The 2005 WHO histological classification of odontogenic tumours lays out a classification system for neoplasms and other tumours related to the odontogenic apparatus. At the time of writing (2016), it is still the most widely used classification system.
Abscesses are focal confined collections of suppurative inflammatory material and can be thought of as having three components 1:
a central core comprised of necrotic inflammatory cells and local tissue
peripheral halo of viable neutrophils
surrounded by a 'capsule' with dilated blood vessels...
The parietal and occipital bones in particular are common regions for accessory sutures because of their multiple ossification centres.
The occipital bone has complex development, ossifying from six centres. The foramen magnum is surrounded by four ossification centres. On each side are the exo...
Accessory parotid glands are a normal variant and represent ectopic salivary tissue separate from, but usually in close proximity to, the main parotid glands 1.
Accessory parotid glands are commonly picked up incidentally on ultrasound; seen in ~20% of the general population 2.
Achondroplasia is the most common cause of short-limb dwarfism. (For a general discussion, see the generic article on achondroplasia.)
As the skull base forms by endochondral ossification whereas the skull vault by membranous ossification, there is a marked discrepancy in relative size as the s...
Acinic cell carcinomas of the salivary glands are rare malignant neoplasms that account for 1-3% of all salivary gland tumours.
Pathology may superficially resemble normal serous (acinar) cells of the salivary glands. It is considered a low-grade, indolent malignancy, but with a ten...
Acoustic schwannomas (also known as vestibular schwannomas) are relatively common tumours that arise from the vestibulocochlear nerve (CN VIII) and represent ~80% of cerebellopontine angle masses. Bilateral acoustic schwannomas are strongly suggestive of neurofibromatosis type 2 (NF2).
Acquired cholesteatomas make up 98% of all middle ear cholesteatomas and are almost always closely related to the tympanic membrane, from which most are thought to arise.
The vast majority of acquired cholesteatomas develop as a result of chronic middle ear infection and...
ACR TI-RADS is a reporting system for thyroid nodules on ultrasound proposed by the American College of Radiology (ACR) 1.
This uses a standardised scoring system for reports providing users with recommendations for when to use fine needle aspiration (FNA) or ultrasound follow-up of suspicious ...
Acrocephalopolysyndactyly (ACPS) syndrome is comprised of a rare group of disorders collectively characterised by:
calvarial anomalies: e.g. craniosynostoses
digital anomalies: syndactyly and polydactyly
While there can be some overlap in features, they can be primarily classified into the fo...
Acrocephalosyndactyly syndromes (ACS) is a rare group of disorders collectively characterised by:
calvarial anomalies, e.g. craniosynostoses
digital anomalies, e.g. syndactyly
While there can be some overlap in features, they can be primarily classified into the following majo...
Acute invasive fungal sinusitis is the most aggressive form of fungal sinusitis. It is seen particularly in immunocompromised patients and is the source of significant morbidity and mortality. It should be distinguished from the other two forms of invasive fungal sinusitis, chronic invasive fung...
Acute mastoiditis is largely a disease of childhood and occurs when acute otitis media extends into the mastoid air cells.
When mastoiditis and acute otitis media occur concurrently, sometimes the term acute otomastoiditis is used.
When mucoperiosteal involvement evolves into bo...
Acute otitis externa (AOE), also known as "swimmer's ear", is inflammation of the external auditory canal (EAC) that can involve the pinna as well. Bacterial infection, most commonly with Pseudomonas aeruginosa, is responsible for the overwhelming majority of cases. It is a common condition.
Acute sinusitis is an acute inflammation of the paranasal sinus mucosa that lasts less than four weeks and can occur in any of the paranasal sinuses. If the nasal cavity mucosa is also involved then the term rhinosinusitis may be used.
Fever, headache, postnasal discharge...
Adenocarcinoma of the lacrimal glands is rare, with few cases reported in the literature since it was first described in 1996 1. Primary adenocarcinoma of the lacrimal gland is extremely rare; only 9 cases have been reported in the literature 1,2. It can be classified into high- and low-grade ma...
Adenoid cystic carcinomas are a rare histological subtype of adenocarcinoma.
Adenoid cystic carcinomas are generally considered low grade 4. The tumours have a notable tendency for perineural spread.
They have a wide distribution and mainly occur in relation to the airways...
Adenoid cystic carcinoma (ACC) of the lacrimal glands is an extraconal malignancy usually originating from the orbital lobe of the lacrimal gland.
It often presents with orbital pain and paresthesia, since this type of tumour is frequently associated with perineural sprea...
