2. DEEP NECK SPACES
SPACES OF THE FACE
• Buccal Space
• Canine Space
• Masticator Space
• Submasseteric Space
• Pterygomandibular Space
• Superficial Temporal Space
• Deep Temporal Space
• Infratemporal Space
• Parotid space
SPACES OF THE NECK
• Retropharyngeal Space
• Danger Space
• Prevertebral Space
• Carotid Space
• Submental Space
• Submandibular Space
• Peritonsillar Space
• Parapharyngeal Space
• Anterior Visceral Space
3. BUCCAL SPACE/ BUCCINATOR SPACE
• The buccal space is located in the cheek, in between skin and
buccinator muscle
• BOUNDARIES
Anterior- Angle of mouth
Posterior- Masseter & Masseteric space
Superior- Zygomatic process of maxilla
Superomedial & Inferomedial- Space is limited by attachment of
buccinator muscle, to the alveolar process of maxilla & mandible
below
Inferior- Depressor anguli oris and the attachment of the deep
fascia to the mandible
Medial- Buccinator muscle
Lateral- the platysma muscle, subcutaneous tissue and skin
4. • CONTENTS
1. Buccal fat pad
2. Parotid duct (Stenson’s duct)
3. Accessory Parotid gland
4. Facial & Buccal arteries, corresponding veins
5. Buccal branch of Facial nerve
6. Buccal nerve of Mandibular division of Trigeminal nerve
• COMMUNICATIONS
1. With pterygomandibular space, Infratemporal space,
Submasseteric space & Parapharyngeal space posteriorly
2. With Canine space superiorly
5. CANINE SPACE/ INFRAORBITAL SPACE
• It is located between the levator anguli oris
muscle inferiorly and the levator labii
superioris muscle superiorly
• The term is derived from the fact that the
space is in the Canine fossa and that
infections originating from the maxillary
canine tooth may spread to involve the
space.
7. • CONTENTS
1. Angular artery & vein
2. Infraorbital nerve (Branch of Maxillary
division of Trigeminal nerve)
• COMMUNICATION
With the buccal space posteriorly
8. MASTICATOR SPACE
• It lies between the two layers of deep
cervical fascia
• The superficial layer covers the masseter
muscle, attaches to the zygomatic arch
and continues superiorly to encase the
temporalis muscle
• The deep layer covers the medial and
lateral pterygoid muscles medially and
attaches to the skull base medial to
foramen ovale
9. • BOUNDARIES
Superior- Skull base (greater wing of
sphenoid and squamous temporal bone)
Medially- Pharyngeal mucosa
Laterally- Masseter muscle
Posteromedial- The lateral pterygoid plate,
superior constrictor, tensor and levator veli
palatini muscles
10. • It consists of 4 spaces within itself:
1. Masseteric space inferolaterally
2. Pterygoid space inferomedially
3. Superficial Temporal space
superolaterally
4. Deep Temporal space supermedially
The infratemporal space is the inferior
portion of the deep temporal space
11. • CONTENTS
1. Muscles of mastication (Masseter, Temporalis, Lateral
Pterygoid, Medial Pterygoid)
2. Mandibular division of Trigeminal nerve (enters via
Foramen Ovale)
3. Internal Maxillary artery
4. Inferior alveolar nerve & vessels
• COMMUNICATIONS
With the pterygopalatine fossa exits via the
pterygomaxillary fissure
12. MASSETERIC SPACE
• It is a potential space in the face over the angle
of jaw.
• It is located between the lateral aspect of the
mandible and the medial aspect of the masseter
muscle and its investing fascia
• BOUNDARIES
Anterior- Anterior margin of masseter muscle
Posterior- parotid gland
Superior- Zygomatic arch
Inferior- Inferior border of mandible
Lateral- Masseter muscle
Medial- Lateral surface of Mandibular Ramus
13. • COMMUNICATIONS
1. To the Buccal space anteriorly
2. To the Pterygomandibular space ( around
the posterior margin of the mandibular
ramus to its medial surface) and the Parotid
space posteriorly
3. To the Superficial Temporal space superiorly
• CONTENTS
Masseteric artery and vein
14. PTERYGOID/ PTERYGOMANDIBULAR
SPACE
• It is a potential space between the medial
pterygoid muscle and the medial surface of the
ramus of the mandible.
