Facial lymph nodes: normal and abnormal CT appearance.

Facial lymph node involvement by neoplastic disease is an unusual occurrence. The purpose of this study was to determine the normal and abnormal radiologic appearance of the facial nodes. Two hundred enhanced computed tomographic (CT) studies of patients not at risk for facial node metastasis were studied prospectively to establish a normal control group. One hundred consecutive patients with extensive recurrent or primary cancer of the epidermal structures of the face, the sinonasal region or deep face, or the mucosal surface of the oral cavity were examined prospectively to establish a prevalence for metastatic facial adenopathy. In addition, all cases of facial node metastases seen on imaging studies over an 11-year period (n = 21) were examined retrospectively to establish the spectrum of facial lymphadenopathy. Normal nodes could not be confidently identified on CT studies. When nodal metastasis occurred, it was often in the setting of recurrent disease. The infraorbital nodes tended to be the site of origin for lymphomas isolated to the canine fossa.