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Neck Spaces Anatomy & Infections
Dr. Utkal Mishra
ANATOMY
Cervical Fascia Superficial Cervical
Fascia
Deep Cervical Fascia› Superficial Investing
Layer
› Middle Visceral Layer
› Deep Layer Prevertebral Layer
Alar Layer
Superficial Cervical Fascia
Extends from head & neck to thorax & shoulder.
Contains voluntary muscles of facial expression & platysma.
Superficial Investing Layer
Attachement – Superiorly – Nuchal RidgeInferiorly - Clavicle
It Invests - › Muscles
Sternocleidomastoid Trapezius
› Glands Submandibular Parotid
› Spaces Posterior Triangle Suprasternal space of Burns Parotid Space
Middle Visceral Layer Attached from hyoid & skull
base above to sternum below. Modified to form
› Bucopharyngeal fascia postr. To pharynx
› Pretracheal Fascia› Prethyroid Fascia
2 Divisions – › Muscular Division
Strap Muscles
› Visceral Division Thyroid, Trachea, Pharynx,
Larynx, Esophagus
Deep Layer
2 Layers› Alar Fascia
Lies between middle visceral layer and prevertebral layer
› Pre-vertebral Fascia Vertebral bodies Deep muscles of the
neck
Carotid Sheath
Carotid Sheath› Formed by all three
layers of deep fascia.
› Contains carotid artery, internal jugular vein, and vagus nerve
Deep Neck Spaces Retropharyngeal Space Parapharyngeal Space Danger Space
Retropharyngeal Space Lies behind pharynx between
Buccopharyngeal Fascia & Alar Fascia.
Extends from Base of skull to Bifurcation of trachea.
Space is divided by a median raphe into 2 lateral spaces called SPACE OF GILLETE.
Content – Lymph Nodes, Areolar tissue, Fat
Acute Retropharyngeal Abscess
Commonly seen in children below 3yrs. Cause – IN CHILDREN - Suppuration of
retropharyngeal nodes secondary to infection of adenoids. IN ADULTS – Penetrating Injury by FB or Rigid esophagoscopy.Organism – Streptococci/Staphylococci
Clinical Features – 1. Dysphagia 2. Difficulty Breathing 3. Stridor , Croupy cough 4. Torticollis 5. Bulge in PPW
Treatment –1. Transoral I & D. without GA2. I.V. Antibiotics3. Tracheostomy
Chronic Retropharyngeal Abscess Commonly seen in adults Cause – 1. Caries Spine
2. TB of retropharyngeal nodes
Clinical Features – 1. Discomfort in throat2. Neck rigidity3. Bulge in PPWDiagnosis – X RAY- widening of RP space > 3/4th of vertebral body.
Treatment –1. I & D through a oblique incision along antr. Border of SCM2. Antitubercular Therapy
Para-pharyngeal Space Pyramidal in shape with its
base at the base of skull & its apex at the hyoid bone.
Medial- Buccopharyngeal fascia.
Posteriorly – Prevertebral fascia Lateral – Medial pterygoid Divided into 2 compartments
by Styloid process 1. Anterior/ Prestyloid2. Posterior/ Poststyloid
Para pharyngeal Abscess Cause - 1. Peritonsillar abscess
2. Tonsillitis, Adenoiditis3. Dental caries- Lower last molar4. Bezold Abscess5. Penetrating injuries of neck
Clinical Features –1. Anterior Compartment – Triad of - 1. Prolapse of Tonsil , 2. Trismus due to Med. Pterygoid spasm 3. External swelling behind angle of jaw2. Posterior Compartment –1. Bulge behind postr. Pillar2. Paralysis of IX, X, XI, XII cranial N.3. Swelling of Parotid region
Treatment – 1. IV Antibiotics2. I & D of abscess by a horz. Incision made 2-3 cm below the angle of mandible
Danger Space› Anterior border is alar layer
of deep fascia› Posterior border is pre-
vertebral layer› Extends from skull base to
posterior mediastinum &diaphragm.
› It is so named because it contains loose areolar tissue and offers little resistance to the spread of infection.
Submandibular Space Divided into 2 compartments
by Mylohyoid m.› Sublingual Space
Areolar tissue Hypoglossal and lingual nerves Sublingual gland Wharton’s duct
› Submaxillary Space Anterior bellies of digastrics Submandibular gland (These two subdivisions freely
communicate around the posterior border of the mylohyoid. )
Ludwig’s Angina Infection of Submandibular Space. It is usually a cellulitis not abscess so don’t
expect pus. Aetiology –
1. Dental Infection – premolar, molar2. Submandibular Sialoadenitis3. Fracture Mandible
Clinical Feature –1. Odyniophagia , Trismus2. Tongue pushed up & back3. Swelling of submandibular region
with tenderness & woody hard feel.
4. Laryngeal edema may appear. Treatment -
1. I & D intraoral if sublingual, External transverse incision if submandibular.
2. IV antibiotics
Peritonsillar Abscess (QUINSY) Collection of pus in peritonsillar space between
capsule of tonsil & superior constrictor. Aetiology – Complication of Tonsillitis Organism – Mixed Clinical Feature – Commonly Adult Commonly Unilateral Symptoms - Fever with Chills, Odynophagia ,
Trismus, Hot potato voice , Foul breath, Ipsilateral ear pain
Signs – Tonsillar pillar swollenUvula pushed to opposite sideCervical lymphadenopathyTorticollis
Treatment –
1. I & D2. IV antibiotics3. H2O2 Gargle
4. Interval Tonsillectomy after 6wks
Parotid Abscess Infection of Parotid space between superficial &
deep layer of deep cervical fascia. Aetiology –
1. Dehydration – Post surgical cases after 5-7 d
2. Infections of oral cavity via stenson’s duct
Clinical Feature –1. Parotid area swollen ,tender,
indurated2. No fluctuation3. Congestion of Stenson’s duct opening
with pus exuding on pressure4. Fever with chills & rigor
Diagnosis – USG / CT- SCAN Treatment -
1. I & D With Lazy S incision & skin flap raise
2. IV antibiotics3. IV Fluid
MCQ
Trismus in parapharyngeal abscess is due to spasm of which muscle
Investigation of choice for parapharyngeal abscess ?
What is LINCOLN’S HIGHWAY in neck ?