Pharyngeal spaces
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The document discusses two pharyngeal spaces: 1) The retropharyngeal space is located behind the pharynx, bounded anteriorly by the buccopharyngeal fascia and posteriorly by the prevertebral fascia. It contains retropharyngeal lymph nodes, vessels, and nerves and can develop abscesses from infected lymph nodes. 2) The lateral pharyngeal space is located on the sides of the pharynx, bounded medially by the pharynx and posterolaterally by the parotid gland. It contains the maxillary nerve and branches of the maxillary artery and can develop pus collections known as Ludwig's angina.
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The pharynx is a muscular tube located behind the nose, mouth, and larynx. It has three parts - the nasopharynx, oropharynx, and laryngopharynx. The pharynx connects the nasal cavity, oral cavity, and larynx anteriorly and continues into the esophagus inferiorly. It is innervated by the pharyngeal plexus and has both longitudinal and outer constrictor muscles. Structures in the pharynx include the soft palate, tonsils, epiglottis, and pyriform sinuses. The pharynx serves to transport air and food while providing sensory function.
Deep facial spaces of head and neck
This document discusses the deep fascial spaces of the head and neck region and their clinical management. It begins by defining fascia and describing the different layers of deep cervical fascia. It then numbers the deep fascial spaces according to Grodinsky and Holyoke's 1938 landmark article. The document discusses the anatomy and clinical features of various deep neck spaces including the lateral pharyngeal, retropharyngeal, prevertebral, danger, and peritonsillar spaces. It concludes by describing the surgical management and drainage approaches for infections that may spread to these spaces.
Pharynx anatomy
This document provides a detailed overview of the anatomy of the pharynx and related structures. It describes the pharynx as a musculomembranous tube divided into 3 parts - nasopharynx, oropharynx, and laryngopharynx. It outlines the walls, openings, layers, blood supply, nerve supply, and development of each part. Related structures like the tonsils, auditory tubes, and larynx are also described in detail, including their cartilages, walls, openings, blood supply, nerve supply, and clinical applications.
Surgical treatment of paraphyrngeal and retropharyngeal abscesses
The document discusses various deep neck spaces including the parapharyngeal and retropharyngeal spaces. It describes parapharyngeal and retropharyngeal abscesses, including their etiology, clinical features, investigations, and surgical treatment which involves securing the airway followed by either a transoral or transcervical approach to drain the abscess completely while protecting nearby structures.
Pharynx
The pharynx is a musculofibrous tube that connects the nasal and oral cavities to the larynx and esophagus. It has 5 layers - mucosa, submucosa, pharyngobasilar fascia, muscular layer, and buccopharyngeal fascia. The muscular layer contains the 3 pharyngeal constrictor muscles. The pharynx is divided into 3 parts - nasopharynx, oropharynx, and laryngopharynx. It is supplied by the pharyngeal plexus and drained by pharyngeal veins. Infections can spread from the pharynx to the middle ear through the auditory tube. The killian deh
Nasal cavity and Paranasal Air Sinuses
The nasal cavity and paranasal air sinuses are described. The nasal cavity has 3 regions and is separated from other structures by bones. Each side has a roof, floor, medial and lateral wall. The lateral wall contains conchae that increase surface area. Paranasal sinuses include the frontal, ethmoidal, sphenoidal and maxillary sinuses. They are described in terms of location, openings, blood supply and innervation.
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Surgical treatment of paraphyrngeal and retropharyngeal abscesses
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Temporal & infratemporal region
The temporal fossa is located on the side of the skull and contains the temporalis muscle, middle temporal artery, zygomaticotemporal nerve and artery, and deep temporal nerves and artery. The infratemporal fossa is an irregular space below the zygomatic arch that contains the lateral and medial pterygoid muscles, mandibular nerve and branches, maxillary nerve, chorda tympani nerve, parts of the maxillary artery and branches, and accompanying veins.
Parotid gland
The parotid gland is the largest salivary gland located below and in front of the ear. It is invested by a thick fascial capsule. The facial nerve exits the skull and passes through the gland, dividing into branches that supply facial muscles. The parotid duct exits from the anterior border of the gland and opens into the mouth. The gland receives blood supply from the external carotid artery and drains into local lymph nodes and veins leading to the internal and external jugular veins.
Infrahyoid muscles
The infrahyoid muscles are a group of ribbon-like muscles that include the sternohyoid, omohyoid, thyrohyoid, and sternothyroid. These muscles are arranged in superficial and deep layers and attach to both the hyoid bone and thyroid cartilage, allowing them to depress or elevate these structures. Specifically, the sternohyoid and omohyoid are superficial muscles that depress the hyoid bone, while the sternothyroid and thyrohyoid are deep muscles with actions including depressing the larynx or elevating it through attachment to the hyoid bone.
Ansa cervicalis
The Ansa cervicalis is a nerve loop that lies in the carotid sheath over the larynx and supplies the infrahyoid muscles. It is formed by a superior root from the hypoglossal nerve and first cervical nerve, and an inferior root from the second and third cervical spinal nerves. These roots join in front of the common carotid artery to innervate the sternohyoid, sternothyroid, and inferior belly of the omohyoid muscles, while separate branches from C1 also innervate the thyrohyoid and geniohyoid.
