Infrahyoid Neck Research Articles

Imaging of the Infrahyoid Neck: Systematic Approach

In this presentation a systemic approach to infrahyoid neck imaging analysis is presented based on five individual spaces: the visceral, carotid, retropharyngeal, posterior cervical and perivertebral space. These spaces are defined by the three layers of the Deep Cervical Fascia (DCF). Each space has its own specific anatomical ‘contents’. Therefore, once a disease process is assigned to one space, it is usually possible to formulate a short differential diagnosis based on the anatomy present in that space.

Isolated lesions of the suprasternal notch in pediatric patients.

Palpable masses of the head and neck are a common indication for imaging in the pediatric population. Midline lesions of the infrahyoid neck, particularly lesions isolated to the suprasternal notch, are not well studied. To delineate the histopathological and imaging spectrum of masses that occur within and isolated to the suprasternal notch. A retrospective study was performed to identify patients with an isolated lesion of the suprasternal notch that had available pathological diagnoses. Available imaging was reviewed and characterized by fellowship-trained pediatric radiologists and compared by descriptive statistics to the final pathological diagnoses. Eighteen masses isolated to the suprasternal notch with available pathological diagnoses were identified. Of these, congenital epithelial inclusion cysts were diagnosed in 14 patients (77.8%) with dermoid cysts comprising 11 of those (61.1%) and epidermoid cysts accounting for 3 (16.7%). The most common imaging appearance was a cystic or pseudosolid appearance without vascularity. Isolated resected lesions of the suprasternal notch in pediatric patients are most frequently dermoid/epidermoid cysts, with a differential diagnosis including other less common entities.

Imaging of Treated Thyroid and Parathyroid Disease.

The thyroid and parathyroid glands are endocrine structures located in the visceral space of the infrahyoid neck. Imaging plays a critical role in the evaluation of patients with thyroid cancer, both in the pre and posttreatment setting. Disorders of thyroid function, that is, hyperthyroidism and hypothyroidism, are also fairly common, although imaging utilization is less frequent with these conditions. Parathyroid dysfunction results in disordered calcium metabolism. Imaging is frequently applied in the preoperative assessment of these patients undergoing parathyroidectomy; however, routine imaging in the postoperative setting is uncommon. Parathyroid carcinoma is rare; however, imaging may be used in the pre and posttreatment setting.

Symptomatic Thyroglossal Duct Cyst Presenting With Synchronous and Localized Tongue Base Extranodal Mantle Cell Lymphoma. A Unique Case Report Demonstrating Lymphoma Colonization of Cyst Wall, Potentially Relating to a Persistent Embryological Foramen Cecum Remnant

A 77-year-old male presented with a progressively enlarging midline neck mass. On further investigation he was found to have synchronous thyroglossal duct cyst and extranodal mantle cell lymphoma (MCL) localized to the base of tongue. Both pathologies were managed simultaneously with a surgical approach and the patient remained in clinical remission at the time of publication without indication for systemic oncological treatment. Histology revealed primary extranodal nonblastoid MCL forming a base of tongue mass, with colonization of the thyroglossal duct cyst. Lymphoma was also found in the epithelium of a crypt-like tract traversing one of the tongue base tumor sections. This tract was anatomically and histologically consistent with documented descriptions of the foramen cecum. This case report illustrates a previously undescribed temporal, clinical, and histological association between a base of tongue MCL and symptomatic thyroglossal duct cyst. We provide evidence for a potential causal relationship for the presentation of the thyroglossal duct cyst as a result of oropharyngeal MCL, in the absence of clinical and histological evidence of disseminated disease, directly infiltrating from its tongue base origin to the infrahyoid neck region, potentially via an embryologic foramen cecum remnant. We also highlight the crucial role of the histopathologist in multidisciplinary clinicopathological discussion in demonstrating how fundamental embryological and microanatomical relationships can unite apparently separate diseases.

Superficial, suprahyoid, and infrahyoid neck musculature in naked mole-rats (Heterocephalus glaber): Relative size and potential contributions to independent movement of the lower incisors.

