ANATOMY OF NECK SPACES

CERVICAL FASCIAE
• SUPERFICIAL LAYER

• DEEP LAYER :

- SUPERFICIAL LAYER OR INVESTING LAYER

- MIDDLE LAYER OF DEEP CERVICAL FASCIA
- DEEP LAYER OF DEEP CERVICAL FASCIA
 SUPERFICIAL LAYER
• Composed of subcutaneous tissues that encircle the neck.

• Components:

• Platysma and muscles of facial expression.

• Blood vessels.

• Superficial lymph nodes.

• Cutaneous nerves.
DEEP LAYER OF CERVICAL FASCIA
ENCLOSES:

Vertebrae and paraspinal muscles.

Brachial plexus trunk.
Phrenic Nerve.
Vertebral Artery and Vein
MIDDLE LAYER OF DEEP CERVICAL FASCIA
• BUCCOPHARYNGEAL LAYER IN THE SUPRAHYOID
COMPARTMENT
• INFRAHYOID COMPARTMENT:
- 1ST AND 2ND LAYER ENCLOSES THE
STRAP MUSCLES.
- 3RD LAYER ENCLOSES THE VISCERA
CALLED THE VISCERAL LAYER.
 NECK SPACES
Described in relation to the hyoid bone.

• Suprahyoid Spaces.

• Infrahyoid Spaces.

• Spaces extending up to the entire length of

the neck.
 SUPRAHYOID SPACES
 Sublingual Space.
 Submandibular Space.
 Buccal Space.
 Masticator Space.
 Parotid Space.
 Pharyngeal mucosal Space.
 Parapharyngeal Space
 INFRAHYOID SPACES
• Visceral Space.

• Anterior cervical Space.

• Posterior cervical Space.

 SPACES COMMON TO BOTH SPACES
• Carotid Space.

• Retropharyngeal Space.

• Prevertebral Space.

• Danger Space.
 SUBMANDIBULAR SPACE
 Extends from the Mylohoid muscle superiorly up to
the hyoid bone inferiorly.
 Lacks limiting fascial boundaries and
communicates freely with sublingual space.
 Contents : superficial portions of the
Submandibular gland, lymph nodes, facial artery
and vein, fat and muscles.
SUBMANDIBULAR SPACE
 MASTICATOR SPACE
 Formed by splitting of the SLDCF.

 Extends from skull base to the inferior edge of

the mandible.

 Contents: mandible, muscles of mastication, and

mandibular division of the Vth nerve.
 BUCCAL SPACE
• Small space anterior to the masseter and lateral
to the buccinator.

• Contents: Buccal fat pad

 PAROTID SPACE
• Bounded by the SLDCF.

• Extends superiorly from the external acoustic meatus and inferiorly up to

the mandible.

• Contents: Parotid Gland, proximal part of the parotid duct, intraparotid

lymph nodes and vessels.

• Parotid gland is divided by facial nerve into superficial and deep.

• Division identified on imaging by retromandibular vein.

 PARAPHARYNGEAL SPACE
 Difficult area to examine clinically as it lies buried deep in the upper
neck.

 Extends on the either side of neck from the skull base to the level of
hyoid bone.

 Subdivided into prestyloid and retrostyloid compartmentS.

 Some divide the compartment into 3 compartrments: a,b and c.
 Prestyloid compartment
• fat
• Ascending Pharyngeal Artery,
• Internal Maxillary Artery,
• venous plexus,
• branches Of V3,Cervical
Sympathetic Trunk,
• Minor Salivary Glands
• Deep Portion Of The Parotid
Gland
 Retrostyloid compartment
• Internal Carotid Artery
• Internal Jugular Vein
• Cranial Nerves IX,X,XI,XII
• Lymph nodes
 PHARYNGEAL MUCOSAL SPACE
 Located on the airway side of the Buccopharyngeal fascia in the

nasopharynx and oropharynx.

 No fascial boundaries on the airway side.

 Extend from skull base to the Cricoid cartilage.

 Contents: Mucosa, lymphoid tissue of Waldeyer’s ring, minor salivary

glands, and pharyngeal constrictor muscles.

The mucosal surface of this space on imaging appears uneven
and hence should not be concluded as pathological.

It is an important site of extension of the nasopharyngeal

carcinoma to the skull base via the defects for Eustachian tube
and the levator palitini muscle.
INFRAHYOID SPACES
 VISCERAL SPACES
• Bounded by the MLDCF.

• Extends from the hyoid bone into the mediastinum.

• Contents:

 Pharynx

 Larynx and Hypopharynx.

 Trachea and Esophagus.

 Thyroid and Parathyroid gland.

 Recurrent laryngeal Nerve.

 Juxtavisceral lymph nodes.

 Anterior and Posterior Cervical Space

• Extend from the skull base to the clavicles.

• Infrahyoid portion is predominantly visible because of the fat content.

• The posterior cervical space contains fat, spinal accessory nerves and
spinal accessory chain of deep cervical lymph nodes.
 SPACES COMMON TO BOTH SUPRAHYOID AND
INFRAHYOID REGIONS
• Carotid Space

• Retropharyngeal Space

• Perivertebral Space

• Danger Space
 Carotid Space
 Extends from the skull base to the aortic arch.

 Carotid sheath receives contributions from all three layers of the

DCF.

 Contents: Carotid artery, IJV, lymph nodes, portions of

sympathetic nerves, cranial nerves IX-XII

In suprahyoid
space, this space is
sometimes referred
to as the
Retrostyloid
compartment of the
Parapharyngeal
space
RETROPHARYNGEAL SPACE
• Contains fat and medial and lateral retropharyngeal
(nodes of Rouvier ) lymph nodes in Suprahyoid
region and only fat in the Infrahyoid region.

• Acts pathway for spread of infections / tumors into

the mediastinum from the neck.

 DANGER SPACE

• Posterior to the RPS.

• Bounded by the Alar fascia anteriorly and Prevertebral

portion proper posteriorly.

• Extends from the skull base up to the diaphragm.

 PERIVERTEBRAL SPACE
• Located in the midline posterior to the
retropharyngeal space.
• Extends from the skull base up to the T4 level in
the posterior mediastinum.
• Divided into the anterior Prevertebral and
posterior Paraspinal portions
Prevertebral portion :
Prevertebral and
scalene muscles,
brachial plexus, Phrenic
nerve , vertebral body
and vertebral artery and
vein.

Posterior Paraspinal
portion :
Paraspinal muscles
and posterior elements
of the vertebra.