Suprahyoid Neck Flashcards
Difference of a peritonsillar abscess vs parapharyngeal abscess
Peritonsillar abscess : the middle layer of the DCF is intact, surgical approach from mouth
Parapharyngeal abscess: rapid progression, needs lateral approach
What is special about the relations of the Parapharyngeal space?
Is it a superficial or deep space?
Connects with all deep neck spaces (except DS)
+ Vertically orientated
A deep neck space
Communication of anterior PPS?
Communication of posterior/upper PPS?
Closed upwards but freely into posterior submandibular space
Can extent intracranially - pharyngobasilar fascia
medially foramen ovale, laterally spinosum
What is the medial and upper borders of the PPS?
How does the PPS communicates with the parotid space?
Buccopharyngeal fascia, Pharyngobasilar fascia
Stylomandibular tunnel
Contents of Para-Pharyngeal space
Fat Venous plexus Minor salivary glands Mandibular nerve Internal maxillary artery Ascending pharyngeal artery
Most common lesions of PPS?
Prestyloid : Salivary gland tumour, Benign mixed tumor, Post-styloid : Schwannoma
Fascia and Contents of masticator space?
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)
Describe the root of perineural spread from parotid space upwards
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.
Pseudolesions of the masticator space?
Devervation
Pterygoid venous plexus
Hypertrophied masseter
Contents of parotid space?
Parotid gland, Facial nerve, ECA branches, Retromandibular vein, Lymph nodes
Course of facial nerve in the parotid
What is the border of the superficial and deep lobes of the parotid gland?
Stylomastoid foramen to laterally to retromandibular vein
Facial nerve plane
Parotid space lesions
Haemangioma, Venolymphatic malformations, First branchial cleft cyst
Pseudolesions parotid space
Accessory parotid gland
Aplasia
Fatty degeneration
Borders of Pharyngeal Mucosal Space
From skull base and FORAMEN LACERUM down to cricoid cartilage
covered by the Middle layer of DCF
Includes naso- oro- and hypoparynx mucosal surfaces
Contents of Pharyngeal mucosal space
Mucosa, Waldeyer ring, Minor salivary glands, open Eustachian tube, Torus Tubarius, Superior levator m. and Constrictorpalatini muscles.
Types of carcinomas of pharyngeal mucosal space?
Pharyngeal SCC, NHL
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?
Maxillary sinus
Must see: Masticator space, parotid gland
Tonsills, Tongue base
Valleculae
What is the meeting point of larynx and hypopharynx?
The AryEpiglottic folds
Name two routes of extension of disease from the Pharyngeal Mucosal Space into the skull
Sinus of Morgagni Foramen lacerum (anteriorly to the carotid space)
Which layer of the DCF covers of the carotid space?
All 3 layers of the DCF
Contents of carotid space?
CN 9-12, IJV, ICA, sympathetic ganglion
The level II internal jugular nodes laterally
Retropharyngeal space DCF layers
Anteriorly ML-DCF and Posteriorly DL- DCF (alar fascia posteriorly)
What is the landmark for medial retropharyngeal space lymph nodes?
Longus colli muscle
Paravertebral space extension, layers, parts
From skull base to T4
Prevertebral part
Paraspinal part
It is surrounded by the deep layer of the DCF
Role of paravertebral space in spread of infections?
Redirects tumor and infection in epidural space
Blocks pharyngeal malignancy spread
Contents of prevertebral space
Longus colli and longus capitis m. Scalene m. Brachial plexus roots Phrenic n. VA , vein vertebral bodies
Contents of paraspinal space
Paraspinal muscles
Posterior vertebral column
Branchial plexus C5-T1 roots
What is longus colli tendinitis?
Self limiting inflammation of the longus colli and capitis muscles. High signal in the muscles, fluid but NO lymphadenopathy (ddx infection)
Which spaces are dangerous?
Ventrically orientated
Parapharyngeal,
Retropharyngeal
Paraventrebral
Which nerve is between the ICA and IJV?
X -Vagus
Lymph nodes of the retropharyngeal space
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
What is the important role of parapharyngeal space in route of infection?
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
What is the sinus of Morgagni?
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
What is the Fossa of Rossenmuller?
Herniation of the nasopharyngeal mucosa through sinus of Morgagni.
Retropharyngeal space borders
Between alar fascia and ML-DCF of visceral space
Routes of intracranial extension through masticator space
- Foramen ovale V3 -cavernous sinus
2. Connection with pterygopalatine fossa -sphenopalatine foramen -V2 - intracranial
