Head

Louis M. Teresi, MD
S

and

Neck
#{149}

Radiology
Vinuela, H. Wilson, N. Hanafee, MD MD MD

#{149} obert R B. Lufkin, MD Rosiland B. Dietrich, MD #{149} John R. Bentson, MD

Fernando

#{149} Gabriel #{149} William

MR

Imaging of the Nasopharynx and Floor of the Middle Cranial Fossa Part I. Normal Anatomy

The normal anatomy of the nasopharynx and floor of the middle cranial fossa was analyzed with magnetic resonance (MR) imaging. MR images from five healthy volunteers were correlated with whole-organ cryomicrotome sections from three cadavers. Anatomic connections exist between the paranasopharyngeal spaces and the surface structures of the skull base. These anatomic connections include the intimate relationship between the eustachian tube and the pharyngobasilar fascia, the attachment of the muscles of mastication and deglutition to the skull base, and vascular and nervous structures in the foramina. The inherent contrast between the soft tissues of the nasopharynx and related structures and the bone of the floor of the middle cranial fossa allowed excellent visualization of these anatomic connections.
Index
pharynx, studies,

a new imaging technique is applied to a region of the body it is imperative to first determine what anatomic structures can be consistently visualized and what their normal appearance is. The value of magnetic resonance (MR) in the evaluation of parts of the skull base has been described (i-4). The floor of the middle cranial fossa is frequently involved in pathologic conditions of the nasopharynx and related spaces; the anatomy is complex. This study was undertaken to delineate the normal anatomy of the nasopharynx and floor of the middle cranial fossa as seen on MR images by correlating MR images of healthy volunteers with whole-organ cryomicrotome sections from cadavers. Special attention was given to anatomic structures connecting the nasopharynx and melated spaces with the middle cranial fossa.
HENEVER

axial, coronal, and sagittal planes. Whole-organ sections from the cadavers were prepared using a cryomicrotome freezing and sectioning technique described by Rauschning et al. (5). The specimens were first prepared with an injec-

tion of a pigmented permit identification

veins. In order

barium compound of arteries and

to preserve topographic

to

anatomy, the soft tissues to be examined were frozen in situ in respect to their skeletal structures before there had been draining of blood or other fluids from the region of interest. The frozen specimens were transferred to a horizontal sectioning, (LKB den). mounted heavy-duty 2250; Inside on sledge cryomicrotome

Broma
the a bed

Co.;
freezing that

Stockholm,
compartment

Sweof

the cryomicrotome,

the specimens
weighed

were
approxi-

mately 400 pounds (181.8 kg). This heavy weight prevented vibrations and insured an even shaving slice. The microtome knife sectioned the specimens at predetermined Mm. When thicknesses photography varying was from desired, 5-50 the

surface rubbed
ylene

of the specimen was gently with a warm cloth soaked in ethglycol to produce then a frost-free with sur-

terms:

Head, anatomy, 263.1214

MR studies, 10.1214 263.92 #{149} Nasopharynx, #{149} Skull, anatomy, 10.92 164:811-816

#{149}

NasoMR

MATERIALS

AND

METHODS

face.
sections

Photographs
were

of representative
compared

gross
the re-

Radiology 1987;

MR images from five healthy volunteers were compared with matched whole-organ sections obtained from three
cadavers. pharynges performed net imaging MR examinations of the nasoof healthy volunteers were with a 0.3-T permanent-magsystem (Fonar B-3000; Fonar,

spective unteers.

MR images

from

the

healthy

vol-

RESULTS MR Images of Normal Anatomy

Melville,
lenoid

N.Y.)
surface

with

the were

use of either
bore head Fourier (SE) technique

a sore-

or a 24-cm

ceiver
multisection transform
1 From the Department of Radiological Sciences, University of California Los Angeles School of Medicine, Los Angeles (L.M.T., R.B.L., F.V., R.B.D., G.H.W., J.R.B., W.N.H.). From the 1986 RSNA annual meeting. Received November 18, 1986; revision requested February 10, 1987; revision received April 14; accepted May 6. Supported by Public Health Service grant number 1K08 CA 00979-01, awarded by the National Cancer Institute, Department of Health and Human Services. Address reprint requests to L.M.T., Department of Radiology, UCLA Medical Center, BL-428, Los Angeles, CA 90024. c RSNA, 1987 See also the articles by Teresi (pp. 817-821) and Som (pp. 825-832) in this issue.

coil.

