Deep neck spaces and infection ENT

Deep Neck spaces and infection
retropharyngeal abscess

1. Deep neck spaces & infection Raheef Alatassi

2. objectives Anatomy of the Deep Neck Spaces Deep neck infections

3. Deep Neck Spaces Described in relation to the hyoid Entire length of the neck Suprahyoid Infrahyoid

4. 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

5. 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

6. 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.

7. Deep Neck Spaces A)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.

8. 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.

9. Deep Neck Spaces B) Suprahyoid : 1.Submandibular Space Anterior/Lateral—mandible Superior—mucosa Inferior—superficial layer of deep fascia Posterior/Inferior--hyoid

10. 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 . )

11. Deep Neck Spaces B) Suprahyoid 2.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 .

12. 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.

13. 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 .

14. Deep Neck infection

15. A.Parapharyngeal space infections   Parapharyngeal space infections are potentially life-threatening ? T he 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

16. Clinical features   The cardinal clinical features of parapharyngeal space infections are: Trismus Induration and swelling below the angle of the mandible Medial bulging of the pharyngeal wall Systemic toxicity with fever

17. Diagnosis High dose of IV broad spectrum antibiotics. Surgical drainage. Treatment CT scan MRI

18. 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: Dysphagia & airway obstruction (stridor) Croupy cough, fever with preceding URTI. Torticollis: stiff neck & extended head. Unilateral bulging in posterior pharyngeal wall on one side of the midline.

19. Diagnosis High dose of IV broad spectrum antibiotics. Surgical drainage. Tracheostomy Treatment X-ray (neck lateral view): Widening of prevertebral space. Presence of gas. CT scan MRI

20. complication Acute necrotizing mediastinitis : M ost 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: Widespread necrotizing process extending the length of the posterior mediastinum . Rupture of mediastinal abscess into the pleural cavity with empyema. 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 space infection.

21. Treatment of Para & Retropharyngeal space

22. 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? Torticollis. Airway obstruction. Pneumonia. Mediastinitis .

23. Thank you