Evidence: Review of current literature on neck dissection classification.Consensus Process: Semiannual face-to-face meetings of the Committee for Neck Dissection Terminology and e-mail correspondence.Conclusions: Standardization of terminology for neck dissection is important for communication among clinicians and researchers. New recommendations have been made regarding the following: boundaries between levels I and II and between levels III/IV and VI; terminology of the superior mediastinal nodes; and the method of submitting surgical specimens for pathologic analysis.

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Ferumoxtran 10-enhanced MR imaging was safe and effective and facilitated improved diagnostic performance. Use of iron oxide-enhanced MR imaging increased the positive predictive value by 20% and the accuracy by 14% compared with reader assessment. Differentiating patients with no nodal metastatic involvement was more reliable with ferumoxtran 10-enhanced MR imaging than with precontrast MR imaging.

This imaging-based classification has been endorsed by clinicians who specialize in head and neck cancer. The boundaries of the nodal levels were easily discerned by radiologists and yielded consistent nodal classifications. The reproducibility of this classification will allow it to become an essential component of future classifications of metastatic neck disease.

Over the past 18 years, numerous classifications have been proposed to distinguish among the diverse nodal levels. Some classifications have used surgical landmarks, others physical assessment criteria. These classifications do not agree precisely and exhibit sufficient variation that competent physicians could arrive at slightly different staging of the patient's nodal disease. In the past 2 decades, computed tomography and magnetic resonance imaging have offered progressively more refined anatomical precision, reproducibility, and visualization of deep, clinically inaccessible structures. Because the majority of patients with head and neck malignancies presently undergo sectional imaging prior to treatment planning, we felt a need to integrate anatomical imaging criteria with the 2 most commonly used nodal classifications: those of the American Joint Committee on Cancer and those of the American Academy of Otolaryngology-Head and Neck Surgery. The imaging-based nodal classification proposed herein has been developed in consultation with surgeons interested in such classifications in the hope that the resultant classification would find ready acceptance by both clinicians and imagers. It is our desire that the best attributes of imaging, combined with those of the physical assessment, can result in a better and more consistently reproducible nodal staging than is possible by either

Computed tomographic (CT) scans and magnetic resonance (MR) images in 103 patients with either a deep-lobe parotid tumor extending into the parapharyngeal space, a minor salivary gland tumor, a neuroma, or a paraganglioma were reviewed. The parotid or extraparotid nature of these masses was established by identifying a fat plane between the mass and the parotid gland. This was more reliably accomplished with MR imaging than with CT. Although dynamic CT allowed identification of the glomus tumors, MR imaging also permitted diagnosis of these lesions. The inherent CT and MR imaging characteristics of most of the neuromas and minor salivary gland tumors were indistinguishable. However, the neuromas tended to displace the internal carotid artery anteriorly, whereas the salivary lesions displaced this vessel posteriorly. This artery was better identified on MR images than on CT scans. Thus, these lesions, which are the four most common primary parapharyngeal space tumors, can be distinguished on MR images by evaluating not only their inherent signal characteristics but also the surrounding fat planes and any displacement of the internal carotid artery.

Based on a review of the literature and analysis of six new cases, three categories of enlarged, aerated sinuses are defined, namely: hypersinus, pneumosinus dilatans, and pneumocele. The information gained by our study of the area variation of the frontal sinuses in a normal population (part I of this paper) was utilized to define the term hypersinus. In this condition there is generalized enlargement of the sinus beyond the upper limit of normal in an asymptomatic patient. The principal difference between pneumosinus dilatans and a pneumocele is the presence of bony thinning or erosion in the latter entity. The clinical findings and the possible etiologies of these conditions are discussed.