Surgical anatomy of deep neck spaces
-
Upload
google -
Category
Health & Medicine
-
view
141 -
download
12
Transcript of Surgical anatomy of deep neck spaces
![Page 1: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/1.jpg)
SURGICAL ANATOMY OF DEEP NECK SPACES
DR MANOHAR SURYAWANSHIENT RESIDENT INHS ASVINI
![Page 2: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/2.jpg)
Introduction
• Cervical fascia envelope the muscles, nerves, vessels
and viscera of the neck
• It forms planes and potential spaces that serve to
divide the neck into functional units
• The cervical fascia functions to both direct and limit
the spread of disease processes in the neck
![Page 3: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/3.jpg)
PARTS OF CERVICAL FASCIA
A) Superficial cervical fascia
B) Deep cervical fascia
A) Superficial cervical fascia
• Thin layer that invests the platysma muscle
• Penetrated by the blood vessels that supply the neck
skin
![Page 4: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/4.jpg)
• Deep cervical fascia consists of 3 separate fascia:
![Page 5: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/5.jpg)
Investing layer
• Superior attachments: inferior border of
the mandible, hyoid bone, superior nuchal line,
mastoid processes, zygomatic arches,
spinous processes of C1-C7
![Page 6: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/6.jpg)
• Inferior attachments: manubrium, clavicle, acromion
and spine of the scapula,C7 spinous process,
ligamentum nuchae
Investing layer contd....
![Page 7: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/7.jpg)
• Contents: Majority part except
- Skin
- Subcutaneous vessels
- Sensory nerves
Investing layer contd....
![Page 8: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/8.jpg)
• Splits to enclose both the sternocleidomastoid
and trapezius muscles
Investing layer contd....
![Page 9: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/9.jpg)
Investing layer contd....
![Page 10: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/10.jpg)
• Pretracheal layer- intermediate layer
![Page 11: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/11.jpg)
• Contents:
• Infrahyoid muscles
• Trachea and larynx
• Esophagus
• Recurrent laryngeal nerves
• Superior laryngeal nerves
• Lymph nodes
Pretracheal layer contd...
![Page 12: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/12.jpg)
• Prevertebral fascia
![Page 13: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/13.jpg)
Prevertebral fascia contd...
![Page 14: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/14.jpg)
• Contents:
• 1. Vertebral column-> vertebrae, discs and ligaments,
spinal cord and nerve roots and vessels
• 2. Paravertebral muscles
Prevertebral fascia contd...
![Page 15: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/15.jpg)
• Pierced by the four cutaneous branches of
the cervical plexus:
• Greater auricular nerve
• Lesser occipital nerve
• Transverse cervical nerve
• Supraclavicular nerve
Prevertebral fascia contd...
![Page 16: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/16.jpg)
Carotid sheath
![Page 17: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/17.jpg)
Classification of neck spaces
Deep Neck Spaces are described in relation to the
Hyoid bone
• Suprahyoid neck
• Infrahyoid neck
• Supra and infrahyoid neck (Entire length of neck)
![Page 18: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/18.jpg)
• Suprahyoid neck spaces
- Buccal space - Masticator space
- Submandibular space - Parotid space
- Sublingual space - Peritonsillar space
- Submental space - Parapharyngeal space
![Page 19: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/19.jpg)
Suprahyoid neck spaces
• Buccal space
• It is located between the buccinator and platysma
muscles
![Page 20: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/20.jpg)
• Contents:
• Fat
• Parotid duct
• Facial and buccal vessels
• Facial nerve: buccal branch
• Trigeminal nerve: buccal branch of the mandibular division
Buccal space contd ...
![Page 21: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/21.jpg)
Submandibular space
It is a U-shaped compartment of the suprahyoid neck
![Page 22: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/22.jpg)
• Includes sublingual and submaxillary, divided by
mylohyoid muscle
Submandibular space contd...
![Page 23: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/23.jpg)
• Contents (Submaxillary space):
• Superficial portion of the submandibular gland
• Submandibular lymph nodes (level 1b)
• Facial artery and vein
• Fat
• Inferior loop of the
hypoglossal nerve
Submandibular space contd...
![Page 24: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/24.jpg)
![Page 25: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/25.jpg)
Sublingual space
• Inverted V with its apex pointing anteriorly and is
located between:
• Tongue musculature superiorly
• Anterior one-third of the mylohyoid
muscle inferolaterally
![Page 26: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/26.jpg)
• Posteriorly-communicates with submandibular and
parapharyngeal spaces. Anteriorly, the two
sublingual spaces are communicating via a small
isthmus just below the frenulum.
Sublingual space contd...
![Page 27: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/27.jpg)
• Contents:
- Sublingual gland and duct
- Lingual nerve
- Lingual artery and vein
- Glossopharyngeal and hypoglossal nerves
- Deep portion of the submandibular gland and duct
Sublingual space contd...
![Page 28: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/28.jpg)
Submental space
• Midline space that lies between the anterior
bellies of the digastric muscles
• Contents: anterior jugular vein, submental lymph
nodes (level 1a)
![Page 29: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/29.jpg)
• Boundaries
• Superiorly: mylohyoid muscle
• Inferiorly: superficial layer of the deep cervical fascia
• Laterally: anterior bellies of the digastric muscles
• Anteriorly: mandible
• Posterior: hyoid bone
Submental space contd...
