Head and Neck Imaging, Fifth Ed., Vols. 1 & 2

Som PM, Curtin HD.  Head and Neck Imaging, Fifth Ed., Vols. 1 & 2.  Mosby Elsevier 2011, 3080 pages, $399.00.

Over past three decades head and neck radiology has evolved from a barely visible part of diagnostic radiology to a critical element of neuroradiology. There have been many who have helped forged this field, but none have been more important in this regard than Drs. Som and Curtin. Prominent in their many contributions has been the prior editions of the textbooks Head and Neck Imaging, edited and written in large part by them. Now the Fifth Edition (two volumes) of this standard in radiology is available; the growth of head and neck radiology is mirrored by the increased size of this book, now 3080 pages and nearly 600 pages longer than the Fourth Edition published in 2003). With contributions from 78 other authors, including experts in the fields of pathology, ENT surgery, plastic surgery, radiation oncology, ophthalmology, speech therapy, anatomy, and hematology/oncology, many new and innovative areas are apparent.

The material is divided into 8 separate sections: midface and sinonasal cavities; orbits and visual pathways; central skull base; temporal bone; jaws and TMJs; upper aerodigestive tract; neck; molecular imaging; and image based interventions. The joy of this 2-volume set is that it is thorough in all areas, and one comes away not only with an appreciation of the imaging but also with a deep understanding of the underlying anatomy, embryology, pathophysiology, and treatment options. Let us take the orbits and visual pathways as an example. This 400-page section (as with all other sections) could stand alone as its own textbook. When compared to the Fourth Edition, it not only is 60 pages longer but it contains drawings and illustrations which are in color, making features (particularly the embryology) more vivid. In a major coup for the book there are drawings from Netter and other textbooks, (such as Sobotta’s atlas and Gray’s anatomy) throughout the entire text in all sections. The result is a solid foundation for the high-quality imaging which follows. Extra material is present on important clinical aspects such as ocular movement, autonomic/sensory innervations, retinal function, among others. Tables clearly list critical differential diagnoses such as intraconal lesions, muscle enlargement, calcification, and extra conal lesions. A separate 16-page orbital atlas of CTs and MRs with multiple sequence contains high-quality images that serve as a reference for abnormalities which follow. Images in the chapter on pathology of the eye and orbit are in places of older vintage because, undoubtedly, it is difficult to readily secure new images of very unusual-to-rare lesions. Even with that there has been an upgrading of MRs and CTs in a number of areas. Useful tables abound such as orbital tumors according to age groups, and different and various types of cysts, among others. Valuable also is the section on orbital implants since not infrequently findings in these circumstances are confusing, and, as just one example, there is shown an implantable aqueous shunt.

Magnificent chapters on the paranasal sinuses and mid-face region, along with congenital deformities in these areas, comprise nearly 525 pages. Pathology, patient pictures, diagrams showing surgical approaches along with quality CT/MR images make for a comprehensive review of this entire subject. We read in-depth about FESS and its complications.

Temporal bone anatomy and imaging is often a stumbling block for radiologists. This nearly 400-page section (again worthy of a textbook in its own right) details the anatomy, high resolution CT, cryomictotomes, and all tumors/trauma/infections/malformations. A 4-page Table describes the syndromic conditions associated with congenital abnormalities of the ear (only a savant could put all of this to memory). Diagrams here and throughout the book facilitate learning. This section, like other sections, is not (I don’t think) meant to be read through from beginning to end; rather, these sections serve as resources for review, or to look up findings in certain entities, or to discover why things look the way they do.

Few take pleasure in dental imaging, but these areas are on the film, so having an encyclopedic description at hand of the anatomy, image interpretation, and abnormalities in this area is a good resource. This section encompasses the jaw and TMJ and provides a solid understanding not only of derangements but also the surgical approach/implantations for these abnormalities.

The 704-page section on the neck is all encompassing. A particularly brilliant chapter is on lymph nodes of the neck. Here we are treated to all aspects of this subject from basic structure to function (with outstanding color diagrams), to the clinical importance of lymph node imaging, to staging classifications, to level-based nodal classification. This information is vital, and key diagrams should be copied and placed in a prominent place in neuro reading stations. The basic science in this chapter offers a needed summary for understanding all aspects of lymph node anatomy, physiology, pathology, and imaging.

The other sections of the book follow the same high quality as the sections alluded to above. With newer and crisper fonts and with a layout with far more color and an appropriate division of material, the reading is easier than in prior editions; however, the overriding point is that one gains an in-depth understanding of each area and the diseases described therein.

Words can’t adequately express the tremendous value of this new set of books or their comprehensive nature. No neuroradiologist should be without a personal copy. It is recommended in the highest possible terms.

Head and Neck Imaging, Fifth Ed., Vols. 1 & 2