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 HEAD AND NECK

• Term used collectively to describe the extracranial

structures
– Sinonasal cavity
– Skull base
– Pharynx
– Oral cavity
– Larynx, neck, orbit and temporal bone
 IMAGING METHODS
• Both multislice helical CT and MR can provide exquisite
imaging of the normal and pathologic anatomy of the head
and neck.
• CT is the modality of choice when looking for
calcifications/lithiasis or for detection of fractures.
• MR provides outstanding sensitivity for soft tissue
discrimination. It often demonstrates full extent of the
pathology.
• PET (Positron Emission Tomography) - increased the
sensitivity and specificity in the evaluation of primary and
recurrent malignancies in combination with either CT or MR
infusions imaging.
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 ACUTE SINUSITIS CHRONIC SINUSITIS
Characterized by presence of Mucoperiosteal thickening
air-fluid levels and osseous thickening of the
sinus walls
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Foamy appearing sinus

secretions

Soft tissue findings – best Secretions are desiccated – no

detected on T2WI: high signal signal
hyper intense
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Caused by viral upper

respiratory tract infection
 RADIOGRAPHY

ACUTE SINUSITIS CHRONIC SINUSITIS

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 ACUTE SINUSITIS

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COMMON COMPLICATIONS
OF SINUSITIS

• Inflammatory polyps
• Mucous retention cysts
• Mucoceles more severe

complication
• Cavernous sinus thrombosis
 INFLAMMATORY POLYPS

• Result of chronic inflammation resulting to muscosal

hyperplasia à mucosal redundancy and polyp formation
• Most often blend imperceptibly with mucoperiosteal
thickening and cannot be clearly differentiated.
• Antrochoanal polyp – antral polyp expands to the point
where it prolapses through the sinus ostium.
– Soft tissue mass extending from the maxillary sinus to
fill the ipsilateral nasal cavity and nasopahrynx.
 SINONASAL ACP

POLYPOSIS
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SINONASAL POLYPOSIS
SINONASAL
POLYPOSIS
ANTROCHOANAL POLYP
ANTROCHOANAL POLYP
 MUCOUS RETENTION CYSTS

• Represent obstructed mucous glands within the

mucosal lining.
• Have a characteristic rounded appearance,
measuring one to several centimeters in diameter.
• Maxillary sinus – most commonly involved
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AXIAL T1 AXIAL T2
 MUCOCELE

• Similar to mucous retention cysts, but instead of being

confined to the single mucous gland, the lesion expands to
the point where the entire sinus becomes obstructed.
• Typically occurs because of a mass obstructing the
draining ostium.
• Characteristic: Frank expansion of the sinus with
associated sinus wall bony thinning and remodelling.
• Frontal sinus – most commonly affected
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 CAVERNOUS SINUS THROMBOSIS

• Most commonly results from contiguous spread of

infection from the sinuses or middle third of the face,
or less commonly dental abscess or orbital cellulitis.
• Staphylococcus aureus -- most common infectious
microbe, found in 50-60% of the cases.
• MRI with contrast - modality of choice to confirm its
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CAVERNOUS SINUS THROMBOSIS
CAVERNOUS SINUS THROMBOSIS
OTHER COMPLICATIONS
 REGIONAL - INTRACRANIAL
COMPLICATIONSS OF ACUTE/CHRONIC
• SINUSITIS
Spread of infection occurs through the emissary veins of the
skull
• This includes:
1) Orbital abscess (subperiosteal vs. retroglobar) or cellulitis
2) Optic neuritis from sphenoid sinusitis
3) Meningitis
4) Subdural empyema
5) Brain abscess
6) Cavernous sinus thrombosis
 ORBITAL CELLULITIS/ABSCESS
• Ethmoid sinusitis can lead to subperiosteal abscess along the
medial wall of the orbit.
• Orbital abscess is an indication for emergency surgical
intervention
• Thin-section CT (3mm, contiguous images) performed with
contrast and filmed in soft tissue windows is necessary to
diagnose subtle cases of subperiosteal abscess
 ORBITAL CELLULITIS AND
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BRAIN ABSCESS AND SUBDURAL
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• Inverting Papilloma
• Juvenile nasopharyngeal
angiofibromas
• Malignancies
– Squamous cell carcinoma
 INVERTING PAPILLOMA

• Neoplastic nasal epithelium inverts and grows into the

underlying mucosa.
• These papillomas are not believed to be associated with
allergy or chronic infections because they are almost
invariably unilateral in location.
• Occur exclusively on the lateral nasal wall, centered on
the hiatus semilunaris.
• Increased association with squamous cell carcinoma.
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 JUVENILE NASOPHARYNGEAL
ANGIOFIBROMAS

• Typically seen in male adolescents presenting with epistaxis.

• Tumor arises from fibrovascular stroma of the nasal wall
adjacent to the sphenopalatine foramen.
• Benign, but very locally aggressive
• Classically, tumor fills the nasopharynx and bows the
posterior wall of the maxillary sinus forward.
• Retromaxillary pterygopalatine fossa location is a hallmark
feature.
• Enhances markedly with contrast administration.
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 MALIGNANCIES
• Squamous cell carcinoma – most common (80-
90%)
– often clinically silent until it is quite
advanced.
– Early symptoms are related to obstructive
sinusitis
– Imaging findings: opacified sinus with
associated bony wall destruction.
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THANK YOU!