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Masticator Space: CT and MRI of Secondary Tumor Spread

¹ All authors: Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Ln., Chengdu, Sichuan, 610041, China.

View larger version (106K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Anatomy of masticator space in healthy 34-year-old man. LP = lateral pterygoid muscle, M = masseter muscle, MP = medial pterygoid muscle, P = parapharyngeal space, Pa = parotid gland, T = temporalis muscle. Contrast-enhanced axial (A) and coronal (B) CT images and unenhanced axial (C) and contrast-enhanced coronal (D) T1-weighted images. Internal maxillary artery (horizontal arrows, A and B) emanates from external carotid artery (vertical arrow, A), entering masticator space deep in relation to neck of mandible. Mandibular nerve exits trigeminal ganglion (horizontal arrow, D) and enters masticator space (arrowheads, C and D) through foramen ovale (vertical arrow, B), lying between medial and lateral pterygoid muscles. Vertical arrows in C show pterygopalatine fossae, and oblique arrows in C and D show zygomatic arch.

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Anatomy of masticator space in healthy 34-year-old man. LP = lateral pterygoid muscle, M = masseter muscle, MP = medial pterygoid muscle, P = parapharyngeal space, Pa = parotid gland, T = temporalis muscle. Contrast-enhanced axial (A) and coronal (B) CT images and unenhanced axial (C) and contrast-enhanced coronal (D) T1-weighted images. Internal maxillary artery (horizontal arrows, A and B) emanates from external carotid artery (vertical arrow, A), entering masticator space deep in relation to neck of mandible. Mandibular nerve exits trigeminal ganglion (horizontal arrow, D) and enters masticator space (arrowheads, C and D) through foramen ovale (vertical arrow, B), lying between medial and lateral pterygoid muscles. Vertical arrows in C show pterygopalatine fossae, and oblique arrows in C and D show zygomatic arch.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Anatomy of masticator space in healthy 34-year-old man. LP = lateral pterygoid muscle, M = masseter muscle, MP = medial pterygoid muscle, P = parapharyngeal space, Pa = parotid gland, T = temporalis muscle. Contrast-enhanced axial (A) and coronal (B) CT images and unenhanced axial (C) and contrast-enhanced coronal (D) T1-weighted images. Internal maxillary artery (horizontal arrows, A and B) emanates from external carotid artery (vertical arrow, A), entering masticator space deep in relation to neck of mandible. Mandibular nerve exits trigeminal ganglion (horizontal arrow, D) and enters masticator space (arrowheads, C and D) through foramen ovale (vertical arrow, B), lying between medial and lateral pterygoid muscles. Vertical arrows in C show pterygopalatine fossae, and oblique arrows in C and D show zygomatic arch.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Anatomy of masticator space in healthy 34-year-old man. LP = lateral pterygoid muscle, M = masseter muscle, MP = medial pterygoid muscle, P = parapharyngeal space, Pa = parotid gland, T = temporalis muscle. Contrast-enhanced axial (A) and coronal (B) CT images and unenhanced axial (C) and contrast-enhanced coronal (D) T1-weighted images. Internal maxillary artery (horizontal arrows, A and B) emanates from external carotid artery (vertical arrow, A), entering masticator space deep in relation to neck of mandible. Mandibular nerve exits trigeminal ganglion (horizontal arrow, D) and enters masticator space (arrowheads, C and D) through foramen ovale (vertical arrow, B), lying between medial and lateral pterygoid muscles. Vertical arrows in C show pterygopalatine fossae, and oblique arrows in C and D show zygomatic arch.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Squamous cell carcinoma of right soft palate in 40-year-old woman. Contrast-enhanced CT images show mass in right soft palate (arrow, A) extending into right pterygopalatine fossa (long arrow, B) via greater palatine canal and thereby invading masticator space through pterygomaxillary fissure (short arrow, B). Arrowhead in B shows normal contralateral pterygopalatine fossa.

View larger version (106K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Squamous cell carcinoma of right soft palate in 40-year-old woman. Contrast-enhanced CT images show mass in right soft palate (arrow, A) extending into right pterygopalatine fossa (long arrow, B) via greater palatine canal and thereby invading masticator space through pterygomaxillary fissure (short arrow, B). Arrowhead in B shows normal contralateral pterygopalatine fossa.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Hemangioma of left orbit in 57-year-old man. Unenhanced CT image shows mass (star) with phlebolith (arrow) in left orbit.

View larger version (83K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Hemangioma of left orbit in 57-year-old man. Contrast-enhanced images show mass entering left pterygopalatine fossa (arrowhead, C) through infraorbital fissure (arrowhead, B) and extending into masticator space (star, C). Right infraorbital fissure (arrow, B) and pterygopalatine fossa (arrow, C) are normal.

