Tumors of the oral cavity and paranasal sinuses can spread along nerves to areas apparently removed from the primary tumor. In tumors of the palate, sinuses, and face, this “perineural” spread usually involves the maxillary division of the trigeminal nerve. The pterygopalatine fossa is a pathway of the maxillary nerve and becomes a key landmark in the detection of neural metastasis by computed tomogaphy (CT). Obliteration of the fat in the fossa suggests pathology. Case material illustrating neural extension is presented and the CT findings are described.

http://www.ajnr.org/content/ajnr/5/6/731.full.pdf

CT of Perineural Tumor Extension: Pterygopalatine Fossa

Nasopharyngeal carcinoma (NPC) is an intriguing disease that shows a distinct geographical distribution with well-defined, high-risk ethnic groups. This neoplasm exhibits strong associations with the Epstein-Barr virus, dietary and genetic factors. Radiation therapy is the mainstay of treatment and imaging plays a central role in tumor mapping and radiation therapy planning. NPC provides an excellent model for the study of normal and pathological anatomy of the skull base. It also provides an excellent model in the study of consequences of radiation therapy.

Carcinoma of the nasopharynx

Background

Nasopharyngeal carcinoma (NPC) may infiltrate the pterygopalatine fossa (PPF) and the maxillary nerve. This study illustrates involvement of the naxillary nerve in the PPF with perineural spread to the cavernous sinus.



Methods

One hundred and fourteen patients with proven NPC were studied using magnetic resonance imaging (MRI) and computed tomography (CT). The images were retrospectively reviewed for PPF infiltration and maxillary nerve involvement.



Results

Seventeen (15%) patients showed infiltration of the PPF. Four patients had maxillary nerve involvement and a perineural spread to the cavernous sinus. Of the 17 patients with PPF infiltration, 8 (47%) patients showed hypoesthesia in the distribution of the infraorbital nerve. All 4 patients with contrast-enhancement of the maxillary nerve exhibited infraorbital neuropathy.



Conclusion

Infiltration of the maxillary nerve in the PPF with intracranial spread is uncommon but should be suspected in patients with infraorbital neuropathy. This is important as it affects both prognosis and radiation treatment planning. © 1997 John Wiley & Sons, Inc. Head Neck19: 121–125, 1997.

Pterygopalatine fossa and maxillary nerve infiltration in nasopharyngeal carcinoma

OBJECTIVE. The palatovaginal canal is a short bone tunnel that extends from the pterygopalatine fossa to the roof of the pharynx. The primary purpose of our work was to establish whether the palatovaginal canal can be identified on CT and MR imaging. The secondary goal was to establish the frequency of visualization and the appearance of this canal.MATERIALS AND METHODS. We retrospectively analyzed 150 consecutive direct coronal CT studies obtained for evaluation of the sinonasal cavities. Frequency, bilaterality, and appearance of the palatovaginal canals were recorded. The frequency of the vidian canals was recorded for comparison. We also analyzed 20 MR imaging studies of that area to assess visualization of the palatovaginal canals and their contents. A dry skull specimen was examined using CT, and the images were correlated with those obtained in vivo.RESULTS. The palatovaginal canal could be identified on CT on at least one side in 88 (58.7%) of 150 patients. Unilateral complete canals were found in...

The Palatovaginal Canal: Can It Be Identified on Routine CT and MR Imaging?

CT anatomy of pterygopalatine fossa and its communications: a pictorial review

The CT appearance of the pterygopalatine fossa is described in detail. Anatomic and CT sections were compared in cadavers and patients in axial and coronal CT planes to identify the osseous configuration and vascular and neural contents of the fossa. The normal fat, soft-tissue, and osseous margins are altered by neoplasms in the fossa. CT is an effective technique to evaluate the fossa and contiguous area.

Pterygopalatine fossa: computed tomographic studies.

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Pterygopalatine fossa: computed tomographic studies.