The document discusses the deep neck spaces, which are potential pathways for the spread of infections and tumors in the neck region. It describes the various spaces in detail, including their boundaries, contents, and related pathologies. The key spaces mentioned are the masticator space, parotid space, pharyngeal mucosal space, buccal space, retropharyngeal space, danger space, carotid space, perivertebral space, anterior cervical space, posterior cervical space, submandibular space, and sublingual space. Understanding the anatomy of these spaces aids in the diagnosis and treatment of neck conditions.

1. Dr. Rajendra Singh Lakhawat
DEEP NECK SPACES

2. • Basis for dividing neck into spaces and compartments :
arrangement of superficial and deep layers of cervical fascia
• The importance of these spaces is that they may limit to some
degree the spread of most infections and some tumors
• A proper understanding of their anatomy will also aid in the diagnosis
of various conditions
INTRODUCTION

3. DEEP NECK SPACES
Described in relation to the hyoid bone.
• Suprahyoid Spaces.
• Infrahyoid Spaces.
• Spaces extending up to the entire length of
the neck.

4. SUPRAHYOID SPACES
• Submandibular Space.
• Buccal Space.
• Masticator Space.
• Parotid Space.
• Pharyngeal mucosal Space.
• Parapharyngeal Space

5. INFRAHYOID SPACES
• Visceral Space.
• Anterior cervical
Space.
• Posterior cervical
Space.

6. SPACES COMMON TO BOTH
• Carotid Space.
• Retropharyngeal Space.
• Prevertebral Space.
• Danger Space.

7. Fascia
Superficial
Deep
Superficial
Middle
Deep
CERVICAL FASCIAE

8. SUPERFICIAL FASCIA
• Composed of subcutaneous tissues that
encircle the neck like a collar.
• Encircles the deep fascia
• Components:
• Platysma and muscles of facial expression.
• Subcutaneous veins , nerves and fat
• Superficial lymph nodes.

9. SUPERFICIAL LAYER/INVESTING LAYER
• Complete collar around the neck
• Attachments
• Skullbase , mandible, hyoid , clavicle , sternum
, scapula
• Posteriorly : Ligamentum nuchae and cervical
spinous process
• Splits to cover SCM and Trapezius
• Capsule : parotid and Submandibular gland
• Spaces : Masticator space ,parotid space,
submandibular space and sublingual space.
DEEP CERVICAL FASCIAE

10. SUPERFICIAL LAYER/INVESTING
LAYER

11. • Gross anatomy
• The masticator space are paired suprahyoid cervical spaces
on each side of the face. Each space is enveloped by the
superficial (investing) layer of the deep cervical fascia.
• The superficial layer of deep cervical fascia splits into two at the
lower border of the mandible, the inner layer running deep to
the medial pterygoid muscle and attaches to the skull base
medial to foramen ovale and the outer layer covering masseter
and temporalis muscles and attaches to the parietal cavarium
superiorly.
MASTICATOR SPACE

12. • Contents
• muscles of mastication
• ramus and body of mandible
• mandibular division of the trigeminal nerve(Vc)
• enters the masticator space via the foramen ovale
• inferior alveolar nerve
• inferior alveolar artery and vein

13. •Boundaries and relations
•anteriorly: buccal space
•posterolaterally: parotid space
•medially: parapharyngeal space
•Communications
•Masticator space malignancy can spread
perineurally via the mandibular division of
the trigeminal nerve into the middle cranial fossa

16. MASTICATOR SPACE
M
T
L
Contrast enhanced CT
1 Parapharyngeal space.
2 Masticator space.
3 Carotid space
4 Parotid space.
5 Mucosal space.
6 Perivertebral space (anterior portion). 7
Retropharyngeal space

17. • Related pathology
• odontogenic abscess
• osteomyelitis
• direct spread of squamous cell carcinoma
• lymphoma
• minor salivary gland tumours
• muscle sarcoma
• bone sarcoma
• schwannoma
• neurofibroma
• benign masseteric hypertrophy
• accessory parotid tissue

18. PAROTID SPACE
• Boundary : Investing fascia(Superficial Layer Deep Cervical Fascia) splitting at the
angle of mandible.
• Extends : Superiorly external acoustic meatus
Inferiorly up to the mandible.
• Contents: Parotid Gland, proximal part of the parotid duct, intraparotid lymph nodes
and vessels.
• Parotid gland is divided by facial nerve into superficial and deep.
• Division identified on imaging by retromandibular vein.