Adenoid cystic carcinoma (ACC) of the salivary glands is the most common malignancy involving the minor salivary glands and the second most common malignancy involving the parotid gland.
Adenoid cystic carcinomas arise more commonly in the minor salivary glands (~55%) than in the maj...
Adenoid facies, also known as the long face syndrome, refers to the long, open-mouthed face of children with adenoid hypertrophy. Hypertrophy of the nasopharyngeal pad of lymphoid tissues (adenoids) is the most common cause of nasal obstruction in children. The mouth is always open because upper...
Adenoidal hypertrophy or enlargement is common in childhood and is due to an increase in the size of the adenoids.
nasal congestion: adenoid facies
chronic or recurrent otitis media due to their proximity to the Eustachian tubes
Adenolipoma of the thyroid gland (also known as a thyrolipoma or a thyroid hamartoma) is a rare, benign fat-containing thyroid lesion. These lesions are usually well encapsulated and are composed of varying degrees of follicular thyroid tissue (thyroid adenoma) and mature adipose tissue; the amo...
Adenomatoid odontogenic tumours are rare and differ from most other dentition related lesions in that they more frequently occur in the maxilla.
They are also seen more frequently in females, most frequently in the second decade of life.
They present as an ...
Adrenal vein sampling (AVS) is a procedure where blood is collected from the adrenal veins via catheter to confirm autonomous hormone production, if it is unilateral or bilateral, and to guide further treatment.
AVS is commonly performed in primary aldosteronism, being indicated to ...
Cervical lymphadenopathy in an adult can result from a vast number of conditions. They include:
from head and neck tumours
other neoplastic lesions
Agger nasi air cells are the most anterior ethmoidal air cells lying anterolateral and inferior to the frontoethmoidal recess and anterior and above the attachment of the middle turbinate. They are located within the lacrimal bone and therefore have as lateral relations the orbit, the lacrimal s...
Allergic fungal sinusitis (AFS) is the most common form of fungal sinusitis and is common in warm and humid climates. On imaging, it usually presents as opacification and expansion of multiple paranasal sinuses, unilaterally or bilaterally, with content that is centrally hyperdense on CT. MRI sh...
Allgrove syndrome (also known as triple A syndrome) is an autosomal recessive condition that consists of three main findings:
Alport syndrome is an X-linked recessive disease characterised by:
sensory neural hearing loss: typically high frequency 2
anterior lenticonus: most common ocular abnormality; may result in cataracts
perimacular pigmentary changes
flecks around the fovea 2...
Amaurosis fugax is the transient mono-ocular loss of vision, normally lasting a few seconds to a few minutes, and is secondary to vascular ischaemia/insufficiency. Usually the cause is ascribed to occlusion of the central retinal artery there are a wide number of local and central causes.
Ameloblastic fibro-odontoma (AFO) is a rare benign mixed odontogenic tumour that usually arises in the maxilla and mandible. According to the 2005 WHO classification of odontogenic tumours, it is defined as a benign tumour that resembles ameloblastic fibroma but contains enamel and dentin.
Ameloblastic fibromas appear as unilocular lucent mandibular lesions, most frequently in the posterior mandible, and are usually associated with impacted teeth, centred on the unerupted crown. They, therefore, appear very similar to unilocular ameloblastomas. They are composed of enamel and embr...
Ameloblastomas are locally aggressive benign tumours that arise from the mandible, or, less commonly, from the maxilla. Usually present as a slowly but continuously growing hard painless lesion near the angle of the mandible in the 3rd to 5th decades of life, which can be severely disfiguring if...
Anaplastic thyroid carcinoma (ATC) is a highly aggressive form of thyroid cancer and accounts for ~1-2% of primary thyroid malignancies. Of all the subtypes, this carries the worst prognosis.
Typically occurs in the elderly (peak incidence in 6th to 7th decades). A significant pro...
The anatomy curriculum is one of our curriculum articles and aims to be a collection of articles that represent the core anatomy knowledge.
Head and neck anatomy
Abdominal and pelvic anatomy
Lower limb anatomy
Upper limb anato...
The angular vein drains the anterior region of the scalp 1. It is formed by the union of the supratrochlear and supraorbital veins and becomes the facial vein 1,2,3.
The angular vein is formed at the medial canthus as the supratrochlear vein and supraorbital vein unite 1,2. The a...
