definition of objects in the cervical region€¦ · 1 definition of objects in the cervical region...

1

Definition of Objects in the Cervical Region

Xingyu Wu, Jayaram K. Udupa, Drew A Torigian

Medical Image Processing Group

Department of Radiology, University of Pennsylvania

Philadelphia, PA19104

2

Objects

1. Cervical region

2. Cervical skin outer boundary extended to thoracic region CtSkn

3. Cervical spine extended to thoracic region CtSpn

4. Cervical spinal canal extended to thoracic region CtSC

5. Left parotid gland LPG

6. Right parotid gland RPG

7. Left submandibular gland LSmG

8. Right submandibular gland RSmG

9. Mandible Mnd

10. Thyroid gland TG

11. Cervical great arteries and veins extended to thoracic region CtGAV

12. Orohypopharynx OHPh

13. Cervical esophagus CtEs

14. Supraglottic/glottic larynx SpGLx

15. Cervical trachea CtTr

16. Extended Oral cavity eOC

17. Lips Lp

18. Buccal mucosa BMc

*Note: Sometimes there is an extended portion of the object into the thorax region. Such objects is

attached with a postfix ‘extended to the thoracic region’ in the name. For simplicity reason, the postfix is

omitted in the following part of this file.

3

Superior boundary: The superior most aspect of the mandible.

Inferior boundary: The level at which superior vena cava branches into left and right brachiocephalic veins.

https://commons.wikimedia.org/wiki/File:Skull_human_and_cervical_spine.svg https://www.studyblue.com/notes/note/n/lab-exam-3-/deck/888386

Superior boundary

Inferior boundary

1. Cervical Region

4

Superior boundary: The superior most aspect of the cervical region is the uppermost part of mandible, as shown in figure 1.

Figure 1. Left: Superior boundary of cervical region. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left, where the condyle can be distinguished as marked by green.

1. Cervical Region

* Viewed in the Bone Window

5

Inferior boundary: The superior aspect of the superior vena cava where it branches into left & right brachiocephalic veins (see figure 2).

Figure 2. Left: Inferior boundary of cervical region. An axial CT slice where the superior vena cava is about to branch into left and right brachiocephalic veins. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.

1. Cervical Region

* Viewed in the Softtissue Window

6

Cervical skin outer boundary: Arms to be excluded, otherwise follow Cervical region definition. The boundary between arm and body should include the axillary fat and all the way down to the back, as shown in figure 3.

Figure 3. Left: CtSkn in the thoracic region, in which the skin of arms is excluded. Right: CtSkn in the cervical region

2. Cervical Skin Outer Boundary (CtSkn)


7

Superior boundary: The level at

which the atlas (C1)

disappears.

Inferior boundary: The same

with the definition of Cervical

region.

The cervical spine refers to the vertebrae from the upper part of thorax

and in the neck. (Note: exclude ribs)

Superior boundary

Inferior boundary

http://spinehealth.com/blog/category/cervical-spine/

3. Cervical Spine (CtSpn)

8

Superior boundary: The superior most aspect of the atlas (C1), as shown in figure 4.

Figure 4. Left: Superior boundary of CtSpn. An axial CT slice which contains the superior most aspect of atlas. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.



9

Inferior boundary: The inferior boundary is the same as the definition of Cervical region (See figure 5).

Figure 5. Left: Inferior boundary of CtSpn. The ribs are excluded. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.



10

The cervical spinal canal is the center region of the spine, including the spinal cord, nerve roots, surrounding epidural fat, and cerebrospinal fluid (CSF). See the following figure.

4. Cervical Spinal Canal (CtSC)

Spinal canal

http://www.slideshare.net/AbayAlem/cns-bs2

11

Inferior boundary: Follow the definition of Cervical region.

Figure 6. Left: Superior boundary of CtSC. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.

4. Cervical Spinal Canal (CtSC) Superior boundary: The top of atlas, as shown in figure 6. It is the same with

the superior boundary of cervical/upper thoracic spine. The dens of C2 should

not be included in the spinal canal, as shown in the right figure.


12

The parotid gland situated next to and behind the masseter muscle and

mandibular ramus, appears lobulated and hence a bit textured compared

to muscle, and usually lower in attenuation on CT because of fatty content

(see figure 7).

