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Perineural Metastasis to The Cranial Nerves in Head and Neck Malignancies


INTRODUCTION

Perineural metastasis may occur from any head and neck malignancy, especially adenoid cystic carcinoma, squamous cell carcinoma and lymphomas. Perineural metastasis is an important but often neglected route of spread of the tumor of the head and neck. Recognition of this form of metastatic spreading of the tumor is essential for adequate management.

Certain cranial nerves, both centrally and peripherally, are confined in the bony foramina and canals. Enlargement of the nerves by malignant permeation of the perineural spaces may be reflected by the expansion and erosion of the surrounding bony envelope. The cranial nerves most amenable to the demonstration of the malignant permeation are the trigeminal, facial, and hypoglossal cranial nerves. Although the other nine cranial nerves can be involved, they traverse relatively large foramina and fissures which are not affected by the enlargement of the involved nervous trunks.

This computerized exhibit demonstrates manifestations of the perineural metastasis to the trigeminal, facial, and hypoglossal cranial nerves in head and neck malignancies.


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