Images
rapid

acquired

using

two-dimensional spin-echo

with a repetition and an echo time

28). Four excitations

time (TR) of 500 msec (TE) of 28 msec (SE 500/

in a 256 X 256 matrix

for each image usually were used with a section thickness of 5 mm and 7-mm separations from center-to-center section. Other images were similarly acquired with 384 phase-encoding levels and interpolated to a 512 X 512 display matrix which decreased the pixel size from 0.75
x 0.75 mm to 0.5 X 0.5 mm. Seven simul-

taneous sequence
mm 512 (256

sections were with a total

X 256 matrix) Images

obtained imaging
or were 12.8 obtained

in each time of 8.5

mm (512 in X

matrix).

The nasopharynx is an inverted Jshaped muscular sling suspended from the floor of the middle cranial fossa. Involved in both deglutition and respiration, the nasopharynx connects with the nasal cavity antenionly and with the omopharyngeal cayity infeniorly. It is bounded superiorly by the floor of the sphenoid bone and the clivus, posteriorly by the prevertebral musculature of C-i and C-2, and laterally by the pamapharyngeal constrictor muscles and deep soft tissues of the panapharyngeal space and infratemporal fossa. Superficial soft tissues-At upper levels of the nasopharynx, the bilat-

811

b.

c.

e. Figure
1. Serial axial (SE the eustachian tube orifice. Refer to key for definitions 500/28) MR images (b) and (d) Level of abbreviations. and matched whole-organ of the high nasopharynx. cryosections from lowest level (c) and (e) Level of the sphenopalatine (a) to highest foramen level and (c). (a) Level of pterygoid canal.

Key for Figures

C

clivus carotid carotid cartilaginous cavernous eustachian eustachian foramen

foramen foramen

Iji artery canal base sinus tube tube lacerum

ovale rotundum

levator

palatini

muscle

Pf PG n pvc RC

pterygopalatine

fossa

Ca
CC

lpp it of foramen lacerum M Ma iza orifice MC ME Mf

ninia

lateral lymphoid maxillary mandible maxillary Meckel middle middle middle

medial medial masseter

pterygoid tissue sinus

plate

parotid pterygoid
pterygo-vaginal

gland veins canal muscle

cFL Cs fT
tfO

rectus
sphenoid

capitus
sinus

artery

branches

cavity ear cranial meningeal

pterygoid ptervgoid muscle

Sf Srnf fossa artery

muscle plate

sphenopalatine sphenomaxillary superior orbital

foramen fissure fissure

FL FO FR fR

SOf SP ST T TG tp TT

soft sulcus

palate tubae auditivae

muscle ganglion

fossa
foramen greater

of Rosenmueller
spinosum wing of sphenoid

MP
nip

fS
GW HP lot IT JF

temporalis trigeminal

Ms on

hard
inferior inferior jugular jugular

palate
orbital turbinate foramen vein fissure

orbital optic P pterygoid

palatine petrous

apex nerve process

artery apex

tensor
torus trigeminal ophthalmic

palatini
tubarius nerve nerve

muscle

,l

V Vi V2 fascia V.3

a PA

Iv
LC LP

maxillary
mandibular

nerve
nerve

longus
lateral

coli

muscle
muscle

phf
Pc

pharyngobasilar
ptervgoid canal

pterygoid

812

#{149} Radiology

September

1987

b.

c.

e.

g. Figure 2. Serial coronal (SE 500/28) MR images and matched whole-organ cryosections from most (g). (a) and (b) Level of the sphenopalatine foramen. (c) Level of pterygopalatine fossa and anterior foramen ovale. (f) and (g) Level of foramen lacerum. Refer to key for definitions of abbreviations.
anterior pterygoid level (a) process. to more posterior (d) and (e) Level level of

enally paired recesses of the airway are a characteristic finding (Figs. la, 2c). The orifice of the eustachian tube is seen just anterior (on axial images) or inferior (on coronal images) to the torus tubanius, the most prominent of the superficial landmarks of the nasopharynx. The cartilaginous end of the eustachian tube is usually of similam or lower signal intensity than sum-

rounding muscles. If tubular tonsillan tissue is present, this area may have fairly intense signal depending on the amount of lymphoid tissue present and the effects of volume averaging. The lateral pharyngeal recess (fossa of Rosenmueller) is an airfilled space which projects posterior to the torus tubamius and muscular prominence of the levaton palatini

muscle. Lymphoid tissue lines the musculam sling of the nasopharynx and is most prominent along the roof of the nasopharynx. The signal of lymphoid tissue is always more intense than that of muscle (Fig. la, ib). This bright strip of lymphoid tissue lines the roof and walls of the nasopharynx, often filling the fossae of Rosen-

