Approach to head and neck

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Location is Key to Diagnosis


  • Tube from skull base to thoracic inlet, mucosal lined, squamous cell carcinoma most common tumor
  • Includes nasopharynx, oropharyxn, oral cavity, hypopharynx (hyoid to esophagus), larynx


  • Masticator space - mandible and muscles of mastication, CN V3. Pathology includes abscess (dental), osseous (primary like Ewings or metastasis) and rhabdomyosarcoma
  • Parotid space - salivary tissue (), lymph nodes, CN VII
    • Pleomorphic adenoma - most common mass, benign, mild peripheral enhancement, T2 bright
    • Parotid carcinoma
  • Carotid space - artery (carotid body tumor intense enhancement), vein, CN IX-XII (schwannoma which enhances, neurofibroma (may not enhance as others))
  • Parapharyngeal space - contains fat, used to identify masses in other compartments, because of displacement


  • Perivertebral space - most pathology originates in bone or disc
  • Retropharyngeal space - potential space containing fat and lymph nodes
  • Posterior cervical space - lateral to paraspinal muscles, contains lymph nodes and fat (level 5A and 5B)
    • Cystic hygroma - unilocular lymphatic malformation

Lymphatic and vascular malformations can cross facial planes because congenital (developed before planes). Otherwise, if cross spaces usualy aggressive.