19. PAROTID SPACE

20. • Relations
• lateral to the parapharyngeal space
• medial to superficial space and subcutaneous tissue
• anterior to the carotid space
• posterior belly of the digastric muscle forms a variable portion of the
posteromedial border of the parotid space and at times this muscular
band helps to differentiate a deep-lobe parotid space lesion to one
arising in the carotid space
• posterior to the masticator space

21. • Boundaries
• The space is circumscribed by the superficial layer of the deep
cervical fascia
• superior margin: external auditory canal; apex of the mastoid
process
• inferior margin: inferior mandibular margin (although the parotid
tail can extend further inferiorly below the angle of the
mandible)
• anterior margin: masticator space

22. • Any mass originating from the parotid space will be centered
within the parotid gland.
• A large mass arising within the deep lobe of the parotid will
medially displace fat in the parapharyngeal space and cause
posteromedial displacement of the posterior belly of the
digastric muscle and carotid space. There is also often
associated widening of the stylomandibular notch
Related pathology

23. • congenital
• first branchial cleft cyst
• hemangioma
• cystic hygroma/lymphangioma
• salivary gland tumours
• benign tumour
• primary malignant tumour
• metastatic malignant tumour
• metastatic adenopathy
• lymphoma
• parotid cysts
• inflammatory
• sialadenitis
• chronic granulomatous parotitis
• abscess/cellulitis
• Sjogren's syndrome/autoimmune
• Benign lymphoepithelial cysts (AIDS)
• Nodular fascitis
• Reactive adenopathy

24. Visceral /pretracheal layer
Extent: Hyoid bone to sup mediastinum
SHN : Continues as buccopharyngeal fascia(BPF)
Contents : Trachea, esophagus , larynx , thyroid and parathyroid
gland
Spaces : Pharyngeal mucosal space , retropharyngeal space ,
parapharyngeal space and buccal space
MIDDLE LAYER OF DCF

25. MIDDLE LAYER OF DCF

26. MIDDLE LAYER OF DCF- SPACES

27. PARAPHARYNGEAL SPACE
• Central fat filled spaces in lateral
SHN.
• Extends on the either side of neck
from the skull base to the
submandibular space inferiorly
• Surrounded by PMS , MS , PS , CS
AND RPS.

28. • Contents : Mainly fat ,
pharyngeal venous
plexus , Mandibular N ,
Int mammary A ,
ascending pharyngeal
artery.
• Direction of displacement
of PPS – space of origin
of the lesion
PARAPHARYNGEAL SPACE

29. PARAPHARYNGEAL SPACE

30. PHARYNGEAL MUCOSAL SPACE
• Located on the airway side of the Buccopharyngeal fascia in
the nasopharynx and oropharynx.
• No fascial boundaries on the airway side.
• Extend from skull base to the Cricoid cartilage.

31. PHARYNGEAL
MUCOSAL SPACE

32. • Gross anatomy
• The pharyngeal mucosal space is the most internal compartment
(closest to the airway) deep compartments of the head and neck,
delineated by the middle (pretracheal) layer of deep cervical fascia. It
extends from the base of the skull to the cricoid cartilage
• Contents
• squamous mucosa
• lymphoid tissue belonging to the pharyngeal lymphoid ring
(Waldeyer's ring
• minor salivary glands
• cartilaginous portion of the Eustachean tube
• superior pharyngeal constrictor
• middle pharyngeal constrictor
• levator palatini

33. • Relations
• medial to the parapharyngeal space
• anterior to the retropharyngeal space
• Boundaries
• The pharyngeal mucosal space is internal to the middle layer of
deep cervical fascia:
• superior margin: merging of the middle layer of deep cervical
fascia with the aponeurosis of the superior pharyngeal
constrictor muscle
• inferior margin: cricoid cartilage

34. • Related pathology
• benign minor salivary gland pathology
• nasopharyngeal carcinoma
• squamous cell carcinoma
• adenoid cystic carcinoma
• lymphoma
• minor salivary gland tumours
• juvenile angiofibroma
• tonsillitis
• peritonsillar abscess

35. BUCCAL SPACE
• Extent : Medially - Buccinator
and max alveolar ridge
Post Laterally : Masticator
space
• Contents: Buccal fat pad

36. BUCCAL SPACE

37. • Related pathology
• parotid duct calculi
• odontogenic infection
• tumours: minor salivary gland tumours, vascular lesions (eg
haemangiomas

38. • Extent : Skull base to T4 level
• 2 parts
• Ant : True RPS
• Post : Danger space
• Contents :
• SHN : LN and fat
• IHN : Fat
• pathway for spread of
infections / tumors into the
mediastinum from the neck.
RETROPHARYNGEAL SPACE

39. • Relations
• The retropharyngeal space is:
• anterior to the danger space
• posterior to the pharyngeal mucosal space
• anteromedial to the carotid space
• posteromedial to the parapharyngeal space

40. • Boundaries
• anterior margin: middle layer of the deep cervical fascia
• posterior margin: alar fascia, which separates the
retropharyngeal space from the danger space
• lateral margins: deep layer of the deep cervical fascia
• superior margin: clivus
• inferior margin: the point at which the alar fascia fuses with the
middle layer of the deep cervical fascia, typically around the T4
vertebral body

