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The anatomy of nasopharyngeal carcinoma spread through the pharyngobasilar fascia to the trigeminal mandibular nerve on 1.5 T MRI

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To analyze, from 1.5 Tesla (T) MRI clinical cases, anatomical accessibility of nasopharyngeal tumors through the pharyngobasilar fascia (PBF) to the mandibular nerve for potential perineural spread.


A 6-year retrospective review of 1.5 T MR images were rated for tumor involvement of fascial planes and perineural spread in 15 consecutive patients (10 female, 5 male; mean age 45.8 years, range 19–86) with histopathologically proven tumors of the nasopharynx and referrals for radiotherapy due to intracranial extension.


Nasopharyngeal tumors were best appreciated on T1 fat-saturated, post-gadolinium MRI. Tumors extended through the sinus of Morgagni in all cases. This sinus is a defect in the PBF through which the Eustachian tube and levator veli palatini muscle gain access to the nasopharynx. In six patients, the PBF and tensor veli palatini fascia were breached anteriorly with tumor infiltration of the tensor veli palatini and medial pterygoid muscles. In 13 cases, tumor breached the posterolateral PBF with extension into the poststyloid parapharyngeal space. In three subjects, 3 T images were also acquired and exhibited superior delineation of the anatomy and perineural tumor spread.


At 1.5 T, images showed nasopharyngeal tumors extending through the PBF into the masticator and parapharyngeal spaces, with access to the mandibular nerve and potential for perineural spread. At 3 T, soft tissue resolution appeared superior to 1.5 T. This may reflect not only the increased field strength, but an improved technique and matrix, and future studies are necessary to confirm this observation. Awareness of this anatomy for radiation and surgical planning is essential and may improve the ability for obtaining negative margins, and increasing overall survival.

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  1. Bridgman CF, Humelbaugh FA (1963) Plastic embedded specimens in medical teaching. Med Biol Illus 13:265–272

    CAS  PubMed  Google Scholar 

  2. Bridgman CF, Humelbaugh FA (1963) Plastic embedded teaching specimens. Med Biol Illus 13:177–185

    CAS  PubMed  Google Scholar 

  3. Chong VF, Fan YF (1997) Pterygopalatine fossa and maxillary nerve infiltration in nasopharyngeal carcinoma. Head Neck 19(2):121–125

    Article  CAS  PubMed  Google Scholar 

  4. Chong VF, Fan YF, Khoo JB (1996) Nasopharyngeal carcinoma with intracranial spread: CT and MR characteristics. J Comput Assist Tomogr 20(4):563–569

    Article  CAS  PubMed  Google Scholar 

  5. Curtin HD (1987) Separation of the masticator space from the parapharyngeal space. Radiology 163(1):195–204

    CAS  PubMed  Google Scholar 

  6. Fagan JJ, Collins B, Barnes L et al (1988) Perineural invasion in squamous cell carcinoma of the head and neck. Arch Otolaryngol HeadNeck Surg 124:637–640

    Google Scholar 

  7. King AD, Kew J, Tong M et al (1999) Magnetic resonance imaging of the eustachian tube in nasopharyngeal carcinoma: correlation of patterns of spread with middle ear effusion. Am J Otol 20(1):69–73

    CAS  PubMed  Google Scholar 

  8. King AD, Teo P, Lam WW et al (2000) Paranasopharyngeal space involvement in nasopharyngeal cancer: detection by CT and MRI. Clin Oncol (R Coll Radiol) 12(6):397–402

    CAS  Google Scholar 

  9. Lee KJ, Abemayor E, Sayre J et al (2008) Determination of perineural invasion preoperatively on radiographic images. Otolaryngol Head Neck Surg 139(2):275–280

    Article  PubMed  Google Scholar 

  10. Maheshwar AA, Kim EY, Pensak ML et al (2004) Roof of the parapharyngeal space: defining its boundaries and clinical implications. Ann Otol Rhinol Laryngol 113(4):283–288

