final neck spaces radiology imaging poojitha (1).pptx

neck space radiology usg science

1. RADIOLOGICAL ANATOMY OF DEEP NECK SPACES PRESENTER - D R POOJITHA R

2. The neck has a complex anatomy where many critical anatomical structures are compartmentalized into a small space . Clinicians divide the superficial structures of the neck into various triangles using superficial musculature as landmarks. Radiologists use “spaces”, not triangles, to describe the neck. Neck is divided into various potential spaces by cervical fasciae . INTRODUCTION

3. CERVICAL FASCIAE SUPERFICIAL CERVICAL FASCIAE DEEP CERVICAL FASCIAE : - SUPERFICIAL LAYER OF DEEP CERVICAL FASCIA [INVESTING LAYER] - MIDDLE LAYER OF DEEP CERVICAL FASCIA [VISCERAL LAYER] - DEEP LAYER OF DEEP CERVICAL FASCIA

4. SUPERFICIAL CERVICAL FASCIAE Composed of subcutaneous tissues that encircle the neck. Primary function - to allow the skin to glide easily over the deeper structures of the neck. Components: Platysma and muscles of facial expression. Blood vessels - portions of anterior and external jugular veins Superficial lymph nodes. Cutaneous nerves.

5. SUPERFICIAL LAYER OF DEEP CERVICAL FASCIA [INVESTING LAYER] Superiorly - it attaches to — Superior nuchal line of occipital bone Spinous processes of cervical vertebrae and nuchal ligament Mastoid processes of temporal bones Zygomatic arches Inferior border of mandible Hyoid bone Inferiorly - it attaches to — Manubrium Clavicles Acromion

6. Glands Submandibular Parotid Muscles Sternocleidomastoid Trapezius Strap muscles SUPERFICIAL LAYER OF DEEP CERVICAL FASCIA Spaces Parotid space Masticator space Submandibuar and sublingual space Supra clavicular space

7. Middle Layer of the Deep Cervical Fascia ( VISCERAL LAYER OR PRETRACHEAL LAYER ) Anteriorly: extends from the hyoid bone to the fibrous pericardium ( and continues in the suprahyoid neck as the buccopharyngeal fascia and encloses the pharynx ) Posteriorly: extends from the skull base and follows the outer surface of the pharyngobasilar fascia and the pharyngeal constrictors and is firmly adherent to the muscular wall of pharynx and the esophagus

8. DEEP LAYER OF CERVICAL FASCIA ENCLOSES: Vertebrae and paraspinal muscles. Brachial plexus trunk. Phrenic Nerve. Vertebral Artery and Vein Arises from spinous processes of cervical vertebrae and ligamentum nuchae, attaches superiorly at the skull base. Splits into two layers at the transverse processes ANTERIOR ALAR LAYER - blends with the visceral layer at the level between the C6 AND T4 vertebrae POSTERIOR PREVERTEBRAL LAYER- extends up to coccyx and envelopes vertebral bodies and deep muscles of the neck, extends laterally as the axillary sheath.

9. SPACES OF THE NECK SUPRAHYOID NECK SPACES INFRAHYOID NECK SPACES SPACES COMMON TO BOTH SUPRAHYOID AND INFRAHYOID

10. SUPRAHYOID SPACES Buccal Space. Masticator Space. Parotid Space. Sublingual Space. Submandibular Space. Pharyngeal mucosal Space. Parapharyngeal Space .

11. INFRAHYOID SPACES Visceral Space. Anterior cervical Space. Posterior cervical Space

12. SPACES COMMON TO BOTH SPACES Carotid Space. Retropharyngeal Space. Danger Space. Perivertebral Space.

13. SUPRAHYOID SPACES Buccal Space. Masticator Space. Parotid Space. Sublingual Space. Submandibular Space. Pharyngeal mucosal Space. Parapharyngeal Space .

14. BUCCAL SPACE BOUNDARIES MEDIAL Buccinator muscle POSTERIOR  Masticator space (masseter muscle) CONTENTS: Facial vein, facial and buccal artery, buccal branch of facial nerve Buccal fat pad Minor salivary gland tissue Parotid duct Lymph nodes.

15. MASTICATOR SPACE BOUNDARIES ANTERIOR Buccal space POSTERIOR Parotid space POSTERIR-MEDIALLY Parapharyngeal space SUPERIOR Superior attachment of the temporalis muscle at parietal calvarium INFERIOR Inferior edge of the mandible CONTENTS: Mandible Muscles Of Mastication Mandibular Division Of The Vth Nerve.

16. PAROTID SPACE BOUNDARIES ANTERIOR  masticator space MEDIAL PPS POSTERO-MEDIAL Carotid space and Posterior belly of diagastric SUPERIOR  level of External carotid canal INFERIOR  Mandibular angle CONTENTS: Parotid gland Facial nerve Retromandibular vein External carotid artery Intra parotid lymphnodes

17. SUBLINGUAL SPACE BOUNDARIES ANTERIOR mandible POSTERIOR parapharyngeal space and submandibular space. SUPERIOR  intrinsic muscles of the tongue INFERIO-LATERALLY  mylohyoid muscle CONTENTS: Sublingual gland and duct Deep lobe of submandibular gland and Wharton’s duct Lingual artery and nerve Hypoglossal and glossopharyngeal nerves Areolar tissue

18. SUBMANDIBULAR SPACE BOUNDARIES ANTEROLATERALY mandible POSTERIOR muscles of tongue. SUPERIOR  mylohyoid muscle INFERIOR  hyoid bone SUPERFICIAL  platysma muscle CONTENTS : Superficial portions of the submandibular gland and its duct Lymph nodes(level ib ) Facial artery and vein, Fat and muscles .

