2. Clinical importance:
Various spaces in the neck
18 spaces: suprahyoid and infrahyoid
Clinically important
Intercommunication
infection spreads rapidly: cranial cavity, mediastinum
3. Clinical importance cont.:
If not tackle:- Life threatening conditions
Acute laryngeal oedema
Upper airway compression
Involvement of great vessels, cranial nerves
Severe odynophagia
4. Important Deep Neck Spaces:
1. Peritonsillar space
2. Submaxillary space: sublingual space
submandibular space
3. Retropharyngeal space
4. Parapharyngeal space
5. Parotid space
6. Masseteric space
7. Pre-epiglottic & para-glottic space.
5. Peritonsillar space:
Boundary: laterally : superior constrictor
medially : tonsillar capsule
Infection: peritonsillitis-> Abscess (quinsy)
Pathology : as an complication &
: de novo
6. Peritonsillar space cont.:
s/s:
Pain more severe & unilateral
Muffled sound (hot potatoes sound)
Trismus
Drooling of saliva
Inflamed soft palate
Buried tonsils
Enlarged and tender JD node
7. Management of
peritonsillitis:
Diagnosis: clinically, aspiration of abscess
Treatment: I/V Ampicillin + cloxacillin & metronidazole
Anti-inflammatory: Ibuprofen & paracetamol
Locally antiseptic mouth wash
If abscess: I & D of abscess (site of drainage)
If second attack: tonsillectomy.
8.
9.
10.
11. Submaxillary space:
Boundary:
Superior : mucosa of floor of mouth
Inferior : deep fascia of neck
Divided by myelohyoid muscle
Content: submandibular and sublingual
salivary glands, lymph nodes.
12. Sub maxillary space cont:
Ludwigs angina (inflammation of floor of
mouth):- Browny Induration
Pathology:
Dental origin(80%)
Inflammation of submandibular salivary gland
Lymphadenitis
Trauma floor of mouth
19. Retropharyngeal space cont:
Treatment:
Conservative:
Antibiotics
Anti-inflammatory+ supportive therapy
Surgical: I&D of most bulging area through trans-oral
route
Anaesthesia: blanket anaesthesia
Position: head down and lateral position
20.
21. Parapharyngeal space:
Boundary:
Superior : base of skull
Inferior : Hyoid bone
Medial : pharynx
Lateral : mandible
content: great vessels, last 4 cranial nerves, lymph
nodes, deep lobe of parotid.
22. Parapharyngeal space cont:
S/S:
Pain, fever, odynophagia
Drooling of saliva
Stertor - respiratory obstruction
O/E: lateral neck swelling
bulging of lateral pharyngeal wall
pseudo enlargement of tonsils
23. Parapharyngeal space cont:
Treatment:
Conservative:
Antibiotics
Anti-inflammatory + supportive therapy
Surgical: I&D of most bulging area lateral side of
neck (external route)
Anaesthesia: LA or GA
Position: head turn and lateral position