CT and MR imaging of the buccal space and buccal space masses

The authors describe the normal variations in the buccal space and present the range of buccal space pathologic conditions seen on computed tomographic (CT) and magnetic resonance (MR) images. In a series of 50 patients studied with CT and 30 with MR imaging, the visualization and measurement of the normal facial expression and buccinator muscles, parotidomasseteric fascia, parotid duct, accessory parotid tissue, and facial neurovascular bundle were statistically equivalent. The size of the buccal fat pad was statistically the same from side to side within a given patient. Normal lymph nodes were rarely discernible from the facial neurovascular bundles. In a series of 26 patients with unsuspected buccal space masses, salivary gland tumors were the most common masses. Less frequently, benign lesions (eg, hemangioma and dilated parotid ducts) and soft-tissue malignancies (eg, sarcoma) manifested as buccal space masses. Occasionally, a cheek mass of uncertain cause proved to be lymphadenopathy; however, adenopathy is more commonly associated with clinically evident, deeply infiltrating facial neoplasms. Knowledge of the anatomic variations and expected abnormalities of the buccal space is useful for the radiologist interpreting facial CT or MR images.