Learning objectives
The current exibit aims to:
- To illustrate the radiological anatomy of the parapharyngeal space (PPS).
- To demonstrate diagnostic approach of PPS lesions by using CT and MR techniques.
- To describe the imaging features of a variety of disease processes that may occur in the PPS.
Background
The PPS is defined as the deepest space in the neck and it consists of the pre- and post-styloid regions.
Due to its critical location and anatomic relationships,
it acts as a highway for extension of multitude of lesions to and from this space.
The differentiation of a pre-styloid lesion from a post-styloid lesion is essential for the differential diagnosis.
Clinical examination is limited by the inaccessible location; hence diagnosis of PPS pathologies is completely dependent on imaging.
Findings and procedure details
I-Anatomy of the PPS:
The parapharyngeal space (PPS) is a fascial space in the suprahyoid neck,
shaped like an inverted cone and extends from the skull base down to the level both side soft hypopharynx (1,2) (Figure 1).
The superior border (base) is a portion of the temporal bone lateral to the attachment of the pharyngo-basilar fascia and medial to foramen ovale and spinosum.
It has 3 bony landmarks: scaphoid fossa -origin of the tensor veli palatine-,
spine of the sphenoid bone and styloid process....
Conclusion
A clear understanding of the anatomy of the PPS is crucial for an accurate diagnostic approach of pathology arising in this region.
The pattern of displacement of fat in the PPS in combination with the imaging characteristics of the mass helps to localize the site of origin of the lesion and to narrow the differential diagnosis.
References
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Maheshwar AA,Kim E-Y,
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Role of the parapharyngeal space: Defining its boundaries and clinical implications.
Ann Oto Rhino Laryngo 2004;113:283-288.
3.
Bradley PJ,
Bradley PT,
Olsen KD.
Update on the management of parapharyngeal tumours.
Curr Opin Otolaryngo lHead Neck Surg 2011;19:92-98.
4.
Stambuk HE,
Patel SG: Imaging of the parapharyngeal space.
Otolaryngol ClinNorth Am 2008;41:77-101.
5.
Flint PW,
Haughey BH,
Lund VJ,
et al: Cummings Otolaryngology Head &NeckSurgery.ed5 Philadelphia,...