma?

Answer 2

1. Most common major and minor salivary gland tumour
2. Most common in the parotid but can occur in others
3. 90% occur in the superficial lobe
4. T2 bright with a rim of low signal
5. Small malignant potential and so treated surgically

Question 3

What are the important features of a Warthin’s tumour?

Answer 3

1. Only occurs in the parotid gland
2. Is bilateral in 15%
3. Usually cystic
4. Takes up pertechnetate
5. Usually seen in male smokers

Question 4

What are the important features of mucoepidermoid carcinoma?

Answer 4

1. Most common malignant tumour of minor salivary glands
2. Variable appearance
3. Associated with radiation

Question 5

What are the important features of adenoid cystic carcinoma?

Answer 5

1. Malignant salivary gland tumour which favours minor glands but can be seen in the parotid
2. Can result in perineural spread

Question 6

What are the important features of lymphoepithelial disease of the parotid gland?

Answer 6

1. Bilateral mixed solid and cystic lesions with diffusely enlarged parotid glands
2. Seen in HIV
3. Is painless (unlike parotitis)

Question 7

What are the features of Sjogren’s to the salivary glands?

Answer 7

1. Honeycomb appearance of the gland

2. Increased risk of non-Hodgkins MALT type lymphoma

Question 8

What is in the carotid space?

Answer 8

1. Carotid artery
2. Jugular vein
3. Portions of CN IX, X and XI
4. Internal jugular chain lymph nodes

Question 9

What are paragangliomas?

Answer 9

Vascular tumours arising from neural crest cell derivatives.
“Salt and pepper” appearance from the flow voids and can be multiple/bilateral.
111-In-Octreotide accumulates in these tumours.
4 types:
1. Carotid body tumour at carotid bifurcation
2. Glomus jugulare at skull base with destruction of jugular foramen
3. Glomus vagale above carotid bifurcation and below jugular foramen
4. Glomus tympanicum in the middle ear (“overlying the cochlear promontory”) around Arnoldson and Jacobson nerves.

Question 10

Carotid space mass differential.

Answer 10

1. Squamous cell cancer nodal metastasis
2. Paraganglioma
3. Neurofibroma
4. Schwannoma

Question 11

What is Lemierre’s syndrome?

Answer 11

Lemierre’s syndrome refers to the purulent or septic thrombophlebitis of the internal jugular vein as a complication of pharyngitis.
Usually caused by Fusobacterium necrophorum.
Lemierre’s disease could be even further complicated by distant metastatic abscesses in the lungs with septic pulmonary emboli, brain abscesses or elsewhere (septic arthritis can lead to acute osteomyelitis).

Question 12

What is in the masticator space?

Answer 12

1. Muscles of mastication
2. Angle and ramus of the mandible
3. Inferior alveolar nerve (branch of CN V3)
4. Internal maxillary artery

Question 13

Masticator space pathology differential.

Answer 13

1. Infection - usually odontogenic
2. Sarcomas - rhadomyosarcoma, chondrosarcoma favours the TMJ
3. Cavernous haemangioma
4. Schwannoma
5. Perineural spread from primary melanoma or adenoid cystic tumour

Question 14

What is in the parapharyngeal space?

Answer 14

1. Predominantly fat
2. Trigeminal nerve (V3)
3. Internal maxillary artery
4. Ascending pharyngeal artery

Question 15

Parapharyngeal mass differential.

Answer 15

1. Minor salivary gland tumour
2. Lipoma
3. Cellulitis/abscess
4. Schwannoma

Question 16

How is the parapharyngeal space affected by other neck space lesions?

Answer 16

1. Parotid mass displaces it medially
2. Carotid space causes anterior displacement
3. Masticator space mass causes postero-medial displacement
4. Superficial mucosal space mass causes lateral displacement