The document discusses several clinically important deep neck spaces, including the peritonsillar space, submaxillary space, retropharyngeal space, and parapharyngeal space. Infections in these spaces can spread rapidly to dangerous areas if not treated properly. The peritonsillar space is prone to infections leading to peritonsillar abscesses. The submaxillary space infection is known as Ludwig's angina. Retropharyngeal space infections present with pain, fever, and difficulty swallowing. Both conservative and surgical treatments are discussed for infections in these deep neck spaces.

2. Clinical importance:
Various spaces in the neck
18 spaces: suprahyoid and infrahyoid
Clinically important
Intercommunication
infection spreads rapidly: cranial cavity, mediastinum

3. Clinical importance cont.:
If not tackle:- Life threatening conditions
Acute laryngeal oedema
Upper airway compression
Involvement of great vessels, cranial nerves
Severe odynophagia

4. Important Deep Neck Spaces:
1. Peritonsillar space
2. Submaxillary space: sublingual space
submandibular space
3. Retropharyngeal space
4. Parapharyngeal space
5. Parotid space
6. Masseteric space
7. Pre-epiglottic & para-glottic space.

5. Peritonsillar space:
Boundary: laterally : superior constrictor
medially : tonsillar capsule
Infection: peritonsillitis-> Abscess (quinsy)
Pathology : as an complication &
: de novo

6. Peritonsillar space cont.:
s/s:
Pain more severe & unilateral
Muffled sound (hot potatoes sound)
Trismus
Drooling of saliva
Inflamed soft palate
Buried tonsils
Enlarged and tender JD node

7. Management of
peritonsillitis:
Diagnosis: clinically, aspiration of abscess
Treatment: I/V Ampicillin + cloxacillin & metronidazole
Anti-inflammatory: Ibuprofen & paracetamol
Locally antiseptic mouth wash
If abscess: I & D of abscess (site of drainage)
If second attack: tonsillectomy.

11. Submaxillary space:
Boundary:
Superior : mucosa of floor of mouth
Inferior : deep fascia of neck
Divided by myelohyoid muscle
Content: submandibular and sublingual
salivary glands, lymph nodes.

12. Sub maxillary space cont:
Ludwigs angina (inflammation of floor of
mouth):- Browny Induration
Pathology:
Dental origin(80%)
Inflammation of submandibular salivary gland
Lymphadenitis
Trauma floor of mouth

13. Ludwig’s Angina

14. Submaxillary space cont.:
S/S:
pain
Swelling of floor of mouth
Submandibular & submental region
Trismus
Diagnosis: clinically
Treatment:
Conservative : Antibiotics
: Anti-inflammatory
: local antiseptic mouth wash

15. Submaxillary space cont.:
Surgical treatment:
Incision and drainage: wide incision
Greety sensation
No pus: usually inflammatory fluid & necrotic tissue
NB: always pierce myelohyoid muscle.

17. Retropharyngeal space:
Boundary:
Superior : base of skull
Inferior : posterior mediastinum
Posterior : pre-vertebral fascia
Anterior : bucopharyngeal fascia
Content: Lymph nodes, loose aerolar tissues.
Pathology:suppuration RP lymph node (Rouviere)
:Koch’s spine
:Pharyngeal trauma
:From other neck spaces

18. Retropharyngeal space cont:
S/S:
Pain, fever
Odynophagia
Drooling of saliva
Stertor: respiratory obstruction
o/e: bulging of posterior pharyngeal wall
X-ray soft tissues neck lateral view: increase prevertebral
soft tissue density.

19. Retropharyngeal space cont:
Treatment:
Conservative:
Antibiotics
Anti-inflammatory+ supportive therapy
Surgical: I&D of most bulging area through trans-oral
route
Anaesthesia: blanket anaesthesia
Position: head down and lateral position

21. Parapharyngeal space:
Boundary:
Superior : base of skull
Inferior : Hyoid bone
Medial : pharynx
Lateral : mandible
content: great vessels, last 4 cranial nerves, lymph
nodes, deep lobe of parotid.

22. Parapharyngeal space cont:
S/S:
 Pain, fever, odynophagia
Drooling of saliva
Stertor - respiratory obstruction
O/E: lateral neck swelling
bulging of lateral pharyngeal wall
pseudo enlargement of tonsils

23. Parapharyngeal space cont:
Treatment:
Conservative:
Antibiotics
Anti-inflammatory + supportive therapy
Surgical: I&D of most bulging area lateral side of
neck (external route)
Anaesthesia: LA or GA
Position: head turn and lateral position