The document describes the anatomy of neck spaces. It discusses that the neck can be divided into suprahyoid and infrahyoid spaces based on the hyoid bone. Specific spaces described include the sublingual, submandibular, buccal, masticator, parotid, pharyngeal mucosal, parapharyngeal, visceral, anterior cervical, posterior cervical, carotid, retropharyngeal, prevertebral, and danger spaces. The spaces are delineated by layers of cervical fascia including the superficial, middle, and deep layers. Understanding these neck spaces is important for diagnosing conditions and limiting the spread of infections and tumors.

1. Dr Roshan Valentine
PG Resident
Dept of Radiodiagnosis
St Johns Medical College
CT ANATOMY OF NECK
SPACES

2. NORMAL ANATOMY
• Neck has a complex anatomy
• Compartmentalisation of anatomic structures
Superiorly :
Mandible & mylohyoid anteriorly
Skull base posteriorly
Inferiorly:
Thoracic inlet centrally
Scapula posteriorly

3. INTRODUCTION
• Clinicians : anterior and posterior triangles
• Anatomists : pioneered the work on fascial spaces and anatomy
• Cross sectional imaging helped clinicians , anatomists and
surgeons in dividing it into fascial compartments

4. • Basis for dividing neck into spaces and compartments :
arrangement of superficial and deep layers of cervical fascia
• The importance of this spaces is that they may limit to some degree
the spread of most infections and some tumors
• A proper understanding of their anatomy will also aid in the
diagnosis of various conditions
INTR0DUCTION

5. NECK SPACES
Described in relation to the hyoid bone.
• Suprahyoid Spaces.
• Infrahyoid Spaces.
• Spaces extending up to the entire length of
the neck.

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

7. INFRAHYOID SPACES
• Visceral Space.
• Anterior cervical
Space.
• Posterior cervical
Space.

8. SPACES COMMON TO BOTH
• Carotid Space.
• Retropharyngeal Space.
• Prevertebral Space.
• Danger Space.

9. Fascia
Superficial
Deep
Superficial
Middle
Deep
CERVICAL FASCIAE

10. SUPERFICIAL FASCIA
• Composed of subcutaneous tissues that
encircle the neck like a collar.
• Encircles the deep fascia
• Components:
• Platysma and muscles of facial expression.
• Subcutaneous veins , nerves and fat
• Superficial lymph nodes.

11. SUPERFICIAL LAYER/INVESTING LAYER
• Complete collar around the neck
• Attachments
• Splits to cover SCM and Trapezius
• Capsule : parotid and Submandibular
gland
• Spaces : Masticator space ,parotid space,
submandibular space and sublingual
space.
DEEP CERVICAL FASCIAE

12. SUPERFICIAL LAYER/INVESTING LAYER

13. MASTICATOR SPACE
 Formed by splitting of the
SLDCF.
 Extends from skull base to
the inferior edge of the
mandible.
 Contents: mandible,
muscles of mastication,
and mandibular division of
the Vth nerve.

14. MASTICATOR SPACE
M
T
L

15. PAROTID SPACE
• Boundary : Investing fascia(SLDCF) splitting at the angle of mandible.
• Extends : Superiorly external acoustic meatus
Inferiorly up to the mandible.
• Contents: Parotid Gland, proximal part of the parotid duct, intraparotid lymph nodes
and vessels.
• Parotid gland is divided by facial nerve into superficial and deep.
• Division identified on imaging by retromandibular vein.

16. PAROTID SPACE

17. PAROTID SPACE

18. BOUNDARY
• Investing fascia
splitting at angle of
mandible
EXTENT
• Sup:EAM
• Inf : Mandible
CONTENTS
• Parotid gland
• Facial N
• Retromandibular
vein
• ECA
• LN
PAROTID SPACE

19. SUBMANDIBULAR SPACE
• Extend : Mylohoid superiorly & hyoid
bone inferiorly.
• Communicates freely with sublingual
space.
• Contents : superficial portions of the
Submandibular gland,submental and
submandibular LNs, facial artery and
vein, fat and ant belly of digastric.

