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目的探讨头颈部恶性肿瘤沿三叉神经转移的CT和MRI征象,提高头颈部恶性肿瘤诊断的准确性,帮助临床提高肿瘤的治疗效果。方法回顾分析9例经临床及影像学诊断、有沿三叉神经分支扩散现象的头颈部恶性肿瘤的CT和MRI资料。结果9例中,硬腭腺样囊性癌3例,鼻咽癌2例,上颌窦腺样囊性癌、上颌窦鳞状上皮细胞癌、颊部腺样囊性癌及腮腺腺样囊性癌各1例。9例中,腺样囊性癌共有6例,占67%。在3例硬腭腺样囊性癌和1例上颌窦鳞状上皮细胞癌中可见远离原发灶的腭大孔和翼腭窝扩大,其内密度增高,其中1例还可见同侧卵圆孔扩大,三叉神经节有强化的软组织影。1例上颌窦腺样囊性癌中可见眶下孔破坏,同侧翼腭窝扩大。1例颊部腺样囊性癌可见同侧翼腭窝扩大,圆孔扩大,其内可见强化软组织侵入三叉神经节。1例腮腺腺样囊性癌可见耳颞神经处有软组织影,并破坏同侧卵圆孔侵入颅内。2例鼻咽癌中可见肿瘤侵入咀嚼肌间隙并侵犯同侧三叉神经下颌支。结论头颈部恶性肿瘤可以沿三叉神经扩散,CT和MRI可以对其准确判断,熟悉三叉神经及其周围的头颈部解剖结构对诊断极为重要。
Objective To investigate the CT and MRI features of head and neck malignant tumors along the trigeminal nerve and to improve the accuracy of the diagnosis of head and neck malignant tumors and to help improve the therapeutic effect of the tumors clinically. Methods The CT and MRI data of 9 cases of head and neck malignant tumors which were diagnosed by clinical and imaging diagnosis and had the branching spread along the trigeminal nerve were retrospectively analyzed. Results In 9 cases, 3 cases were hard palate adenoid cystic carcinoma, 2 nasopharyngeal carcinoma, maxillary sinus adenoid cystic carcinoma, maxillary sinus squamous cell carcinoma, buccal adenoid cystic carcinoma and parotid adenoid cystic carcinoma One case each. In 9 cases, adenoid cystic carcinoma in a total of 6 cases, accounting for 67%. In 3 cases of hard palate adenoid cystic carcinoma and 1 case of maxillary sinus squamous cell carcinoma, the palatal foramen and pterygopalatine fossa far away from the primary foci were enlarged and its internal density was increased. One case also showed ipsilateral foramen ovale Enlargement, Trigeminal ganglia with enhanced soft tissue shadow. One case of maxillary sinus adenoid cystic carcinoma showed destruction of the infraorbital foramen, ipsilateral palatal fossa enlarging. One case of buccal adenoid cystic carcinoma showed ipsilateral pterygopalatine fossa enlargement, round hole expansion, which can be seen to strengthen the soft tissue invasion of the trigeminal ganglion. One case of parotid adenoid cystic carcinoma seen in the temporal nerve with soft tissue shadow, and destruction of the ipsilateral foramen ovale penetrated the brain. 2 cases of nasopharyngeal carcinoma visible tumor invasion of the masticatory muscle gap and violations of the ipsilateral trigeminal mandibular branch. Conclusion Head and neck malignant tumor can spread along the trigeminal nerve, CT and MRI can accurately judge it, and familiar with the trigeminal nerve and the surrounding head and neck anatomy is extremely important for the diagnosis.