Meyers Differential Diagnosis in Neuroimaging: Head and Neck

1. Auflage 2016
ISBN: 978-1-62623-476-5
Verlag: Thieme Medical Publishers
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 664 Seiten, PDF

Authored by renowned neuro-radiologist Steven P. Meyers, is a stellar guide for identifying and diagnosing head and neck disease based on location and neuroimaging results. The succinct text reflects more than 25 years of hands-on experience gleaned from advanced training and educating residents and fellows in radiology, neurosurgery, and otolaryngology. The high-quality MRI and CT scans have been collected over Dr. Meyers's lengthy career, presenting an unsurpassed visual learning tool.

The distinctive 'three-column table plus images' format is easy to incorporate into clinical practice, setting this book apart from larger, disease-oriented radiologic tomes. This layout enables readers to quickly recognize and compare abnormalities based on more than 1,500 high-resolution images. Chapters cover skull imaging, temporal bone imaging, orbital imaging, paranasal imaging, suprahyoid neck imaging, and infrahyoid neck imaging, for a full spectrum of head and neck pathologies.

Key Highlights

• Tabular columns organized by anatomical abnormality include neck, facial, and skull based imaging findings and a summary of key clinical data that correlate to the images
• Congenital/developmental and acquired abnormalities including solitary or multiple orbital lesions; and solitary, multifocal, or diffuse sinonasal disease
• Abnormalities of the skull, craniovertebral junction, tempormandibular joint, infrahyoid neck, anterior and posterior cervical space, perivertebral space, and brachial plexus

This visually rich resource is a must-have diagnostic tool for residents, fellows, and practitioners in radiology, otolaryngology-head and neck surgery, and neurosurgery. The highly practical format makes it ideal for daily rounds, as well as a robust study guide for physicians preparing for board exams.

Autoren/Hrsg.

Meyers, Steven

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Bildgebende Verfahren, Nuklearmedizin, Strahlentherapie Neuroradiologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Neurologie, Klinische Neurowissenschaft
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Kopf- & Halschirurgie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Medizinische Diagnose und Diagnostik

Inhaltsverzeichnis

1 Skull and Temporal Bone
2 Orbit
3 Paranasal Sinuses and Nasal Cavity
4 Suprahyoid Neck
5 Infrahyoid Neck
6 Lesions That Can Involve Both Suprahyoid and Infrahyoid Neck
7 Brachial Plexus

Leseproben

Chapter 2
Orbit

Introduction

2.1 Congenital and developmental abnormalities

2.2 Acquired lesions involving the eye

2.3 Extraocular lesions of the orbit

References

2 Orbit

Table 2.1   Congenital and developmental abnormalities

Table 2.2   Acquired lesions involving the eye

Table 2.3   Extraocular lesions of the orbit

Introduction

Bony Orbit

The bony orbit is a four-sided pyramidal structure within which are the eye (globe), fat, extraocular muscles, nerves, and blood vessels.1,2,3,4,5 The is composed of the frontal process of the maxilla, lacrimal bone, lamina papyracea, and sphenoid bone (Fig. 2.1). The is composed of the zygoma, frontal bone, and greater wing of the sphenoid bone (Fig. 2.2). The is composed of the zygoma and orbital plate of the maxilla. At the posterolateral aspect of the orbital floor is the inferior orbital fissure, which the second division of the trigeminal nerve traverses. The V2 nerve enters the orbit from the pterygopalatine fossa. The V2 nerve is located in a sulcus along the posterior orbital floor, where it eventually enters the infraorbital canal and emerges from the infraorbital foramen. Other structures that pass through the inferior orbital fissure are the inferior ophthalmic vein, infraorbital branch of the maxillary artery, and autonomic branches of the pterygopalatine ganglion. The is composed mostly of the frontal bone, as well as the lesser wing of the sphenoid bone posteriorly.

Superior Orbital Fissure

The superior orbital fissure is located between the greater and lesser sphenoid wings (Fig. 2.3). The superior orbital fissure is a passage through which nerves from the cavernous sinus (Fig. 2.4) enter the orbits, including the ophthalmic (V1) division of the trigeminal nerve, trochlear nerve (CN IV), oculomotor nerve (CN III), abducens nerve (CN VI), and sympathetic nerve fibers. The annulus of Zinn (annulus tendineus communis) at the superior orbital fissure is a fibrous ring to which the extraocular muscles attach. The superior ophthalmic vein also crosses through the superior orbital fissure.

Fig. 2.1   Illustration showing the osseous components of the medial wall of the orbit. From THIEME Atlas of Anatomy: Head and Neuroanatomy, Thieme 2007, Illustration by Karl Wesker.

Fig. 2.2   Illustration showing the osseous components of the lateral wall of the orbit. From THIEME Atlas of Anatomy: Head and Neuroanatomy, © Thieme 2007, Illustration by Karl Wesker.

Fig. 2.3   Illustration showing the posterior osseous components of the orbits as well as the superior orbital fissures, optic canals, and adjacent nasal cavity and paranasal sinuses. From THIEME Atlas of Anatomy: Head and Neuroanatomy, © Thieme 2007, Illustration by Karl Wesker.