Arteries of carotid triangle
The common carotid artery divides into the external and internal carotid arteries at level of the upper border of the thyroid cartilage. The external carotid artery gives off 8 branches including the superior thyroid, lingual, and facial arteries. It terminates by dividing into the maxillary and superficial temporal arteries. The carotid sinus located at the bifurcation of the common carotid artery acts as a baroreceptor to regulate blood pressure. The carotid body situated posterior to the bifurcation acts as a chemoreceptor in response to changes in blood gases.
Anterior triangles of neck
The anterior triangle of the neck is divided into four smaller triangles by the digastric muscle and omohyoid muscle. The submental triangle is bounded by the digastric muscles and hyoid bone, and contains submental lymph nodes and veins. The digastric triangle contains the submandibular gland and lymph nodes, as well as the hypoglossal and lingual nerves. The carotid triangle contains the common carotid artery and its branches, internal and external jugular veins, and the vagus, accessory, and hypoglossal nerves. The muscular triangle contains the infrahyoid muscles - sternohyoid, sternothyroid, thyrohyoid, and omohyoid.
Sternocleidomastoid muscle
The sternocleidomastoid muscle originates from the manubrium sterni and clavicle. It inserts into the mastoid process and superior nuchal line of the occipital bone. The spinal accessory nerve provides motor innervation and branches from C2 provide proprioceptive innervation. The muscle acts to turn the chin to the opposite side, tilt the head toward the shoulder on the same side, and draw the head forward. Torticollis is a deformity where the head is bent to one side caused by spasm or contracture of the sternocleidomastoid and trapezius muscles, which can result from rheumatic, reflex, congenital, or birth-related causes
Posterior triangle of the neck
The posterior triangle is a space on the side of the neck bounded anteriorly by the sternocleidomastoid muscle, posteriorly by the trapezius muscle, and inferiorly by the middle third of the clavicle. It is divided into the occipital triangle and supraclavicular triangle by the omohyoid muscle. The occipital triangle contains nerves like the spinal accessory nerve and branches of the cervical plexus. The supraclavicular triangle contains structures of the brachial plexus like the trunks and nerves to muscles like serratus anterior. Lymph nodes in the posterior triangle drain the neck.
Deep cervical fascia
The deep cervical fascia of the neck forms several layers including the investing, pretracheal, prevertebral, carotid sheath, buccopharyngeal, and pharyngobasilar fasciae. The investing fascia surrounds the neck and splits to enclose muscles and glands. The pretracheal fascia suspends the thyroid gland. The prevertebral fascia forms the floor of the posterior triangle and extends into the mediastinum. The carotid sheath contains the major neck vessels. Infections can spread in various directions through fascial planes.
Eyelids & Lacrimal Apparatus
The eyelids are composed of several layers including skin, superficial fascia, palpebral fascia, and conjunctiva. The palpebral fascia forms the tarsal plates which provide stiffness to the lids. The tarsal plates contain meibomian glands whose ducts open at the lid margins. The lacrimal apparatus includes the lacrimal gland, conjunctival sac, lacrimal puncta and canaliculi, lacrimal sac, and nasolacrimal duct which secretes and drains tear fluid from the eye. The face develops from five processes- frontonasal, two maxillary, and two mandibular processes. Canalization of an ectodermal
Face
The face is supplied by a rich vascular network. The facial artery is the main blood vessel and gives off branches that supply the different regions of the face. The facial vein drains the face and connects with the cavernous sinus, making the upper lip and lower nose dangerous areas for infections. The face has a dense network of lymphatic vessels that drain to preauricular, submandibular, and submental lymph nodes. The facial nerve innervates all the facial muscles to allow for facial expressions.
Scalp
The scalp is made up of five layers: skin, connective tissue, aponeurotic layer containing the occipitofrontalis muscle, loose areolar layer, and pericranium covering the skull. It has a rich blood supply from branches of the external and internal carotid arteries. Veins drain into various vessels like the angular vein and external jugular vein. Lymphatic drainage is to preauricular, parotid, postauricular, mastoid, and occipital lymph nodes. Injuries to the scalp can cause significant bleeding due to adherence of blood vessels to fibrous tissue.
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Pharyngeal spaces
- 2. RETROPHARYNGEAL SPACE Situation: Dead space behind pharynx. Function: Acts as a bursa for expansion of pharynx during deglutition Boundaries: Anterior: Buccopharymgeal fascia Posterior: Prevertebral fascia Sides: Carotid sheath Superior: Base of skull Inferior: Open and continuous with superior mediastinum.
- 3. Contents: Retropharyngeal lymph nodes, pharyngeal plexus of vessels and nerves/ loose areolar tissue. Clinical anatomy: Pus collection due to lymph node abscess. It should be differentiated from cold abscess of spine of cervical vertebrae
- 4. LATERAL PHARYNGEAL SPACE Situation: Side of pharynx Boundaries: Medial: Pharynx Posterolateral: Parotid gland Anterolateral: Medial Pterygoid Posterior: Carotid sheath Contents: Maxillary nerve and branches of maxillary artery Clinical Anatomy: Pus collection/Ludwig's angina