Sandbox dni

Anatomic Considerations

Deep Neck Spaces

Based on their spatial relation to the hyoid, deep neck spaces may be divided into three anatomic groups:

• Spaces above the level of the hyoid

• Peritonsillar space

– The peritonsillar space lies between the palatine tonsil and the lateral superior pharyngeal constrictor muscle and is bounded anteriorly and posteriorly by the tonsillar pillars. Infection of the peritonsillar space is commonly associated with tonsillitis in older children.

• Submandibular space

– The submandibular space encloses the space between the mandible and the hyoid and consists of two compartments: the supramylohyoid compartment and the inframylohyoid compartment. Infection of the submandibular space is typically caused by odontogenic pathogens, including Streptococcus viridans, Staphylococcus spp., Prevotella spp, and Peptostreptococcus spp.

• Parapharyngeal space (lateral pharyngeal space or pharyngomaxillary space)

– The parapharyngeal space lies between the middle layer and the superficial layer of deep cervical fascia. Infection of the parapharygeal space often arises from pharyngitis, tonsillitis, otitis, mastoiditis, parotitis, and cervical lymphadenitis.

• Masticator space (temporal space)

– The masticator space locates between the pterygoid muscle medially and the masseter muscle laterally. Infection of the masticator space generally originates from the posterior mandibular molars.

• Buccal space

– The buccal space lies between the buccinator muscle medially and the skin of the cheek laterally. Infection of the buccal space is often odontogenic in origin.

• Parotid space

– The parotid space lies between the parapharyngeal space and the parotid fascia. Infection of the parotid space frequently stems from parotid duct obstruction or lymphadenitis.

• Spaces that involve the entire length of the neck

• Retropharyngeal space (retrovisceral space or retroesophageal space)

– The retropharyngeal space is bounded by the carotid sheaths laterally and extends from the skull base to the mediastinum. Infection of the retropharyngeal space is typically polymicrobial in origin.

• Danger space

– The danger space lies between the alar fascia anteriorly and the prevertebral fascia posteriorly. Infection in the danger space tends to complicate mediastinitis, empyema, and sepsis.

• Prevertebral space

– The prevertebral space extends between the prevertebral fascia and the underlying vertebral bodies. Infection in the prevertebral space may be secondary to Pott's disease or retropharyngeal and danger space infections.

• Carotid space ((visceral vascular space)

– The carotid space is encased by the carotid sheaths and harbors the carotid artery, internal jugular vein, cranial nerves (CN IX, X, XI, and XII), and cervical sympathetic chain. Infection of the carotid space may result from disseminated infections of the adjacent spaces or direct inoculation.

• Spaces below the level of the hyoid

• Anterior visceral space (pretracheal space)

– The anterior visceral space lies between the infrahyoid strap muscles and the esophagus. Infection of the anterior visceral space is commonly associated with traumatic insult to the anterior esophageal wall.