3. The buccal space is a deep facial space
lying adjacent to the maxillary alveolar
ridge.
It has been previously defined in anatomic
studies performed to delineate the spread
patterns of facial infections. Although the
buccal space has received limited
attention in the radiology literature,
knowledge of the anatomic variations and
expected pathologic entities is useful
information for the radiologist interpreting
facial computed tomographic (CT) or
magnetic resonance (MR) images.
4. Three-dimensional depiction of the buccal
spaces. The right buccal space is red and
projected on the skeleton of the face. The left
buccal space is transparent pink to demonstrate
the course of the parotid duct, which appears
brown to green.
6. The buccal space’s anatomical boundaries
are the buccinator muscle medially, the
superficial layer of the deep cervical fascia
and the muscles of facial expression
laterally and anteriorly. The masseter
muscle, mandible, and lateral and medial
pterygoid muscles outline the posterior
margin of the buccal space from lateral to
medial The posterior border of the buccal
space ends at the parotid gland.
The lack of boundaries superiorly,
inferiorly, and posteriorly demarcates the
important pathways for the spread of
infections to and from the buccal space.
7. Contents of the buccal space:
The main duct of the parotid gland
(Stenson’s duct) courses in a transverse
fashion through the buccal fat pad, and it
pierces the buccinator muscle opposite
the second maxillary molar. This parotid
duct separates the buccal space into two
equal-sized
anterior
and
posterior
compartments.
8. The other contents include the minor
salivary glands, accessory parotid
lobules, facial, and buccal arteries,
facial vein, lymphatic channels and
the branches of the facial and
mandibular nerves.
9. Normal anatomy of the upper buccal space,
contrast material-enhanced CT scan (a) and
unenhanced T1-weighted MR image (b)
10. Normal anatomy of the middle buccal space
depicted by a contrast-enhanced CT scan (a)
and unenhanced T1-weighted MR image (b).
11. Normal anatomy of the lower buccal space depicted
by a contrast-enhanced CT scan (a) and unenhanced
T1-weighted MR image (b).
12. Normal anatomy of the buccal space depicted at different levels
in the coronal plane by unenhanced T1-weighted MR images
13. Normal anatomy of the buccal space depicted at different levels
in the sagittal plane by unenhanced T1-weighted MR. (a)
Sagittal view through the face at the level of the lateral orbit. (b)
Sagittal view through the face at the level of the medial orbit
15. A variety of diseases are known to
occur within the buccal space,
including:
Developmental lesions,
Infection and inflammation,
Neoplastic lesions
And other miscellaneous conditions.
16. Accessory parotid tissue, congenital
fistula of the parotid duct, dermoid
cyst and vascular lesions such as
hemangioma
and
vascular
malformation
are
common
developmental lesions found in
this location.
18. Infected
dermoid
cyst
Coronal enhanced
T1-weighted
MR
image shows the
cystic mass (thin
arrow) in the left
buccal space. The
mass has an irregular
margin and it has
infiltrated into the
surrounding
buccal
fat pad. Note the
thickening
of
the
superficial muscles of
facial expression and
the investing fascia
19. Hemangioma.
Axial T2-weighted
MR image shows
an irregular mass
(arrows)
having
high
signal
intensity involving
the buccal space
and the masticator
space.
20. Hemangioma in a patient with a buccal mass that
enlarged when the patient bent forward. Axial T1weighted (a) and coronal T2-weighted (b) images reveal
an inhomogeneous mass in the posterior part of the
buccal space that extended superiorly (arrowhead in b)
and medially The mass is isointense relative to the
masseter muscle with T1 W and hyperintense in T2 W.
These findings are typical for a hemangioma,
21. Venous malformation: A. transverse T2-weighted MR image
shows a high signal intensity mass lesion occupying the buccal
space and the masticator space. with multiple phleboliths (arrows)
having low signal intensity.
B. The lateral radiograph obtained after the percutaneous injection of
an ethanolamine oleate and iodized oil mixture shows the
radiopaque cast fillingthe vascular space of the lesion. With multiple
laminated phleboliths (arrows).
22. Arteriovenous malformation : A. transverse T2weighted MR image shows the intermediate signal
intensity mass lesion (arrows) with multiple signal voids
(arrowheads) in the right buccal space.
B. A MR angiography shows the tortuous and dilated
facial artery and the internal maxillary artery.
24. Infections and Inflammation
Abscess: Enhanced
axial CT scan shows a
multiloculated low density
area (thick arrows) with
peripheral
rim
enhancement in the left
buccal space, parotid
space
and
parapharyngeal space.
There are multiple right
periapical
abscesses
confined by the right
buccinator (thin arrow).
25. The most common tumor of the
buccal space are:
Minor salivary gland tumors such as
pleomorphic adenoma, adenoid cystic
carcinoma, acinic cell carcinoma and
mucoepidermoid carcinoma.
The other tumors are those originating
from muscular, neural, connective and
lymphatic tissues, and these include
rhabdomyoma,
rhabdomyosarcoma,
neurofibroma,
schwannoma,
lipoma,
liposarcoma, lymphoma, and metastatic
lymphadenopathy.