• BOUNDARIES
Anterior- Posterior border of buccal space
Posterior- Parotid gland
Superior- Lateral Pterygoid muscle
Inferior- Inferior border of mandible (lingual surface)
Medial- Medial Pterygoid muscle
Lateral- Ascending ramus of mandible
15. • CONTENT
1. The mandibular division of the Trigeminal nerve
2. The inferior alveolar artery and vein
3. The sphenomandibular ligament
4. Mylohyoid nerve and vessels
• COMMUNICATION
1. To the buccal space anteriorly
2. To the lateral pharyngeal space and peritonsillar space
medially
3. To the submasseteric space laterally
4. To the parotid space posteriorly
5. To the deep temporal/ infratemporal space superiorly
16. SUPERFICIAL TEMPORAL SPACE
• Located between Temporalis fascia laterally &
Temporalis muscle medially
• BOUNDARIES
Lateral- Skin & Temporalis fascia
Medial- Lateral border of Temporalis muscle
Inferior- Superior surface of Lateral Pterygoid
Superior & Posterior- Attachment of Temporalis to
cranium
Anterior- Posterior wall of maxillary sinus,
Pterygomaxillary fissure
17. • CONTENT
1. Temporal fat pad
2. Temporal branch of facial nerve
• NEIGHBOURING SPACES
1. Buccal space anteriorly
2. Deep Temporal space medially
18. DEEP TEMPORAL SPACE
• It is a potential space located deep to the Temporalis muscle
• The inferior portion of the deep temporal space- Infratemporal space
• The deep temporal space is separated from the pterygomandibular space by the
lateral pterygoid muscle inferiorly and from the superficial temporal space by the
temporalis muscle laterally
• The deep temporal space + superficial temporal space= Temporal spaces
19. • BOUNDARIES
Lateral- Medial surface of Temporalis muscle
Medial- Lateral surface of temporal bone
Inferior- Superficial surface of Lateral Pterygoid
muscle
Superior & Posterior- Attachment of Temporalis to
cranium
Anterior- Attachment of fascia to orbital process of
zygoma
20. • CONTENT
1. Pterygoid plexus
2. Internal Maxillary Artery & Vein
3. Mandibular division of Trigeminal nerve
4. Skull base foramina
• COMMUNICATION
1. Buccal space anteriorly
2. Superficial Temporal space laterally
21. INFRATEMPORAL SPACE
• It is a potential space located posterior to the
maxilla, between the lateral pterygoid plate of the
sphenoid bone medially and by the base of skull
superiorly
• BOUNDARIES
Superior- Greater wing of sphenoid
Inferior- Lateral Pterygoid muscle & Pterygomandibular
space
Anterior- Infratemporal surface of maxilla & Posterior
surface of zygomatic bone
Medial- The Lateral Pterygoid plate, part of the lateral
pterygoid muscle and lateral pharyngeal wall
Posterior- Parotid gland
Lateral- Temporalis , Ramus of mandible
22. • CONTENT
1. Branches of the maxillary artery
2. Pterygoid venous plexus
• COMMUNICATION
1. Pterygomandibular space inferiorly
2. Buccal space anteriorly and inferiorly
3. Cavernous sinus via the pterygoid plexus of veins
23. PAROTID SPACE
• The space lies behind the ramus of the
mandible and around the parotid gland.
• Parotid space is formed by the superficial layer
of the deep cervical fascia which splits to
surround superficial lobe of the parotid gland.
• Fascial layer is very thick superficially but very
thin on the deep side of the parotid gland
where parotid abscess can burst to form a
parapharyngeal abscess and thence spread to
the mediastinum.