    PubMed  Google Scholar 

  11. Rapidis AD, Givalos N, Gakiopoulou H et al (2005) Adenoid cystic carcinoma of the head and neck Clinicopathological analysis of 23 patients and review of the literature. Oral Oncol 41(3):328–335

    Article  PubMed  Google Scholar 

  12. Rouviere (1956) Anatomie Topoqraphique Du Tete et du Cou. Masson, Paris

    Google Scholar 

  13. Som PM, Biller HF, Lawson W (1981) Tumors of the parapharyngeal space: preoperative evaluation, diagnosis and surgical approaches. Ann Otol Rhinol Laryngol Suppl 90(1 Pt 4):3–15

    CAS  PubMed  Google Scholar 

  14. Som PM, Curtin HD (1996) Fascia and spaces. In: Som PM, Curtin HD (eds) Head and neck imaging, vol 3. Mosby, St Louis, pp 738–755

    Google Scholar 

  15. Som PM, Curtin HD, Silvers AR (1997) A re-evaluation of imaging criteria to assess aggressive masticator space tumors. Head Neck 19(4):335–341

    Article  CAS  PubMed  Google Scholar 

  16. Stambuk HE, Patel SG, Mosier KM et al (2005) Nasopharyngeal carcinoma: recognizing the radiographic features in children. AJNR Am J Neuroradiol 26(6):1575–1579

    PubMed  Google Scholar 

  17. Su CY, Hsu SP, Lui CC (1993) Computed tomography, magnetic resonance imaging, and electromyographic studies of tensor veli palatini muscles in patients with nasopharyngeal carcinoma. Laryngoscope 103(6):673–678

    Article  CAS  PubMed  Google Scholar 

  18. Su CY, Lui CC (1996) Perineural invasion of the trigeminal nerve in patients with nasopharyngeal carcinoma. Imaging and clinical correlations. Cancer 78(10):2063–2069

    Article  CAS  PubMed  Google Scholar 

  19. Su CY, Lui CC (2001) Unilateral palate paralysis in patients with nasopharyngeal carcinoma: imaging and clinical correlations. Laryngoscope 111(4 Pt 1):645–649

    Article  CAS  PubMed  Google Scholar 

  20. Teresi LM, Lufkin RB, Vinuela F et al (1987) MR imaging of the nasopharynx and floor of the middle cranial fossa. Part I. Normal anatomy. Radiology 164(3):811–816

    CAS  PubMed  Google Scholar 

  21. Teresi LM, Lufkin RB, Vinuela F et al (1987) MR imaging of the nasopharynx and floor of the middle cranial fossa. Part II. Malignant tumors. Radiology 164(3):817–821

    CAS  PubMed  Google Scholar 

  22. Vogl T, Dresel S, Bilaniuk LT et al (1990) Tumors of the nasopharynx and adjacent areas: MR imaging with Gd-DTPA. AJR Am J Roentgenol 154(3):585–592

    CAS  PubMed  Google Scholar 

  23. von Ludinghausen M, Kageyama I, Miura M et al (2008) Morphological peculiarities of the deep infratemporal fossa in advanced age. Surg Radiol Anat 28(3):284–292

    Article  Google Scholar 

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We would like to thank Professor Vishy Mahadevan, Head of Anatomy at the Royal College of Surgeons UK for providing the cadaveric specimen and expertise in the anatomic dissection. The authors would also like to thank the generosity of whole body donors for anatomical materials that were provided by the UCLA Donated Body Program.

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Correspondence to Jonathan J. Wisco.

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Hyare, H., Wisco, J.J., Alusi, G. et al. The anatomy of nasopharyngeal carcinoma spread through the pharyngobasilar fascia to the trigeminal mandibular nerve on 1.5 T MRI. Surg Radiol Anat 32, 937–944 (2010).

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