The document summarizes the anatomy of the neck spaces. It describes the layers of fascia in the neck - superficial, deep and its divisions. It then discusses the various neck spaces in detail - their boundaries, contents and clinical importance. The key neck spaces mentioned are retropharyngeal space, danger space, visceral vascular space enclosing carotid sheath and various suprahyoid and infrahyoid spaces like submandibular, pharyngomaxillary, masticator and parotid spaces. It also briefly covers the classification of neck spaces by Grodinsky and Holyoke.

1. NECK SPACES: SURGICAL
ANATOMY
Dr. Himanshu mishra
1st yr PG

2. Neck
• The neck is a tube
providing continuity from
the head to the trunk.
• It extends anteriorly from
the lower border of the
mandible to the upper
surface of the
manubrium of sternum.
• posteriorly from the
superior nuchal line on
the occipital bone of the
skull to the intervertebral
disc between the CVII
and TI vertebrae.

3. Anatomy of the Cervical Fascia
• Superficial Fascia
• Deep Fascia Also known as Fascia Colli
• Superficial
• Middle
• Deep

4. A.Investing layer B. Muscular Pretracheal layer
C. Visceral Pretracheal layer D. Prevertebral layer
• Also known as
•Fascia Colli

5. The superficial fascia in the neck contains a thin sheet
of muscle (the platysma), which begins in
the superficial fascia of the thorax, runs upward to
attach to the mandible and blend with the muscles
on the face, is innervated by the cervical branch of the
facial nerve [VII].

6. Superficial Layer
• Superior attachment –
zygomatic process
• Inferior attachment –
thorax, axilla.
• Similar to
subcutaneous tissue
• Ensheathes platysma
and muscles of facial
expression
• Marginal mandibular n.
lies deep to it

7. Superficial Layer of the Deep Cervical
Fascia
• Completely surrounds the neck from skull to chest
• Arises from spinous processes, ligamentum nuchae
• Superior border – nuchal line, external occipital
protuberance,skull base, zygoma, mandible
• Inferior border –spine of scapula, clavicle and manubrium
• Anterio border- symphysis menti, hyoid bone
• Splits to enclose parotid gland. The superficial part k/a
parotid fascia. And the deep part form stylomandibular
ligament.

8. • Envelopes
• SCM
• Trapezius
• Submandibular gland
• Parotid gland
• Supra sternal space of
burns and supra
clavicular space
• It forms the roof of ant &
posterior triangle
• It forms pulleyes for to
bind tendons of diagatric
& omohyoid muscle.

9. Clinical importance
• Parotid swellings are very pain full due to
unyielding nature of parotid fascia.
• While excising submandibular salivary gland
the ECA should be secured.

10. SUPRASTERNAL SPACE OF
BURNS CONTAINS
Sternal head of 2
SCMs
Jugular Venous arch
Inter Clavicular lig.
Lymph Node

11. SUPRACLAVICULAR
SPACE CONTAINS
• External Jugular Vein
• Supraclavicular
Nerve
• Vessels
• lymphatics

13. Middle Layer of the Deep Cervical Fascia
Visceral Division
• Superior border
• Anterior – hyoid and thyroid cartilage
• Posterior – skull base
• Inferior border – continuous with fibrous pericardium in
the upper mediastinum.
• Buccopharyngeal fascia
• Name for portion that covers the pharyngeal
constrictors and buccinator.
• Envelopes
• Thyroid
• Trachea
• Esophagus
• Pharynx
• Larynx

14. Muscular
Division
• Superior border –
hyoid and thyroid
cartilage
• Inferior border –
sternum, clavicle and
scapula
• Envelopes infrahyoid
strap muscles

15. Deep Layer of Deep Cervical Fascia
• Arises from spinous processes and ligamentum
nuchae.
• Lies deep to the trapezius
• Forms fascial carpet of the posterior triangle, which is
also the fascia on the lateral surface of scalene
muscles
• Reflected outwards as a sleeve along the brachial

16. Deep Layer of Deep Cervical Fascia
• Splits into two layers at
the transverse processes:
• Alar layer
• Prevertebral layer
Envelopes vertebral
bodies and deep
muscles of the neck.

18. Carotid Sheath
• Formed by all three
layers of deep fascia
• Anatomically separate
from all layers.
• Contains carotid artery,
internal jugular vein,
and vagus nerve
• “Lincoln’s Highway”
• Travels through
pharyngomaxillary
space.
• Extends from skull base
to thorax.

19. Deep Neck Spaces
• Described in relation
to the hyoid
• Entire length of the
neck
• Suprahyoid
• Infrahyoid

20. • A.Entire length of the neck
1. Retropharyngeal Space 2. Danger Space 3. Prevertebral
Space 4. Visceral Vascular Space
• B.Suprahyoid 5. Submandibular Space 6. Lateral
Pharyngeal Space 7. Masticator/Temporal Space 8. Parotid
Space 9. Peritonsillar Space
• C. Infrahyoid 10. Anterior Visceral Space.

21. • 1.prevertibral space
• 2.danger space
• 3. retropharyngeal
space
• 4. lateral pharyngeal
• 5. submandibular
space
• 6. masticator &
temporal space
• 7. Parotid space

22. Superficial space
• Surrounds platysma
• Contains areolar tissue,
nodes, nerves and
vessels
• Involved in cellulitis and
superficial abscesses
• Treat with incision along
Langer’s lines, drainage
and antibiotics

23. Retropharyngeal Space
• Entire length of neck.
• Anterior border – fascia
covering pharynx and
esophagus
(buccopharyngeal
fascia)
• Posterior border - alar
layer of deep fascia
• Superior border - skull
base
• Inferior border – superior
mediastinum T4
• Midline raphe- spaces of
Gilette
• Contains
retropharyngeal nodes.