The ansa cervicalis is a component of the cervical plexus which gives muscular branches to the geniohyoid muscle of the suprahyoid group and all 4 of the infrahyoid muscles.
superior root: derived from the anterior primary rami of C1
inferior root: derived from the anter...
The anterior cervical space is a small infrahyoid compartment of the head and neck. It is a fat containing space and is not enclosed by fascia 1.
posterior: carotid space
medial: visceral space
superior: submandibular space
Anterior cord syndrome (also known as Beck's syndrome or anterior spinal artery syndrome) is a clinical subset of spinal cord injury syndromes, due to ischaemia/infarction of the anterior two-thirds of the spinal cord, typically sparing the posterior third.
The anterior cranial fossa constitutes the floor of cranial vault which houses the frontal lobes of the brain.
Structures present in the midline of anterior cranial fossa from anterior to posterior are:
groove for superior sagittal sinus
groove for anterior meningeal vessels
The anterior division of the mandibular division of the trigeminal nerve has four branches, which are all motor branches except one. The four branches are:
deep temporal nerves
lateral pterygoid nerves
The anterior ethmoidal artery is a branch of the ophthalmic artery. It supplies the anterior and middle ethmoidal sinuses, frontal sinus, the lateral nasal wall and the nasal septum (see nasal cavity).
It traverses the anterior ethmoidal foramen with the anterior ethmoidal nerve (which ...
The anterior ethmoidal nerve is an extraconal branch of the nasociliary nerve, a branch of ophthalmic division of the trigeminal nerve. Some authors describe it as either the terminal branch or a direct continuation of the nasociliary nerve. It branches off distal to the infratrochlear nerve an...
The anterior jugular vein is a paired tributary of the external jugular vein.
It arises beneath the chin in the region of the hyoid bone or suprahyoid neck.
Origin and course
The anterior jugular vein has its origin as the confluence of several small superficial subma...
The anterior lacrimal crest is a bony projection on the frontal process of the maxilla continuous with the orbital rim which creates the lateral margin of the lacrimal sac fossa. The medial palpebral ligament is attached to anterior lacrimal crest.
Immediately anterior to the anterior lacrimal ...
The anterior superior alveolar canal courses through the anterior wall of the maxillary sinus, and contains the anterior superior alveolar nerve, artery and vein. Usually, it shares a common channel with the infraorbital canal but when seen separately should not be confused for a fracture.
The anterior superior alveolar nerve, also known as the anterior superior dental nerve, is the third branch of the infra-orbital nerve, from the maxillary division of the trigeminal nerve. It is the largest of the superior alveolar nerves and contributes to the superior dental plexus.
The anterior triangle forms the anterior compartment of the neck and is separated from the posterior triangle by the sternocleidomastoid muscle. The triangles of the neck are surgically focussed, first described from early dissection-based anatomical studies which predated cross-sectional anatom...
Antrochoanal polyps (ACP) are solitary sinonasal polyps that arise within the maxillary sinus. They pass through and enlarge the sinus ostium and posterior nasal cavity to the nasopharynx.
Similar polyps can arise in the sphenoid sinus extending into the nasopharynx: these are termed sphenoch...
An antrolith is a calcified mass within the maxillary sinus. The origin of the nidus of calcification may be extrinsic (foreign body in sinus) or intrinsic (stagnant mucus, fungal ball).
Most antroliths are small and asympotomatic. Larger ones may present as sinusitis with symptoms like pain a...
Arrested pneumatisation of the skull base is an anatomical variant that most commonly occurs in association with the sphenoid sinus. It is known that the sphenoid bones undergo early fatty marrow conversion antecedent to normal pneumatisation. However, for unclear reasons, some individuals exper...
The arteries of the head and neck are branches of the common carotid and subclavian arteries.
common carotid artery
internal carotid artery (segments)
persistent stapedial artery
The aryepiglottic folds are two ligamentomuscular structures within the supraglottic larynx that function to protect the airway when swallowing.
Each aryepiglottic fold is comprised of the superior ligamentous edge of the quadrangular membrane and covering mucous membrane1, the e...
The arytenoid cartilages are paired hyaline cartilages that articulate with the sloping upper border of the lamina of the cricoid cartilage by the cricoarytenoid joint. This joint allows movement of the arytenoid cartilages, which is vital in approximating, tensing and relaxing the vocal folds.
The ascending cervical artery is 1 of the 4 branches of the thyrocervical trunk (off the first part of the subclavian artery).
It is a small artery that ascends medial to the phrenic nerve on the prevertebral fascia. It contributes many small spinal branches into the intervertebral foramina of ...
