Lesions of parapharyngeal region
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Transcript of Lesions of parapharyngeal region
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• The parapharyngeal space is shaped like a pyramid, inverted with its base at the skull base, with its apex inferiorly pointing to the greater cornu of the hyoid bone .
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•The fascia of the stylopharyngeus, styloglossus, and tensor veli palatini muscles separates prestyloid and poststyloid spaces•styloid process
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• Superior margin: base of skull• Inferior : greater cornu of the hyoid bone• Medial : middle layer of deep cervical fascia• Lateral : investing fascia covering the deep lobe
of the parotid• Anterior : investing fascia covering the medial
pterygoid• Posterior : prevertebral fascia
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•1. internal maxillary artery•2. inferior alveolar nerve•3. lingual nerve•4. auriculotemporal nerve
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• Contents of carotid sheath –>internal carotid artery, internal jugular vein, and cranial nerves 9, 10 and 12.
• Cervical sympathetic chain• Numerous lymph nodes
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• Spread of adjacent tumors -nasopharyngeal and oropharyngeal carcinoma, chordoma, and synovial sarcoma
• Minor salivary gland tumors -pleomorphic adenoma• Neurogenic tumors• Lymph nodes• Paragangliomas• Parapharyngeal space abscess• Parotid deep lobe tumors• Branchial cleft cysts
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CAROTID ARTERY•Ectasia•Aneurysm•Dissection•Encasement by direct squamous cell carcinoma.
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• Asymmetric enlargement• Thrombosis • Thrombophlebitis• Meningioma (from jugular foramen)
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• Neurogenic Tumor• Neuroblastoma• Paraganglioma
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• Neck mass• Oropharyngeal mass• Unilateral eustachian tube dysfunction• Dysphagia• Dyspnea• Obstructive sleep apnea• CN deficits• Horner syndrome• Pain• Trismus• Symptoms of catecholamine excess
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Localizing the lesion
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• Displacement of the lateral wall of the pharyngeal space medially,
• Displacement of the parotid gland laterally while maintaining an inta c t fa t p la ne with the deep lobe of parotid gland
• Displacement of the carotid vessels posteriorly
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• Anterolateral displacement of the prestyloid parapharyngeal fat.
• Anterior or medial displacement of the internal carotid artery with o blite ra tio n o f fa t p la ne s around the great vessels.
• Extension posterior to the styloid process with its anterolateral displacement.
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Pleomorphic adenoma in a 35 yr-old-woman. Contrast enhanced axial CT scan shows a minimally enhancing water attenuation well-defined mass extending into the prestyloid parapharyngeal space with widening of the stylomandibular tunnel.
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• Prestyloid/poststyloid compartment?
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Axial unenhanced T1-weighted spin-echo MR image shows low-signal-intensity mass . Medial fat line between mass and pharyngeal mucosa is displaced but preserved, whereas lateral fat line between mass and parotid gland is not seen, indicating parotid origin.
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Contrast enhanced axial CT scan shows a heterogeneously enhancing Schwannoma with areas of necrosis displacing the internal carotid artery anteromedially.
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Neurofibroma in a 22yr-old-man. Contrast enhanced axial CT scan shows the minimally enhancing tumor in the post-styloid space causing anterior displacement of ICA
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• Presence of internal flow voids on MR Imaging in a mass that is greater than 2 cm is suggestive of paraganglioma, rather than Schwanoma.
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Carotid body tumor in a 26 yr-old-man.
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Post contrast axial CT shows intensely enhancing vagale tumor causing anterior displacement of the internal carotid artery
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Malignant peripheral nerve sheath tumor Axial T2-weighted spin-echo MR image shows tumor (arrows) is slightly hyperintense to muscle
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tumor (arrows) extends into eustachian tube (arrowheads).
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Immediately life threatening lesion ??
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Skull base extension of the meningioma seen as hyperostosis of the adjacent skull base with a small calcified intracranial infratentorial component
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Tumor causing smooth scalloping and widening of jugular foramen ??
schwanoma
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Post contrast Axial CT shows a peripherally enhancing right parapharyngeal abscess with air pockets
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Tubercular lymphadenitis
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Metastatic lymphnodes
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• Pleomorphic adenoma is the most common tumor involving the p re s ty lo id compartment.
• Neurogenic tumors commonly involve the p o s ts ty lo id compartment.
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Thank you