Role of Computed Tomography (CT) in Localisation and Characterisation of Suprahyoid Neck Masses

Abstract

Background: Suprahyoid neck lesions are difficult to assess only by means of clinical inspection and therefore imaging techniques are required to precisely evaluate suprahyoid neck spaces. The aim of this study was to evaluate the distinctive role of computed tomography in the assessment of anatomical source and pathological type of masses involving the suprahyoid neck spaces.

Material/methods: Sixty patients presenting with suprahyoid neck masses underwent computed tomography of the neck. The CT findings were correlated with histopathological findings and a final diagnosis was made.

Results: Overall, male preponderance was seen except in the case of parotid space lesions where female predominance was seen. The most common aetiology was squamous cell carcinoma and the majority of cases (30%) were seen in patients aged 41-50 years. The majority of lesions were found in the pharyngeal mucosal space (n=16) with squamous cell carcinoma being the most common pathology. In the parotid space, pleomorphic adenoma and in the prestyloid parapharyngeal space, squamous cell carcinoma were the most common lesions, respectively. In the retropharyngeal space, an equal incidence of malignant and inflammatory aetiologies was seen. Abscesses were the most common lesions in the prevertebral space. The pleomorphic adenoma was the most common benign tumour and was also the second most common tumour in the suprahyoid neck spaces. CT had an excellent correlation with histopathological findings with sensitivity of 96.4%, specificity of 100%, positive predictive value of 100% and a negative predictive value of 91.67%.

Conclusions: Computed tomography definitely has a major role to play in the evaluation of suprahyoid neck masses as it has an excellent correlation with post-operative histopathological diagnosis.

Keywords: Head and Neck Neoplasms; Neck; Pathology; Tomography, Spiral Computed.

Figure 1

Pie diagram showing distribution of lesions in each suprahyoid neck space.

Figure 2

Heterogeneous mass (squamous cell carcinoma) in the left tonsillar fossa in a patient presenting with painful swelling. The mass is causing a bulge and narrowing of the oropharynx, with loss of fat planes with the base of the tongue and retropharyngeal space on the left side.

Figure 3

Ill-defined heterogeneous mass (squamous cell carcinoma) in the right masseteric space and retromolar trigone region in a patient presenting with difficulty in swallowing.

Figure 4

Well-defined, marginated enhancing mass in the right parotid gland (pleomorphic adenoma) extending through the widened stylomandibular tunnel into the right prestyloid parapharyngeal space. Areas of coarse calcification are seen in the deep part. It is causing a mild deviation of the oropharyngeal airway to the left.

Figure 5

Low-attenuating collections with a rim enhancement in the left tonsillar fossa (abscesses) in a patient presenting with fever, sore throat and painful swelling. The mass is causing a bulge in the medial wall of oropharynx and displacing the parapharngeal space laterally.

Figure 6

Pie diagram showing the pattern of enhancement of suprahyoid masses on contrast-enhanced CT.