19. PHARYNGEAL MUCOSAL SPACE BOUNDARIES SUPERIOR  base of skull INFERIOR cricoid cartilage RELATIONS: LATERAL  parapharyngeal space POSTERIOR  retropharyngeal space CONTENTS : Nasopharynx and oropharynx Lymphoid tissue of  waldeyer's ring (adenoidal, palatine, and lingual tonsils) Minor salivary gland Superior and middle pharyngeal constrictor

20. PARAPHARYNGEAL SPACE BOUNDARIES MEDIALLY  Pharyngeal mucosal space LATERALLY  Parotid space and Masticator space POSTERIORLY Carotid space POST-MED Retropharyngeal space SUPERIORLY Base of skull

21. CONTENTS: Fat Ascending pharyngeal &internal maxillary artery, Venous plexus, Branches of mandibular nerve, Cervical sympathetic trunk, Minor salivary glands deep portion of the parotid gland Significance: Masticator Space Displaces The Parapharyngeal Fat Posteromedially Parotid Space Displaces The Parapharyngeal Fat Anteromedially Pharyngeal Mucosal Space Displaces The Parapharyngeal Fat Posterolaterally Retropharyngeal Space, Danger Space, And Prevertebral Space Displace The Parapharyngeal Fat Anterolaterally Carotid ( Poststyloid Parapharyngeal) Space Displaces The Parapharyngeal Fat Anteriorly

22. INFRAHYOID SPACES Visceral Space. Anterior cervical Space. Posterior cervical Space

23. ANTERIOR CERVICAL SPACE RELATIONS: posterior: carotid space medial: visceral space superior: submandibular space CONTENTS : FAT

24. POSTERIOR CERVICAL SPACE EXTENT : superior: M astoid tip and base of skull. Inferior : clavicle RELATIONS: Anterior : carotid space Medially :prevertebral space Superficially: sternocleidomastoid and trapezius muscle CONTENTS: Fat Spinal accessory nerve(cranial nerve XI) Preaxillary  brachial plexus (​dorsal scapular nerve) Lymph nodes IIb, III ,IV and V Space in the postero -lateral part of neck.

25. VISCERAL SPACE CONTENTS: Thyroid gland Parathyroid glands Esophagus Larynx Hypopharynx Trachea Recurrent laryngeal nerve Lymph nodes (level VI) EXTENDS: Superiorly: hyoid Inferiorly: superior mediastinum

26. SPACES COMMON TO BOTH SUPRAHYOID AND INFRAHYOID REGIONS Carotid Space Retropharyngeal Space Danger Space P eri vertebral Space

27. CAROTID SPACE BOUNDARIES SUPERIORLY  Skull base into jugular foramen INFERIORLY aortic arch LATERALLY parotid space MEDIALLY lateral margin of retropharyngeal ANTERIORLYPPS ( Poststyloid Parapharyngeal Space) CONTENTS: Carotid Artery Internal Jugular Vein Cranial Nerves IX,X,XI,XII Lymph nodes Sympathetic plexus

28. Retropharyngeal Space BOUNDARIES Anterior – middle layer of Deep Cervical Posterior - alar layer of deep fascia Superior - skull base Inferior – T4 vertebral level CONTENTS: Suprahyoid region fat medial and lateral retropharyngeal (nodes of Rouvier ) lymph nodes Infrahyoid region fat Acts pathway for spread of infections/ tumours into the mediastinum from the neck .

29. DANGER SPACE Boundaries: Anterior : Alar fascia and Retro Pharyngeal Space. Posterior: Prevertebral fascia . Superior : skull base Inferior : diaphragm. Contents - fat Danger space Significance: Potential pathway for spread of cervical infection into middle and lower mediastinum. Closed space so infection enters by penetrating its walls

30. P ERI VERTEBRAL SPACE Extends along entire length of vertebral column Anterior border is prevertebral fascia Posterior border is vertebral bodies and deep neck muscles The deep layer of fascia is attached to the transverse processes anteriorly and posteriorly to the spinous processes and ligamentum nuchae thus dividing the Prevertebral space into two spaces.

31. The Prevertebral space proper:( anterior compartment ) Prevertebral and scalene muscles . B rachial plexus . Phrenic nerve . V ertebral body and vertebral artery and vein. Posterior Paraspinal portion :(posterior compartment) Paraspinal muscles V ertebral laminae and spinous processes. P ERI VERTEBRAL SPACE

32. REFERENCES CT AND MRI OF THE WHOLE BODY 5 TH EDITION BY JOHN R HAAGA IMAGING OF THE NECK SPACES: DIAGNOSTIC RADIOLOLGY – BERRY series

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