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The Cervicocranium: Its Radiographic Assessment¹

¹ From the Department of Radiology, University of Texas Medical School, 6431 Fannin, MSB 2.100, Houston, TX 77030. Received October 26, 1999; revision requested December 7; revision received December 20; accepted February 1, 2000. Address correspondence to the author (e-mail: john.h.harris@uth.tmc.edu).

Acute injuries of the cervicocranium (from the occiput to the second cervical intervertebral disk) may be radiographically obscure due to minimal displacement of fracture fragments, minor alterations of normal anatomic relationships (occipitoatlantal subluxation), or superimposition of normal skeletal structures. With the nasooropharynx adequately distended with air, the normal cervicocranial prevertebral soft-tissue contour is congruent with the anterior cortical margin of the cervicocranium; namely, concave above, convex anterior to, and concave below the anterior tubercle of C1. Alterations of the normal cervicocranial prevertebral soft-tissue contour due to hemorrhage into the retropharyngeal fascial space from subtle fractures or ligamentous injuries should prompt further assessment of the cervicocranium by means of computed tomography (CT). Cervicocranial CT prompted by an abnormal cervicocranial prevertebral soft-tissue contour has yielded a 16% positive injury rate, approximately three times the rate of acute cervical spine injuries reported in the literature.

Index terms: Atlas and axis, fractures, 31.41 • Neck, CT, 31.1211, 127.1211 • Neck, fractures, 31.41, 127.41 • Neck, radiography, 31.11, 127.11 • Radiology and radiologists, How I Do It

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