Parotid Gland

http://slideplayer.com/slide/10026666/1

Figure 7. Left: An illustration of parotid gland (one side). Right: Both sides of parotid glands in CT image, as circled by green.

5 & 6. Left and Right Parotid Gland (LPG & RPG)

13

Figure 8. Left: The superior boundary of LPG & RPG. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.

Superior boundary: Where the parotid glands are about to disappear.

The external auditory canal can be used for reference, as shown in

figure 8.



14

Inferior boundary: Where the parotid glands are about to appear, as

shown in figure 9.

Figure 9. Left: The inferior boundary of LPG & RPG, which are circled by green. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.



15

http://www.slideshare.net/ananthatiger/salivary-glands-3789068

The left and right submandibular glands are situated under the mandible on

both sides. They are generally brighter (less fatty) than the parotid glands on

CT (see figure 10).

Figure 10. Left: An illustration of submandibular gland (one side). Right: Both submandibular glands in CT image, as circled by green.

7 & 8. Left and Right Submandibular Gland (LSmG & RSmG)

16

Superior boundary: Where the submandibular glands are about to appear, usually at the level of the inferior aspect of the medial pterygoid muscle and mylohyoid muscle, see figure 11. Note to distinguish the pterygoid muscles which are lateral to the submandibular glands.

Figure 11. Left: The superior boundary of LSMG & RSmG. The submandibular glands are circled by green. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.

pterygoid

muscle



17

Inferior boundary: Where the submandibular glands are about to appear. There could be some difference of slices on the left and right sides. The RSmG is used as an example in figure 12.

Figure 12. Left: The inferior boundary of RSmG, where the submandibular glands are visible. Middle left: An axial slice immediately superior to the slice on left. Middle right: An axial slice immediately inferior to the slice on left. The RSmG becomes invisible here. Right: Three axial slices inferior to the slice on left, where both the LSMG and RSmG disappear.



18

Mandible is a single object. It has high attenuation on CT and extends to

the region of the ear, as shown in figure 13.

Figure 13. Left: An illustration of mandible structure. Right: Mandible in axial CT slice, as circled by green.

9. Mandible (Mnd)

19

Inferior boundary: Where the mandible appears inferiorly, depending on the

pose of head, see figure 14.

Figure 14. Left: The inferior boundary Mnd. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left. Top row: Mnd appears at the chin. Bottom row: Mnd appears posteriorly.

9. Mandible (Mnd) Superior boundary:: The same as the superior boundary of the cervical region.


20

Thyroid gland is a butterfly

shaped structure situated in front

of the trachea, appears brighter

than the surrounding soft tissue

on CT because of iodine content,

as shown in figure 15.

http://www.organsofthebody.com/thyroid/

Figure 15. Top: An illustration of thyroid gland. Bottom: Thyroid gland in axial CT slice, as circled by green.

10. Thyroid Gland (TG)

21

Superior boundary: Where the thyroid gland disappears. It is usually along the thyroid cartilage, see figure 16 as marked by green.

Figure 16. Left: The superior boundary TG. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.



22

Inferior boundary: The first slice where the thyroid gland appears, which is brighter than the surrounding tissues on CT, as marked by green (See figure 17).

Figure 17. Left: The inferior boundary TG. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.



23

The cervical great arteries and veins include right & left common carotid arteries, right & left internal carotid arteries, and right and left internal jugular veins / brachiocephalic veins, as shown in figure 18.

Figure 18: Left: The arterial system in the Cervical region. Right: The venous system in the Cervical region

http://www.organsofthebody.com/thyroid/ http://www.slideshare.net/katemilani7/circulation-online

11. Cervical Great Arteries and Veins (CGAV)

24

Figure 19. Illustration of right & left common carotid artery in both diagram and CT slice (circled in green).

The right common carotid artery arises

from the innominate (also called right

brachiocephalic) artery, and branches

into the right external carotid artery and

the right internal carotid artery.

