5. SUPERFICIAL FASCIA
Composed of subcutaneous tissues that
encircle the neck like a collar.
Encircles the deep fascia
Components:
Platysma and muscles of facial
expression.
Subcutaneous veins , nerves and fat
Superficial lymph nodes.
6. SUPERFICIAL LAYER/INVESTING
LAYER
Complete collar around the neck
Splits to cover SCM and Trapezius
Capsule : parotid and Submandibular gland
Spaces : Masticator space ,parotid space,
submandibular space and sublingual space.
DEEP CERVICAL FASCIAE
8. Extent: Hyoid bone to sup mediastinum
SHN : Continues as buccopharyngeal fascia(BPF)
Contents : Trachea, esophagus , larynx , thyroid
and parathyroid gland
Spaces : Pharyngeal mucosal space ,
retropharyngeal space , parapharyngeal space
and buccal space
MIDDLE LAYER OF DCF (Visceral /pretracheal
layer)
9. Extent : skull base to superior
mediastinum T4 level.
Encircles : Paravertebral and
paraspinal muscles, vertebral body ,
vertebral blood vessels , phrenic nerve
and brachial plexus trunk
Spaces : involve both SHN and IHN –
CS , RPS, DS , PVS and posterior
cervical space.
: Involving only IHN - Visceral
spaces and anterior cervical space
DEEP LAYER OF DCF(Prevertebral fascia)
10.
11.
12. NECK SPACES
Described in relation to the hyoid bone.
Suprahyoid Spaces.
Infrahyoid Spaces.
Spaces extending up to the entire length of
the neck.
13. Spaces extending up to the entire length of the
neck:
Carotid Space.
Retropharyngeal Space.
Danger space.
Peri-vertebral Space (prevertebral component & para-
spinal component) .
20. Paired tubular structure
traversing SHN and IHN
Skull base to superior
mediastinum
Lateral to RPS
Enveloped by carotid sheath : all
3 layers of DCf
Contents : SHN – ICA IJV ,
CN9-12,
:IHN - CCA, IJV ,
CN10 trunk ( vagus)
CAROTID SPACE
25. Extent : Skull base to T4 level
2 parts
Ant : True RPS
Post : Danger space
Contents :
SHN : LN and fat
IHN : Fat
pathway for spread of
infections / tumors into the
mediastinum from the neck.
RETROPHARYNGEAL SPACE
26. Relations
The retropharyngeal space is:
anterior to the danger space
posterior to the pharyngeal
mucosal space
anteromedial to the carotid space
posteromedial to the
parapharyngeal space
27.
28. DANGER SPACE
Extends from the skull base up to the diaphragm
Posterior to the RPS.
Bounded by the Alar fascia anteriorly and Prevertebral fascia posteriorly.
Content : loose areolar tissue which provides easy pathway for the spread of infections.
In healthy patients, it is indistinguishable from the retropharyngeal space. 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.
30. Posterior midline space
of SHN and IHN
Enclosed by deep layer
of DCF
Extent : base of skull to
level of coccyx
2 compartments :
Prevertebral and
Paraspinal
PERIVERTEBRAL SPACE
31.
32. Extent : Above the mylohyoid
muscle
Contents : Sublingual gland
and their ducts , LNs,
hypoglossal muscle , lingual
artery and vein ,hypoglossal N
and deeper portion of
submandibular gland.
SUBLINGUAL SPACE
34. SUBMANDIBULAR SPACE
Extend : Mylohoid superiorly & hyoid
bone inferiorly.
Communicates freely with sublingual
space.
Contents : superficial portions of the
Submandibular gland,submental and
submandibular LNs, facial artery and
vein, fat and ant belly of digastric.
38. MASTICATOR SPACE
Formed by splitting of the
SLDCF.
Extends from skull base to
the inferior edge of the
mandible.
Contents: mandible, muscles
of mastication, and
mandibular division of the Vth
nerve.
40. PAROTID SPACE
Boundary : Investing fascia(SLDCF) splitting at the angle of mandible.
Extends : Superiorly external acoustic meatus
Inferiorly up to the mandible.
Contents: Parotid Gland, proximal part of the parotid duct, intraparotid
lymph nodes and vessels.
Parotid gland is divided by facial nerve into superficial and deep.
43. Visceral space
The visceral space extends from the hyoid bone to the superior
mediastinum (level of aortic arch / T4), and is surrounded by the
middle layers of the deep cervical fascia.
