JAPANESE JOURNAL OF ORAL & MAXILLOFACIAL SURGERY

Vol. 54 No. 8       2008

ISSN: 0021-5163      UBIC: 151-J

ABSTRACT

Differential diagnosis of the neck masses is a little bit difficult. However, appropriate procedures for diagnostic imaging make it possible to focus on several possible lesions. First step to differential diagnosis is to localize the mass in a particular anatomical space using contrast enhanced CT or MRI. This step facilitates the differential diagnosis by limiting the types of the lesions arising in the given anatomical location. The sites related to the neck masses are submandibular, carotid, parapharyngeal and parotid gland spaces. Displacement of the vessels is an important sign to differentiate lymph node diseases from other diseases. They are facial artery and vein in the submandibular space, and carotid artery and jugular vein in the carotid space. It is also difficult to differentiate among lymph node diseases. A combination of several imaging modalities, such as CT, MRI, and ultrasonography makes differential diagnosis more accurate. Lymph node diseases that must be differentiated each other are lymph node metastasis, malignant lymphoma, and lymphadenitis. Specific lymphadenitis such as tuberculosis must be also differentiated from simple lymphadenitis. Important findings for differential diagnosis are inflammatory changes in the border of the nodes or fascia, in CT, and echogenic hilum and vascularity in the ultrasonography. However, patient history, clinical findings, and laboratory data must be also considered to make the final clinical diagnosis. Keywords: imaging diagnosis, submandibular space, carotid space, parapharyngeal space, parotid gland space.

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