The ascending pharyngeal artery, the smallest branch of the external carotid artery, is a long, slender vessel, deeply seated in the neck, beneath the other branches of the external carotid and under the stylopharyngeus.
origin: a branch of the external carotid artery
Assessment of thyroid lesions is commonly encountered in radiological practice.
hyperplastic / colloid nodule / nodular hyperplasia: 85%
papillary: 60-80% of carcinomas
Ultrasound along with nuclear medicine, is an important modality for assessment of thyroid lesions, and it is also frequently used to guide biopsy. Diagnostic criteria for thyroid nodules continue to evolve with improving ultrasound technology.
The asterion is the junction on the side of the posteroinferior calvarium where three sutures meet:
It is located at the posterior end of the parietotemporal suture, whereas the pterion is located at the anterior end.
It is one of...
Asteroid hyalosis is a degenerative condition of the eye where there is accumulation of calcium soaps in vitreous chamber.
The prevalence increases with age from 0.2% 43-54 year olds to 2.9% in 75-86 year olds. The overall prevalence is 1.2%. It is more commonly unilateral and fav...
The American Thyroid Association (ATA) guidelines for assessment of thyroid nodules are meant to improve inter- and intra-reader consistency during assessment of thyroid nodules on ultrasound, and to facilitate communication with referring endocrinologists.
The 2015 guidelines stress the import...
The atlantodental interval (ADI), as the name suggests, is the horizontal distance between the anterior arch of the atlas and the dens of the axis, used in the diagnosis of atlanto-occipital dissociation injuries and injuries of the atlas and axis.
It is the distance (in mm) between the posteri...
This mnemonic helps when remembering the ascending order of structures that corresponds to each waveform in an auditory brainstem response (ABR) tracing:
E: eighth nerve action potential (wave I)
C: cochlear nucleus (wave II)
O: olivary complex (superior) (wave III)
An auricular pseudocyst is a rare and benign cystic swelling resulting from intracartilaginous accumulation of fluid within the pinna.
While it can occur at any age and in either gender, it typically presents in middle aged males with a mean age of presentation being around 35-40 ...
The auriculotemporal nerve is a sensory branch of the posterior division of the mandibular division of the trigeminal nerve.
The auriculotemporal nerve divides posteriorly from the posterior division of the mandibular division before dividing into two roots separate to encircle t...
Autoimmune thyroiditises (AIT) refers to a group of conditions where there is inflammation involving the thyroid gland related to thyroid antibodies.
They are most common thyroid disease group in the paediatric population 5.
Entities that fall under this category inclu...
This classification was initially proposed by Bailey in 1929 2 and remains the most widely used classification system at time of writing (July 2016).
Bailey classification of second branchial cleft cysts provides a structure for classing second branchial cleft cysts into four types. It is no lo...
The Ballet sign refers paralysis of voluntary movements of the eyeball with preservation of the automatic movements. Sometimes this sign is present with exophthalmic goitre and hysteria.
Barrow caroticocavernous fistula classification divides caroticocavernous fistulas into direct (type A) or indirect (types B-D). This classification was proposed by Barrow et al. in 1985 1 and at the time of writing (mid 2016) remains the most widely used system for describing caroticocavernous ...
The base of the skull (or skull base) forms the floor of the cranial cavity and separates the brain from the structures of the neck and face.
The base of the skull is a bony diaphragm composed of a number of bones including (from anterior to posterior):
The basion is the median (midline) point of the anterior margin of the foramen magnum.
It is one of the skull landmarks, craniometric points for radiological or anthropological skull measurement.
Various lines and measurements using the basion are made in the diagnosis of ...
The basion-axial interval (BAI), as the name suggests, is the horizontal distance between the basion and the posterior cortex of the axis, used in the diagnosis of atlanto-occipital dissociation injuries.
It is the distance (in mm) between the basion and the superior extension of the posterior ...
The basion-dens interval (BDI), as the name suggests, is the distance between the basion and the tip of the dens, used in the diagnosis of atlanto-occipital dissociation injuries.
It is the distance from the most inferior portion of the basion to the closest point of the superior aspect of the ...
A mnemonic used to remember the behavioural changes of obstructive sleep apnoea (OSA) is:
P: poor school performance
L: lack of concentration
Behçet disease is a multi-systemic and chronic inflammatory vasculitis of unknown aetiology.
The mean age at which Behçet disease occurs is 20-30 years. The disease is most prevalent in the Mediterranean region, Middle East and East Asia. The highest incidence has been reported in...