The left common carotid artery arises

from the aortic arch (or sometimes from

a common trunk with the left subclavian

artery from the aortic arch), and

branches into the left external carotid

artery and the right internal carotid

artery. The arteries are generally

narrower and more symmetric left to

right than the internal jugular veins.

https://en.wikipedia.org/wiki/Common_carotid_artery

11. Cervical Great Arteries and Veins (CGAV)

25

The superior boundary is where they bifurcate into the internal and external carotid arteries. There may exist a difference of several slices between right and left common carotid arteries. The right side is illustrated in figure 20.

Figure 20. Left: The superior boundary of right common carotid artery. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.

right

common

carotid

artery

right

external

carotid

artery

right

Internal

carotid

artery

11.1 Right & Left Common Carotid Artery


26

The inferior boundary of the right common carotid artery is the level at which it arises from the innominate (right brachiocephalic) artery, as shown in figure 21.

Figure 21. Left: The inferior boundary of right common carotid artery, as marked by green. Middle: An axial slice immediately superior to the slice on left, where the innominate artery has branched. Right: An axial slice immediately inferior to the slice on left where the innominate artery has not yet fully branched.


Innominate artery right subclavian artery


27

The inferior boundary of the left common carotid artery is the level at which it arises from the aortic arch (or sometimes from a common trunk with the left subclavian artery), as shown in figure 22.

Figure 22. Left: The inferior boundary of left common carotid artery. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.

left common carotid artery


aortic arch left subclavian artery


28

The right and left internal carotid artery branch off from the right and left

common carotid arteries, respectively, and travel through the skull to supply

the brain.

Figure 23. Left: Illustration of right and left internal carotid arteries. Middle: Right

internal carotid artery in CT image (green circle). Right: Left internal carotid artery in

CT image (green circle).

http://www.yoursurgery.com/ProcedureDetails.cfm?Proc=9

11.2 Right & Left Internal Carotid Artery

29

Superior boundary: A small distance below the foramen magnum where the artery curves anteriorly and then posteriorly. There could be several slices of difference in the right and left sides. Figure 24 shows an example of the right side.

Inferior boundary: Where the common carotid artery branches superiorly, which is equivalent to the superior boundary definition of the right and left common carotid arteries, respectively.

Figure 24. Left: The superior boundary of right internal carotid artery. Middle left: An axial slice immediately superior to the slice on left. The curve can be distinguished in this slice. Middle right: An axial slice immediately inferior to the slice on left. Right: An angiographic image of the internal carotid artery in the sagittal plane for cross-reference with the three axial images.

11.2 Right & Left Internal Carotid Artery

Internal carotid artery curve

left

middle left

middle right


30

The right and left brachiocephalic

veins start from the branch point of

the superior vena cava, and extend

to the roots of internal jugular veins.

They are generally thicker than the

neighboring brachiocephalic artery,


Superior boundary

Inferior boundary

http://thegoofyanatomist.weebly.com/5-veins.html

Figure 25. Top: Illustration of right and left brachiocephalic veins. Bottom: Right and

left brachiocephalic veins in CT image, circled in green.

11.3 Right & Left Brachiocephalic Vein

31

Superior boundary: The root of right & left internal jugular veins, as shown

in figure 26 (use the right side for illustration). There is a slight difference of

slices between the left and right sides.

right internal jugular vein

right subclavian vein

Figure 26. Left: The superior boundary of right brachiocephalic vein, as marked by

green. Middle: An axial slice immediately superior to the slice on left. Right: An axial

slice immediately inferior to the slice on left.

Inferior boundary: The same as the inferior boundary of cervical region.

11.3 Right & Left Brachiocephalic Vein


32

Figure 27. Right: Right and left internal jugular veins in CT slice. Left: An illustration of

their boundaries.

The right and left internal jugular veins branch from the brachiocephalic veins, and extend into the skull. They are next to the common and internal carotid arteries.

Superior

boundary

Inferior

boundary

https://www.studyblue.com/notes/note/n/head-neck/deck/6995581

11.4 Right & Left Internal Jugular Vein

33

Inferior boundary: The same as the superior boundary of right and left brachiocephalic veins.

Superior boundary: The level at which they are about to enter the skull

base. We use the left side for illustration in figure 28.

Figure 28. Left: The superior boundary of left internal jugular vein. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left. The left internal jugular vein is marked by green.

11.4 Right & Left Internal Jugular Vein


34

Superior boundary

Inferior boundary

https://en.wikipedia.org/wiki/Pharynx

Figure 29. Illustration of the pharynx boundaries.

