July Journal Round-Up – Head & Neck

Phil Touska is the new trainee representative for the British Society of Head and Neck Imaging (BSHNI), and here’s his thoughts on the most recent and relevant publications in head and neck radiology:

Head & Neck Cancer

AJCC 8 is on its way and promises to improve the accuracy of staging and correlation with survival and reflects more recent data. The main changes include separate staging for HPV related and non-HPV related SCC, reflecting the more favourable prognosis of HPV related disease. In addition, depth of invasion is now included in the staging of oral cancer (small, but deeply invasive lesions carry a worse prognosis) and there is a new N3b stage for non-HPV related SCC, reflecting extranodal spread (Lydiatt et al. Jan 2017).


Whilst the ‘third eye’ might provide insight, the ‘third window’ is associated with a diminution of the senses, hearing loss in particular. Although many of us may have come across semicircuar canal dehiscence, the aetiology of the associated hearing loss and the spectrum of similar conditions may be less familiar. Ho et al. provide an excellent insight into the various different abnormalities that may cause ‘third window’ defects (Ho et al.  2017).


A group of rhinologists have recently convened to discuss the scintillating topic of the frontal sinus and its drainage pathway. This resource is helpful if you are communicating with surgeons carrying out endoscopic procedures in this region, alerting them to supra-agger or supra bulla cells (Wormald et al. 2016). A further helpful resource on frontal sinus drainage pathway anatomy can be found in the AJNR (Daniels et al. 2003).


Reviewing soft tissue radiographs of the neck for foreign bodies can occasionally result in confusion and pitfalls abound. If you have ever wondered about the location of the triticeous cartilage or wanted to know the ossification patterns of the cricoid and aretyoid cartilages, look no further than Radiographics (Castan Senar et al. 2017), free for RSNA members.


There is increasing interest in the use of dual energy CT in the head and neck. It works on the principle of imaging at two tube voltages, the photoelectric effect predominating at the lower voltage; hence, enhancing lesions will attenuate more, increasing conspicuity. The technique can also be used to isolate iodine creating ‘iodine maps’ to delineate lesions, create virtual non-contrast studies and reduce deleterious metal artefact Roele et al. 2017 and Vogl et al. 2012.

Phil can be contacted on bshnitrainees@gmail.com. Look out for his summary of the 2017 British Society for Head and Neck Imaging Annual Meeting coming later this week!


  • Lydiatt WM, Patel SG, O’Sullivan B, Brandwein MS, Ridge JA, Migliacci JC, Loomis AM, Shah JP. Head and Neck cancers-major changes in the American Joint Committee on cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017 Mar;67(2):122-137.
  • Ho ML, Moonis G, Halpin CF, Curtin HD. Spectrum of Third Window Abnormalities: Semicircular Canal Dehiscence and Beyond. AJNR Am J Neuroradiol. 2017 Jan;38(1):2-9.
  • Castán Senar A, Dinu LE, Artigas JM, Larrosa R, Navarro Y, Angulo E. Foreign Bodies on Lateral Neck Radiographs in Adults: Imaging Findings and Common Pitfalls. Radiographics. 2017 Jan-Feb;37(1):323-345.
  • Wormald PJ, Hoseman W, Callejas C, Weber RK, Kennedy DW, Citardi MJ, Senior BA, Smith TL, Hwang PH, Orlandi RR, Kaschke O, Siow JK, Szczygielski K, Goessler U, Khan M, Bernal-Sprekelsen M, Kuehnel T, Psaltis A. The International Frontal Sinus Anatomy Classification (IFAC) and Classification of the Extent of Endoscopic Frontal Sinus Surgery (EFSS). Int Forum Allergy Rhinol. 2016 Jul;6(7):677-96.
  • Daniels DL, Mafee MF, Smith MM, Smith TL, Naidich TP, Brown WD, Bolger WE, Mark LP, Ulmer JL, Hacein-Bey L, Strottmann JM. The frontal sinus drainage pathway and related structures. AJNR Am J Neuroradiol. 2003 Sep;24(8):1618-27.
  • Roele ED, Timmer VCML, Vaassen LAA, van Kroonenburgh AMJL, Postma AA. Dual-Energy CT in Head and Neck Imaging. Curr Radiol Rep. 2017;5(5):19.
  • Vogl TJ, Schulz B, Bauer RW, Stöver T, Sader R, Tawfik AM. Dual-energy CT applications in head and neck imaging. AJR Am J Roentgenol. 2012 Nov;199(5 Suppl):S34-9.

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