This document describes the anatomy and clinical features of various fascial spaces in the head and neck region. It discusses the superficial and deep cervical fascia layers and specific spaces such as the retropharyngeal space, parapharyngeal space, danger space, submandibular space, and parotid space. For each space, it outlines the causes of infection, clinical presentation, and treatment approach which typically involves intravenous antibiotics and incision and drainage of any abscesses.

3.  Superficial Cervical Fascia
 Deep Cervical Fascia
› Superficial Investing Layer
› Middle Visceral Layer
› Deep Layer
 Prevertebral Layer
 Alar Layer

4.  Extends from head & neck
to thorax & shoulder.
 Contains voluntary muscles
of facial expression &
platysma.

5.  Attachement –
Superiorly – Nuchal Ridge
Inferiorly - Clavicle
 It Invests -
› Muscles
 Sternocleidomastoid
 Trapezius
› Glands
 Submandibular
 Parotid
› Spaces
 Posterior Triangle
 Suprasternal space of Burns
 Parotid Space

6.  Attached from hyoid & skull
base above to sternum below.
 Modified to form
› Bucopharyngeal fascia postr. To
pharynx
› Pretracheal Fascia
› Prethyroid Fascia
 2 Divisions –
› Muscular Division
 Strap Muscles
› Visceral Division
 Thyroid, Trachea, Pharynx,
Larynx, Esophagus

7.  2 Layers
› Alar Fascia
 Lies between middle
visceral layer and
prevertebral layer
› Pre-vertebral Fascia
 Vertebral bodies
 Deep muscles of the
neck

8.  Carotid Sheath
› Formed by all three
layers of deep
fascia.
› Contains carotid
artery, internal
jugular vein, and
vagus nerve

9.  Retropharyngeal Space
 Parapharyngeal Space
 Danger Space

10.  Lies behind pharynx between
Buccopharyngeal Fascia & Alar
Fascia.
 Extends from Base of skull to
Bifurcation of trachea.
 Space is divided by a median
raphe into 2 lateral spaces
called SPACE OF GILLETE.
 Content – Lymph Nodes,
Areolar tissue, Fat

11.  Commonly seen in children below 3yrs.
 Cause – IN CHILDREN - Suppuration of
retropharyngeal nodes
secondary to infection of adenoids.
IN ADULTS – Penetrating Injury by FB
or Rigid esophagoscopy.
Organism – Streptococci/Staphylococci
 Clinical Features –
1. Dysphagia
2. Difficulty Breathing
3. Stridor , Croupy cough
4. Torticollis
5. Bulge in PPW
 Treatment –
1. Transoral I & D. without GA
2. I.V. Antibiotics
3. Tracheostomy

12.  Commonly seen in adults
 Cause – 1. Caries Spine
2. TB of retropharyngeal
nodes
 Clinical Features –
1. Discomfort in throat
2. Neck rigidity
3. Bulge in PPW
Diagnosis – X RAY- widening of RP
space > 3/4th of vertebral body.
 Treatment –
1. I & D through a oblique incision
along antr. Border of SCM
2. Antitubercular Therapy

13.  Pyramidal in shape with its base
at the base of skull & its apex at
the hyoid bone.
 Medial- Buccopharyngeal
fascia.
 Posteriorly – Prevertebral fascia
 Lateral – Medial pterygoid
 Divided into 2 compartments by
Styloid process
1. Anterior/ Prestyloid
2. Posterior/ Poststyloid

14.  Cause - 1. Peritonsillar abscess
2. Tonsillitis, Adenoiditis
3. Dental caries- Lower last molar
4. Bezold Abscess
5. Penetrating injuries of neck
 Clinical Features –
1. Anterior Compartment –
Triad of - 1. Prolapse of Tonsil ,
2. Trismus due to Med.
Pterygoid spasm
3. External swelling
behind angle of jaw
2. Posterior Compartment –
1. Bulge behind postr. Pillar
2. Paralysis of IX, X, XI, XII cranial N.
3. Swelling of Parotid region
 Treatment –
1. IV Antibiotics
2. I & D of abscess by a horz. Incision made
2-3 cm below the angle of mandible

15. › Anterior border is alar layer of
deep fascia
› Posterior border is pre-
vertebral layer
› Extends from skull base to
posterior mediastinum
&diaphragm.
› It is so named because it
contains loose areolar tissue
and offers little resistance to
the spread of infection.

16.  Divided into 2 compartments
by Mylohyoid m.
› Sublingual Space
 Areolar tissue
 Hypoglossal and lingual nerves
 Sublingual gland
 Wharton’s duct
› Submaxillary Space
 Anterior bellies of digastrics
 Submandibular gland
 (These two subdivisions freely
communicate around the
posterior border of the
mylohyoid. )

17.  Infection of Submandibular Space.
 It is usually a cellulitis not abscess so don’t expect
pus.
 Aetiology –
1. Dental Infection – premolar, molar
2. Submandibular Sialoadenitis
3. Fracture Mandible
 Clinical Feature –
1. Odyniophagia , Trismus
2. Tongue pushed up & back
3. Swelling of submandibular region with
tenderness & woody hard feel.
4. Laryngeal edema may appear.
 Treatment -
1. I & D intraoral if sublingual, External
transverse incision if submandibular.
2. IV antibiotics

18.  Collection of pus in peritonsillar space between
capsule of tonsil & superior constrictor.
 Aetiology – Complication of Tonsillitis
 Organism – Mixed
 Clinical Feature –
 Commonly Adult
 Commonly Unilateral
 Symptoms - Fever with Chills, Odynophagia , Trismus,
Hot potato voice , Foul breath, Ipsilateral ear pain
 Signs – Tonsillar pillar swollen
Uvula pushed to opposite side
Cervical lymphadenopathy
Torticollis
Treatment –
1. I & D
2. IV antibiotics
3. H2O2 Gargle
4. Interval Tonsillectomy after 6wks

19.  Infection of Parotid space between superficial &
deep layer of deep cervical fascia.
 Aetiology –
1. Dehydration – Post surgical cases after 5-7 d
2. Infections of oral cavity via stenson’s duct
 Clinical Feature –
1. Parotid area swollen ,tender, indurated
2. No fluctuation
3. Congestion of Stenson’s duct opening with
pus exuding on pressure
4. Fever with chills & rigor
Diagnosis – USG / CT- SCAN
 Treatment -
1. I & D With Lazy S incision & skin flap raise
2. IV antibiotics
3. IV Fluid