View larger version (83K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Hemangioma of left orbit in 57-year-old man. Contrast-enhanced images show mass entering left pterygopalatine fossa (arrowhead, C) through infraorbital fissure (arrowhead, B) and extending into masticator space (star, C). Right infraorbital fissure (arrow, B) and pterygopalatine fossa (arrow, C) are normal.

View larger version (133K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —Juvenile angiofibroma of left pterygopalatine fossa in 17-year-old boy. Contrast-enhanced CT image reveals intensely enhanced mass centered in left pterygopalatine fossa (star). Mass extends laterally into masticator space (arrowhead) via pterygomaxillary fissure. Right pterygopalatine fossa (arrow) is normal.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —Schwannoma of right pterygopalatine fossa in 28-year-old woman. Contrast-enhanced CT image displays unenhanced mass in right pterygopalatine fossa (star). Mass extends into fat planes between masticatory muscles of right masticator space (short arrows). Left pterygopalatine fossa (long arrow) is normal.

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —Rhabdomyosarcoma of right buccal space in 30-year-old woman. Contrast-enhanced CT images show mass in right buccal space (horizontal arrow, A), lateral to buccinator muscle (arrowhead, A), extending posteriorly to anterior aspect of ramus (horizontal arrow, B), and entering masticator space (star, C). Left buccal space (oblique arrows, A and B) and left masticator space (arrow, C) are normal.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —Rhabdomyosarcoma of right buccal space in 30-year-old woman. Contrast-enhanced CT images show mass in right buccal space (horizontal arrow, A), lateral to buccinator muscle (arrowhead, A), extending posteriorly to anterior aspect of ramus (horizontal arrow, B), and entering masticator space (star, C). Left buccal space (oblique arrows, A and B) and left masticator space (arrow, C) are normal.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —Rhabdomyosarcoma of right buccal space in 30-year-old woman. Contrast-enhanced CT images show mass in right buccal space (horizontal arrow, A), lateral to buccinator muscle (arrowhead, A), extending posteriorly to anterior aspect of ramus (horizontal arrow, B), and entering masticator space (star, C). Left buccal space (oblique arrows, A and B) and left masticator space (arrow, C) are normal.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —Squamous cell carcinoma of right lower gingiva in 62-year-old man. Contrast-enhanced CT images reveal gingival mass (star, A) that destroys alveolar bone (arrows, A and B), invades buccal space (arrowheads, A and C), spreads posteriorly to destroy ramus (arrow, C), and enters masticator space (black arrows, D). Left masticator space (white arrow, D) is normal.

View larger version (79K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —Squamous cell carcinoma of right lower gingiva in 62-year-old man. Contrast-enhanced CT images reveal gingival mass (star, A) that destroys alveolar bone (arrows, A and B), invades buccal space (arrowheads, A and C), spreads posteriorly to destroy ramus (arrow, C), and enters masticator space (black arrows, D). Left masticator space (white arrow, D) is normal.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —Squamous cell carcinoma of right lower gingiva in 62-year-old man. Contrast-enhanced CT images reveal gingival mass (star, A) that destroys alveolar bone (arrows, A and B), invades buccal space (arrowheads, A and C), spreads posteriorly to destroy ramus (arrow, C), and enters masticator space (black arrows, D). Left masticator space (white arrow, D) is normal.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7D —Squamous cell carcinoma of right lower gingiva in 62-year-old man. Contrast-enhanced CT images reveal gingival mass (star, A) that destroys alveolar bone (arrows, A and B), invades buccal space (arrowheads, A and C), spreads posteriorly to destroy ramus (arrow, C), and enters masticator space (black arrows, D). Left masticator space (white arrow, D) is normal.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8 —Squamous cell carcinoma of right buccal mucosa in 58-year-old man. Mass (star) infiltrates submucosal fat plane, buccinator muscle, and expected location of pterygomandibular raphe and extends into pterygomandibular space (arrowhead), part of masticator space. Left buccinator (long horizontal arrow) and submucosal fat plane (short horizontal arrow) are normal. Left expected location of pterygomandibular raphe (oblique arrow) is normal.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9 —Squamous cell carcinoma of right lateral oropharyngeal wall in 71-year-old man. Mass (star) in oropharynx spreads to expected location of pterygomandibular raphe and invades masticator space (arrows). Left expected location of pterygomandibular raphe (arrowhead) is normal.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10 —Schwannoma of trigeminal ganglion in 22-year-old man. Contrast-enhanced coronal T1-weighted image shows heterogeneously enhanced mass (star) that extends inferiorly via foramen ovale (arrow) and lies between pterygoid muscles of masticator space (arrowhead).

