Anatomy of neck spaces DR SUBHODH H R

What’s the diagnosis? ?

Specific Learning Objectives List all the triangles of neck Describe the anatomy of the triangles of the neck List the fascia of the neck List the spaces of the neck Describe briefly the following spaces of the neck: 1. Retropharyngeal space 2. Danger space 3. Submandibular space 4. Peritonsillar space 5. Parapharyngeal space List the levels of cervical lymph nodes

TRIANGLE S OF THE NECK

TRIANGLES OF THE NECKSUBDIVISION S

ANTERIOR TRIANGLE BOUNDARIES ANT- midline of neck POST- sternocleidomastoid SUP- mandible (lower margin). Subdivided to smaller triangles

CONTENTS OF ANTERIOR TRIANGLE In Carotid -cut through Sternocleidomastoid 2” Above sternum sheath: • Carotid A. • Int. Jug. V. , • Vagus N. • Hypoglossal n. XII & ansa cervicalis

POSTERIOR TRIANGLE Boundaries • Superficial cover - superficial fascia, platysma and Investing Layer • Deep - (floor) Prevertebral layer of fascia

CONTENTS OF POSTERIOR TRIANGLE • • Occipital artery Great Auricular n. Lesser occipital n. Accessory n. (XI) External Jugular Vein Supra- clavicular nerves Superficial branches of Cervical plexus Trans Cerv. n.

POST. TRIANGLE ( DEEPER ) Brachial plexus roots & trunks • Phrenic nerve • Note: Accessory n. divides post. triangle into 'Carefree' -superior 'Careful' - inferior

POST. TRIANGLE (DEEPER) Brachial plexus roots & trunks Phrenic n. Subclavian vein Transverse (superf. ) Cervical A. Suprascapular A. Subclavian a. note: Usually Subclavian vein is not in post triangle

CERVICAL FASCIA SUPERFICIAL LAYER DEEP LAYER SUPERFICIAL OR INVESTING LAYER MIDDLE/ VISCERAL/ PRETRACHEAL DEEP/ INTERNAL/ PREVERTEBRAL

DEEP NECK SPACE Retropharyngeal Space • "Posterior to pharynx and esophagus • "Anterior to alar layer of deep fascia • "Extends from skull base to T 1 T 2

Adults Cause—trauma, TB, retained FB, instrumentation, extension from adjoining deep neck space Pediatrics "Cause—suppurative process in lymph nodes #Nose, adenoids, nasopharynx, sinuses

DEEP NECK SPACES Danger Space • "Anterior border is alar layer of deep fascia • "Posterior border is prevertebral layer • "Extends from skull base to diaphragm

DANGER SPACE Presentation and exam nearly identical to retropharyngeal space infection "Cause—extension from retropharyngeal, prevertebral or parapharyngeal space

DEEP NECK SPACES SUPRAHYOID Submandibular Space • Anterior/Lateral—mandible • Superior—mucosa • Inferior—superficial layer of deep fascia • Posterior/Inferior--hyoid

DEEP NECK SPACES Submandibular Space Sublingual Space • Areolar tissue • Hypoglossal and lingual nerves • Sublingual gland • Wharton’s duct Submylohyoid Space • Anterior bellies of digastrics • Submandibular gland

Submandibular Space • Cause— 70 -85% have odontogenic origin • First molar and anterior • Second and third molars • Sialadenitis, lymphadenitis, lacerations of the floor of mouth, mandible fractures

DEEP NECK SPACES Suprahyoid: Peritonsillar Space • Lateral—superior pharyngeal constrictor • Superior—anterior tonsil pillar • Medial—capsule of palatine tonsil • Inferior—posterior tonsil pillar

Peritonsillar Space Cl/f: • Fever, malaise • Dysphagia, odynophagia • “Hot-potato” voice, trismus, bulging of superior tonsil pole and soft palate, deviation of uvula • Cause—extension from tonsillitis

DEEP NECK SPACES Suprahyoid: Parapharyngeal Space "Superior—skull base "Inferior—hyoid "Anterior—ptyergomandibular raphe "Posterior—prevertebral fascia "Medial—buccopharyngeal fascia "Lateral—superficial layer of deep fascia

DEEP NECK SPACES Suprahyoid: Parapharyngeal Space " Prestyloid • #Medial—tonsillar fossa • #Lateral—medial pterygoid • #Contains fat, connective tissue, nodes " Poststyloid • Carotid sheath • Cranial nerves IX, X, XII

Parapharyngeal Space • Cl/f: • Fever, chills, malaise • Pain, dysphagia, trismus • Medial bulge of lateral pharyngeal wall • Cause—infection of pharynx, tonsil, adenoids, dentition, parotid, mastoid, suppurative lymphadenitis, extension from other deep neck spaces

Fascial planes and Neck spaces

Lymph Node Levels

LEVEL LYMPH NODE GROUP 1 a 1 b 2 a 2 b 3 4 a Submental nodes Submandibular nodes Upper jugular, anterior to C. N. 11 Upper jugular, posterior to C. N. 11 Middle jugular nodes Lower jugular nodes, (behind clavicular head of SCM muscle) Lower jugular nodes, (behind sternal head of SCM muscle) Posterior triangle nodes( spinal accessory group) Posterior triangle nodes, (transverse cervical artery group, supraclavicular group) Anterior(central) compartment nodes(paratracheal, perithyroidal, Delphian) Superior Mediastinal nodes 4 b 5 a 5 b 6 7

Thank you… P. S : Images in this presentation have been taken from Google Images