Radiation Medicine

, Volume 24, Issue 1, pp 1–8 | Cite as

Perineural spread in head and neck malignancies

  • Hiroya Ojiri


Perineural tumor spread (PNS) of head and neck malignancies is a well-known form of metastatic disease in which a lesion can migrate away from the primary site along the endoneurium or perineurium. This pattern of spread may create a poor prognosis and require aggressive treatment when curable. Although representative histologies are squamous cell carcinoma and adenoid cystic carcinoma, other malignancies such as malignant lymphoma and sarcoma also can show such a specific pattern of extent. PNS can be insidious, often delaying diagnosis. Knowledge of anatomy of the nerves is crucial in the imaging diagnosis of PNS, to detect early curable disease. The facial nerve and the maxillary and mandibular divisions of the trigeminal nerve are most commonly affected. General clinical issues and the diagnostic imaging of PNS along these nerves are discussed in the current article.


Parotid Gland Adenoid Cystic Carcinoma Mandibular Canal Inferior Alveolar Nerve Infraorbital Nerve 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1).
    Ballantyne AJ, McCarten AB, Ibanez ML. The extension of cancer of the head and neck through peripheral nerves.Am J Surg, 106: 651–667, 1963.PubMedCrossRefGoogle Scholar
  2. 2).
    Dodd GD, Dolan PA, Ballantyne AJ, Ibanez ML, Chau P. The dissemination of tumors of the head and neck via the cranial nerves.Radiol Clin North Am, 8: 445–461, 1970.PubMedGoogle Scholar
  3. 3).
    Mendenhall WM, Parsons JT, Mendenhall NP,et al. Carcinoma of the skin. InManagement of Head and Neck Cancer: A Multidisciplinary Approach, 2nd ed. (Million RR, Cassisi MJ, eds.; Lippincot, Philadelphia), pp. 643–692, 1994.Google Scholar
  4. 4).
    Ginsberg LE. Imaging of perineural tumor spread in head and neck cancer.Semin Ultrasound CT MR, 20: 175–186, 1999.PubMedCrossRefGoogle Scholar
  5. 5).
    Wilson-Pauwels L, Akesson EJ, Stewart PA. Trigeminal nerve. InCranial Nerves: anatomy and clinical comments. (B.C. Decker, Burlington), pp. 50–69, 1988.Google Scholar
  6. 6).
    Caldemeyer KS, Mathews VP, Righi PD, Smith RR. Imaging features and clinical significance of perineural spread or extension of head and neck tumors.Radiographics, 18: 97–110, 1998.PubMedGoogle Scholar
  7. 7).
    Matzko J, Becker DG, Phillips CD. Obliteration of fat planes by perineural spread of squamous cell carcinoma along the inferior alveolar nerve.AJNR Am J Neuroradiol, 15: 1843–1845, 1994.PubMedGoogle Scholar
  8. 8).
    Schmalfuss IM, Tart RP, Mukherji S, Mancuso AA. Perineural tumor spread along the auriculotemporal nerve.AJNR Am J Neuroradiol, 23: 303–311, 2002.PubMedGoogle Scholar
  9. 9).
    Carter RL, Foster CS, Dinsdale EA, Pittam MR. Perineural spread by squamous carcinomas of the head and neck: a morphological study using antiaxonal and antimyelin monoclonal antibodies.J Clin Pathol, 36: 269–275, 1983.PubMedGoogle Scholar
  10. 10).
    Nemzek WR, Hecht S, Gandour-Edwards R, Donald P, McKennan K. Perineural spread of head and neck tumors: how accurate is MR imaging?AJNR Am J Neuroradiol, 19: 701–706, 1998.PubMedGoogle Scholar
  11. 11).
    Williams LS, Mancuso AA, Mendenhall WM. Perineural spread of cutaneous squamous and basal cell carcinoma: CT and MR detection and its impact on patient management and prognosis.Int J Radiat Oncol Biol Phys, 49: 1061–1069, 2001.PubMedCrossRefGoogle Scholar
  12. 12).
    Parker GD, Harnsberger HR. Clinical-radiologic issues in perineural tumor spread of malignant diseases of the extracranial head and neck.Radiographics, 11: 383–399, 1991.PubMedGoogle Scholar

Copyright information

© Japan Radiological Society 2006

Authors and Affiliations

  • Hiroya Ojiri
    • 1
  1. 1.Department of RadiologyJiker University School of MedicineTokyoJapan

Personalised recommendations