Computed tomography evaluation of alterations in the masticator space due to invasion by malignant head and neck neoplasms

Campinhos, Mariana Luiza Bittencourt; Curioni, Otavio Alberto; Soares, Aldemir Humberto; Marcucci, Marcelo

doi:10.1590/0100-3984.2023.0024-en

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Original Article • Radiol Bras 56 (5) • Sep-Oct 2023 • https://doi.org/10.1590/0100-3984.2023.0024-en copy

Computed tomography evaluation of alterations in the masticator space due to invasion by malignant head and neck neoplasms

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To evaluate alterations in the masticator space due to the dissemination of malignant neoplasms originating from the tonsillar fossa, retromolar trigone, maxillary sinus, or nasopharynx, using computed tomography (CT), as well as to correlate the presence of trismus with the CT findings and the dimensions of the tumor.

Materials and Methods:

We evaluated the medical records of 65 patients with malignant tumors in the regions described. The images were analyzed by two physician examiners, working independently, who were blinded to the clinical data. In the evaluation of the masticator space, the following parameters were considered: symmetry with the contralateral space; obliteration of the fat plane, retromolar trigone, or pharyngeal space; edema/atrophy of the medial or lateral pterygoid muscles; and destruction of the mandibular ramus.

Results:

Obliteration of the fat plane was found in 69.2% of the patients. Asymmetry, edema/atrophy, and bone destruction were detected in 27.7%, 26.2%, and 20.0% of the patients, respectively. Trismus was identified in 15.4% of the patients. Of the patients with trismus, 90.0% had stage T4 tumors, compared with only 43.8% of those without trismus. Trismus was 11.6 times more common among the patients with stage T4 tumors than among those with lower-stage tumors. Neoplasms of the tonsillar fossa and retromolar trigone collectively accounted for 95.0% of the cases. The CT scans showed edema/atrophy of the pterygoid muscles in 60.0% of the patients with trismus and in 21.8% of those without. An association was observed between T4 tumor stage and edema/atrophy of the pterygoid muscles. In addition, the risk of trismus was 5.4 times higher among the patients with stage T4 tumors.

Conclusion:

In our patient sample, the most common finding was obliteration of the fat plane, followed by asymmetry and edema/atrophy. Most of the patients with T4 tumors had trismus, together with edema/atrophy of the pterygoid muscles.

Keywords:
Tomography; X-ray computed, Neoplasms; Masticatory muscles; Neoplasms; Trismus

Finding	K	P	Interobserver agreement
Asymmetry in relation to the contralateral masticator space	0.146	0.224	Weak
Obliteration of the fat plane	0.457	0.003	Moderate
Edema/atrophy of the pterygoid muscles	0.279	0.024	Fair
Destruction of the mandibular ramus	0.918	< 0.001	Almost perfect

Finding	Trismus		Total n (%)	Relative risk	Odds ratio (95% CI)	P ^* * Fisher’s exact test.
Finding	Yes n (%)	No n (%)	Total n (%)	Relative risk	Odds ratio (95% CI)	P ^* * Fisher’s exact test.
Asymmetry in relation to the contralateral masticator space Yes	10 (100.0) 5 (50.0)	55 (100.0) 12 (21.8)	65 (100.0) 17 (26.2)	0.42	3.58 (0.89-14.46)	0.111
No	5 (50,0)	43 (78.2)	48 (73.8)	0.12	1.00	0.111
Obliteration of the fat plane Yes	10 (100.0) 8 (80.0)	55 (100.0) 37 (67.3)	65 (100.0) 45 (69.2)	0.22	1.95 (0.37-10.12)	0.711
No	2 (20.0)	18 (32.7)	20 (30.8)	0.11	1.00	0.711
Edema/atrophy of the pterygoid muscles Yes	10 (100.0) 6 (60.0)	55 (100.0) 12 (21.8)	65 (100.0) 18 (27.7)	0.50	5.38 (1.30-22.19)	0.022^† † Statistically significant.
No	4 (40.0)	43 (78.2)	47 (72.3)	0.09	1.00	0.022^† † Statistically significant.
Destruction of the mandíbular ramus Yes	10 (100.0) 4 (40.0)	55 (100.0) 9 (16.4)	65 (100.0) 13 (20.0)	0.44	3.41 (0.80-14.57)	0.103
No	6 (60.0)	46 (83.6)	52 (80.0)	0.13	1.00	0.103

Stage	Trismus		Total n (%)	Risk	Odds ratio (95% CI)	P ^* * Fisher’s exact test.
Stage	No n (%)	Yes n (%)	Total n (%)	Risk	Odds ratio (95% CI)	P ^* * Fisher’s exact test.
Any	48 (100.0)	10 (100.0)	58 (100.0)
T0-T3	27 (56.3)	1 (10.0)	28 (48.3)	0.04	1.00	0.012^† † Statistically significant.
T4	21 (43.8)	9 (90.0)	30 (51.7)	0.43	11.57 (1.36-98.67)

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[1] Correspondence: Dra. Mariana Luiza Bittencourt Campinhos. Rua Conde de Irajá, 184/241, Vila Mariana. São Paulo, SP, Brazil, 04119-905. Email: maricampinhos@gmail.com.