Naked mole-rats (Heterocephalus glaber) are fossorial, eusocial rodents that exhibit the unusual capability of moving their lower incisors independently in lateral and rostroventral directions. The evolution of this trait would presumably also involve concurrent alterations in neck musculature to support and control movements of the lower incisors. In order to assess morphological adaptations that might facilitate these movements, we performed detailed dissections of the neck musculature of adult naked mole-rats. In addition to characterizing attachment sites of superficial, suprahyoid, and infrahyoid musculature, we also quantified muscle mass and mandibular features thought to be associated with gape (condyle height, condyle length, and jaw length). Based on muscle attachment sites, the platysma myoides may contribute to lateral movement of the lower incisor and hemi-mandible in naked mole-rats. The large digastric muscle is likely to be a main contributor to rostroventral movement of each lower incisor. The geniohyoid and mylohyoid muscles also likely contribute to rostroventral movements of the lower incisors, and the mylohyoid may also produce lateral spreading of the hemi-mandibles. The transverse mandibular (intermandibularis) muscle likely serves to reposition the lower incisors back to a midline orientation following a movement.

Report of a non-looped variant of ansa cervicalis with omohyoid innervation from accessory nerve branch and omohyoid attachment to mastoid process.

A variant of the innervation of the infrahyoid neck musculature is reported in which the typical looped ansa cervicalis structure is absent. In this variant, the infrahyoid muscles (sternohyoid, sternothyroid omohyoid and thyrohyoid) were innervated by a presumptive superior root of "ansa cervicalis" traveling with vagus nerve (CN X) and not branching from hypoglossal nerve (CN XII). The omohyoid muscle, typically innervated by the inferior root of ansa cervicalis, is instead innervated by nerve fibers branching from the accessory nerve (CN XI). This formation created a non-looping variant of ansa cervicalis. Furthermore, the omohyoid muscle did not attach to the hyoid bone but instead attached to the mastoid process of the temporal bone by merging its fibers superiorly and posteriorly with the clavicular portion of the sternocleidomastoid muscle, creating a "sternocleidoomomastoid" muscle innervated by a branch of accessory nerve. This variation was found in one black male cadaver from a cohort of 25 male and female cadavers. Only one variation of ansa cervicalis was observed. As neck dissections and surgical procedures of this region are performed for a variety of conditions-including coronary artery bypass grafting and metastatic neck disease-variations of this type are of broad clinical surgical importance.

Infrahyoid involvement may be a high-risk factor in the management of non-odontogenic deep neck infection: Retrospective study

ObjectivesThis study sought to investigate the impact of involvement of the infrahyoid neck space on the management of non-odontogenic DNI. MethodEighty-one patients treated for non-odontogenic DNI over 5 years were retrospectively recruited into this study. Demographics, etiology, radiology results, treatments, duration/cost of hospital stay, and complications were recorded. Differences between DNIs with and without infrahyoid involvement, as defined based on an anatomical chart, were analyzed. ResultsSixty-two male and 19 female patients with a median age of 46.22 years were included. Fifteen patients had cellulitis, and 66 patients had abscesses. Streptococcus was the most commonly observed bacterium. Compared with DNIs only in suprahyoid spaces (n = 60, 74.07%), DNIs with infrahyoid space involvement (n = 21, 25.93%) were associated with higher incidences of the involvement of ≥3 spaces (85.71%, P = 0.000), mediastinitis (38.10%, P = 0.000), tracheostomy (28.57%, P = 0.008), surgery using a transcervical approach (66.67%, P = 0.000), and intensive care unit therapy (19.05%, P = 0.004), as well as longer hospital stays (16 days, P = 0.000) and higher costs ($2872, P = 0.000). ConclusionInfrahyoid involvement should be regarded as a high-risk factor in the management of deep neck infection (DNI). A relatively aggressive plan that includes transcervical surgery and tracheostomy should be considered at earlier stages for DNI with infrahyoid involvement.

