A re-evaluation of imaging criteria to assess aggressive masticator space tumors

Som, Peter M.; Curtin, Hugh D.; Silvers, Abraham

doi:10.1002/(sici)1097-0347(199707)19:4<335::aid-hed12>3.0.co;2-8

Cited by 17 publications

(8 citation statements)

References 26 publications

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“…Some factors may have contributed to our findings: the small number of patients with trismus (n = 10), the type of equipment used, the slice thickness, and the level of experience of the evaluators. Although 3- to 5-mm slices have typically been used in previous studies ( 26 , 32 ) , the advantages of multislice CT over single-slice CT include the reduced examination time and the smaller thickness of the slices, which can be as thin as 0.5 mm, thus generating high-definition multiplanar reconstructions. In addition, multislice CT allows the tube voltage and current to be changed, which can result in fewer metallic artifacts, producing images with better definition.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography evaluation of alterations in the masticator space due to invasion by malignant head and neck neoplasms

Campinhos,

Curioni,

Soares

et al. 2023

Radiol Bras

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Objective: To evaluate alterations in the masticator space due to the dissemination of malignant neoplasms originating from the tonsillar fossa, retromolar trigone, maxillary sinus, or nasopharynx, using computed tomography (CT), as well as to correlate the presence of trismus with the CT findings and the dimensions of the tumor. Materials and Methods: We evaluated the medical records of 65 patients with malignant tumors in the regions described. The images were analyzed by two physician examiners, working independently, who were blinded to the clinical data. In the evaluation of the masticator space, the following parameters were considered: symmetry with the contralateral space; obliteration of the fat plane, retromolar trigone, or pharyngeal space; edema/atrophy of the medial or lateral pterygoid muscles; and destruction of the mandibular ramus. Results: Obliteration of the fat plane was found in 69.2% of the patients. Asymmetry, edema/atrophy, and bone destruction were detected in 27.7%, 26.2%, and 20.0% of the patients, respectively. Trismus was identified in 15.4% of the patients. Of the patients with trismus, 90.0% had stage T4 tumors, compared with only 43.8% of those without trismus. Trismus was 11.6 times more common among the patients with stage T4 tumors than among those with lower-stage tumors. Neoplasms of the tonsillar fossa and retromolar trigone collectively accounted for 95.0% of the cases. The CT scans showed edema/atrophy of the pterygoid muscles in 60.0% of the patients with trismus and in 21.8% of those without. An association was observed between T4 tumor stage and edema/atrophy of the pterygoid muscles. In addition, the risk of trismus was 5.4 times higher among the patients with stage T4 tumors. Conclusion: In our patient sample, the most common finding was obliteration of the fat plane, followed by asymmetry and edema/atrophy. Most of the patients with T4 tumors had trismus, together with edema/atrophy of the pterygoid muscles.

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Section: Discussionmentioning

confidence: 99%

Computed tomography evaluation of alterations in the masticator space due to invasion by malignant head and neck neoplasms

Campinhos,

Curioni,

Soares

et al. 2023

Radiol Bras

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“…O fato de os examinadores do presente estudo não terem ampla experiência, embora tenham recebido treinamento em radiologia de cabeça e pescoço, pode também ter influenciado nos resultados. Muitos estudos não mencionam o número de examinadores envolvidos e alguns têm apenas um avaliador (8,20,23) , mas a maioria dos estudos que têm mais de dois examinadores envolvidos utiliza o consenso entre eles quando há divergência de opinião sobre as imagens avaliadas (23)(24)(25)(26)(27) . Em apenas um dos estudos revistos (28) a avaliação foi feita por mais de um examinador e utilizando o método kappa para estimar a concordância entre observadores.…”

Section: Discussionunclassified

“…Pascoal et al (31) encontraram correlação entre a presença de trismo e destruição óssea em tumores originários da loja tonsilar. Som et al (26) observaram, por meio de TC, destruição óssea do ramo mandibular em 80% das neoplasias envolvendo o EM. Alguns fatores podem ter contribuído para nossos achados: o pequeno número de pacientes com trismo (n = 10), o tipo de equipamento utilizado, a espessura de corte e a experiência dos avaliadores.…”

Section: Discussionunclassified

Avaliação das alterações do espaço mastigador decorrentes de invasão de neoplasias malignas de cabeça e pescoço por meio de tomografia computadorizada