The pharynx is composed of the nasopharynx, oropharynx, and

hypopharynx. In the current application, we are excluding the

nasopharynx. Its thickness is approximately 3 mm. The craniocaudal

boundaries are shown in figure 29.

12.Orohypopharynx(OHPh)

35

Superior boundary: The inferior tips of pterygoid plates, as shown in

figure 30.

Figure 30. Left: The superior boundary of orohypopharynx, where the tips of pterygoid plates just appear. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.

pterygoid

plate pterygoid

plate



36

Inferior boundary: The inferior aspect of the cricoid cartilage, as shown

in figure 31, where the cricoid cartilage is about to disappear.

Figure 31. Left: The inferior boundary of orohypopharynx. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.

cricoid cartilage



37

Anterior boundary: In order from top to bottom: Base of tongue, posterior

aspect of supraglottic/glottic larynx, and posterior aspect of posterior cricoid

cartilage.

Figure 32. Anterior pharyngeal boundaries as marked by green. Left: Posterior to tongue base. Middle left: Posterior to epiglottis of supraglottic/glottic larynx (lumen is always excluded). Middle right: Posterior to aryepiglottic folds of supraglottic/glottic larynx. Right: Posterior to the cricoid cartilage.

tongue base


epiglottis aryepiglottic fold cricoid cartilage


38

Posterior boundary: Prevertebral muscle or vertebra, which are separated

from the pharynx by a fat plane. These boundaries are shown in figure 33.

Figure 33. Posterior pharyngeal boundaries. Left: Anterior to prevertebral muscle and vertebral body. Right: Anterior to vertebral body.

prevertebral muscle


vertebra


39

https://gi.jhsps.org/GDL_Disease.aspx?CurrentUDV=31&GDL_Cat_ID=BB532D8A-43CB-416C-

9FD2-A07AC6426961&GDL_Disease_ID=197E00D5-029B-48B8-9A68-53077FCC9A0F

Superior boundary

Inferior boundary

The cervical esophagus is

under the orohypopharynx. It is

next to the cervical trachea and

brighter than the surrounding

tissues, and sometimes with

lumen contained, as shown in the

right figure.

13. Cervical Esophagus (CtEs)

Esophagus

40

Superior boundary: The inferior aspect of the cricoid cartilage, as shown in

figure 34. It is the same with the inferior boundary of orohypopharynx.

cricoid cartilage

Figure 34. Left: The superior boundary of cervical esophagus, which is the inferior aspect of the cricoid cartilage. The cervical esophagus region is marked by green. Middle: An axial slice immediately superior to the slice on left, from which the cricoid cartilage can still be distinguished. Right: An axial slice immediately inferior to the slice on left.



41

Inferior boundary: Follow the definition of Cervical region. The cervical

esophagus near its inferior boundary is brighter than the surrounding

mediastinal fat, as shown in figure 35.

Figure 35. Left: The inferior boundary of cervical esophagus. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.



42

The larynx is composed of supraglottic, glottic, and subglottic components.

In the current application, we are only including the supraglottic and glottic.

Superior boundary

Inferior boundary

http://teachmeanatomy.info/neck/viscera/larynx/laryngealcartilages/

Superior boundary: The top

aspect of epiglottis.

Inferior boundary: The inferior

edge of the anterior aspect of the

thyroid cartilage (fully including

the true vocal cords).

Anterior boundary: The posterior

border of hyoid bone, strap

muscles, and posterior border of

the thyroid cartilage.

Posterior boundary: The posterior

borders of the epiglottis and

aryepiglottic folds, the anterior

borders of pharyngeal constrictor

muscle, arytenoid cartilages, and

posterior cricoid cartilage.

Figure 36. Illustration of the Supraglottic/glottic larynx

14. Supraglottic/glottic larynx (SpGLx)

43

Superior boundary: The top aspect of epiglottis, as shown in figure 37.

Figure 37. Left: The superior boundary of larynx. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left. The larynx region is marked by green.



44

Inferior boundary: The inferior edge of the anterior aspect of the thyroid

cartilage, which is also the inferior aspect of true vocal cords, as shown in

figure 38. Note that the true vocal cords should be fully included.

