Anatomy of Deep Neck spaces Radiology Pictorial representation

1. ANATOMY OF NECK SPACES
Dr. Sudhan

2. • The deep spaces of neck is separated by fascial planes and also by the hyoid
bone into supra and infra-hyoid neck.
• There is continuation of some suprahyoid neck spaces into the infrahyoid neck
spaces, and continuation of some infrahyoid neck spaces into the superior
mediastinum.
• Suprahyoid Neck: Encompasses the deep spaces between the
and
• Infrahyoid Neck: Lies inferiorly between the hyoid bone and

3. • Three layers of
form the boundaries of
the deep spaces in the neck.
• The investing fascia completely
surrounds the neck and split to
enclose
the and
• The pretracheal fascia encloses
the content of the visceral
space.
• The paravertebral fascia
encloses the paraspinous and
prevertebral muscles to form
the prevertebral space.
• The carotid sheath is a dense
framework of areolar tissue that
surrounds the carotid arteries,
internal jugular vein and vagus
nerve and receives
contributions from all three
layers of deep cervical fascia.

4. DEEP CERVICAL FASCIA

5. DEEP NECK SPACES

6. SUPRAHYOID NECK INFRAHYOID NECK SUPRA- AND INFRAHYOID NECK
PARAPHARYNGEAL SPACE ANTERIOR CERVICAL SPACE CAROTID SPACE
PAROTID SPACE POSTERIOR CERVICAL SPACE RETROPHARYNGEAL SPACE
PHARYNGEAL MUCOSAL SPACE VISCERAL SPACE PERIVERTEBRAL SPACE
MASTICATOR SPACE DANGER SPACE
BUCCAL SPACE

7. PARAPHARYNGEAL SPACE

8. CONTENTS
• Fat (Main Component)
• Lymph Nodes
The para-pharyngeal space is
shaped like a pyramid, inverted
with its base at the ,
with its apex inferiorly pointing
to the greater cornu of
the

10. Relations
Medial to the .
Lateral to the .
Anterior to the .
Posterior to the .
Divisions
Prestyloid compartment
Poststyloid compartment

11. displaces the
parapharyngeal fat anteromedially
displaces the
parapharyngeal fat posteromedially
displaces the
parapharyngeal fat anteriorly
displaces the
parapharyngeal fat posterolaterally
and
displace the parapharyngeal fat
anterolaterally

12. Related pathology
A lesion arising in the parapharyngeal space will displace the
posteriorly and/or is completely surrounded by parapharyngeal
space fat. Lesions include:
(most common)
Parapharyngeal cellulitis /

13. PHARYNGEAL MUCOSAL SPACE

14. The pharyngeal mucosal
space is the most internal
compartment (closest to the
airway) of the deep
compartments of the head and
neck, delineated by the middle
(pretracheal) layer of
.
It extends from the base of
the skull to the
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

15. Contents
Squamous mucosa
Lymphoid tissue belonging to the
pharyngeal lymphoid ring
( )
Cartilaginous portion of
the
Relations
Medial to the
Anterior to
the

16. Related pathology

17. Parotid space

18. • The parotid space is a roughly
pyramidal space, the broad elongated
base facing laterally, formed by the
superficial layer of the
overlying the superficial lobe of
the parotid gland, and its apex
pointing medially.
• It is traversed by the external carotid
artery (ECA), retromandibular vein and
facial nerve.

19. Contents
• Intraparotid
(ECA)

20. Related pathology
Congenital
Agenesis
First branchial cleft cyst
Hemangioma
Cystic hygroma/lymphangioma

Benign tumour
Primary malignant tumour
Metastatic malignant tumour
Metastatic adenopathy
Inflammatory
Chronic granulomatous parotitis
Abscess/cellulitis
Sjogren's syndrome/autoimmune
Benign lymphoepithelial cysts (AIDS)
Nodular fascitis
Reactive adenopathy

21. Masticator space

22. Contents
• Ramus and body
of
• Mandibular division of
the
and vein.

23. Boundaries and relations
• Anteriorly:
• Posterolaterally:
• Medially:

24. Related pathology
Direct spread of
Benign masseteric hypertrophy
Accessory parotid tissue

25. RETROPHARYNGEAL SPACE

26. The retropharyngeal space (also
known as the true
retropharyngeal space to
distinguish it from the
, which is sometimes
referred to as part of the
retropharyngeal space) is one of
the seven
.
It is a midline space that consists
largely of fatty areolar tissue and
contains lymph nodes that drain
the and

27. The retropharyngeal space is posterior to the and ,
and extends from the base of the skull to a variable level between the T1
and T6 vertebral bodies. The main component of the retropharyngeal
space is areolar fat.
Lymph nodes are found in the portion of the retropharyngeal space
above the hyoid bone, and these lymph nodes drain the pharynx, nasal
cavity, paranasal sinuses and middle ears. These lymph nodes are
prominent in children, and atrophy with age

28. Contents
Areolar fat
Lymph nodes (lateral and medial
retropharyngeal) only above hyoid
Small vessels
Relations
The retropharyngeal space is:
Anterior to the
Posterior to the
Anteromedial to the
Posteromedial to
the

29. Related pathology
• Metastatic adenopathy

30. DANGER SPACE

31. • The danger space is a potential
space located behind the
true , which
connects the
to the .
• In healthy patients, it is
indistinguishable from
the . It is
only visible when distended by
fluid or pus, below the level of T1-
T6, since the retropharyngeal
space variably ends at this level.