![Page 30: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/30.jpg)
• Masticator space
• Superficial layer of the deep cervical fascia as it
surrounds the masseter laterally and the pterygoid
muscles medially
![Page 31: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/31.jpg)
• Direct communication with the temporal space
superiorly deep to the zygoma
• Subdivided into superficial and deep spaces by the
body of the temporalis muscle
Masticator space contd...
![Page 32: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/32.jpg)
• Contents:
- Muscles of mastication
- Ramus and body of mandible
- Inferior alveolar nerve
- Inferior alveolar vein and artery
- Mandibular division of the trigeminal nerve (V3)
– enters the masticator space via the foramen ovale
Masticator space contd...
![Page 33: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/33.jpg)
• Masticator space has larger area at skull base and
has Foramen ovale at it’s roof, allowing potential
tumor spread
Masticator space contd...
![Page 34: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/34.jpg)
Parotid space
• Surrounded by the superficial layer of the deep fascia
that sends dense connective tissue septa from the
capsule into the gland
![Page 35: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/35.jpg)
• Contents:
- Parotid glands
- Intraparotid lymph nodes
- Intraparotid facial nerve
- External carotid artery
- Retromandibular vein
Parotid space contd...
![Page 36: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/36.jpg)
Peritonsillar space
• Medially- capsule of the palatine tonsil
• Laterally- superior constrictor
• Superiorly- anterior tonsillar pillar
• Inferiorly- posterior tonsillar pillar
![Page 37: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/37.jpg)
![Page 38: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/38.jpg)
Parapharyngeal space
![Page 39: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/39.jpg)
![Page 40: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/40.jpg)
![Page 41: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/41.jpg)
Parapharyngeal space contd...
![Page 42: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/42.jpg)
![Page 43: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/43.jpg)
Surgical importance
• Directly involved by lateral extension of peritonsillar
abscesses
• Other sites for infections: pharynx, dentition, salivary
glands, nasal infections, or Bezold abscess.
• Medial displacement of the lateral pharyngeal wall
and tonsil is a hallmark of a parapharyngeal space
infection
Parapharyngeal space contd...
![Page 44: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/44.jpg)
• Displacement patterns of fat within the
parapharyngeal space will aid in the localisation:
- Parotid space displaces the parapharyngeal fat
anteromedially
- Masticator space displaces the parapharyngeal fat
posteromedially
Parapharyngeal space contd...
![Page 45: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/45.jpg)
- Carotid space displaces the parapharyngeal fat
anteriorly
- Retropharyngeal space
and danger space displace
the parapharyngeal fat
anterolaterally
![Page 46: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/46.jpg)
Approaches
![Page 47: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/47.jpg)
Cervical transpharyngeal approach
![Page 48: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/48.jpg)
![Page 49: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/49.jpg)
Infrahyoid neck Spaces
• Anterior cervical space or Pretracheal space
- Enclosed by the middle layer of the deep cervical fascia
- Runs from the thyroid cartilage into the anterior
superior mediastinum to the arch of the aorta
- Below the level of the thyroid gland this space
communicates laterally with the retropharyngeal space
![Page 50: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/50.jpg)
Anterior cervical space contd ...
![Page 51: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/51.jpg)
Posterior cervical space
![Page 52: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/52.jpg)
Supra and infrahyoid neck spaces
- Retropharyngeal space
- Prevertebral space
- Danger space
- Carotid space
![Page 53: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/53.jpg)
• Carotid space:
- Cylindrical space that extends from the skull base to
the aortic arch
- Bifurcation of the common carotid usually occurs at
the boundary of the suprahyoid and infrahyoid space
Carotid space contd...
![Page 54: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/54.jpg)
Carotid space contd...
![Page 55: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/55.jpg)
Carotid space contd...
![Page 56: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/56.jpg)
• Boundaries:
- Superior margin: lower border of jugular foramen
- Inferior margin: aortic arch
- Anterolateral margin: sternocleidomastoid muscle
Carotid space contd...
![Page 57: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/57.jpg)
Retropharyngeal space
- Lies posterior to the pharynx and oesophagus
- Base of the skull to a variable level between the T1
and T6 vertebral bodies
![Page 58: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/58.jpg)
Retropharyngeal space contd...
![Page 59: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/59.jpg)
• Retropharyngeal soft tissue -> 14mm (<15yr)
and -> 22mm in adults is abnormal
Retropharyngeal space contd...
![Page 60: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/60.jpg)
Danger space
![Page 61: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/61.jpg)
Danger space contd...
Axial view of Danger space
![Page 62: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/62.jpg)
![Page 63: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/63.jpg)
Perivertebral space
- Posterior to the retropharyngeal space and danger
space
- Skull base to the upper mediastinum
• Subdivided into:
• Prevertebral portion: anteriorly located
• Paraspinal portion: posteriorly located
![Page 64: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/64.jpg)
Perivertebral space contd...
![Page 65: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/65.jpg)
References
• Scott-Brown’s 7th edition
• Cummings 5th edition
• UTMB
• Radiopaedia
![Page 66: Surgical anatomy of deep neck spaces](https://reader035.fdocuments.in/reader035/viewer/2022081505/58734de41a28ab56378b5a5b/html5/thumbnails/66.jpg)
THANK YOU