Figure 38. Left: The inferior boundary of larynx, where the thyroid cartilage is about to disappear. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left, where the anterior aspect of the thyroid cartilage is not visible.

thyroid

cartilage


true vocal

cord


45

Anterior boundary: From top to bottom: hyoid bone, strap muscles, and

thyroid cartilage.

Figure 39. SpGLx anterior boundaries as marked by green. Left: SpGLx including epiglottis. Middle left: Posterior to hyoid bone. Middle right: Posterior to strap muscles. Left: Posterior to thyroid cartilage.


thyroid cartilage hyoid bone strap muscles


46

Posterior boundary: From top to bottom: Posterior border of epiglottis,

posterior borders of aryepiglottic folds, anterior border of pharyngeal

constrictor muscle, arytenoid cartilages, and cricoid cartilage. The

boundaries are shown in figure 40.

Figure 40. SpGLx boundaries as marked by green. Left: Anterior to the border of epiglottis and aryepiglottic folds. Middle left: Anterior to pharyngeal constrictor muscle. Middle right: Anterior to arytenoid cartilages. Right: Anterior to cricoid cartilage.

arytenoid cartilage pharyngeal constrictor muscle cricoid cartilage



47

Superior boundary

Inferior boundary (Inferior of Cervical region)

Figure 41. Illustration of the vertical boundaries for cervical trachea.

The trachea is under the

supraglottic/glottic larynx. It

extends all the way down to

the lungs but we only

consider the region within the

Cervical region, i.e. cervical

trachea, as illustrated in

figure 41.

15. Cervical Trachea (CtTr)

http://humanphysiology2011.wikispaces.com/file/view/The_co

nducting_zone_of_the_respiratory_system.jpg/211935804/25

0x355/The_conducting_zone_of_the_respiratory_system.jpg

48

Superior boundary: The inferior aspect of the anterior portion of the cricoid

cartilage, a complete cartilaginous ring, as shown in figure. The trachea is

of uniform thickness anteriorly and laterally around the center lumen with

C-shaped cartilage, but does not have cartilage along its posterior aspect,


Figure 42. Left: The superior boundary of cervical trachea, which is the inferior aspect of the cricoid cartilage. The cervical trachea region is marked by green. Middle: An axial slice immediately superior to the slice on left, from which the cricoid cartilage can still be distinguished. Right: An axial slice immediately inferior to the slice on left.


cricoid cartilage * Viewed in the Softtissue Window

49

Inferior boundary: Follow the definition of Cervical region, as shown in

figure 43.

Figure 43. Left: The inferior boundary of cervical trachea. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.



50

Superior boundary

Inferior boundary


The extended oral cavity is posterior to the mandible and maxilla. It

includes the soft palate and the tongue, as shown in figure 44.

Figure 44. Illustration of the extended oral cavity craniocaudal boundaries.

16. Extended Oral Cavity (eOC)

51

Superior boundary: The inferior aspect of the hard palate, as shown in

figure 45.

Figure 45. Left: The superior boundary of extended oral cavity, where the hard palate is about to join with the maxilla. The extended oral cavity boundary is marked by green. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.

hard

palate



52

Inferior boundary: The superior aspect of the hyoid bone posteriorly, and

superior aspect of mylohyoid muscle anteriorly, as shown in figure 46.

Figure 46. Left: The inferior boundary of the extended oral cavity, in which the boundary is marked by green. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left, where the superior most aspect of the hyoid bone appears.

hyoid bone


mylohyoid muscle * Viewed in the Softtissue Window

53

Anterior boundary: The inner surface of the mandible and the maxilla.

Posterior boundary: The anterior border of hard palate, the posterior

borders of soft palate, uvula, and base of tongue. Examples are shown in

figure 47.

Figure 47. Extended oral cavity boundaries as marked by green. Left: Posterior to maxilla and anterior to hard palate. Middle: Posterior to maxilla and anterior to posterior border of soft palate. Right: Posterior to mandible and anterior to posterior borders of tongue base and uvula.

uvula soft palate



54

Superior boundary

Inferior boundary


The lips are inferior to the tip of the nose, and superior to the lower edge

of the mandibular tooth sockets, as shown in figure 48. They include soft

tissue attenuation muscles anterior and lateral to the anterior portions of

the maxilla and mandible.