41. RETROPHARYNGEAL SPACE

42. RETROPHARYNGEAL SPACE

44. Related
pathology
retropharyngea
l abscess
metastatic
adenopathy
lymphoma

45. DANGER SPACE
• Posterior to the RPS.
• Bounded by the Alar fascia anteriorly and Prevertebral portion proper posteriorly.
• Extends from the skull base up to the diaphragm.
• Content : loose areolar tissue which provides easy pathway for the spread of
infections.
• This is called danger space because it is a potential path for spread of infections
(e.g. retropharyngeal abscess) from the pharynx to the mediastinum

47. • Extent : skull base to superior
mediastinum T4 level.
• Encircles : Paravertebral and
paraspinal muscles, vertebral
body , vertebral A and Vn ,
phrenic nerve and brachial
plexus trunk
• Spaces : involve both SHN and
IHN – CS , RPS, DS , PVS and
posterior cervical space.
: Involving only IHN -
Visceral spaces and anterior
cervical space
DEEP LAYER OF DCF(Prevertebral fascia)

48. • Gross anatomy
• The carotid space is a roughly cylindrical space that extends
from the skull base through to the aortic arch. It is
circumscribed by all three layers of the deep cervical fascia,
forming the carotid sheath
• Lateral to RPS
• The bifurcation of the common carotid usually occurs at the
boundary of the suprahyoid and infrahyoid spaces
CAROTID SPACE

49. • Suprahyoid carotid space:
• anteriorly: masticator space; parapharyngeal space
• laterally: parotid space
• posteriorly: perivertebral space
• The suprahyoid portion of the carotid space is often
synonymous with the post-styloid compartment of
the parapharyngeal space
Relations

50. • superior margin: lower border of jugular foramen
• inferior margin: aortic arch
• anterolateral margin: sternocleidomastoid muscle
Boundaries

51. • comMon carotid artery inferiorly and internal carotid
artery superiorly
• internal jugular vein
• glossopharyngeal nerve (CN IX): anterior to vessels
• vagus nerve (CN X): posterior to vessels in posterior notch;
extends below hyoid to mediastinum within the carotid sheath
• accessory nerve (CN XI)
• hypoglossal nerve (CN XII)
• sympathetic nerves: medial to vessels lateral to retropharyngeal
space
• deep cervical lymph node chain
Contents

53. CAROTID SPACE

54. SHN

55. IHN

56. CAROTID SPACE
IJV
styloid ica ijv
cca

58. • Posterior midline space
of SHN and IHN
• Enclosed by deep layer
of DCF
• Extent : base of skull to
level of coccyx
• 2 compartments :
Prevertebral and
Paraspinal
PERIVERTEBRAL SPACE

59. PERIVERTEBRAL SPACE- CONTENTS

62. CERVICAL SPACES
• ANTERIOR CERVICAL SPACE : Hyoid to clavicle
• Content : Only fat
• Relations
• posterior: carotid space
• medial: visceral space
• superior: submandibular space
• Related pathology
• lipoma (most common)
• second branchial cleft cysts

63. Location
• posterolateral part of the neck extending from the mastoid tip
and base of skull to the clavicles
• most of the volume is in the infrahyoid neck, with some
extension into the suprahyoid neck
• between superficial layer of the deep cervical fascia and deep
layer of deep cervical fascia
• Deep and posterior to sternocledomastoid
POSTERIOR CERVICAL SPACE

64. • Contents
• spinal accessory nerve (cranial nerve XI)
• preaxillary brachial plexus
• ​dorsal scapular nerve
• spinal accessory lymph nodes
• Fat
• Relations
• superficial: sternocleidomastoid and trapezius muscles
• deep: prevertebral space
• anterior: carotid space

65. • Related pathology
• spinal accessory nodal disease (e.g. infection, lymphoma,
metastases)
• lesion in posterior cervical space typically cause anteromedial
displacement of the carotid space and posteromedial
displacement of the prevertebral space

66. CERVICAL SPACES

67. CERVICAL SPACES

70. SUBMANDIBULAR SPACE
• Extend : Mylohoid superiorly & hyoid
bone inferiorly.
• Communicates freely with sublingual
space.
• Contents : superficial portions of the
Submandibular gland,submental and
submandibular LNs, facial artery and
vein, fat and ant belly of digastric.

71. SUBMANDIBULAR SPACE

72. SUBMANDIBULAR SPACE

74. Extent : Above the mylohyoid
muscle
Contents : Sublingual gland
and their ducts , LNs,
hypoglossal muscle , lingual
artery and vein , hypoglossal
N and deeper portion of
submandibular gland.
SUBLINGUAL SPACE

75. SUBLINGUAL SPACE