Biopsy of Head and Neck Lesions

Although deep-seated head and neck lesions have traditionally been evaluated by surgical means, less invasive image-guided percutaneous biopsy techniques are now available. Nevertheless, major blood vessels, the trachea, and osseous structures such as the maxilla, mandible, and vertebrae often preclude direct access to these lesions. In the present chapter, we will review the various approaches used for image-guided percutaneous biopsies of head and neck lesions and discuss the anatomic considerations, technical aspects, advantages, and limitations of each approach. For biopsies of suprahyoid head and neck lesions, including those of the skull base and upper cervical vertebrae, various approaches such as the subzygomatic, retromandibular, paramaxillary, submastoid, transoral, and posterior approaches can be used. Lesions in the infrahyoid portion of the neck and lower cervical vertebrae can be accessed by the anterolateral (between the airways and the carotid sheath), posterolateral (posterior to the carotid sheath), and direct posterior approaches. The location and extent of the lesions and their relationships to adjacent structures influence the choice of the needle trajectory to use. Familiarity with head and neck anatomy and careful planning of the procedure are necessary to ensure that a biopsy is both precise and safe.