Beruflich Dokumente
Kultur Dokumente
the Neck
Marie Grobbelaar
Department of Radiology
Tygerberg Academic Hospital
Embryology
Branchial Arches
Branchial arches
Arch
1
Nerve
Mandibula
r division
(V3)
Muscles
Skeleton
Muscles of
mastication,
mylohyoid, ant belly
digastricus, tensor
palatini, tensor
tympani
Incus, malleus,
maxilla, zygomatic
bone, part of temp
bone, part of
mandible
VII
Muscles of facial
expression, post
belly digastricus,
stylohyoid, stapedius
Stapes, styloid
process, lesser horn
+ upper body hyoid
IX
Stylopharyngeus
4-6
Cricothyroid,
contrictors of
pharynx, intrinsic
laryngeal muscles
Laryngeal cartilages
Branchial pouches
Branchial clefts
4 pairs
Only 1st cleft contributes to a definitive structure
external auditory meatus.
Proliferation of mesenchymal tissue of 2nd arch
causes it to overlap 3rd + 4th.
Merges in lower part of neck and 2,3,4th clefts
loose contact with outside.
Temporary cavity cervical sinus forms.
Thyroid - embryology
duct cysts
Branchial cleft anomalies
Cystic hygromas
Dermoid and Epidermoid cysts
Thymic cysts
Parathyroid cysts
Laryngoceles
Bronchogenic cysts
Gastrointestinal duplication cysts
Location
Cystic hygromas
floor of mouth
Parathyroid cysts
Laryngoceles
suprasternal notch or
supraclavicular area
Gastrointestinal duplication
cysts
paralaryngeal space
CT with contrast in
fistula
Axial CECT
MRI T1
Axial CECT
Axial
MRI Sagittal T2
MRI Coronal T2
Drawing shows the path of second branchial cleft anomalies, which can occur
anywhere along a line from the supraclavicular region to the oropharyngeal mucosa.
The path travels lateral to the common carotid artery, then heads medially between
the external carotid (EC) and internal carotid (IC) arteries under the
glossopharyngeal nerve (IX) and above the hypoglossal nerve (XII). If the tract
continues further along this course, it will enter the parapharyngeal space and
pierce the middle constrictor muscle before ending as an opening within the tonsillar
fossa.
Submand
gland
Carotid space
MRI Axial T1
SCM
MRI Axial T2
CECT
MRI Coronal T1
Axial CT
Axial CT
Coronal CT
Axial MRI
Axial MRI
Rare.
Children and young adults.
Second most common congenital lesion of the posterior
cervical space of the neck after cystic hygroma.
Most located in the posterior cervical space, posterior to the
SCM and posterior to the common / internal carotid artery.
Superior to the superior laryngeal nerve.
Majority on the left.
If a fistula present, will pierce thyrohyoid membrane en route
to the pyriform fossa.
May be associated with ectopic parathyroid gland.
Painless mass in posterior triangle of neck.
Surgical excision.
CT and MRI unilocular, cystic mass in posterior cervical
space.
T1 signal variable, T2 high.
Rare.
Children and young adults.
Majority on the left.
Manifest as a sinus tract rather than a cyst / fistula.
Arises from the pyriform fossa, pierces the
thyrohyoid membrane, and descends into the
mediastinum, following the path of the
tracheoesophageal groove. If the tract is long
enough, a left-sided lesion will eventually travel
under the aortic arch before ascending into the
neck along the ventral surface of the common
carotid artery. Most of these lesions are short and
thus sinus tracts
Inferior to the superior laryngeal nerve.
May be associated with ectopic parathyroid gland.
Cystic Hygroma
Cystic Hygroma
CECT
MRI Axial T1
MRI Coronal T1
CECT
MRI Coronal T1
MRI Axial
Axial CECT
Coronal CECT
Axial CECT
US
MRI Coronal T1
Axial CECT
Thymic cysts
NECT
NECT
Parathyroid Cysts
Laryngocele
Laryngocele
Manifests in adults.
Hoarseness, dysphagia, and stridor may occur with internal
laryngoceles.
A compressible soft-tissue mass is seen with the external type
which may expand when a Valsalva maneuver is performed.
Increased frequency of laryngoceles in patients with laryngeal
carcinoma, best appreciated on T2-weighted images on which
the neoplasm is lower in signal intensity compared with that of
the fluid within the laryngocele
CT - well-defined, smooth mass in the lateral aspect of the
superior paralaryngeal space. Internal laryngoceles will be
limited by the thyrohyoid membrane. External and mixed
laryngoceles lie superficial to the thyrohyoid membrane at the
point of insertion of the superior laryngeal nerve and vessels.
MRI - best appreciated on T2-weighted images.
Axial CT
Extremely rare.
In infants as well as adults.
Occur in males about three times as often as in
females.
Present as swelling or draining sinus, usually
located in the suprasternal notch or
supraclavicular area.
MRI Axial T2
References