Contents
• thyroid gland
• parathyroid gland
• oesophagus
• larynx
• hypopharynx
• trachea
• recurrent laryngeal nerve
• lymph nodes (level VI)
44.
45. CERVICAL SPACES
ANTERIOR CERVICAL SPACE : Hyoid to clavicle
Content : Only fat
POSTERIOR CERVICAL SPACE : Extend from the skull base to the
clavicles.
Deep and posterior to sternocledomastoid
Content : fat, spinal accessory nerves and spinal accessory chain of deep cervical
lymph nodes.
51. Extension:
Superiorly-Base of skull including posterior part of body of sphenoid and
the basilar part of the occipital bone.
Inferiorly-pharynx continues with oesophagus at the level of 6th cervical
vertebra/ lower border of cricoid cartilage.
Posteriorly-Prevertebral fascia separating it from cervical spine
Anteriorly-Communication with Nasal cavity, Oral cavity, and Larynx.
52.
53. Division of Pharynx
The nasal part – NASOPHARYNX/ EPIPHARYNX
(extends from base of skull to soft palate)
The oral part – OROPHARYNX
(extends from lower border of soft palate to upper
border of epiglottis)
The laryngeal part – LARYNGOPHARYNX/
HYPOPHARYNX
(extends from upper border of epiglottis to lower
border of cricoid cartilage)
54.
55. NASOPHARYNX
Roof- Basisphenoid and Basiocciput.
Posterior wall- Arch of Atlas vertebrae covered by prevertebral muscles and
fascia.
Anterior wall- Posterior nasal apertures (Choanae).
Lateral wall on both sides
- Opening of Eustachian Tube
-Tubal opening bounded by Tubal elevation/Torus tubarius
-Fossa of Rosenmuller or Lateral/Pharyngeal Recess
Inferiorly- It communicates with oropharynx
56.
57.
58.
59.
60. OROPHARYNX
Above- communicates with nasopharynx through nasopharyngeal isthmus.
Below- opens into laryngopharynx.
Anterior wall-
upper part- oropharynx communicates with oral cavity through oropharyngeal
isthmus/ Isthmus of Fauces.
lower part- base of tongue
- lingual tonsils
- valleculae
Posterior wall- Third cervical vertebrae.
Lateral wall- Palatine/Faucial tonsil
- Anterior pillar (Palatoglossus muscle)
- Posterior pillar (Palatopharyngeus muscle)
61.
62.
63.
64.
65.
66.
67.
68. Laryngopharynx
Lower part of pharynx situated behind and partly on sides
of the larynx.
Hypopharynx lies opposite to 3rd, 4th, 5th, 6th cervical
vertebrae.
Clinically it is divided into 3 regions-
1. Pyriform Sinus (fossa)
2. Post-cricoid region
3. Posterior Pharyngeal wall
73. • The larynx is a 5-7 cm long
structure.
Its upper boundary starts at the tip
of the epiglottis, opposite the 3rd
to 4th cervical vertebra.
• Its lower end is at the lower
border of the cricoid cartilage
and continuous with trachea
below
This lies opposite the 6th cervical
vertebra.
75. Three mucosal folds, the
glossoepiglottic folds - namely, a
central and two lateral folds - pass
from the anterior surface of the epiglottis
to the base of the tongue. These form
paired recesses between the base of
the tongue and the epiglottis known as
the valleculae.
76. A further pair of mucosal folds pass
from the lateral margin of the
epiglottis posteriorly to the
arytenoid cartilages separating the
larynx from the piriform fossae.
These are the aryepiglottic folds
which, together with the epiglottis,
define the entrance to the larynx.
77. The cavity of the larynx is divided into
three parts by upper and lower pairs of
mucosal folds. The upper pair of folds
are the false cords. The space
between the laryngeal entrance and
the false cords is known as the
vestibule of the larynx.
The lower pair of folds are the true
cords and contain the vocal ligaments,
which are responsible for voice
production. The space between the
false and true vocal cords is the
laryngeal ventricle or sinus of larynx
78.
79. LEVELS OF THE LARYNX AND
THEIR BOUNDARIES
The supraglottic division:
From the superior-most tip of the epiglottis -to
vestibular folds
The glottis:
Space between vestibular folds and vocal
folds
The subglottic region
From vocal folds -to the inferior portion of the
cricoid cartilage.
82. Cross-sectional anatomy of the
larynx
Supraglottic level
The larynx is anterior to the piriform sinuses, separated from them by
the aryepiglottic folds.