Volume

164

Number

Radiology

#{149} 813

mueller.
airway,

sue ing
ages from

On axial images of the lower hypentrophied lymphoid tismay have a lobulated on undulatsurface contour. On coronal imit will appear to hang down

it forms boundaries
space.

the

medial of the

and lateral parapharyngeal

space ap-

chian
directly cerum laterally.

tubes

to the

base

of the skull

The

paraphanyngeal

pears as a loose network na! fibrofatty tissue and

symmetric. Within the

of high-sigis always
parapharyn-

between the fonamen Iamedially and foramen ovale This relationship is best ap-

(Fig. mally
never planes

the roof 2c). The located obliterate

surrounding

of the nasopharynx lymphoid tissue

tonsil (adenoids)

pmeciated on axial images (Fig. ic). The foramen lacerum and foramen
ovale make up a pathway into the

of the
is nor-

pharyngeal

submucosally the deeper

the

and will tissue tissue are muscles

geal space small branches of the external carotid artery, pharyngeal veins, and mandibular nerve are seen as round or linear, mediumto lowintensity structures.

cranium
munication

since
with

they
the

are in direct
cavernous

comsinus.

The

eustachian

tube

travels

from

nasopharynx.

the

Deep to the lymphoid palatal and phanyngeal

la, 2d, 2e, 2f).

(6) (Figs.

The

levator

veli palatini muscle, some of whose fibers anise from the short limb of the cartilaginous eustachian tube, oniginates from the quadmate area of the petrous bone. The tensor ve!i palatini muscle originates from the scaphoid fossa of the sphenoid bone antemolateral to the levatom veli palatini muscle. The levator veli palatini muscle and the cartilaginous portion of the eustachian tube pass directly to the soft palate through an aperture in the
pharyngobasilar nus of Mongagni fascia called the si(6). The tensor veli

infratemponal fossa paranasopharyngea! bounded anteriorly by the wall of the maxillary antrum enally by the deep head of
to the poralis muscle and the

The

lies lateral space. It is posterior and latthe tem-

the skull base to the nasopharynx as a slowly curving, invented S. Because of its S-shaped course, only small segments of it are seen on axial on

coronal images. cm long, tapers

nor wall of the

The bony part, over down from the antemiddle ear to its on-

zygomatic

arch. The medial and lateral pterygoid muscles fill the bulk of the infratemponal fossa. Superiorly, numerous

fice, which is known as the isthmus. The cartilaginous portion, over 2 cm

long, mus joins the bony part and fits into a sulcus at the isthon the skull

foramina

perforate

the

base

of

the sphenoid bone. The largest of the fonamina, the fonamen ovale, is noutine!y of the visible as a defect in the cortex

ated The

sphenoid bone and is appmecibest on coronal images (Fig. 2d). orifice of the fonamen ovale is
by fat, within which can

base, the sphenoid sulcus (sulcus tubae auditivae) between the greater wing of the sphenoid bone and the apex of the petrous portion of the temporal bone (Figs. ic, le, 3a). The
cartilaginous portion first arches

surrounded

palatini directly
ulus

muscle reaches the by hooking around

of the medial pterygoid

palate inthe hamplate.

be seen the mandibular branch tngeminal nerve. Postemolateral the fomamen ovale, the foramen
osum provides a pathway for the

of the to spin-

These

muscles

are routinely

visible

as

bands of intermediate signal intensity flanking the airway. At the level of the hand palate, the superior constnictor muscle and Passavant muscle mainly bound the nasopharynx posterolaterally. On axial images, these muscles appear as a band of intenmediate intensity surrounding the later-

meningeal artery. Numerous smaller foramina connect small branches of the mandibular segment of the maxil!ary artery and pterygoid plexus of
veins and are infrequently and seen on

downward and forward across the parapharyngeal space. Before the pharyngeal orifice, it makes another slight curve downward and forward. Only the anterior portion of the cantilage turns infeniorly from this
plane. Here the torus tubanius a small margin rests depresof the against and sion on the fits into posterior

media!

pterygoid

plate.