Campinhos,

Curioni,

Soares

et al. 2023

Radiol Bras

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Resumo Objetivo: Avaliar, por meio de tomografia computadorizada, alterações do espaço mastigador (EM) decorrentes de disseminação de neoplasias malignas originárias da loja tonsilar, trígono retromolar, seio maxilar e nasofaringe, e correlacionar presença de trismo com achados tomográficos e dimensões do tumor. Materiais e Métodos: Foram selecionados prontuários de 65 pacientes portadores de tumores malignos nas regiões descritas. A análise das imagens foi realizada por dois examinadores médicos, separadamente, sem o conhecimento das informações clínicas. Na avaliação do EM, foram considerados: simetria com o EM contralateral; obliteração do plano gorduroso, do trígono retromolar e do espaço faríngeo; edema e/ou atrofia dos músculos pterigóideos medial e lateral; destruição do ramo da mandíbula. Resultados: Foram observados obliteração do plano gorduroso em 69,2% dos pacientes, assimetria em 27,7%, espessamento/atrofia em 26,2% e destruição óssea em 20,0%. Presença de trismo foi encontrada em 15,4% dos pacientes. Na associação entre dimensão do tumor e trismo, foram observados trismo em 90,0% dos tumores em estágio T4, enquanto a porcentagem de tumores em estágio T4 sem trismo foi de 43,8%. Pacientes com tumores T4 apresentaram 11,6 vezes mais trismo que os dos demais estágios. Neoplasias da loja tonsilar e trígono retromolar perfizeram 95,0% dos casos. Em 60,0% dos pacientes com trismo havia edema e/ou atrofia dos músculos pterigóideos na tomografia computadorizada e em 21,8% nos sem trismo. Observou-se associação entre tumores T4 e edema e/ou atrofia dos músculos pterigóideos e 5,4 vezes mais chance de apresentarem trismo. Conclusão: A maioria dos pacientes apresentou obliteração do plano gorduroso, seguido de assimetria e espessamento/atrofia. O trismo estava presente na maioria dos pacientes T4 com espessamento/atrofia dos músculos pterigóideos.

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“…However, preservation of the involved fascia does not exclude a malignancy. For this reason, any indeterminate mass in the masticator space should prompt a biopsy [3, 25] (Fig. 13).…”

Section: Soft Tissue Tumoursmentioning

confidence: 99%

Anatomy and pathology of the masticator space

et al. 2013

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ObjectiveThis article reviews and illustrates the anatomy and pathology of the masticator space (MS).BackgroundPathology of the masticator space includes inflammatory conditions, vascular lesions, and tumours. Intrinsic tumours of this space can be benign and malignant, and they may arise from the mandibular ramus, the third division of the trigeminal nerve, or the mastication muscles. Malignant tumours may appear well defined and confined by the masticator fascia, without imaging signs of aggressive extension into neighbouring soft tissues. Secondary invasion of the masticator space can also occur with tumours of the nasopharynx, oropharynx, oral cavity, and parotid glands. Perineural tumour spread (PNS), especially along the trigeminal nerve, can also occur with masticator space malignancies.ConclusionMasses of the MS are difficult to evaluate clinically, and computed tomographic (CT) and magnetic resonance (MR) images are essential for the diagnosis and characterisation of these lesions. Malignant tumours may appear well defined and confined by the fascia. Thus, when a mass is identified, a biopsy should be done promptly. PNS may occur in tumours involving the MS and its recognition on imaging studies is essential to plan the appropriate treatment.Teaching points• Differentiating between intrinsic and extrinsic lesions is essential to the differential diagnosis• Infections of the MS may cross the fascia and mimic neoplasms on imaging studies• Malignant tumours may show no aggressive signs, such as bone erosion or violation of the fascia• Perineural spread (PNS) is often clinically silent and frequently missed at imaging and leads to tumour recurrence

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A re-evaluation of imaging criteria to assess aggressive masticator space tumors

Cited by 17 publications

References 26 publications

Computed tomography evaluation of alterations in the masticator space due to invasion by malignant head and neck neoplasms

Computed tomography evaluation of alterations in the masticator space due to invasion by malignant head and neck neoplasms

Avaliação das alterações do espaço mastigador decorrentes de invasão de neoplasias malignas de cabeça e pescoço por meio de tomografia computadorizada

Anatomy and pathology of the masticator space

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