26. Benign Neoplastic Lesions: Minor
salivary gland tumor
Pleomorphic adenoma: A. Axial T2-weighted MR
image shows a round, well-defined mass with bright
signal intensity in the right buccal space.
B. Axial T1-weighted MR image shows a round mass
with low signal intensity in the right buccal space.
C. An enhanced Axial T1-weighted MR image shows
homogeneous enhancement of the lesion.
27. Monomorphic
adenoma:
Contrast-enhanced
CT scan shows a
well-circumscribed
mass
with
rim
enhancement and
excellent demarcation
of the submucosal fat
pad
dotted
lines)
between the buccal
mucosa (arrows) and
the
buccinator
muscles
(arrowheads),
indicating that this
was not a buccal
mucosal
or
submucosal mass
29. Solitary Fibrous Tumor: A, Axial T1-weighed MR
image shows a well-marginated mass that is isointense
to the muscle in the right posterior buccal space. The
mass displaces the parotid duct and the facial vein
anteriorly and compresses the masseter muscle
posteriorly.
B, Axial T2-weighted MR image shows that the mass
has mainly high signal intensity, with linear signal
isointensity in the medial peripheral portion.
30. C and D, Axial ( C) and coronal ( D) contrast- enhanced
T1-weighted MR images reveal homogeneously strong
enhancement of the mass, with the less enhanced
portion in the medial peripheral portion which represent
the hypocellular collagenous sclerotic area found at
pathologic correlation.
31. Malignant Neoplastic lesions
Minor salivary gland tumor
Adenoid cystic carcinoma: A. Axial T2-weighted MR image shows a
small round mass (arrows) with central bright signal intensity and ill-defined
infiltration of high signal intensity into the right buccinator muscle.
B. An enhanced transverse T1-weighted MR image shows peripheral
enhancement of the mass. With ill-defined infiltration into the right
buccinator muscle (arrowheads) with significant enhancement.
32. Carcinoma ex pleomorphic adenoma: A. Axial
T2-weighted MR image shows a round mass of
bright signal intensity and small, low signal
intensity spots in the left buccal space
B. An enhanced axial T1-weighted MR image
shows the mildly enhancing foci (arrow).
33. CT scan, after an
injection of iodinated
contrast material into the
parotid duct shows the
opacifled right parotid
duct.
The
duct
is
displaced posteriorly by
the
homogeneously
enhancing, well-defined
mass. The mass proved
to be an adenoid
cystic carcinoma at
surgery.
34. CT scan with
contrast shows
a
submucosal
mass in the
posterior buccal
space infiltrating
the
pterygoid
muscle
At
surgery,
an
adenoid cystic
carcinoma was
removed.
35. Aggressive
mucoepidermoid
carcinoma:
CT scan with contrast
shows a mass in the
right posterior buccal
space with a lowattenuation
center
suggestive of necrosis
and infiltrating margins
with mandibular cortical
remodeling. The bone
remodeling
suggests
the characteristic slow
growth of most minor
salivary gland tumors.
Also their is infiltration
of the masseter muscle.
36. Mesenchymal tumors
(Rhabdomyosarcomas)
A. Axial T2-weighted MR image shows a round, well-demarcated
mass of high signal intensity in the right buccal space.
B. An enhanced coronal T1-weighted MR image shows the
heterogeneous enhancement of the lesion.
38. Lymphoma
A transverse CT
scan shows a
homogeneous
solid mass in the
left buccal space.
With lack of mass
effect on the left
masseter muscle
39. Peripheral T-cell lymphoma A. Axial CT scan
shows the ill-defined infiltrative lesions in both
buccal space and the subcutaneous layer on the
right cheek with overlying skin thickening
B. Axial T1-weighted MR image shows the illdefined infiltrative lesions in the same area
41. Extranodal lymphoma of the huccal space in a patient
who presented with bilateral cheek enlargement. Tiweighted (a) and T2-weighted (b) images show bilateral
homogeneous masses (arrows) along the course of the
parotid ducts. With isointense signal relative to the
surrounding musculature in T1 WI and slightly increased
signal intensity relative to the subcutaneous fat in T2 WI.
45. Contrast enhanced
CT scan shows a
left buccal space
mass.
Due
to
enlargement
of
the
masseter
muscle
as
a
result of myositis
46. Idiopathic parotid duct ectasia in a patient who
presented with persistent, painless, bilateral cheek
enlargement. Contrast-enhanced CT scans obtained
at two different levels reveal dilated parotid ducts
bilaterally
47. Foreign
body
granuloma in a 49year-old woman with
a history of paraffin
injection into both
cheeks 20 years ago.
A
transverse
enhanced CT scan
shows the ill-defined
infiltration and several
small
calcifications
around the bilateral
buccal spaces.
48. Kimura disease in a 14-year-old boy. A. transverse T2weighted MR image shows an infiltrative mass-like lesion
(arrow) having high signal intensity in the left buccal
space.
B. transverse enhanced T1-weighted MR image shows
moderate enhancement of the lesion.