Figure 48. Illustration of the craniocaudal boundaries of lips.

17. Lips (Lp)

55

Superior boundary: The uppermost aspect of the hard palate, as shown

in figure 49.

Figure 49. Left: The superior boundary of lips, where the hard palate is about to disappear. The boundary is marked by green. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.

17. Lips (Lp)


56

Inferior boundary: The lower edge of the mandibular tooth sockets, which

is also the superior aspect of mandibular body, as shown in figure 50.

Figure 50. Left: The inferior boundary of lips, where the tooth sockets join with the mandible body. Middle: An axial slice immediately superior to the slice on left. The tooth sockets are clearly distinguished. Right: An axial slice immediately inferior to the slice on left. The tooth sockets cannot be distinguished at this level.

tooth sockets

17. Lips (Lp)

mandible body


57

Inferior boundary: Figure 51 shows the corresponding soft tissue window

of figure 50 in the previous slice.

Figure 51. Left: The inferior boundary of lips. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.

17. Lips (Lp)


58

Anterior boundary: The outer surface of the skin. If the mouth is open,

include lips on both sides.

Posterior boundary: From top to bottom: maxilla, maxillary teeth, tongue,

mandibular teeth, mandibular body, and air just deep to lips (if seen). Some

key slices are shown in figure 52.

Figure 52. Lip boundaries as marked by green. Left: Posterior boundary includes the maxilla, maxillary teeth, and air. Middle: When the mouth is open, the two sides of the lips are included. Right: Posterior boundary is the mandibular teeth.

17. Lips (Lp)


59

The buccal mucosa is on the inner sides of the mouth in the cheek areas,

which is below the inferior aspect of the hard palate, to the upper edge of

tooth sockets, as illustrated in figure 53.

Figure 53. Illustration of the buccal mucosa anatomy

http://www.headandneckcancerguide.org/adults/introduction-to-

head-and-neck-cancer/oral-cancers/buccal-cancer/anatomy/

18. Buccal Mucosa (BMc)

60

Superior boundary: Where the buccal mucosa becomes invisible. It is

also the inferior aspect of hard palate and the bottom of the maxillary

sinus, as shown in figure 54.

Figure 54. Left: The superior boundary of buccal mucosa, where its boundaries are marked by green. It is thinner than the lips. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.


hard palate


61

Inferior boundary: Where the buccal mucosa is about to disappear. It is

also the upper edge of the tooth sockets, where the mandibular ramus

joins with the mandible body, as shown in figure 55.

Figure 55. Left: The inferior boundary of buccal mucosa, where its boundaries are marked by green. Middle: An axial slice immediately superior to the slice on left. Right: An axial slice immediately inferior to the slice on left.



62

Anterior boundary: The lips and the teeth.

Posterior boundary: The medial pterygoid muscle. These boundaries are

shown in figure 56.

Figure 56. The boundaries of buccal mucosa. Left: Posterior to the lips, and anterior to the medial pterygoid muscle. Right: Posterior to the teeth and lips, and anterior to the medial pterygoid muscle.


medial pterygoid muscle * Viewed in the Softtissue Window

63

References [1] Brouwer, Charlotte L., et al. "CT-based delineation of organs at risk in the head and neck

region: DAHANCA, EORTC, GORTEC, HKNPCSG, NCIC CTG, NCRI, NRG Oncology and

TROG consensus guidelines." Radiotherapy and Oncology 117.1 (2015): 83-90.

[2] Brouwer, Charlotte L., et al. "CT-based delineation of organs at risk in the head and neck

region: DAHANCA, EORTC, GORTEC, HKNPCSG, NCIC CTG, NCRI, NRG Oncology and

TROG consensus guidelines." Radiotherapy and Oncology 117.1 Supplementary1&2 (2015):

83-90

[3] Hall, William H., et al. "Development and validation of a standardized method for

contouring the brachial plexus: preliminary dosimetric analysis among patients treated with

IMRT for head-and-neck cancer." International Journal of Radiation Oncology* Biology*

Physics 72.5 (2008): 1362-1367.

definition of objects in the cervical region€¦ · 1 definition of objects in the cervical region...

Documents