MR images.
Pharyngobasilar fascia tube.-The configuration pharynx is determined eustachian

of the
by the

nasovery

al and posterior walls of the airway. Other muscles that contribute to the signal intensity in this region indude the tensor veli palatini, levator veli palatini, salpingopharyngeus, and palatopharyngeus.
Parapharyngeal poral fossa.-The space lies latenial space and infratempanapharyngeal

Pterygopalatine fossa.-The pterygopalatine fossa is a medial depression of the pterygomaxillary fissure which lies between the pterygoid process

tough pharyngobasilar fascia which attaches to the base of the skull from the posterior margin of the medial pterygoid plate to the petrous part of the temporal bone immediately in front of the carotid fomamina (Figs. 1,
3). Its fibers are continuous with that of the foramen lacerum (7) (Fig. lb. ld). On axial and coronal images, the pharyngobasi!ar fascia is seen as a

and
sagittal

the

maxillary
images

sinus.
it appears

On

axial

and

as a flat

to the palatal musdes and extends from the base of the skull to the oropharynx (Figs. la, lb. 2d, 2f, 3a). Its boundaries are defined
by the buccopharyngeal fascia. The

space filled with high-signal fat (Figs. lc, 2a). The sphenopalatine fonamen is located at the medial margin of the signal-void perpendicular plate of the palatine bone. The pterygopalatine fossa connects with the
nasal fossa through this aperture.

medial

fascia or phanyngeal

part is the

of the buccopharyngeal epimysium of the supeniconstrictor muscle.

The

lateral

boundary
fascia

of the
is a reflection

buccoof

low-intensity line extending from the medial ptenygoid plate to the carotid foramen, medial to the tensor pa!atini muscle. From the carotid foramina, the fascia reflects medially over the longus coli and rectus capitus muscles. The fascia thus forms entirely closed and very resistant an fi-

The pterygopalatine communication

bital fissure

with laterally.

fossa is in free the inferior orand the infraor

superiorly

temporal

fossa

The

foramen

rotundum, which ring of negligible

appears signal,

as a line lies within

the
bone

greater
anterior

wing

of the
point

sphenoid
where

pharyngeal

to the

the deep cervical fascia, which covers the deep surface of the panotid gland and pterygoid muscles. These layers are sparse and loosely applied to their respective muscles of origin to accommodate the tremendous movement of the pharynx that occurs duning swallowing. The buccopharyngeal fascia is not visible on computed tomography scans or MR images, but 814
#{149}

brotic chamber that is continuous with the fibrous tissue occupying the foramen lacerum. The only aperture
is the sinus of Morgagni, sage of the eustachian of the levator palatini for the pas-

the
into the

skull

base

the

tube and fibers muscle. Near fascia is divided

for eusta-

a gutter that is responsible strong attachment of the

the medial pterygoid plate joins the basisphenoid bone (Fig. lc). From here, the second division of the tngeminal nerve passes through the upper pterygomaxi!lary fossa forming the sphenopa!atine ganglion as it courses toward the inferior orbital fissure and infraorbita! groove and canal. These nerves appear as small, round soft-tissue structures inconsisSeptember 1987

Radiology

round rounded

low-intensity structures by high-intensity fat,

sunthe in-

dividual

branches

are rarely
clivus up the

seen.

Skull base.-The noid bone make

and basispheposterior wall

and

roof

of the

nasopharynx.

Their

cortical are seen

margins show only by virtue

no signal and of the conrelaand

trast with interfacing higher-signal soft tissues (Fig. 2). The intimate tionship of the mucosa, muscles,

fat lining

the

clivus

and

floor

of the

sphenoid sinus is seen best on cononal images. Fatty marrow within the clivus and sphenoid bone gives a characteristic high signal. goid (vidian) canal can be in the basisphenoid bone signal, rounded (coronal The pteryseen withas a lowimages) on high-signal

linear
structure

(axial (Figs.

and

sagittal
by

images)

surrounded

marrow

ic, 2c). Sympathetic

and parasympathetic nerves that course with the internal carotid antery are transmitted through the pterygoid canal with the pterygoid artery to the pterygopalatine and nasal fossae. The fomamen lacerum forms a gap

between
tnous bone ality rotid cartilage apex (upper filled artery

the
and

anterior

tip of the

pe-

tube

the basisphenoid clivus). This gap is in mewith cartilage, and the cadoes not go through the lies just above the carti-

but

lage
poloti

as it leaves

the

carotid

canal

to

enter (Fig.

the posterior cavernous 2f). The cartilaginous

sinus base of the

foramen lacenum has virtually no signal, and only a thin strip of fibrofatty tissue separates it from the signalvoid men
.

Cortuloginous end of eustochion tube Styloid process nt jugular

v mt

carotid lacemum

artery. and channels,

Above the foralateral to the clivus

15

the

cavernous and crania!

sinus.
the carotid an-

Vascular

tery,
ennous tently
corotido Longus and rectus capitus mm

nerves

of the

cayconsis2d).

sinus can be on MR images

resolved (1) (Fig.

