DEEP NECK SPACES & INFECTION

RAHEEF ALATASSI

OBJECTIVES

• Anatomy of the Deep Neck Spaces

• Deep neck infections

DEEP NECK SPACES

•Described in relation to the hyoid

A.Entire length of the neck

B.Suprahyoid

C.Infrahyoid

Deep

Neck spaces

Entire

length

1.Retropharyng

eal Space

2.Danger Space

3.Prevertebral

Space

4.Visceral

Vascular Space

Suprahyoi

d

1.Submandibula

r Space

2.Parapharyng

eal Space

3.Peritonsillar

Space

Infrahyoid

1.Anterior

Visceral Space

DEEP NECK SPACES

A)Entire Length of

Neck: Superficial

Space

• Surrounds platysma

• Contains areolar

tissue, nodes, nerves

and vessels

• Involved with

cellulitis and

superficial abscesses

DEEP NECK SPACES

A)Entire Length of

Neck:

1.Retropharyngeal Space

• Posterior to pharynx

and esophagus

• Anterior to alar layer of

deep fascia

• Extends from skull base

to T1-T2

DEEP NECK SPACES

A)Entire Length of Neck:

2.Danger Space•Anterior border is alar layer of deep

fascia

• Posterior border is prevertebral layer

• Extends from skull base to diaphragm and is so named because it contains loose areolar tissue and offers little resistance to the spread of infection.

DEEP NECK SPACESA)Entire Length of Neck:

3.Prevertebral Space• Anterior border is prevertebral fascia

• Posterior border is vertebral bodies

• Extends along entire length of vertebral column.

• Infection in this space tends to stay somewhat localized due to the dense fibrous attachments between the fascia and the deep muscles.

DEEP NECK SPACES

A)Entire Length of Neck: 4.Visceral Vascular Space

• Carotid Sheath• It is termed the “Lincolin’s highway”

of the neck . • It extends from the base of skull

into the mediastinum and because it receives contributions from all three layers of deep fascia it can become secondarily involved by infection in any other deep neck space by direct spread.

DEEP NECK SPACES

B)Suprahyoid:

1.Submandibular Space

•Anterior/Lateral—mandible

• Superior—mucosa

• Inferior—superficial layer of

deep fascia

• Posterior/Inferior--hyoid

DEEP NECK SPACES

B)Suprahyoid :

1.Submandibular Space comprises

• Sublingual Space• Areolar tissue

• Hypoglossal and lingual nerves

• Sublingual gland

• Wharton’s duct

• Submylohyoid Space• Anterior bellies of digastrics

• Submandibular gland

• (These two subdivisions freely communicate around the posterior border of the mylohyoid. )

DEEP NECK SPACES

B)Suprahyoid2.Parapharyngeal Space (pharyngomaxillary

space )

• Superior—skull base-petrous portion of temporal bone

• Inferior—hyoid• Anterior—ptyergomandibular raphe• Posterior—prevertebral fascia• Medial—buccopharyngeal fascia• Lateral—superficial layer of deep fascia,medial

pterygoid and parotid .

• The parapharyngeal space communicates with submandibular , retropharyngeal, parotid and masticator spaces with important implications in spread of infection .

DEEP NECK SPACES

B)Suprahyoid:

3.Peritonsillar Space• Medial—capsule of palatine tonsil

• Lateral—superior pharyngeal constrictor

• Superior—anterior tonsil pillar

• Inferior—posterior tonsil pillar.

• This space contains loose areolar tissue, primarily in the area adjacent to the soft palate, which explains why the majority of peritonsillar abscesses will localize to the superior pole of the tonsil.

DEEP NECK SPACES

C)Infrahyoid:

1.Anterior Visceral Space

• Formed by middle layer of deep fascia

• Contains thyroid, trachea, esophagus.

This potential space 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 .

DEEP NECK INFECTION

A.PARAPHARYNGEAL SPACE INFECTIONS

• Parapharyngeal space infections are potentially life-threatening ?

• The diagnosis of parapharyngeal space involvement is often delayed.

• Infection of the parapharyngeal space may arise from :

• 1- Dental infections most common

• 2- peritonsillar abscess.

• 3- parotitis, otitis, or mastoiditis (Bezold's abscess) Rarly.

• Infection of the anterior compartment of the parapharyngeal space is

more common than the posterior compartment

CLINICAL FEATURES

The cardinal clinical features of parapharyngeal

space infections are:

1)Trismus

2)Induration and swelling below the angle of the

mandible

3)Medial bulging of the pharyngeal wall

4)Systemic toxicity with fever

DIAGNOSIS

1) High dose of IV

broad spectrum

antibiotics.

2) Surgical drainage.

TREATMENT

1) CT scan

2) MRI

B.RETROPHARYNGEAL SPACE INFECTION

• It’s the most serious of deep space infections ??? Risk of Acute

necrotizing mediastinitis. Much more common in children and infants

than in adults.

Clinical features:

1) Dysphagia & airway obstruction (stridor)

2) Croupy cough, fever with preceding URTI.

3) Torticollis: stiff neck & extended head.

4) Unilateral bulging in posterior pharyngeal wall on one side of the

midline.

DIAGNOSIS

1) High dose of IV broad

spectrum antibiotics.

2) Surgical drainage.

3) Tracheostomy

TREATMENT

1) X-ray (neck lateral view):

Widening of prevertebral

space.

Presence of gas.

1) CT scan

2) MRI

COMPLICATIONAcute necrotizing mediastinitis:

• Most feared complication of a retropharyngeal space infection.

• An infection in the "danger" space may drain by gravity into the posterior

mediastinum, resulting in mediastinitis and empyema.

• Clinically, onset of acute necrotizing mediastinitis is rapid and is

characterized by the following:

1. Widespread necrotizing process extending the length of the posterior

mediastinum.

2. Rupture of mediastinal abscess into the pleural cavity with empyema.

3. Pleural or pericardial effusions, frequently with tamponade

• The mortality of acute necrotizing mediastinitis in adults is high.

Aspiration pneumonia is another potential complication of retropharyngeal

MCQ

• The danger space refer to that space just posterior to the

retropharyngeal space and anterior to the prevertebral space. It

is called this because infection involving this space can lead to

which of the following?

a) Torticollis.

b) Airway obstruction.

c) Pneumonia.

d) Mediastinitis.

THANK YOU