32. Boundaries
• Anteriorly:
• Posteriorly:
• Superiorly:
• Inferiorly: posterior at the level of the
Related pathology
• It is a potential path for spread of infections e. g. from
the to the mediastinum.

33. CAROTID SPACE

34. • The carotid space is
roughly cylindrical space
that extends from the skull
base through to the aortic
arch.
• It is circumscribed by all
three layers of the
, forming
the carotid sheath.
• The bifurcation of the
common carotid usually
occurs at the boundary of
the suprahyoid and
infrahyoid spaces

35. Contents
inferiorly and
superiorly
anterior to vessels
posterior
to vessels in posterior notch;
extends below hyoid to
mediastinum within the carotid
sheath
• Sympathetic nerves: medial to
vessels lateral to
retropharyngeal space
• Deep cervical lymph node
chain

36. Relations
• Suprahyoid carotid space:
• Anteriorly:
• Laterally:
• Posteriorly:
• The suprahyoid portion of the
carotid space is often
synonymous with the post-
styloid compartment of
the
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

37. Related pathology
• A mass originating from the carotid space will cause anterior
displacement of the parapharyngeal space. Lesions can include:
• Ectatic carotid artery
• Asymmetrically enlarged internal jugular vein
• Arterial or venous thrombosis
• Internal jugular vein thrombophlebitis
• Carotid artery dissection
• Carotid artery aneurysms
• Metastatic or reactive lymphadenopathy

38. THE BUCCAL SPACE OR BUCCINATOR SPACE

39. The buccal spaces are paired
fat contained spaces on each
side of the face forming
cheeks. Each space is
enveloped by the superficial
(investing) layer of the
.
It is located between the
buccinator and platysma
muscles, therefore only a
small potential space with
limited contents.

40. Contents
• Fat: cheek padding
• Accessory parotid gland in
20% of people which can
cause facial asymmetry;
readily seen on MRI
and buccal arteries and
corresponding veins
(CN VII): buccal
branch
(CN
V): of the
mandibular division (CN vc)

41. Communications
• Buccal space infection can spread to
or from the teeth. There is no real
boundary between the buccal space
and the submandibular space
inferiorly.
• There is also potential
communication with the
pterygomandibular region
, infratemporal space and to the
parapharyngeal space posteriorly.
Related pathology
• Tumours:
, vascular lesions (eg
haemangiomas)

42. ANTERIOR CERVICAL SPACE

44. Contents
• Areolar fat
Relations
• Posterior:
• Medial:
• Superior:
Related pathology
(most common).
.

45. POSTERIOR CERVICAL SPACE

46. • Posterolateral part of the
neck extending from the
mastoid tip and
to the

47. Contents
(cranial
nerve XI)
• Preaxillary
•
• Spinal accessory lymph nodes
• Fat
Relations
• Superficial:
and
• Deep:
• Anterior:

48. PERIVERTEBRAL SPACE

49. • The perivertebral space is a
cylinder of soft tissue lying
posterior to the
and
surrounded by the
prevertebral layer of the
and extends from
the skull base to the upper
mediastinum.
• The deep cervical fascia sends a
deep slip to the transverse
process which subdivides the
space into:
• Prevertebral portion:
Anteriorly located
• Paraspinal portion:
Posteriorly located

50. Contents
• Prevertebral portion.
• Cervical vertebral body and
disc
• Scalene muscles
and vein
• Paraspinal portion
• Posterior elements of cervical
vertebrae

51. Related pathology
• Chondromas
• Direct invasion by squamous cell carcinoma
• Pseudotumours
• Anterior herniated disc
• Vertebral osteophytes
tendon calcification
• Lymphoma

52. VISCERAL SPACE

53. • The visceral space extends
from the to
the
(level of aortic
arch / T4), and is surrounded
by the middle layers of
the

54. Contents
• Lymph nodes ( )

55. SUMMARY
• The deep spaces of the neck present a variety of unique oncologic,
infectious, congenital, and vascular lesions.
• An understanding of the anatomy, imaging characteristics and
differentials of each particular region are vital in making an accurate
diagnosis.
• The radiologist's role in accurate diagnosis of these lesions and
understanding of their manifestation plays a crucial role in patient care
and management.

56. THANK YOU