82
89. Glottic level
A complete ring of cartilage is seen at this level –thyroid
cartilage anteriorly & lamina of the cricoid &arytenoid
cartilages posteriorly.
The anterior fusion of the vocal cords is known as the
anterior commissure and is very thin when the cords are
abducted. Similarly, the posterior commissure, which is
seen between the arytenoids
The larynx is elliptical in shape at the level of the true
cords and triangular at the level of the false cords, which
are at a slightly higher level.
89
93. Infraglottic level
Just below the cords the
larynx is elliptical. The
lamina of the cricoid is
posterior, with the
cricothyroid membrane
anterior.
At a lower level the larynx is
more circular and the cricoid
forms a complete ring. Part
of the lobes of the thyroid
gland may be seen laterally,
93
105. All the lymph from the region of the head & necks drains into deep
cervical LNs either directly from the tissues or indirectly after
passing through the outlying group of LNs.
The efferents from deep cervical node form the jugular trunk,which
on the Rt side drain in to the Rt lymphatic duct & on the Lt side in to
the thoracic duct then both open in to the junction of the suclavian &
internal jugular vein on their respective sides.
106.
107. HORIZONTAL CHAIN - Outer circle
- Inner circle
VERTICAL CHAIN
level 1 consist of sub mental,
submandibular nodes
level 2 consist of upper jugular nodes
level 3 consist of middle jugular group
level 4 lower jugular group
level 5 posterior triangle group
level 6 anterior compartment group
level 7 superior mediastinal group
level 8 supraclavicular nodes
level 9 retropharyngeal nodes
108. Level I
Submental and submandibular nodes
Level I A
Submental nodes, between the medial
margins of the anterior bellies of the digastric
muscles.
Level I B
Submandibular nodes, lateral to level I A
nodes and anterior to the back of the
submandibular salivary gland.
109.
110. Level II
Upper internal jugular nodes, posterior to the back of the
submandibular salivary gland, anterior to the back of the
sternocleidomastoid muscle and above the level of the
bottom of the body of the hyoid bone.
111.
112.
113. Level III
Middle jugular nodes, between the level of the bottom of the
body of the hyoid bone and the level of the bottom of the cricoid
arch, anterior to the back of the sternocleidomastoid muscle.
114.
115.
116. Level IV
Low jugular nodes, between the level of the bottom of the
cricoid arch and the level of the clavicle, anterior to a line
connecting the back of the sternocleidomastoid muscle and the
posterolateral margin of the anterior scalene muscles; they are
lateral to the carotid arteries.
117.
118. Level V
Posterior triangle nodes, posterior to the back of the
sternocleidomastoid muscle, and posterior to the line described in level
IV.
Level V A Above the level of the bottom of the cricoid arch.
Level V B Between the level of the bottom of the cricoid arch and the
level of the clavicle
119.
120.
121. Level VI
Upper visceral nodes, between the carotid
arteries from the level of the bottom of the
body of the hyoid bone to the level of the top
of manubrium.
Extend from mandible to thoracic inlet and from base of skull to scapulae
Skullbase , mandible, hyoid , clavicle , sternum , scapula
Posteriorly : Ligamentum nuchae and cervical spinous process
DS; danger space
(Left) Lateral graphic of the cervical neck shows the tubular carotid space (CS) extending from the skull base (carotid canal and jugular foramen) to the aortic arch.
RIGHT: Axial graphic of the skull base viewed from below shows the carotid space abutting the skull base. The ICA enters the carotid canal , while the jugular foramen gives rise to the internal jugular vein. Notice CN 9-11 exiting the jugular foramen. CN12 is more medial as it leaves the hypoglossal canal.
LEFT : outside ijv , ica , styloid process
Right : IJV ( big) cca (small)
Ant : Pharynx and esophagus , posteriorly : cervical and upper thoracic spine
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 (virtual at this level).
Boundary : Investing fascia(SLDCF) splitting at the angle of mandible.
Extends : Superiorly external acoustic meatus
Inferiorly up to the mandible.
Contents: Parotid gland Facial N Retromandibular vein ECA LN
Parotid gland is divided by facial nerve into superficial and deep.
Division identified on imaging by retromandibular vein.
Contrast enhanced CT 1 Parapharyngeal space. 2 Masticator space. 3 Mucosal space. 4 Carotid space 4 Parotid space. 5 Mucosal space. 6 Perivertebral space (anterior portion). 7 Retropharyngeal space (virtual at this level).
