Suprahyoid Neck

Question 1

Difference of a peritonsillar abscess vs parapharyngeal abscess

Answer 1

Peritonsillar abscess : the middle layer of the DCF is intact, surgical approach from mouth

Parapharyngeal abscess: rapid progression, needs lateral approach

Question 2

What is special about the relations of the Parapharyngeal space?

Is it a superficial or deep space?

Answer 2

Connects with all deep neck spaces (except DS)
+ Vertically orientated

A deep neck space

Question 3

Communication of anterior PPS?

Communication of posterior/upper PPS?

Answer 3

Closed upwards but freely into posterior submandibular space

Can extent intracranially - pharyngobasilar fascia
medially foramen ovale, laterally spinosum

Question 4

What is the medial and upper borders of the PPS?

How does the PPS communicates with the parotid space?

Answer 4

Buccopharyngeal fascia, Pharyngobasilar fascia

Stylomandibular tunnel

Question 5

Contents of Para-Pharyngeal space

Answer 5

Fat 
Venous plexus
Minor salivary glands
Mandibular nerve
Internal maxillary artery
Ascending pharyngeal artery

Question 6

Most common lesions of PPS?

Answer 6

Prestyloid : Salivary gland tumour, Benign mixed tumor, Post-styloid : Schwannoma

Question 7

Fascia and Contents of masticator space?

Answer 7

SL-DCF

Masseter m. Pterygoids m. (medial and lateral), Temporalis m.
Body and ramus mandible, TMJ
Mandibular n. V3 and inferior alveolar n. (foramen Ovale)

Question 8

Describe the root of perineural spread from parotid space upwards

Answer 8

The auriculotemporal nerve which is a branch of V3 connects with facial nerve in the parotid. So route either backwards through V3 foramen ovale or facial nerve.

Question 9

Pseudolesions of the masticator space?

Answer 9

Devervation
Pterygoid venous plexus
Hypertrophied masseter

Question 10

Contents of parotid space?

Answer 10

Parotid gland, Facial nerve, ECA branches, Retromandibular vein, Lymph nodes

Question 11

Course of facial nerve in the parotid

What is the border of the superficial and deep lobes of the parotid gland?

Answer 11

Stylomastoid foramen to laterally to retromandibular vein

Facial nerve plane

Question 12

Parotid space lesions

Answer 12

Haemangioma, Venolymphatic malformations, First branchial cleft cyst

Question 13

Pseudolesions parotid space

Answer 13

Accessory parotid gland
Aplasia
Fatty degeneration

Question 14

Borders of Pharyngeal Mucosal Space

Answer 14

From skull base and FORAMEN LACERUM down to cricoid cartilage
covered by the Middle layer of DCF

Includes naso- oro- and hypoparynx mucosal surfaces

Question 15

Contents of Pharyngeal mucosal space

Answer 15

Mucosa, Waldeyer ring, Minor salivary glands, open Eustachian tube, Torus Tubarius, Superior levator m. and Constrictorpalatini muscles.

Question 16

Types of carcinomas of pharyngeal mucosal space?

Answer 16

Pharyngeal SCC, NHL

Question 17

On a CT scan how do you know you are at the level of the nasopharynx?

On a CT scan how do you know you are at the level of the oropharynx?

Answer 17

Maxillary sinus

Must see: Masticator space, parotid gland
Tonsills, Tongue base
Valleculae

Question 18

What is the meeting point of larynx and hypopharynx?

Answer 18

The AryEpiglottic folds

Question 19

Name two routes of extension of disease from the Pharyngeal Mucosal Space into the skull

Answer 19

Sinus of Morgagni 
Foramen lacerum (anteriorly to the carotid space)

Question 20

Which layer of the DCF covers of the carotid space?

Answer 20

All 3 layers of the DCF

Question 21

Contents of carotid space?

Answer 21

CN 9-12, IJV, ICA, sympathetic ganglion

The level II internal jugular nodes laterally

Question 22

Retropharyngeal space DCF layers

Answer 22

Anteriorly ML-DCF and Posteriorly DL- DCF (alar fascia posteriorly)

Question 23

What is the landmark for medial retropharyngeal space lymph nodes?

Answer 23

Longus colli muscle

Question 24

Paravertebral space extension, layers, parts

Answer 24

From skull base to T4
Prevertebral part
Paraspinal part
It is surrounded by the deep layer of the DCF

Question 25

Role of paravertebral space in spread of infections?

Answer 25

Redirects tumor and infection in epidural space

Blocks pharyngeal malignancy spread

Question 26

Contents of prevertebral space

Answer 26

Longus colli and longus capitis m.
Scalene m.
Brachial plexus roots
Phrenic n.
VA , vein
vertebral bodies

Question 27

Contents of paraspinal space

Answer 27

Paraspinal muscles
Posterior vertebral column
Branchial plexus C5-T1 roots

Question 28

What is longus colli tendinitis?

Answer 28

Self limiting inflammation of the longus colli and capitis muscles. High signal in the muscles, fluid but NO lymphadenopathy (ddx infection)

Question 29

Which spaces are dangerous?

Answer 29

Ventrically orientated
Parapharyngeal,
Retropharyngeal
Paraventrebral

Question 30

Which nerve is between the ICA and IJV?

Answer 30

X -Vagus

Question 31

Lymph nodes of the retropharyngeal space

Answer 31

From skull base to T1-T2
Lateral group down to oropharynx
Medial group to hypopharynx (landmark longus colli m.)
Medial group usually disappears age of 4

Question 32

What is the important role of parapharyngeal space in route of infection?

Answer 32

Communicates with all spaces (not directly with DS) but posteriorly with retropharyngeal space can extent to DS.
Or infection of any space can go to PPS->RPS->DS

Question 33

What is the sinus of Morgagni?

Answer 33

Gap in the upper part of the pharyngobasilar fascia in the posterolateral nasopharynx. Eustachian tube and levator veli palatini m (torus tubarius) pass through. Pathway of least resistance for tumours and infections

Question 34

What is the Fossa of Rossenmuller?

Answer 34

Herniation of the nasopharyngeal mucosa through sinus of Morgagni.

Question 35

Retropharyngeal space borders

Answer 35

Between alar fascia and ML-DCF of visceral space

Question 36

Routes of intracranial extension through masticator space

Answer 36

1. Foramen ovale V3 -cavernous sinus

2. Connection with pterygopalatine fossa -sphenopalatine foramen -V2 - intracranial