Coronal
high nerves emnous

images
signal that transmitted sinus. The

show

small

foci

of

correspond through abducens

to cranial the caynerve

Figure

3. (a) Photograph of normal the insertion of the pharyngobasilar

nasopharynx. Right half of the

skull base showing fascia (broken line). diagram is at a level about

half. The pharyngobasilar fascia (heavy black line) cartilaginous end of the eustachian tube and levator palatini muscle. fascia (dotted lines) outlines the limits of the prestyloid parapharyngeal
retropharyngeal space (dashed line) lies between the pharyngobasilar

bone landmarks and foramina and (b) Composite axial diagram of the 1 cm more cephalad than the left surrounds the airway and encloses the

The buccopharyngeal space. The potential

fascia and the prever-

(VI) passes through the areolan cavity of the cavernous sinus, and the oculomotor nerve (III) and trochlear nerve (IV) are found in its lateral wall. The optic nerve (II) lies medial
to the cavernous within sinus. Meckel The tnigemi-

tebral ramen plate,

musculature. CC = carotid canal, FL foramen lacerum, spinosum, JF jugular foramen, lpp lateral pterygoid pbf = pharyngobasilar fascia, Pc pterygoid canal, pvc sphenopalatine foramen, ST sulcus tubae auditivae.

FO foramen ovale, fS foplate, mp medial pterygoid pterygo-vaginal canal, Sf

nal

nerve

(V) ganglion

and

its
and

branches,

cavity

the cavernous on good-quality an intermediate

sinus, are easily seen MR images and have signal.

tently seen on MR images. Within the pterygopalatine fossa, the pterygopalatine segment of the maxillary artery makes a characteristic loop and Volume 164 Number 3

gives offbranches to the middle crama! and infratempomal fossae, orbit, nose, palate, and pharynx. Although segments of the artery are seen as

CONCLUSION The related skull base, nasopharynx, spaces are crossover and be#{149}

areas

Radiology

815

tween the intraand extracranial structures of the head and neck. Their anatomy is detailed and presents a formidable task in MR imaging (8-12). Herein we have analyzed the normal MR anatomy of the nasopharynx and floor of the middle cranial fossa by correlating MR images from healthy volunteers with wholeorgan cryomicmotome sections from cadavers. Anatomic structures connecting the nasopharynx and related spaces with the middle cranial fossa have been emphasized. The intimate relationship of the phamyngobasilan fascia and eustachian tube to the skull base has been described in detail. The inherent contrast between the soft tissue of the nasophamynx and related spaces and the bone of the floor of the middle cranial fossa allows excellent visualization of the numerous fomamina and fissures of

the skull base connecting the intracranial and extracranial compartments. Coronal and axial images are most useful in making side-to-side comparisons of relevant structunes. U References
1. Daniels imaging
1985; 2. Daniels

7.

Del Regato respiratory

tract. In:

JA, Spjut HJ. Cancer of the system and upper digestive

Ackerman and Delregatos can-

cer: diagnosis, treatment, St. Louis: Mosby, 1977;

8. Silver JA, Mawad ME,

and prognosis. 224-410.

Hilal 5K, et a!.

9. DL, Pech P. Mark of the cavernous

6:187-192. DL, Pech P. Pojunas KW, et al. 10.

L, et al. MR sinus. AJNR

Trigeminal nerve: with MR imaging.

159:577-583. 3. Daniels DL, Herfkins

anatomic Radiology

correlation 1986;
PR, et al. 11.

Computed tomography of the nasopharynx and related spaces. I. Anatomy. Radiology 1983; 147:725-731. Dillon WP, Mills CM, Kjos B, Degroot J, Brant-Zawadzki M. Magnetic resonance imaging of the nasopharynx. Radiology 1984; 152:731-738. Mancuso AA, Bohman L, Hanafee W, Maxwell D. Computed tomography of the nasopharynx: normal and variants of normal. Radiology 1980; 137:113-121.
Mancuso AA, Hanafee WN. Nasophar-

R, Koehler

Magnetic resonance nal auditory canal.

151:105-108.

imaging Radiology

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inter-

4.

Han JS, Huss RG, Benson JE, et al. imaging of the skull base. J Comput Tomogr 1984; 8:944-952.
Rauschning W, Bergstrom K, Pech

MR Assist
12. P.

5.

Correlative craniospinal anatomy studies by computed tomography and cryomicrotomy. J Comput Assist Tomogr 1983; 7:913.

ynx and parapharyngeal space. In: Computed tomography and magnetic resonance imaging of the head and neck. Baltimore: Williams & Wilkins, 1985; 428443. Doubleday LC, Bao-Shan J, Wallace S. Computed tomography of the infratemporal fossa. Radiology 1981; 138:619-624.

6.

Last RJ. Anatomy: 6th ed. New York:

1978.

regional Churchill

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816

#{149}

Radiology

September

1987