Current Case:

A 62-year-old man with a suspected recurrent lesion around the pterygoid plates on MRI and PET/CT came for a biopsy.

The patient was referred for a CT guided biopsy which was done using a paramaxillary approach.

The video discusses

  1. The case
  2. The diagnosis
  3. The paramaxillary approach referencing a recent AJNR article on this subject.

Video

Region: Head & Neck
Age: 62 years
Findings: Mass along posterior wall of maxillary sinus and peri-pterygoid region
Lesion Biopsied: Same
Size of Lesion: Not relevant
Gun: 18G Cook, 10 mm throw, short
No of cores: 8 for histopath in 4 vials
Sedation: No
Position & Approach: Supine, head mildly turned to left, paramaxillary
Time Taken (marker to wash-out): 8 mins
Complication: None
Level of Difficulty: 3/5
Diagnosis: Squamous cell carcinoma recurrence

Other Cases Using the Paramaxillary Approach

(From superficial to deep)

Case 149: Upper Buccal Space Biopsy with a Paramaxillary Approach
Suprahyoid head neck biopsies are usually simple, if the anatomy is understood well. Buccal space lesion biopsies are even simpler.
CT Guided BiopsyBhavin Jankharia
Case 24: Oropharyngeal / Parapharyngeal Mass Biopsy
68-years old with a left parapharyngeal- oropharyngeal mass. The CT guided biopsy was simple. The video explains safe routes and discusses two papers.
CT Guided BiopsyBhavin Jankharia
Case 123: Nasopharyngeal Mass Biopsy
CT-guided nasopharyngeal mass biopsies are usually simple and straightforward if you are aware of the anatomy.
CT Guided BiopsyBhavin Jankharia
Case 181 - Transbuccal, Paramaxillary Approach for a Carotid Space Mass using the Styloid Process a Fixed Point
A safe path can usually be found for head & neck lesion biopsies under CT guidance, if you understand the anatomy well.
CT Guided BiopsyBhavin Jankharia
Case 78: Lateral Pharyngeal / Retropharyngeal Lesion Biopsy with a Paramaxillary Approach
Lateral Pharyngeal / Retropharyngeal Lesion Biopsy with a Paramaxillary Approach
CT Guided BiopsyBhavin Jankharia
Live Session - Discussion of Jan 2026 Cases
In this live session, I discussed 6 cases showing how I did the biopsies and answered questions from the attendees
CT Guided BiopsyBhavin Jankharia
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Index and Table of Contents

175 Cases with Videos
10 Cases with Images (With or Without Short Videos)
2 Snippets
5 Lectures
4 Cases of the Day (CODs)

Table of Contents
Table of Contents
CT Guided BiopsyBhavin Jankharia

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CT Guided BiopsyBhavin Jankharia

Previous Posts:

Case 183 - Gantry Angulation to Access a Segment 8 Liver Lesion Using Biliary Radicles as Fixed Points
CT with angulation can help with segment 8 liver lesions
CT Guided BiopsyBhavin Jankharia

Other Sites and Cases:

Case of the Day on YouTube