25. SPACES ALONG THE ENTIRE LENGTH
OF NECK
Retropharyngeal space
Danger space
Prevertebral space
Carotid space
26. RETROPHARYNGEAL SPACE
• The area between the buccopharyngeal
fascia of the middle layer and alar layer of
the deep layer of the deep cervical fascia
• Also known as Posterior visceral space/
Lincoln highway of Body
• Suprahypoid portion- Lymph nodes
draining the pharynx, nasal cavity, paranasal
sinuses and middle ear
• Acts as a bursa to allow expansion of
pharynx during deglutition
27. • BOUNDARIES
Superior- Base of the skull
Inferior- Bifurcation of Trachea (alar fascia fuses
with the buccopharyngeal fascia at about the
level of T4 and the carina)
Lateral- Carotid sheath & its contents
Anterior- Buccopharyngeal fascia covering
constrictors of Pharynx
Posterior- Alar fascia
• The space is divided into two lateral
compartments ( Spaces of Gillette ) by a
fibrous raphe
28. • CONTENT
1. Lymph node of Rouviere ( Retropharyngeal LN)
2. Fat
3. Loose areolar tissue
4. Small vessels
• COMMUNICATION
With Parapharyngeal space anterolaterally on bothsides
• RELATIONS
1. Anterior to the danger space
2. Posterior to the pharyngeal mucosal space
3. Anteromedial to the carotid space
4. Posteromedial to the Parapharyngeal space
29. DANGER SPACE
• Lies between the alar fascia and prevertebral fascia and
extends from the skull base down to the posterior
mediastinum where the alar, visceral and prevertebral
layers of the deep cervical fascia fuse.
• Lies between Retropharyngeal space & Prevertebral
space.
• BOUNDARIES
Superior- Base of skull (clivus)
Inferior- Posterior mediastinum upto the level of diaphragm
Anterior- Alar layer of deep cervical fascia
Posterior- Prevertebral layer of the deep cervical fascia
Lateral- Fuses to tips of Transverse process
30. • CLINICAL IMPORTANCE
Mortality
Erosion of Major
vessels, lower
airway & Upper
digestive tract
To the posterior
mediastinum which
contains Vena cava,
Aortic arch,
Thoracic duct,
Trachea,
Oesophagus
Potential route for
the downward
spread of infection
from the
Retropharyngeal or
prevertebral space
31. PREVERTEBRAL SPACE
• Potential space that lies between the vertebral bodies and
the prevertebral fascia anteriorly
• BOUNDARIES
Anterior- Prevertebral layer of the deep cervical fascia
Posterior- Vertebral bodies
Superior- Base of skull
Inferior- Coccyx
• CONTENT
1. Prevertebral muscles
2. Scalene muscles
3. Vertebral artery & vein
4. Brachial plexus
5. Phrenic nerve
32. CAROTID SPACE
• Roughly cylindrical space that extends
from the skull base through the aortic
arch.
• It is circumscribed by the carotid sheath.
• BOUNDARIES
Superior- Lower border of Jugular foramen
Inferior- Aortic arch
Lateral margin- fascia of SCM
Anterior margin- Stylopharyngeal
aponeurosis ( TVS fascia)
Medial margin- Cloison sagittale
Posterior margin- Prevertebral fascia
Cloison
sagittale
Prevertebral
fascia
Internal Jugular
Vein
Posterior Belly of
Digastric
Mandible
Internal
carotid
artery
Stylopharyngeus M.
Styloglossus M.
External
carotid
artery
Stylohyoid M.
Sternocleido
mastoid M.
33. • CONTENT
1. Common carotid artery inferiorly
2. Internal carotid artery superiorly
3. Internal jugular vein
4. Ansa cervicalis (embedded in the
anterior wall of sheath)
5. Vagus nerve ( posterior to vessel)
6. Accessory nerve
7. Hypoglossal nerve
8. Sympathetic nerves (medial to vessels
& lateral to RPS)
9. Deep cervical lymph node chain ( level
II, III, IV)
35. SUBMENTAL SPACE
• It is a potential space located between the
mylohyoid muscle anteriorly, the platysma
muscle inferiorly, under the chin in the
midline.
