Deep Neck Spaces and Infections - Radioloksabha

Deep Neck Spaces and Infections - Radioloksabha

Deep Neck Spaces Anatomy and Infections Dr. SHWETA SHENDEY NECK SPACES The basis for dividing the neck into spaces and compartment is the arrangement of superficial and deep layers of cervical fascia Concept is used to formulate the differential diagnosis , determine the extent of disease and

facilitate the surgical and therapy planning, It is based on arrangement of 2 layers of cervical fascia in suprahyoid and infrahyoid neck Deep Neck Spaces Anatomy of the Cervical Fascia Anatomy of the Deep Neck Spaces Superficial Layer Deep Layer

Superficial Middle Deep Cervical Fascia Cervical Fascia Superficial Layer Platysma Muscles of Facial Expression

with subcutaneous fat, Veins nerve and lymph nodes Superficial layer or investing layer of deep cervical fascia Forms a complete collar around the neck and envelops sternocleidomastoid, trapezius and attaches to skull base, mandible, hyoid, clavicle, sternum and scapula. The two halves of fascia attaches posteriorly to ligamentum

nuchae and cervical spinous process, This layer divides to form the capsule of submandibular and parotid gland. The spaces included are Masticator space parotid space Submandibular and sublingual space Suprasternal space of burns Cervical Fascia Superficial Layer of the

Deep Cervical Fascia (rule of twos) Muscles Sternocleidomastoid Trapezius

Glands Submandibular Parotid Spaces Masticator space parotid space Submandibular and sublingual space Suprasternal space of burns MIDDLE LAYER OF DEEP CERVICAL

FASCIA Also known as visceral or pretracheal layer It extends from hyoid bone anteriorly to pericardium and continues in suprahyoid neck as buccopharengyal fascia which encloses pharynx; nasopharynx and oropharynx. Spaces included are pharyngeal mucosal space Retropharengyal space Parapharengyal space Buccal space

Cervical Fascia Middle Layer of the Deep Cervical Fascia Muscular Division Infrahyoid Strap Muscles Visceral Division Pharynx, Larynx, Esophagus, Trachea,

Thyroid Buccopharyngeal Fascia Deep layer of DCF It extends from the skull base to the third thoracic vertebra. The deep layer encircles vertebrae, paravertebral and paraspinal muscles ,vertebral artery and vein, phrenic nerve and trunk of brachial plexus. Alar Layer

Posterior to visceral layer of middle fascia Anterior to prevertebral layer Prevertebral Layer Vertebral bodies Deep muscles of the neck Cervical Fascia Deep Layer of Deep Cervical Fascia The spaces included are:

Carotid space Retropharyngeal space Danger space Prevertebral space Posterior cervical space Cervical Fascia Carotid Sheath Formed by all three layers of deep fascia Contains carotid

artery, internal jugular vein, and vagus nerve Lincolns Highway Deep Neck Spaces Described in relation to the hyoid Entire length of the

neck Suprahyoid Infrahyoid DEEP NECK SPACES Along entire length of neck: 1.Superficial space 2.Retropharengyal space 3.Danger space 4.Prevertebral space 5.Visceralvascular space

Deep Neck Spaces Entire Length of Neck: Superficial Space Surrounds platysma Contains areolar tissue, nodes, nerves and vessels Involved with cellulitis and superficial abscesses Deep Neck Spaces

Entire Length of Neck: 1.Retropharyngeal Space Posterior to pharynx and esophagus Anterior to alar layer of deep fascia Extends from skull base to T4 level Contents:fat and lymph nodes

The nodes are arranged in 2 groups ie medial group and lateral nodes of rouviere. Retropharyngeal space Lateral soft tissue X-ray (extension, inspiration) abnormal findings: 1. C2-post pharyngeal soft tissue >7mm 2. C6adults >22mm, peads >14mm Deep Neck Spaces

Entire Length of Neck: 2.Danger Space Anterior border is alar layer of deep fascia Posterior border is prevertebral layer Extends from skull base to diaphragm and is so named because it contains loose areolar tissue and offers little resistance to the

spread of infection. Deep Neck Spaces Entire Length of Neck: 3.Prevertebral Space Anterior border is prevertebral fascia Posterior border is vertebral bodies,ALL and deep neck muscles

Extends along entire length of vertebral column upto coccyx Infection in this space tends to stay somewhat localized due to the dense fibrous attachments between the fascia and the deep muscles. Deep Neck Spaces

Entire Length of Neck: 4.Visceral Vascular Space Carotid Sheath Like the prevertebral space the visceral vascular space is quite compact, contains little areolar tissue and is resistant to the spread of infection. It is termed the Lincolins

highway of the neck . It extends from the base of skull into the mediastinum and because it receives contributions from all three layers of deep fascia it can become secondarily involved by infection in any other deep neck space by direct spread. CAROTID SPACE

Wwithin the sheath carotid artery lies medial to IJV which becomes anterior to artery in lower neck. The vagus lies posterior to vessels Symphathetic trunk may lie either posterior to vessels or or may be embeded in sheath wall. Lesions of carotid space will compress the parapharyngeal space anteriorly,displaces the parotis gland laterally. the pathologies of carotid space are pseudotumours,inflammatory lesions,vascular pathology,vagal schwannoma,neurofibroma and

paraganglioma. SUPRAHYOID:PHARYNGEAL MUCOSAL SPACE It is the area of nasopharynx and oropharynx on inner side of buccopharyngeal fascia. Buccopharyngeala fascia seperates pharyngeal mucosal space from retropharyngeal space posteriorly and parapharyngeal space laterally. The major content include mucosa of pharynx ,lymphoid tissue, adenoids and minor salivary gland.

