neck fascia and spaces Flashcards
layers of cervical fascia
- superficial
- deep: superficial, middle (visceral, muscular), deep (alar, prevertebral)
superficial layer attachments
- superior attachment–> zygomatic arch
- inferior attachment–> thorax-axilla
- similar to subcutaneous tissue
- ensheath platysma and muscles of facial expression
deep cervical fascia function
- supports viscera, vessels, muscles, and deep lymph nodes
- limits spread of infection
- provides slipperiness that allows neck structures to move and pass over each other without difficulties
3 layers of deep cervical fascia
- superficial (investing layer)
- middle (pretracheal fascia)
- deep (prevertebral)
superficial layer of the deep fascia (investing layer) boundaries
- completely surrounds the neck
- arises from spinous processes
- superior border: nuchal line, skull base, zygoma, mandible
- inferior border: chest and axilla
- splits at mandible and covers the masseter laterally and the medial surface of the medial pterygoid
what does the superficial layer of the deep fascia (investing layer) envelope?
- SCM
- trapezius
- submandibular gland
- parotid gland
- forms floor of submandibular space
borders of the visceral division of the middle layer (pretracheal fascia)
-superior: anterior–hyoid and thyroid cart
posterior–skull base
-inferior: continuous with fibrous pericardium in the upper mediastinum
-buccopharyngeal fascia (covers the pharyngeal constrictors and buccinator)
the visceral division of the pretacheal fascia envelopes what?
- thyroid
- trachea
- esophagus
- pharynx
- larynx
muscular division of the middle layer (pretracheal fascia)
envelopes infrahyoid strap muscles
why does the thyroid gland move with swallowing?
- pretracheal fascia
- levator glandula thyroidea
what does the deep layer of deep cervical fascia arise from?
from spinous processes and ligamentum nuchae
2 layers of deep layer
- alar
- prevertebral
alar layer of deep layer
- superior border–skull base
- inferior border–upper mediastinum at T1-T2
prevertebral layer of deep layer
- superior border–skull base
- inferior border–coccyx
- envelopes vertebral bodies and deep muscles of the neck
- extends laterally as the axillary sheath
carotid sheath
- formed by all three layers of deep fascia
- anatomically separate from all layers
- contains carotid artery, internal jugular vein, vagus nerve
- travels thru pharyngomaxillary space
- extends from skull base to thorax
deep neck spaces that are the entire length of the neck
- superficial space
- retropharyngeal
- danger
- prevertebral
- vascular visceral
suprahyoid spaces
- submandibular
- pharyngomaxillary
- parotid
- peritonsillar
- temporal
- masticator
infrahyoid spaces
anterior visceral (hyoid to thorax)
superficial space
entire length of neck
- surrounds platysma
- contains areolar tissue, nodes, nerves, and vessels
- involved with cellulitis and superficial abscesses
- treat with incision along langer’s lines, drainage and antibiotics
retropharyngeal space
- entire neck
- anterior–pharynx and esophagus (buccopharyngeal fascia)
- posterior–alar layer of deep fascia
- superior–skull base
- inferior–superior mediastinum (combines with buccopharyngeal fascia at level of T1-T2)
- *contains retropharyngeal nodes
danger space
- entire length of neck
- anterior–alar layer of deep fascia
- posterior–prevertebral layer
- extends from skull base to diaphragm (why it’s dangerous)
- **contains loose areolar tissue
prevertebral space
- entire neck
- anterior–prevertebral fascia
- posterior–vertebral bodies and deep neck muscles
- lateral–transverse processes
- extends along entire length of vertebral column
visceral vascular space
- entire length of neck
- carotid sheath
- deep cervical lymph nodes and receive drainage from most of lymphatic vessels in head and neck
submandibular space
- superior–oral mucosa
- inferior–superficial layer of deep fascia
- anterior and lateral–mandible
- posterior–hyoid and base of tongue musculature
2 components of submandibular space
- separated by mylohyoid muscle
1. sublingual space–areolar tissue, hypoglossal and lingual nerves, sublingual gland, wharton’s duct
2. submaxillary space–anterior bellies of digastric, submental compartment, submaxillary compartment, submandibular gland
lateral pharyngeal space
- suprahyoid
- superior–skull base
- inferior–hyoid
- anterior–pterygomandibular raphe
- posterior–prevertberal fascia
- medial–buccopharyngeal fascia
- lateral–superficial layer of deep fascia
2 parts of lateral pharyngeal space
- subdivided by styloid process
1. prestyloid: muscular compartment, medial–tonsillar fossa, lateral–medial pterygoid, contains fat, CT, nodes
2. poststyloid: neurovascular compartment, carotid sheath, cranial nerves IX, X, XI, XII, sympathetic chain
stylopharyngeal aponeurosis of zuckerkandel and testut
- alar, buccopharyngeal, and stylomuscular fascia
- prevents infectious spread from anterior to posterior
what neck spaces does lateral pharyngeal space communicate with?
