What is the most important space to look for in an image of the neck and why?
The parapharyngeal space
It actually just contains fat, but by looking at the mass effect you can tell where the tumor is localized - huuuge help in making the differential
How do head and neck tumors tend to spread?
perineurally - through foramen along with nerves - this is why they tend to have a long, worm like appearance- they grow through holes
What is a very common cancer of the nasopharynx?
squamous cell carcinoma
What are some signs you'd see on an x-ray of a neck with infected bone?
- soft tissue swelling
- if with contrast - enhancing
- narrowing of the disc space if the infection is wearing away at the bone - they'll collapse
How will a normal sinus compared to a sinusitis on MRI?
healthy = sinuses should be black
sinusitis = there will be soft tissue swelling into the sinuses due to inflammation - less black
What sort of imaging should someone with a subperiosteal abscess get and why?
Head CT because you need to find out how far back it goes and whether it penetrates the cranial cavity
What happens in a carotid aortic dissection?
There is a little tear in the intima surrounding the artery and blood will be able to enter the space between the intima and the wall
this means you get blood flowing in 2 separate spaces and it greatly reduces the size of the lumen, sometimes blocking it off entirely
will often stop when it reaces the skull base
What might you see on imaging with a carotid aortic dissection?
a flap coming off the artery
dilatation of the vessel
What nerve is usually involved in vocal cord paralysis?
the recurrent laryngeal nerve - the left side is more often affected
Where does an acoustic schwannoma occur? Do they have conductive or sensory neural hearing loss?
It arises from the schwann cells surrounding the vestibulocochlear nerve (CN8)
they have sensory neural hearing loss
What will you see on imaging of an acoustic schwannoma?
and "ice cream cone" in the nerve basically
What is congenital cholesteatoma?
What sort of hearing loss do they have - conductive of sensory neural?
It's benign soughing of the squamous epithelium that lines the middle ear, resulting in a mass of keratinized epithelium
they have conductive hearing loss
What is Thyroid opthalmopathy? In what disease does it happen?
In hyperthyroidism - there are autoantibodies that attack the intraoccular muscles and cause them to enlarge
the bony orbit is a closed space, so if anything enlarges the eyes stick out - this is thyroid opthalmopathy