Benign lymphoepithelial lesions (BLL or BLEL), also misleadingly known as AIDS-related parotid cysts (ARPC), are mixed solid and cystic lesions that enlarge the parotid glands, and are usually associated with cervical lymph node enlargement, and nasopharyngeal lymphofollicular hyperplasia.
There are a number of benign metastasising tumours:
benign metastasising meningioma 1,2
benign metastasising leiomyoma 3
primary adenoma of thyroid 4
giant cell tumour of bone 5
Benign minor salivary gland pathology is a broad term that encompasses a number of relatively uncommon pathologies that affect the minor salivary glands of the head and neck:
salivary retention cysts
A Bezold abscess is a complication of acute otomastoiditis where the infection erodes through the cortex medial to the attachment of sternocleidomastoid, at the attachment site of the posterior belly of the digastric muscle, and extends into the infratemporal fossa. Due to it being deep to the i...
The Biffl scale or grade illustrates the spectrum of blunt cerebrovascular injury (BCVI) seen on angiography (both CTA and DSA). Some authors refer to the grading scale as the Denver scale, which is not to be confused with the Denver criteria, a set of clinical and risk factors for BCVI.
Bilateral thinning of the parietal bones, also known as biparietal osteodystrophy, is an uncommon, slowly progressive acquired disease of middle-aged people with slight female predilection. It is typically an incidental finding.
The aetiology is unknown but is thought to be an age-r...
Bill's bar is a landmark that divides the superior compartment of the internal acoustic meatus into an anterior and posterior compartment. Anterior to Bill's bar, in the anterior superior quadrant, are the facial nerve (CN VII) and nervus intermedius, and posterior to it in the posterior superio...
The bimastoid line has been described and used to evaluate basilar invagination on frontal skull plain film and coronal reconstructed CT image.
The bimastoid line is drawn between the inferior tips of the of mastoid processes bilaterally. The tip of the odontoid process of C2 normally projects ...
The binocular distance (BOD) is a measurement between the two lateral (outer) canthi of each eye. It is sometimes used as a accessory fetal biometric parameter where it is often documented on both 2nd trimester anatomy scans on axial brain scans. The largest diameter of the orbit should be used ...
Black eyebrow sign is the description given on plain facial radiographs to intra-orbital air 1.
Air rises into the most superior aspect of the orbit, almost always in the context of a facial fracture, in a linear fashion, giving the appearance of a eyebrow. The fracture is usually an orbital bl...
The black turbinate sign refers to an area of non-enhancing mucosa on MRI in a patient with angioinvasive fungal sinus infection / rhinocerebral mucormycosis.
Mucormycosis is caused by fungi that include Mucor, Rhizopus, and Absidia species. It is seen in diabetic and immunocompromised patient...
Blunt traumatic neck injury is uncommon because it is usually protected by the head, shoulders, and chest. This term is generally used to refer to injuries of the neck besides to cervical spine injuries, which are common.
Blunt injury to the neck is most commonly from motor vehicle ...
The body of the sphenoid bone is the midline cubical portion of the sphenoid bone, hollowed by the sphenoid air sinuses.
The body has superior, inferior, anterior, posterior, and lateral surfaces.
The superior surface features:
ethmoidal spine: prominent spine that articulates...
Bogorad syndrome also known as the syndrome of crocodile tears, is characterized by residual facial paralysis with profuse lacrimation during eating. It is caused by a misdirection of the regenerating autonomic fibers to the lacrimal gland instead of to the salivary gland.
The Bolger classification of maxillary sinus hypoplasia proposed by Bolger et al in 1990 1 takes into account associated anomalies of the uncinate process, which are of utmost importance for planning functional endoscopic sinus surgery (FESS).
Maxillary sinus hypoplasia in itself is asymptomati...
The bony orbit refers to the bones that constitute the margins of the orbits, that is the roof, medial and lateral walls and floor. The orbital margin or rim refers to the anterior circular margin of the orbit. The orbital apex refers to the posterior confluence of the orbit, where the optic can...
Boogards angle is measured by drawing a line from basion to opisthion and another line along the plane of the clivus to the basion intersecting the first line - the angle between these two lines is measured .
The normal angle is 126+/- 6°. If the angle measures more than 136° it is indicative o...
Bouthillier et al described (in 1996) 1 a seven segment internal carotid artery (ICA) classification system. It remains the most widely used system for describing ICA segments at the time of writing (mid 2016).
There are few others classifications systems including proposed by Fisher (1938), Gi...