- parotid
- masticator
- peritonsillar
- submandibular
- retropharyngeal
peritonsillar space
- suprahyoid
- medial–capsule of palatine tonsil
- lateral–superior pharyngeal constrictor
- superior–anterior tonsil pillar
- inferior–posterior tonsil pillar
what are the masticator and temporal spaces formed by?
superficial layer of deep cervical fascia
masticator space
- antero-lateral to pharyngomaxillary space
- contains masseter, pterygoids, body of ramus of mandible, inferior alveolar nerves and vessels, tendon of temporalis muscle
temporal space
- continuous with masticator space
- lateral–temporalis fascia
- medial–periosteum of temporal bone
- superficial and deep spaces divided by temporalis muscle
parotid space
- suprahyoid
- superficial layer of deep fascia: deep septa from capsule into gland, direct communication to parapharyngeal space
contents of parotid space
- external carotid artery
- posterior facial vein
- facial nerve
- lymph nodes
anterior visceral space (pretracheal)
- infrahyoid
- enclosed by visceral division of middle layer of deep fascia
- contains thyroid **
- surrounds trachea
boundaries of anterior visceral space
- superior–thyroid cartilage
- inferior–anterior superior mediastinum down to the arch of the aorta
- posterior–anterior wall of esophagus
- communicates laterally with retropharyngeal space below the thryoid gland
why does infection in pretracheal space does not spread upward?
infection in pretracheal space is prevented from spread upwards by the attachment of pretracheal fascia and sternothyroid muscle to the oblique ridge of thyroid cartilage
classification of fascial spaces
- face–buccal, canine, masticatory, parotid
- suprahyoid–sublingual, submandibular, lateral pharyngeal, pretonsillar
- infrahyoid–pretracheal
- spaces of total neck–retropharyngeal, space of carotid sheath
infraorbital space/canine space
thin potential space bw levator anguli oris and levator labii superioris muscles
sources of infection in canine space
- infections from maxillary canines and bicuspids
- extension from buccal space
- skin infection from nose and upper lip
buccal space
between the buccinator and overlying skin and superficial fascia
-may become involved via upper jaw or lower jaw molars
what does the sublingual space contain?
- submandibular duct (whartons)
- sublingual gland
- sublingual and lingual nerve
- terminal branches of lingual artery
- part of submandibular gland
what can the sublingual space be divided into?
- proper sublingual space
- mandibular-lingual sulcus (right and left)
spread from sublingual space
- sublingual space of opposite side
- submandibular space
- pterigomandibular space
- parapharyngeal space
- submental and submandibular lymphnodes
deep neck spaces
- retropharyngeal
- lateral pharyngeal
- pretracheal spaces all lie on superficial side of visceral division of the middle layer of the deep cervical fascia
parapharyngeal space abscess
- infection in pharynx, tonsils, adenoids, teeth, parotid, lymph node chains
- middle ear infections or mastoiditis
- extension of infection from: peritonsillar space, submandibular space, retropharyngeal space, masticator space
infection from lower 3rd molar could go to?
submandibular space
maxillary abscess can go to
- canine space
- infratemporal space–> orbit
- buccal space
mandibular abscess can go to
- submandibular space, masticator spaces
- lateral pharyngeal space (dangerous)
- carotid sheath–> cranium
- retropharyngeal space
- mediastinum
ludwigs angina
- life threatening infection
- bilateral infection of sublingual and submandibular spaces
- infection of fascial tissue covering glands
- rare but serious–mortality is close to 100%
- cause–dental infection in 90% of cases
symptoms of ludwigs angina
- neck swelling and pain
- fever
- decreased PO
- odynophagia
- malaise
- torticollis
- otalgia
- trismus
- vocal quality change
- worsening of snoring, sleep apnea
diagnosis of ludwigs angina
- clinically
- lateral neck plain film, MRI, CT
treatment of ludwigs angina
- antibiotic
- surgical drainage
when are complications more common with ludwig’s angina?
in old, diabetic and immunocompromized patients
descending necrotizing mediastinitis
mediastinal infection in which pathology originates in fascial spaces of head and neck and extends down
- retropharyngeal and danger space–71%
- visceral vascular –20%
- anterior visceral–7-8%
- mortality rate–14-40%
- hundreds of published cases
symptoms of descending necrotizing mediastinitis
- respiratory difficulty
- tachycardia
- erythema/edem
- skin necrosis
- crepitus
- chest pain
- back pain
- shock
