Palatal adenoid cystic carcinoma presenting as perineural spread to the cavernous sinus

Adenoid cystic carcinoma of the hard or soft palate is a slow-growing, insidious disease with a tendency to spread via a perineural mechanism along the palatine branches of the maxillary division of the trigeminal nerve. Such spread may present first as a tumor in the pterygopalatine fossa or cavernous sinus. The purpose of this manuscript is to report three cases of palatal adenoid cystic carcinoma which presented as a mass in the cavernous sinus prior to discovery of the palate primary tumor. The imaging features of these cases are emphasized as is the need to search for a head and neck primary lesion when faced with a cavernous sinus mass.