24. Danger space
• Entire length of neck
• Anterior border - alar
layer of deep fascia
• Posterior border -
prevertebral layer
• Extends from skull
base to diaphragm
• Contains loose
areolar tissue.
• Space 4 of Grodinsky
and Holyoke

26. GRODINSKYAND HOLYOKE
CLASSIFICATION
• SPACE 1- The potential space superficial and
deep to platysma muscle.
• SPACE 2- the space behind the anterior layer
of deep cervical fascia
• SPACE 3- pretracheal space lying anterior to
trachea
• SPACE 3a- Lincoln’s highway
• SPACE 4- danger space , potential space
between the alar and prevertebral fascia
INTRA CRANIAL
COMPLICATIONS OF OTITIS
MEDIA
Dr Himanshu Mishra
2nd year PG

27. Prevertebral Space
• Entire length of neck
• Anterior border -
prevertebral fascia
• Posterior border -
vertebral bodies and
deep neck muscles
• Lateral border –
transverse processes
• Extends along entire
length of vertebral
column

28. Visceral Vascular Space
• Entire length of neck
• Carotid Sheath
• “Lincoln Highway”
• 3a of GRODINSKY
AND HOLYOKE
• Can become
secondarily involved
with any other deep
neck space infection
by direct spread

29. Submandibular Space
• Suprahyoid
• Superior – oral
mucosa
• Inferior - superficial
layer of deep fascia
• Anterior border –
mandible
• Lateral border -
mandible
• Posterior - hyoid and
base of tongue
musculature

30. Mylohyoid divides this space
into
Superior Sublingual compartment
Inferior Submaxillary compartment
• Sublingual compartment aka
sublingual space
• Submaxillary compartment
sometimes being referred as
submandibular space

31. SUBLINGUAL SPACE
Contains
• Sublingual gland
• Whartons duct
• Hypoglossal N.
• Lingual N.
• Loose areolar tissue

32. SUBMAXILLARY SPACE
Contains
• Submandibular gland
• Lymph nodes
Infection of this space known as
Ludwigs angina
MYLOHYOID LINE - relationship of
mylohyoid to tooth apices – determine
the route of infection spread
Anterior to 2nd molar :
(above the mylohyoid ): sublingual
space
2nd & 3rd molar
(roots below mylohyoid) : submaxillary
& parapharyngeal space

33. Pharyngomaxillary space
• (Para pharyngeal Space
lateral pharyngeal,
peripharyngeal,
pharyngomaxillary,
pterygopharyngeal,
pterygomandibular,
pharyngomasticatory)
• Superior—skull base
• Inferior—hyoid
• Posterior—prevertebral fascia
• Medial—buccopharyngeal
fascia,tonsil
• Lateral—med pterygoid,
mandible, parotid

35. • Prestyloid
• Muscular compartment
• Medial—tonsillar fossa
• Lateral—medial pterygoid
• Contains fat, connective
tissue, nodes, int maxillary
a. inf alveolar n., lingual n.,
auriculotemporal n.
• Poststyloid
• Neurovascular
compartment
• Carotid sheath
• Cranial nerves IX, X, XI, XII
• Sympathetic chain

36. RELATION WITH OTHER SPACES
• MEDIAL: pharyngeal mucosal
space
• LATERAL : parotid space
• POSTEROMEDIAL:
retropharyngeal space
• ANTEROLATERAL : masticator
space
• POSTERIOR : carotid
space
• INFERIOR :
submandibular space
• Central connection for major
deep neck spaces

37. PERITONSILLAR SPACE
BORDERS
• MEDIAL : capsule of palatine tonsil
• LATERAL : sup. Constrictor of
pharynx
• ANTERIOR : ant. Tonsillar pillar
• POSTERIOR : post. Tonsillar pillar
• Consists of loose areolar tissue
• Mainly in area adjacent to soft palate
• Infection of this space known as
Qunincy which spread to para
pharyngeal space

38. MASTICATOR SPACE
• investing layer split at inferior border of mandible to cover
medial pterygoid & masseter. It continues superiorly to
cover inferior tendon of temporalis muscle and fuse with
superficial temporalis fascia
• Divided into subspaces:
• Btn masseter & ramus of mandible : Massetoric space
• Btn pterygoid & ramus of mandible: pterygoid space
• Btn superficial temporal fascia & temporalis: superficial
temporal space
• Btn deep temporal fascia & temporal bone : deep temporal
space

39. PAROTID SPACE
• It is formed by investing
layer from all side.
RELATION
• Lateral to
parapharyngeal space
• Anterior to carotid space
• Posterior to masticator
space

40. CONTENTS
• Parotid gland
• Facial nerve
• External carotid artery
• Retro mandibular vein

41. BUCCAL SPACE
BOUNDARIES
• ANTERIORLY : zygomatic
major above & depressor anguli
oris below
• POSTERIORLY : anterior
border of masseter
• INFERIORLY : inferior border of
mandible
• MEDIALLY : buccinators
• LATERALLY : skin &
subcutaneous tissue

42. CONTENTS
• Parotid duct
• Anterior facial artery & vein
• Transverse facial artery & vein
• Buccal fat pad

43. CANINE SPACE
• BOUNDARIES:
• SUPERIORLY: quadratus
labbi superioris
• INFERIORLY : orbicularis ori
• MEDIALLY : anterior surface
of maxilla
• LATERALLY : zygomatic
major
• CONTENTS:
• Angular artery & vein
• Infra orbital Nerve

44. Thank you