• BOUNDARIES
Lateral- Anterior belly of digastric
Anterior & Inferior- Superficial layer of deep
cervical fascia
Superior- Mylohyoid
Posterior- Hyoid
36. • CONTENT
1. Submental lymph nodes
2. Areolar connective tissue
3. Anterior jugular veins
• COMMUNICATION
1. Submandibular spaces posterolaterally
2. Sublingual spaces superiorly ( via erosion
through Mylohyoid)
37. SUBMANDIBULAR SPACE
• It is a suprahyoid deep compartment of
head and neck that encompasses
the submandibular gland and surrounding
structures.
• BOUNDARIES
Superior- floor of mouth mucosa
Lateral- Mandible
Medial- Muscles of tongue
Anteroinferior- Anterior belly of Digastric muscle
Posteroinferior- Posterior belly of Digastric
muscle
38. • CONTENT
1. Submandibular gland
2. Branches of facial & lingual artery
3. Submandibular Lymph nodes
4. Hypoglossal nerve
5. Nerve to Mylohyoid
6. Lingual nerve
7. Sublingual space has sublingual gland &
Wharton’s duct
39. • The space is divided by the mylohyoid muscle
into:
Sublingual space
Submylohyoid space/ submandibular
compartment
The two compartments are continuous around the
posterior border mylohyoid muscle
• COMMUNICATIONS
1. Submental space anteriorly & medially
2. Sublingual space posteriorly & superiorly
3. Parapharyngeal space laterally
40. PERITONSILLAR SPACE
• Potential space between fibrous capsule of tonsil
medially & Superior Constrictor laterally.
• BOUNDARIES
Medial- Capsule of palatine tonsil
Lateral- Superior Constrictor muscle
Anterior- Palatoglossus muscle (Anterior tonsillar pillar)
Posterior- Palatopharyngeus muscle (Posterior tonsillar
pillar)
Superior- Torus tubaris/ level of hard palate
Inferior- Pyriform sinus
42. PARAPHARYNGEAL SPACE
• Also known as Pterygomaxillary space,
Pharyngomaxillary space,
Pterygomandibular space and lateral
pharyngeal space
• It is an inverted cone with its base
bounded by the petrous portion of the
temporal bone and its apex at the level
of the hyoid
43. • BOUNDARIES
Medial - Distensible
Superior pharyngeal constrictor muscle & LVP & TVP
Buccopharyngeal membrane
Pharynx
Lateral – Relatively immobile
Deep lobe of the parotid gland
Medial pterygoid
Ramus of the mandible
Fascia of the Posterior belly of digastric ( below the
level of mandible)
Posterior – Prevertebral fascia
Carotid sheath posterolaterally
Retropharyngeal space posteromedially
Anterior – Pterygomandibular raphae
44. • It is divided into two compartment by the
Aponeurosis of Zuckerkandl and Testut.
• CONTENT
1. Prestyloid compartment
Fat
Connective tissue
Maxillary artery
Inferior alveolar nerve
Lingual nerve
Auriculotemporal nerve
Deep parotid lobe
2. Poststyloid compartment
Carotid sheath and its contents
Sympathetic chain
Associated lymphnodes
45. • COMMUNICATION
1. Anterolateral- Masticator space
2. Posterolateral- Parotid space
3. Anteromedial- Pharyngeal mucosal
space
4. Posteromedial- Prevertebral space,
Retropharyngeal space and Danger
space
5. Posterolateral- Carotid space
46. ANTERIOR VISCERAL/ PRETRACHEAL
SPACE
• It is formed anteriorly by the middle layer of DCF
that envelopes the thyroid and the trachea
• Posteriorly by the deep layer of DCF
• It extends from the hyoid bone superiorly to the
superior mediastinum (level of aortic arch / T4)
• CONTENT
1. Larynx
2. Hypopharynx
3. Thyroid & Parathyroid glands
4. Recurrent laryngeal nerve
5. Proximal trachea
6. Cervical esopahgus
7. Lymph nodes (level VI)