20. SUBMANDIBULAR SPACE

21. SUBMANDIBULAR SPACE

23. Extent : Above the mylohyoid
muscle
Contents : Sublingual gland
and their ducts , LNs,
hypoglossal muscle , lingual
artery and vein , hypoglossal
N and deeper portion of
submandibular gland.
SUBLINGUAL SPACE

24. SUBLINGUAL SPACE

25. Visceral /pretracheal layer
Extent: Hyoid bone to sup mediastinum
SHN : Continues as buccopharyngeal fascia(BPF)
Contents : Trachea, esophagus , larynx , thyroid and parathyroid
gland
Spaces : Pharyngeal mucosal space , retropharyngeal space ,
parapharyngeal space and buccal space
MIDDLE LAYER OF DCF

26. MIDDLE LAYER OF DCF

27. MIDDLE LAYER OF DCF- SPACES

28. PHARYNGEAL MUCOSAL SPACE
• Located on the airway side of the Buccopharyngeal fascia in the nasopharynx
and oropharynx.
• No fascial boundaries on the airway side.
• Extend from skull base to the Cricoid cartilage.
• Contents: Mucosa, lymphoid tissue of Waldeyer’s ring, minor salivary glands,
and pharyngeal constrictor muscles.

29. PHARYNGEAL
MUCOSAL SPACE

30. PARAPHARYNGEAL SPACE
• Central fat filled spaces in lateral
SHN.
• Extends on the either side of neck
from the skull base to the
submandibular space inferiorly
• Surrounded by PMS , MS , PS , CS
AND RPS.

31. • Contents : Mainly fat ,
pharyngeal venous plexus
, Mandibular N , Int
mammary A , ascending
pharyngeal artery.
• Direction of displacement
of PPS – space of origin
of the lesion
PARAPHARYNGEAL SPACE

32. PARAPHARYNGEAL SPACE

33. BUCCAL SPACE
• Extent : Medially - Buccinator
and max alveolar ridge
Post Laterally : Masticator space
• Contents: Buccal fat pad

34. BUCCAL SPACE

35. • Extent : Skull base to T4 level
• 2 parts
• Ant : True RPS
• Post : Danger space
• Contents :
• SHN : LN and fat
• IHN : Fat
• pathway for spread of
infections / tumors into the
mediastinum from the neck.
RETROPHARYNGEAL SPACE

36. RETROPHARYNGEAL SPACE

37. RETROPHARYNGEAL SPACE

38. DANGER SPACE
• Posterior to the RPS.
• Bounded by the Alar fascia anteriorly and Prevertebral portion proper posteriorly.
• Extends from the skull base up to the diaphragm.
• Content : loose areolar tissue which provides easy pathway for the spread of
infections.

40. • Extent : skull base to superior
mediastinum T4 level.
• Encircles : Paravertebral and
paraspinal muscles, vertebral
body , vertebral A and Vn ,
phrenic nerve and brachial plexus
trunk
• Spaces : involve both SHN and
IHN – CS , RPS, DS , PVS and
posterior cervical space.
: Involving only IHN -
Visceral spaces and anterior
cervical space
DEEP LAYER OF DCF(Prevertebral fascia)

41. • Paired tubular structure
traversing SHN and IHN
• Skull base to superior
mediastinum
• Lateral to RPS
• Enveloped by carotid sheath :
all 3 layers of DCf
• Contents : SHN – ICA IJV ,
CN9-12,
:IHN - CCA, IJV ,
CN10 trunk ( vagus)
CAROTID SPACE

42. CAROTID SPACE

43. CAROTID SPACE
IHN
SHN

44. CAROTID SPACE

45. • Posterior midline space
of SHN and IHN
• Enclosed by deep layer
of DCF
• Extent : base of skull to
level of coccyx
• 2 compartments :
Prevertebral and
Paraspinal
PERIVERTEBRAL SPACE

46. PERIVERTEBRAL SPACE- CONTENTS

48. CERVICAL SPACES
• ANTERIOR CERVICAL SPACE : Hyoid to clavicle
• Content : Only fat
• POSTERIOR CERVICAL SPACE : Extend from the skull base to the clavicles.
• Deep and posterior to sternocledomastoid
• Content : fat, spinal accessory nerves and spinal accessory chain of deep cervical lymph nodes.

49. CERVICAL SPACES

50. CERVICAL SPACES