Dual Ectopic Thyroid: An Uncommon Imaging Diagnosis

ABSTRACTEctopic thyroid means presence of thyroid gland tissue in abnormal position. Dual ectopic thyroid is the presence of thyroid gland tissue in two different abnormal locations. It is a rare entity. We report a case of 17-year-old girl who presented with a gradually increasing swelling in the upper neck. Her thyroid tests were abnormal, with mildly reduced T3 and T4 levels and increased TSH levels. Ultrasound revealed an isoechoic homogenous lesion in the intermuscular planes, in the infrahyoid neck. Contrast-enhanced computed tomography (CECT) of neck was performed which showed two similarly homogenously enhancing lesions, one in the base of tongue and another in the infrahyoid neck. Thyroid gland was not seen in its normal location. On the basis of these findings, diagnosis of dual ectopic thyroid was made. Patient was managed with thyroid hormone replacement therapy to manage hypothyroidism and decrease the size of swelling.How to cite this articlePrabhakar N, Gupta V, Panda N, Khandelwal N. Dual Ectopic Thyroid: An Uncommon Imaging Diagnosis. J Postgrad Med Edu Res 2015;49(2):83-84.

PET/MRI and PET/CT in follow-up of head and neck cancer patients

Positron emission tomography (PET)/MRI combines the functional ability of PET and the high soft tissue contrast of MRI. The aim of this study was to assess contrast-enhanced (ce)PET/MRI compared to cePET/CT in patients with suspected recurrence of head and neck cancer (HNC). Eighty-seven patients underwent sequential cePET/CT and cePET/MRI using a trimodality PET/CT-MRI set-up. Diagnostic accuracy for the detection of recurrent HNC was evaluated using cePET/CT and cePET/MRI. Furthermore, image quality, presence of unclear (18)F-fluorodeoxy-D-glucose (FDG) findings of uncertain significance and the diagnostic advantages of use of gadolinium contrast enhancement were analysed. cePET/MRI showed no statistically significant difference in diagnostic accuracy compared to cePET/CT (91.5 vs 90.6%). Artefacts' grade was similar in both methods, but their location was different. cePET/CT artefacts were primarily located in the suprahyoid area, while on cePET/MRI, artefacts were more equally distributed among the supra and infrahyoid neck regions. cePET/MRI and cePET/CT showed 34 unclear FDG findings; of those 11 could be solved by cePET/MRI and 5 by cePET/CT. The use of gadolinium in PET/MRI did not yield higher diagnostic accuracy, but helped to better define tumour margins in 6.9% of patients. Our data suggest that cePET/MRI may be superior compared to cePET/CT to specify unclear FDG uptake related to possible tumour recurrence in follow-up of patients after HNC. It seems to be the modality of choice for the evaluation of the oropharynx and the oral cavity because of a higher incidence of artefacts in cePET/CT in this area mainly due to dental implants. However, overall there is no statistically significant difference.

Anatomic and Dosimetric Correlation in the Treatment of Advanced Larynx Cancer: When Is the Brachial Plexus at Risk?

Anatomic and Dosimetric Correlation in the Treatment of Advanced Larynx Cancer: When Is the Brachial Plexus at Risk?

Emergency Imaging Assessment of Deep Neck Space Infections

Deep neck space infection may lead to severe and potentially life-threatening complications, such as airway obstruction, mediastinitis, septic embolization, dural sinus thrombosis, and intracranial abscess. The clinical presentation is widely variable, and often early symptoms do not reflect the disease severity. The complication risk depends on the extent and anatomical site: diseases that transgress fascial boundaries and spread along vertically oriented spaces (parapharyngeal, retropharyngeal, and paravertebral space) have a higher risk of complications and require a more aggressive treatment compared with those confined within a nonvertically oriented space (peritonsillar, sublingual, submandibular, parotid, and masticator space). Imaging has 5 crucial roles: (1) confirm the suspected clinical diagnosis, (2) define the precise extent of the disease, (3) identify complications, (4) distinguish between drainable abscesses and cellulitis, and (5) monitor deep neck space infection progression. Ultrasonography is the gold standard to differentiate abscesses from cellulitis, for the diagnosis of lymphadenitis. and to identify internal jugular thrombophlebitis in the infrahyoid neck. However, field-of-view limitation and poor anatomical information confine the use of ultrasonography to the evaluation of superficial lesions and to image-guided aspiration or drainage. Computed tomography (CT) combines fast image acquisition and precise anatomical information without field-of-view limitations. For these reasons, it is the most reliable technique for the evaluation of deep and multicompartment lesions and for the identification of mediastinal and intracranial complications. Contrast agent administration enhances the capability to differentiate fluid collections from cellulitis and allows the detection of vascular complications. Magnetic resonance imaging is more time-consuming than CT, limiting its use to selected indications. It is the technique of choice for assessing the epidural space involvement in pre- and paravertebral space infections and complements CT in the evaluation of the infections reaching the skull base.