Fig. 2.4   Coronal view of the contents of the cavernous sinuses and adjacent anatomic structures. From THIEME Atlas of Anatomy: Head and Neuroanatomy, © Thieme 2007, Illustration by Karl Wesker.

Orbital Apex

The orbital apex is located posteriorly and contains the superior orbital fissure between the lateral orbital wall and orbital roof, the optic canal in the lesser wing of the sphenoid bone, and the inferior orbital fissure (Fig. 2.5).

Optic Canal

The optic canal is located within the lesser wing of the sphenoid bone and is medial to the anterior clinoid process and superomedial to the superior orbital fissure. A thin bone wall separates the optic canal and superior orbital fissure. The optic canal contains the optic nerve and ophthalmic artery.

Extraocular Muscles

The extraocular muscles include the medial, lateral, superior, and inferior rectus muscles that originate from the annulus of Zinn and course through orbital fat before inserting onto their respective positions on the globe (Fig. 2.6). The superior oblique muscle also originates from the annulus of Zinn and courses anteriorly to the trochlea, where its tendon turns to insert on the posterolateral margin of the globe. The inferior oblique muscle originates from the periorbita at the inferomedial aspect of the globe and courses anteriorly, where its tendon inserts on the inferolateral aspect of the globe. The seventh extraocular muscle, the levator palpebrae superioris, originates from the lesser sphenoid wing and extends anteriorly to become the aponeurosis, which inserts onto the tarsal plate and eyelid skin. CN III innervates the levator palpebrae superioris and inferior oblique muscles, as well as the medial, superior, and inferior rectus muscles. The motor nucleus of CN III is located in the dorsal portion of the midbrain ventral to the periaqueductal gray at the level of the superior colliculi. CN VI innervates the lateral rectus muscle, and CN IV innervates the superior oblique muscle.

Sensory Nerves

The ophthalmic division of CN V within the lateral wall of the cavernous sinus divides into three branches (lacrimal, frontal, and nasociliary nerves), which then enter the orbit through the superior orbital fissure. The lacrimal nerve provides postganglionic secretomotor fibers to the lacrimal gland and sensory fibers in the conjunctiva and skin. The frontal nerve is located in the upper orbit between the levator palpebrae and periorbita and provides sensory input from the forehead and medial eyelid. The nasociliary nerve passes between the superior oblique and medial rectus muscles and divides into anterior and posterior ethmoidal nerves, nerve branches to the ciliary ganglion, and the infratrochlear nerve, which receives sensory input from the globe, medial upper eyelid, and forehead.

Branches from the maxillary division of CN V enter the inferior orbital fissure from the pterygomaxillary fossa and pass anteriorly through the orbit in the infraorbital canal to receive sensory input from the lower eyelid, conjunctiva, cheek, and upper lip. A branch of the infraorbital nerve is the superior alveolar nerve, which receives sensory input from the upper anterior teeth. The zygomatic V2 branch of CN V enters the inferior orbital fissure and receives sensory input from the skin at the lateral orbit and supplies additional secretomotor fibers to the lacrimal gland.

Fig. 2.5   Coronal view of the anatomic relationship of structures at the orbital apex. From THIEME Atlas of Anatomy: Head and Neuro anatomy, © Thieme 2007, Illustration by Karl Wesker.

Fig. 2.6   Axial view of the extraocular muscles and their anatomic relationships to adjacent structures. From THIEME Atlas of Anatomy: Head and Neuroanatomy, © Thieme 2007, Illustration by Karl Wesker.

Periorbita, Tenon’s Capsule, and Orbital Fat

Along the inner bony walls of the orbit is a fibrous lining referred to as the that is tightly attached to bone at the orbital margins anteriorly (orbital septum), suture lines and fissures, and anterior lacrimal crest. is a fascial sheath that surrounds the eye, separating the globe from the adjacent orbital fat. This fascial sheath fuses anteriorly with the sclera at the scleral-corneal junction and bulbar conjunctiva. Structures that extend through Tenon’s capsule include the tendons of the extraocular muscles, optic nerve, ciliary nerves, and veins from the choroid and sclera (vortex veins). The potential space that can occur between the sclera and Tenon’s capsule is referred to as the episcleral or Tenon’s space, which is a site where infection, inflammation, and neoplasms can enter. surrounds the globe, extraocular muscles, and optic nerve. Connective tissue septa separate the intraconal fat deep to extraocular muscles from the extraconal fat.

Eye

The eye (globe) has three primary layers (sclera, uveal tract, and retina; Fig. 2.7).

The is the outermost layer, which consists of the transparent cornea anteriorly and a fibrous opaque portion that extends posteriorly where it fuses with the dural sheath of the optic nerve.

The is a pigmented vascular layer between the sclera and retina. The uveal tract includes the iris, ciliary body, and choroid. The extends from the optic nerve to the ora serrata (anterior-most margin of the retina). The choroid has firm attachments to the adjacent sclera anteriorly at the ora serrata/ciliary body and posteriorly...