E4555. Space-of-Origin-Based Approach to Suprahyoid Neck Neoplasms: A Pictorial Review
Authors
Samir Dagher;
The University of Texas MD Anderson Cancer Center
Maria Gule-Monroe;
The University of Texas MD Anderson Cancer Center
Jeanie Choi;
The University of Texas MD Anderson Cancer Center
Diana Kaya;
The University of Texas MD Anderson Cancer Center
Max Wintermark;
The University of Texas MD Anderson Cancer Center
Kim Learned;
The University of Texas MD Anderson Cancer Center
Fehime Ucisik;
The University of Texas MD Anderson Cancer Center
Background
The suprahyoid neck (SHN), which runs from the hyoid bone to the base of the skull, is subdivided into multiple spaces defined by the superficial, middle and deep layers of the deep cervical fascia. A space-of–origin-based differential diagnosis can be established for SHN masses, which can then be further narrowed based on imaging characteristics and clinical presentation.
Educational Goals / Teaching Points
The goals of this educational exhibit are to review the anatomy of the SHN spaces as outlined by the layers of deep cervical fascia, to provide a space-of-origin-based approach to lesion localization and differential diagnosis for SHN masses, and to review characteristic imaging findings of benign and malignant neoplasms arising from SHN spaces through cases from a tertiary cancer center.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The SHN is compartmentalized into the parapharyngeal, pharyngeal mucosal, masticator, buccal, parotid, carotid, retropharyngeal, danger, perivertebral and posterior cervical spaces. The direction of displacement of parapharyngeal fat and prevertebral muscles is particularly useful to determining the space-of-origin of a mass. Shape, texture and enhancement pattern on CT and MRI further guide the differential diagnosis. Familiarity with the relationship of these spaces with the skull base is essential to evaluate perineural spread and subsequent intracranial extension of disease, thus further guiding management and prognosis.
Conclusion
The space-of-origin-based approach to SHN neoplasms is a critical and integral part of developing a comprehensive differential diagnosis. It requires a deep understanding of how fascial compartments interact with and displace each other, as well as their unique contents, their abutment to the cranial base, and imaging characteristics of the mass in question.