Computed Tomographic Evaluation of Thyroglossal Duct Cysts in Children Under 11 Years of Age

The purpose of this study was to review the computed tomography (CT) features of thyroglossal duct cysts (TDCs) in children less than 11 years of age. A retrospective chart review was performed at Chonnam National University Hospital for the period of March 2005 to June 2011. CT scans of 16 patients having TDCs were evaluated for the following features: site of the mass, relationship to the midline, walls, margins, internal septa, rim enhancement, internal density, and the presence or absence of the thyroid gland. Of the 16 lesions, 8 (50%) were located in the midline and 12 (75%) were infrahyoid in location. Twelve (75%) of the 16 patients had well-circumscribed walls and peripheral rim enhancement. Internal septa were seen in four of the cysts, and all but one of the cysts demonstrated homogeneous or low-density attenuation. The most common CT findings of TDCs in children less than 11 years of age were a homogeneous or low-density lesion. TDCs in children under the age of 11 years were mostly located in the infrahyoid neck.

Pilomatricoma in the Head and Neck: CT Findings in Three Patients

We report three cases of pilomatricoma, one in the infrahyoid neck and the others in the preauricular area. In all cases, CT showed well marginated soft tissue masses that were located mainly in the subcutaneous fat, partly attaching to the overlying skin. There was no evidence of infiltration to deeper structures. Substantial amounts of calcification were found in one tumor. Pilomatricoma should be included in diagnostic consideration when CT shows a well marginated subcutaneous soft tissue mass adherent to the skin with or without visible calcification in the head and neck region.

MR IMAGING OF THE THORACIC INLET

The borders of the thoracic inlet define an oblique plane that angles downward from the spine anteriorly to the first ribs. It is therefore best to consider the thoracic inlet as a region or "zone" which extends a short distance above and below this plane to include the lower portion of the infrahyoid neck and the upper portion of the superior mediastinum. MRs multiplanar imaging capability allows the thoracic inlet to be subdivided into four distinct zones; visceral, neurovascular, pulmonary, and spinal. The first section of this article reviews the normal anatomy of each zone and the sequence protocol for imaging of the brachial plexus. The second section discusses differential diagnoses relevant to each zone. Pathologic processes are also presented.

頚動脈間隙の臨床

The carotid space, which is not necessarily identical to the carotid sheath that encircles the common carotid artery or internal carotid artery, internal jugular vein, and vagus nerve, extends from the skull base to the aortic arch. Constituents outside of the carotid sheath include the sympathetic chain and deep cervical lymph nodes. This space is bordered by the parotid, parapharyngeal, retropharyngeal, and prevertebral spaces in the suprahyoid neck. The visceral, retropharyngeal, posterior cervical, and prevertebral spaces bound the carotid space in the infrahyoid neck. The suprahyoid portion of this space is often referred to as the retrostyloid compartment of the parapharyngeal space.We discussed anatomical and diagnostic findings regarding this space. Common lesions of the space, diagnostic criteria of metastatic lymph nodes in CT or MRI, clinical manifestations of internal jugular vein thrombosis and carotid syncope, preservation of neural function during neurinoma surgery, and modern trends in paraganglioma surgery were also discussed.

INFRAHYOID NECK

Imaging is an indispensable tool in patients with clinical suspicion of infrahyoid neck disease. CT and MR imaging can establish a positive diagnosis by showing a true mass (versus a pseudomass). In addition, by defining the exact space of origin of the lesion and its characteristics (CT density, MR signal, homo- or heterogeneity, contour, contrast enhancement), imaging can predict the correct diagnosis. Because it offers multiplanar, multiparameter information, MR imaging, performed with a dedicated coil and appropriate artifact-reduction techniques, usually is the modality of choice.

