1. ANATOMY OF NECK SPACES
AND LEVELS OF CERVICAL
LYMPH NODES

2. NECK SPACES

3. Deep Neck Space Anatomy
• Space Involving Entire Length Of Neck
• Space Limited To Above The Hyoid Bone
• Space limited To Below The Hyoid Bone

4. Cervical fascial planes

5. Space Involving Entire Length Of Neck
1. Retropharyngeal Space
2. Prevertebral Space
3. Carotid Sheath Space

6. Retropharyngeal Space
• Between visceral
division of middle layer
and alar division of deep
layer
• Extend from skull base
to T2 level
• More common in
children due to presence
of retropharyngeal node

8. Retropharyngeal space
• Lateral soft tissue X-ray (extension, inspiration) abnormal
findings:
• 1. C2-post pharyngeal soft tissue >7mm
• 2. C6–adults >22mm, peads >14mm
• 3. STS of post pharyngeal region >50% width of vertebral
body

9. Prevertebral space
• Potential space
posterior to
prevertebral division
and anterior to
vertebral bodies
• Extends from skull
base to the coccyx

12. Carotid sheath Space
• Made up from all
deep cervical fascia
• Infection from any
deep fascia can
spread to this space.

15. Space Limit To Above The Hyoid Bone
1. Parapharyngeal Space
2. Submandibular Space
3. Masticator Space
4. Temporal Space
5. Parotid Space

16. Parapharyngeal Space
(Lateral pharyngeal Space)
Boundary
• Superiorly : Skull base
• Inferiorly : Hyoid bone
• Laterally : Medial pterygoid m.
• Medially :Buccopharyngeal fascia
• Anteriorly : Submandibular space
• Posteromedialy : Prevertebral fascia
and retrophryngeal space

18. Submandibular Space
Divided into 2 spaces by
mylohyoid m.
1. Sublingual space (above
mylohyoid m.)
2. Submaxillaly space (below
mylohyiod m.)
• These 2 spaces can
communicate each other
by mylohyoid cleft

20. Masticator Space
• Between masticator m.
and superficial layer of
deep cervical fascia
(Masticator m. = massestor
m.,medial and lateral
pterygoid m. and
temporalis muscle)
• Locate anterior and
lateral to parapharyngeal
space

21. Parotid Space
• Between parotid gl. and
superficial layer of deep
cervical fascia
• Infection can spread easily to
parapharyngeal space due to
uncompleted encircle at
upper inner surface of parotid
gland.

23. Space Limit To Below The Hyoid Bone
Anterior Viseral Space
(Pretracheal Space)
• Between trachea,
esophagus and middle
layer of deep cervical
fascia
• Extend from hyoid bone
to superior mediastinum

26. • A 27 year old patient has had a sore throat
for the past 10 days.
• On Follow up
• He does have pain on the left side of his
neck along a swollen lymph node. It hurts
for him to turn his head to the left.

27. • On exam, his throat is red, but there is no
pus and his airway is patent.
• There are several swollen and tender
lymph nodes in the neck.
• He complains of pain turning his head to
the left side. He doesn’t have any signs of
meningitis. Nothing else seems abnormal
on his physical exam

31. LEVELS OF CERVICAL LYMPH
NODES

32. Deep Lymph Nodes
1. Submental
2. Submandibular (Submaxillary)
Anterior Cervical Lymph Nodes (Deep)
3. Prelaryngeal
4. Thyroid
5. Pretracheal
6. Paratracheal
Deep Cervical Lymph Nodes
7. Lateral jugular
8. Anterior jugular
9. Jugulodigastric
Inferior Deep Cervical Lymph Nodes
10. Juguloomohyoid
11. Supraclavicular (scalene

34. Level I
Submental and submandibular nodes

35. Level I A
Submental nodes, between the medial
margins of the anterior bellies of the
digastric muscles.

36. Level I B
Submandibular nodes, lateral to level I A
nodes and anterior to the back of the
submandibular salivary gland.

38. Level II
Upper internal jugular nodes, posterior to
the back of the submandibular salivary
gland, anterior to the back of the
sternocleidomastoid muscle and above the
level of the bottom of the body of the hyoid
bone.

40. Level III
Middle jugular nodes, between the level of
the bottom of the body of the hyoid bone
and the level of the bottom of the cricoid
arch, anterior to the back of the
sternocleidomastoid muscle.

42. Level IV
Low jugular nodes, between the level of
the bottom of the cricoid arch and the level
of the clavicle, anterior to a line connecting
the back of the sternocleidomastoid muscle
and the posterolateral margin of the anterior
scalene muscles; they are lateral to the
carotid arteries.

44. Level V
Posterior triangle nodes, posterior to the
back of the sternocleidomastoid muscle,
and posterior to the line described in level
IV.

46. • Level V A Above the level of the bottom of
the cricoid arch.
• Level V B Between the level of the bottom
of the cricoid arch and the level of the
clavicle

47. Level VI Upper visceral nodes, between the
carotid arteries from the level of the bottom
of the body of the hyoid bone to the level of
the top of manubrium.
Level VII Superior mediastinal nodes,
between the carotid arteries below the level
of the top of the manubrium and above the
innominate vein.

54. Thank You