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Dr Roshan Valentine
PG Resident
Dept of Radiodiagnosis
St Johns Medical College
CT ANATOMY OF NECK
SPACES
NORMAL ANATOMY
• Neck has a complex anatomy
• Compartmentalisation of anatomic structures
Superiorly :
Mandible & mylohyoi...
INTRODUCTION
• Clinicians : anterior and posterior triangles
• Anatomists : pioneered the work on fascial spaces and anato...
• Basis for dividing neck into spaces and compartments :
arrangement of superficial and deep layers of cervical fascia
• T...
NECK SPACES
Described in relation to the hyoid bone.
• Suprahyoid Spaces.
• Infrahyoid Spaces.
• Spaces extending up to th...
SUPRAHYOID SPACES
• Sublingual Space.
• Submandibular Space.
• Buccal Space.
• Masticator Space.
• Parotid Space.
• Pharyn...
INFRAHYOID SPACES
• Visceral Space.
• Anterior cervical
Space.
• Posterior cervical
Space.
SPACES COMMON TO BOTH
• Carotid Space.
• Retropharyngeal Space.
• Prevertebral Space.
• Danger Space.
Fascia
Superficial
Deep
Superficial
Middle
Deep
CERVICAL FASCIAE
SUPERFICIAL FASCIA
• Composed of subcutaneous tissues that
encircle the neck like a collar.
• Encircles the deep fascia
• ...
SUPERFICIAL LAYER/INVESTING LAYER
• Complete collar around the neck
• Attachments
• Splits to cover SCM and Trapezius
• Ca...
SUPERFICIAL LAYER/INVESTING LAYER
MASTICATOR SPACE
 Formed by splitting of the
SLDCF.
 Extends from skull base to
the inferior edge of the
mandible.
 Con...
MASTICATOR SPACE
M
T
L
PAROTID SPACE
• Boundary : Investing fascia(SLDCF) splitting at the angle of mandible.
• Extends : Superiorly external aco...
PAROTID SPACE
PAROTID SPACE
BOUNDARY
• Investing fascia
splitting at angle of
mandible
EXTENT
• Sup:EAM
• Inf : Mandible
CONTENTS
• Parotid gland
• Fa...
SUBMANDIBULAR SPACE
• Extend : Mylohoid superiorly & hyoid
bone inferiorly.
• Communicates freely with sublingual
space.
•...
SUBMANDIBULAR SPACE
SUBMANDIBULAR SPACE
Extent : Above the mylohyoid
muscle
Contents : Sublingual gland
and their ducts , LNs,
hypoglossal muscle , lingual
artery...
SUBLINGUAL SPACE
Visceral /pretracheal layer
Extent: Hyoid bone to sup mediastinum
SHN : Continues as buccopharyngeal fascia(BPF)
Contents ...
MIDDLE LAYER OF DCF
MIDDLE LAYER OF DCF- SPACES
PHARYNGEAL MUCOSAL SPACE
• Located on the airway side of the Buccopharyngeal fascia in the nasopharynx
and oropharynx.
• N...
PHARYNGEAL
MUCOSAL SPACE
PARAPHARYNGEAL SPACE
• Central fat filled spaces in lateral
SHN.
• Extends on the either side of neck
from the skull base ...
• Contents : Mainly fat ,
pharyngeal venous plexus
, Mandibular N , Int
mammary A , ascending
pharyngeal artery.
• Directi...
PARAPHARYNGEAL SPACE
BUCCAL SPACE
• Extent : Medially - Buccinator
and max alveolar ridge
Post Laterally : Masticator space
• Contents: Buccal ...
BUCCAL SPACE
• Extent : Skull base to T4 level
• 2 parts
• Ant : True RPS
• Post : Danger space
• Contents :
• SHN : LN and fat
• IHN :...
RETROPHARYNGEAL SPACE
RETROPHARYNGEAL SPACE
DANGER SPACE
• Posterior to the RPS.
• Bounded by the Alar fascia anteriorly and Prevertebral portion proper posteriorly.
...
• Extent : skull base to superior
mediastinum T4 level.
• Encircles : Paravertebral and
paraspinal muscles, vertebral
body...
• Paired tubular structure
traversing SHN and IHN
• Skull base to superior
mediastinum
• Lateral to RPS
• Enveloped by car...
CAROTID SPACE
CAROTID SPACE
IHN
SHN
CAROTID SPACE
• Posterior midline space
of SHN and IHN
• Enclosed by deep layer
of DCF
• Extent : base of skull to
level of coccyx
• 2 c...
PERIVERTEBRAL SPACE- CONTENTS
CERVICAL SPACES
• ANTERIOR CERVICAL SPACE : Hyoid to clavicle
• Content : Only fat
• POSTERIOR CERVICAL SPACE : Extend fro...
CERVICAL SPACES
CERVICAL SPACES
CT anatomy of Neck Spaces RV
CT anatomy of Neck Spaces RV
CT anatomy of Neck Spaces RV
CT anatomy of Neck Spaces RV
CT anatomy of Neck Spaces RV
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CT anatomy of Neck Spaces RV

CT anatomy of neck spaces describing suprahyoid and infrahyoid neckspaces

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CT anatomy of Neck Spaces RV

  1. 1. Dr Roshan Valentine PG Resident Dept of Radiodiagnosis St Johns Medical College CT ANATOMY OF NECK SPACES
  2. 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. 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. 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. 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. 6. SUPRAHYOID SPACES • Sublingual Space. • Submandibular Space. • Buccal Space. • Masticator Space. • Parotid Space. • Pharyngeal mucosal Space. • Parapharyngeal Space
  7. 7. INFRAHYOID SPACES • Visceral Space. • Anterior cervical Space. • Posterior cervical Space.
  8. 8. SPACES COMMON TO BOTH • Carotid Space. • Retropharyngeal Space. • Prevertebral Space. • Danger Space.
  9. 9. Fascia Superficial Deep Superficial Middle Deep CERVICAL FASCIAE
  10. 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. 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. 12. SUPERFICIAL LAYER/INVESTING LAYER
  13. 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. 14. MASTICATOR SPACE M T L
  15. 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. 16. PAROTID SPACE
  17. 17. PAROTID SPACE
  18. 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. 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. 20. SUBMANDIBULAR SPACE
  21. 21. SUBMANDIBULAR SPACE
  22. 22. 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
  23. 23. SUBLINGUAL SPACE
  24. 24. 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
  25. 25. MIDDLE LAYER OF DCF
  26. 26. MIDDLE LAYER OF DCF- SPACES
  27. 27. 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.
  28. 28. PHARYNGEAL MUCOSAL SPACE
  29. 29. 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.
  30. 30. • 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
  31. 31. PARAPHARYNGEAL SPACE
  32. 32. BUCCAL SPACE • Extent : Medially - Buccinator and max alveolar ridge Post Laterally : Masticator space • Contents: Buccal fat pad
  33. 33. BUCCAL SPACE
  34. 34. • 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
  35. 35. RETROPHARYNGEAL SPACE
  36. 36. RETROPHARYNGEAL SPACE
  37. 37. 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.
  38. 38. • 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)
  39. 39. • 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
  40. 40. CAROTID SPACE
  41. 41. CAROTID SPACE IHN SHN
  42. 42. CAROTID SPACE
  43. 43. • 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
  44. 44. PERIVERTEBRAL SPACE- CONTENTS
  45. 45. 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.
  46. 46. CERVICAL SPACES
  47. 47. CERVICAL SPACES

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