Infrahyoid spread of deep neck abscess: anatomical consideration.

The aim of this study was to determine the pathway of infrahyoid extension of the oropharyngeal abscess considering the anatomy of the fascial spaces by cross-sectional imaging. CT scans and MR images were retrospectively reviewed in ten patients with known infrahyoid extension of oropharyngeal abscesses (eight with acute tonsillitis, two with acute phlegmonous oropharyngitis). In seven of eight patients tonsillar abscesses descended along the deep cervical fascia converging on the hyoid bone and further accumulated in the anterior cervical space through which extension to the mediastinum took place in four patients. In seven patients the abscesses involved the retropharyngeal space at the infrahyoid neck. In two of these seven patients the abscesses directly extended down into the upper mediastinum through the retropharyngeal space. In one patients of the seven mediastinal spread of an abscess occurred through the posterior cervical space, not through the retropharyngeal space. Cross-sectional imaging is valuable in the evaluation of deep neck abscesses and the pathway of spread. The anterior cervical space in the infrahyoid neck is important for mediastinal extension of pharyngeal abscesses.

Book reviews

This genuinely pocket-sized handbook contains 500 pages of highly concentrated information about the anatomy, radiology and pathology of the face, skull base and neck. It is organized principally into three closely defined anatomical regions: suprahyoid neck, infra-hyoid neck, and head and neck above the hard palate.

Computed tomography of deep neck infections

We retrospectively reviewed the CT of 11 patients with deep neck infections with a special emphasis on the location and extent of the infection, the presence or absence of a drainable abscess, and, if any, associated complications. CT correctly denoted the location and extent of the space infection, even though the individual layers of the deep cervical fascia per se could not be identified. Infection was most frequent at the transhyoid neck(n=7)and confined to the suprahyoid and infrahyoid neck in 2 cases, respectively. There were common spaces involved according to etiology. All 3 patients with dental infections of the lower third molar had involvement of the submylohyoid space. In 1 patient with a fishbons injury to the month floor, the infection was found at the submylohyoid space as well as sublingual space. CT clearly pointed out the presence of a drainable abscess in alll surgically proved 10 patients, among whom the gas bubbles were seen in 5 patients. In addition, CT demonstrated the significant complications of deep neck infection, and these were mediastinal involvement(n=2), airway encroachment(n=2), jugular vein thrombosis(n=2), and reactive cervical 1ympnadenopathy(n=5). We conclude that CT can be used as a principal diagnostic tool in the evaluation of deep neck infections.

Computed tomography of the infrahyoid neck. Part II: pathology.

HomeRadiologyVol. 145, No. 2 PreviousNext Computed tomography of the infrahyoid neck. Part II: pathology.D L Reede, M A Whelan, R T BergeronD L Reede, M A Whelan, R T BergeronD L ReedeM A WhelanR T BergeronPublished Online:Nov 1 1982https://doi.org/10.1148/radiology.145.2.7134444MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: 1982 FiguresReferencesRelatedDetailsCited ByExpert Review of Anticancer Therapy, Vol. 15, No. 2Parapharyngeal and Masticator Space LesionsHead & Neck, Vol. 31, No. 10Veterinary Radiology <html_ent glyph="@amp;" ascii="&"/> Ultrasound, Vol. 44, No. 3Evolution of Diagnostic Neuroradiology from 1904 to 19991Norman E. Leeds, , and Stephen A. Kieffer, 1 November 2000 | Radiology, Vol. 217, No. 2Cancer, Vol. 71, No. 7Radiologic Clinics of North America, Vol. 27, No. 2Neuroradiology, Vol. 30, No. 1Journal of Computed Tomography, Vol. 12, No. 1Current Problems in Diagnostic Radiology, Vol. 14, No. 6Head & Neck Surgery, Vol. 7, No. 1The value of CT scanning in the diagnosis of tuberculous lymphadenitis of the neckComputerized Radiology, Vol. 8, No. 1Radiologic Clinics of North America, Vol. 22, No. 1Radiologic Clinics of North America, Vol. 22, No. 1Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 145, No. 2 Metrics Altmetric Score PDF download