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11 —Adenoid cystic carcinoma of right parotid gland in 51-year-old man. Small portion of parotid mass (star) extends into masticator space (horizontal arrow) along internal maxillary artery (thin oblique arrow). Left masticator space (thick oblique arrow) is normal.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12A —Recurrent adenoid cystic carcinoma of right submandibular gland with perineural spread along lingual nerve in 65-year-old man. Contrast-enhanced T1-weighted images reveal enhanced infiltrating mass (arrowheads) in right sublingual space. Left mylohyoid muscle (long arrows), hyoglossus muscle (short arrows), and sublingual space are normal.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12B —Recurrent adenoid cystic carcinoma of right submandibular gland with perineural spread along lingual nerve in 65-year-old man. Contrast-enhanced T1-weighted images reveal enhanced infiltrating mass (arrowheads) in right sublingual space. Left mylohyoid muscle (long arrows), hyoglossus muscle (short arrows), and sublingual space are normal.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12C —Recurrent adenoid cystic carcinoma of right submandibular gland with perineural spread along lingual nerve in 65-year-old man. Images rostral to B show enhanced nodules at expected location of lingual nerve (arrowheads). Note atrophied right masticatory muscles (arrows, D).

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12D —Recurrent adenoid cystic carcinoma of right submandibular gland with perineural spread along lingual nerve in 65-year-old man. Images rostral to B show enhanced nodules at expected location of lingual nerve (arrowheads). Note atrophied right masticatory muscles (arrows, D).

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13A —Adenoid cystic carcinoma of left parotid gland with perineural spread along auriculotemporal nerve in 36-year-old man. Contrast-enhanced CT images show mass in left parotid gland (arrows, A) that infiltrates along auriculotemporal nerve (arrowhead, B) between medial pterygoid muscle (black arrow, B) and lateral pterygoid muscle (white arrow, B), spreads to mandibular nerve, and extends superiorly to trigeminal ganglion and cavernous sinus (arrow, D) via enlarged foramen ovale (arrowhead, C). Note atrophied left masticatory muscles and normal right foramen ovale (arrow, C).

View larger version (133K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13B —Adenoid cystic carcinoma of left parotid gland with perineural spread along auriculotemporal nerve in 36-year-old man. Contrast-enhanced CT images show mass in left parotid gland (arrows, A) that infiltrates along auriculotemporal nerve (arrowhead, B) between medial pterygoid muscle (black arrow, B) and lateral pterygoid muscle (white arrow, B), spreads to mandibular nerve, and extends superiorly to trigeminal ganglion and cavernous sinus (arrow, D) via enlarged foramen ovale (arrowhead, C). Note atrophied left masticatory muscles and normal right foramen ovale (arrow, C).

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13C —Adenoid cystic carcinoma of left parotid gland with perineural spread along auriculotemporal nerve in 36-year-old man. Contrast-enhanced CT images show mass in left parotid gland (arrows, A) that infiltrates along auriculotemporal nerve (arrowhead, B) between medial pterygoid muscle (black arrow, B) and lateral pterygoid muscle (white arrow, B), spreads to mandibular nerve, and extends superiorly to trigeminal ganglion and cavernous sinus (arrow, D) via enlarged foramen ovale (arrowhead, C). Note atrophied left masticatory muscles and normal right foramen ovale (arrow, C).

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13D —Adenoid cystic carcinoma of left parotid gland with perineural spread along auriculotemporal nerve in 36-year-old man. Contrast-enhanced CT images show mass in left parotid gland (arrows, A) that infiltrates along auriculotemporal nerve (arrowhead, B) between medial pterygoid muscle (black arrow, B) and lateral pterygoid muscle (white arrow, B), spreads to mandibular nerve, and extends superiorly to trigeminal ganglion and cavernous sinus (arrow, D) via enlarged foramen ovale (arrowhead, C). Note atrophied left masticatory muscles and normal right foramen ovale (arrow, C).

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14 —Squamous cell carcinoma of right maxillary sinus in 48-year-old man. Contrast-enhanced CT image reveals mass (star) in right maxillary sinus that has destroyed posterior wall of sinus and spread into masticator space (arrow). Left maxillary sinus and masticator space (arrowhead) are normal.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 15A —Extranodal non-Hodgkin's lymphoma in 15-year-old boy. Contrast-enhanced axial CT image shows infiltrating mass (star) in left masticator space involves pterygoid muscles and extends into pterygopalatine fossa (arrow).

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 15B —Extranodal non-Hodgkin's lymphoma in 15-year-old boy. Reformatted contrast-enhanced coronal CT image reveals mass (arrowhead) that eroded skull base (arrow), and roof of masticator space.

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