Anatomy of Head and Neck
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Anatomy of Head and Neck Christina M. Thuerl, MD Klinik und Poliklinik für Nuklearmedizin Slides are not to be reproduced without permission of author. Why is knowledge of anatomy neccessary? • therapy depends on localization and extension of disease di • communication with clinical partners Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Anatomy of Head and Neck Basic subdivision: Suprahyoid Neck • Nasopharynx • Oral cavity • Oropharynx Infrahyoid Neck • Larynx L • Hypopharynx Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Anatomy of Head and Neck • Why is this subdivision necessary? • The primary tumors in each of these areas have different routes of • spread • nodal dissemination • prognosis Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Nasopharynx B Bounderies: d i Anterior: posterior nasal cavity p y Posterosuperior: Lower clivus, upper cervical spine and prevertebral spine, muscles Inferior: Divided from the oropharynx by a horizontal line drawn along the hard and soft palates palates. Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Nasopharynx Sphenoidal sinus Fossa of Rosenmüller Torus tubarius Slides are not tothe be reproduced pharyngeal entrance of Eustachian tube without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Nasopharynx Torus tubarius Orifice of the Eustachian tube (symmetric) Fossa of Rosenmüller with air (can be asymmetric) Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Lymphatics in Nasopharynx •Rich capillary lymphatic plexus •Drainage to lateral retropharyngeal nodes and Level II, V Level II Level V Slides are not to be reproduced without permission of author. Retropharyngeal nodes can not be palpated © Nuklearmedizin, UniversitätsSpital Zürich What is another name for the lateral retropharyngeal nodes? A Virchow`s Virchow s node B Rouviere`s node C Rodin`s node D sentinel node Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Oral cavity and oropharynx The oral portion of the upper aerodigestive tract is divided into two major components: the oral cavity and the oropharynx. Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Oral cavity and oropharynx Borders of the oral portion are the palate and the tip of the epiglottis. Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Anatomic definition Oral cavity Anterior tonsillar pillar The oral cavity is separated from the oropharynx by • the anterior tonsillar pillars, • th circumvallate the i ll t papillae, ill • and the junction of theSlides hard and soft palate. are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Anatomic definition Oral cavity Circumvallate papillae The oral cavity is separated from the oropharynx by • the anterior tonsillar pillars, • th circumvallate the i ll t papillae, ill • and the junction of theSlides hard and soft palate. are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Anatomic definition Oral cavity C t t off orall cavity Contents it • • • • • Oral tongue lips p buccal mucosa hard palate al eolar ridge and alveolar retromolar trigone • floor of the mouth: sublingual and submandibular space Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Tongue The tongue comprises • • intrinsic (no bony attachment) and extrinsic (with bony attachement) muscles Intrinsic • Sup and inf longitudinal • Vertical • Horizontal Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Tongue The tongue comprises • • Genioglossus g intrinsic (no bony attachment) and extrinsic (with bony attachement) muscles Intrinsic • Sup and inf longitudinal • Vertical • Horizontal Hyoglossus Geniohyoid m. Extrinsic E ti i • Hyoglossus • Genioglossus • Palatoglossus • Styloglossus Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Floor of mouth • extrinsic muscles of the tongue • mylohyoid y y muscle seperates sublingual and submandibular space Geniohyoid m. Mylohyoid m. Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Imaging issues Oral cavity First drainage node of oral cavity cancers Jugulodigastric nodes Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Lymph node levels Hyoid bone Levell II: L Level II: Level III: Level IV: Level V: Level VI: Level VII: submental, b t l submandibular b dib l upper jugular mid-jugular lower jugular posterior triangle prelaryngeal, pre-/paratracheal upper mediastinal Inferior border of cricoid Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Drainage lymph nodes of posterior oral cavity Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Oropharynx Medial glossopharyngeal fold / glossoepiglottic fold Lateral glossopharyngeal fold Vallecula epiglottica (pharnygoepiglottic fold) incidence of SCC SCCa: • Palatine tonsil tonsil (50%) • base off tongue/ b t / vallecula (20%) • Soft palate (10%) • pharyngeal wall Tongue g base and p posterior third of the tongue Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Cartilagineous skeleton Epiglottis Thyroid cartilage superior cornu of thyroid cartilage superior thyroid notch lamina of thyroid cartilage til Arytenoid cartilages Cricoid cartilage posterior lamina anterior arch Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Invasion of thyroid cartilage Sclerosis sclerosis is sign of Slides beginning invasion. are not to be reproduced Later: osteolysis without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Larynx Supraglottic larynx false vocal cords d Glottis Ventricle Subglottis Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Larynx Lymphatic drainage • Two embryological separate parts of the larynx • The supraglottis develops from the buccopharyngeal origin: LN metastases are rich lymphatic pathways more frequent f • The glottis and the subglottis are derived from the tracheobronchial buds: LN metastases are rare fewer lymphatic pathways Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Larynx Supraglottis: above true vocal cords Paraglottic spaces Paraglottic spaceand pre-epiglottic Preepiglottic space: clinical blind spots aryepiglottic fold epiglottis piriform sinus Slides are not to be reproduced without permission of author. level of scan © Nuklearmedizin, UniversitätsSpital Zürich Supraglottic Larynx Epiglottic SCCa Infiltration of the pre- and paraglottic space aryepiglottic fold epiglottis piriform sinus Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich To what region does the piriform sinus belong ? A nasopharynx B oropharynx C larynx D hypoparynx Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Intimate relationships between Larynx and Hypopharynx Larynx:Epiglottis Supraglottic Larynx: Aryepiglottic Fold Paraglottic space Thyroid cartilage Lumen Piriform Sinus: H Hypopharynx h Posterior hypopharyngeal wall Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Intimate relationships between Larynx and Hypopharynx Larynx: Aryepiglottic Fold Hypopharynx: Piriform sinus Posterior hypopharyngeal wall Low dose CT Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Intimate relationships between Larynx and Hypopharynx Larynx: Arytenoid Cartilages Hypopharynx: Piriform sinus Low dose CT Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Larynx Glottis: true vocal cords I case off tumor In t invasion i i off the th anterior commissure, all neighboring structures are at risk for neoplastic destruction. Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Hypopharynx piriform sinussinus-posterior hypopharyngeal wall wall-postcricoid t i id area Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Hypopharynx Piriform sinus sinus--posterior wallwall-postcricoid area glossoepiglottic g pg fold N Necrotic ti LN metastasis t t i Enlarged retropharyngeal space Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich Hypopharynx Piriform sinus sinus--posterior wallwall-postcricoid area cricoid Slides are not to be reproduced without permission of author. © Nuklearmedizin, UniversitätsSpital Zürich