The most common malignant lesion of pharengyal mucosal space is carcinoma,non hodgkins lymphoma,rhabdomyosarcoma and tumours of minor salivary gland. Deep Neck Spaces(suprahyoid) 1.Submandibular Space Is located below mandible inferior to myelohyoid muscle Sublingual space is located above myelohyoid muscle

There is direct communication between these two spaces at posterior aspect of myelohyoid muscle. Deep Neck Spaces Suprahyoid: Submandibular Space comprises Sublingual Space

Areolar tissue Hypoglossal and lingual nerves Lingual artery and vein Sublingual gland Deep portion of submandibular gland

Submylohyoid Space Anterior bellies of digastrics Submandibular gland Submandibular and submental lymph nodes Facial artery and vein Inferior loop of hypoglossal nerve SUBMANDIBULAR SPACE Congenital lesion such as branchial cleft cyst ,

cystic hygromas, dermoids, epidermoids and thyroglossal duct cysts Abscess and inflammation Tumours of submandibular gland;pleomorphic adenoma, mucoepidermoid cancers and adenocytic carcinomas. Duct calculi. Deep Neck Spaces Suprahyoid 2.Parapharyngeal Space (pharyngomaxillary

space ) An anatomic recess shaped like an inverted pyramid with base towards skull and apex at greater cornu of hyoid

It is seperated from pharyngeal mucosla space medially by buccopharyngeal fascia Laterally from the masticator space by investing layer of DCF covering medial aspect of medial pterygoid and deep lobe of parotid. Posteriorly seperated from prevertebral space by prevertebral fascia.

PARAPHARYNGEAL SPACE Content: mainly fat, also contains pharyngeal venous plexus, mandibular nerve ,

internal mammary artery, and ascending pharengyal artery, lymph nodes and ectopic salivary gland rests. The importance of parapharyngeal space is its central location and its relationship with other spaces if neck. Parapharyngeal space communicates with submandibular , retropharyngeal, parotid and masticator spaces with important implications in spread of infection. Primary PPS masses typically dispaces lateral wall of pharyngeal mucosal space medially , deep lobe of parotid laterally and coontent of carotid sheath posteriorly .

Lesions in this space include shwannoma , benign salvary lesions,lipomas, atypical branchial ccleft cysts and lesions spreading from adjacent compartment. Deep Neck Spaces Suprahyoid: Parapharyngeal Space comprises: Prestyloid Medialtonsillar fossa

Lateralmedial pterygoid Contains fat, connective tissue, nodes Poststyloid Carotid sheath Cranial nerves IX, X, XII The stylopharyngeal aponeurosis of Zuckerkandel is formed by the intersection of the alar,

buccopharyngeal and stylomuscular fascia and acts as a barrier to the spread of infection from the prestyloid compartment to the poststyloid compartment. Deep Neck Spaces Suprahyoid: Peritonsillar Space Medialcapsule of palatine tonsil

Lateralsuperior pharyngeal constrictor Superioranterior tonsil pillar Inferiorposterior tonsil pillar. This space contains loose areolar tissue, primarily in the area adjacent to the soft palate, which explains why the majority of peritonsillar abscesses will localize to the superior pole of the tonsil.

Deep Neck Spaces Suprahyoid:3.Masticator and Temporal Spaces Formed by the superficial layer of deep cervical fascia and contains.

Masseter and pterygoids Temporalis. Ramus of mandible 3RD diivsion of 5th nerve. The masticator space is in direct

communication with the temporal space superiorly deep to the zygoma. The temporal space has as its lateral boundary the superficial layer of deep fascia and its medial boundary the periosteum of the temporal bone. It is subdivided into superficial and deep spaces by the body of the temporalis muscle. This space contains the

internal maxillary artery and the mandibular nerve. MASTICATOR SPACE Lesions in the masticator space typically includes : Nerve sheath tumours, lipoma, mandibular and soft tissue sarcomas, dental tumours and cysts and abscess, osteomyelitis. Vascular lesions like haemangioma nad lymphangioma.

In children rhabdomyosarcoma may arise in this space. Deep Neck Spaces Suprahyoid:4. Parotid Space Formed by superficial layer of deep fascia and dense septa from capsule into gland. Parotid gland is divided into superficial and deep lobe by the plane of facial nerve.

In addition to the parotid gland, this space contains the parotid lymph nodes, the facial nerve and posterior facial vein. Lesions are considered intraparotid if the 50% or greater circumference is surrounded by parotid tissue. . PAROTID SPACE Identification of fat planes between the lesion and parotid

indicates parapharengyal space site of origin whereas direct continuity of the mass to gland indicates deep lobe of parotid origin. The fascial envelope is deficient on the supero-medial surface of the gland, facilitating direct communication between this space and the parapharyngeal space. Lesion of the parotid space include benign tumours like pleomorphic adenoma , warthins tumour and less commonly malignant tumours. In children 50% of lesions are haemangiomas.

Deep Neck Spaces Infrahyoid: Anterior Visceral Space Formed by middle layer of deep fascia Contains thyroid, trachea, esophagus. This potential space runs from the thyroid cartilage into the anterior superior mediastinum to the

arch of the aorta. Below the level of the thyroid gland this space communicates laterally with the retropharyngeal space . THANK YOU

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