fascia-neck
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Chapter 34 Fascia and Spaces of the Neck 1825
FIGURE 34-20 Axial contrast-enhanced CT scan (A) through the midneck shows a right-sided, nonhomogeneous, lobulated fatty or cystic mass apparently in the space most commonly known as either the posterior triangle space or the posterior cervical space. In B, a CT scan more caudal than A, the medial extension of this mass into a widened spinal canal is seen. The displaced anterior scalene muscle is also seen (arrow). A T2-weighted MR image (C) confirms the neurogenic origin of this lesion, which extends from the spinal cord into the lateral neck. The lesion also had high T1-weighted signal intensity, suggesting the presence of fat. This was a neurofibroma, as indicated by both its neurogenic origin and its fatty nature. On imaging, schwannomas are never this fatty. The DLDCF had been lifted over this lesion as it enlarged, and it is this fascia that separates the neurofibroma from the adjacent structures in the posterior cervical space. Refer also to Figure 34-5 for images of schwannomas.
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Table 34-1 |
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THE SPACES OF THE NECK AND THEIR CONTENTS |
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Space or Anatomic Region |
Major Structures Either Within or Bordering Each Space |
Superficial Fascia (subcutaneous tissues) |
Subcutaneous fat, subcutaneous venules, lymphatics and nerves, platysma muscle, portions of anterior and |
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external jugular veins |
Visceral Compartment |
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Retropharyngeal space |
Pharynx, medial and lateral retropharyngeal lymph nodes, fat |
Retrovisceral space (retroesophageal) |
Esophagus, fat |
Pretracheal space |
Larynx, trachea, thyroid gland, parathyroid glands, recurrent laryngeal nerve, sympathetic trunk, level VI |
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lymph nodes, thyroid arteries, fat |
Danger Space |
Fat, retropharyngeal and retroesophageal space in front, prevertebral space behind, parapharyngeal spaces |
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on either side |
Prevertebral Space |
Anterior longitudinal ligament, cervical vertebrae and discs, longus coli and longus capitis muscles, phrenic |
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nerve, fat |
Carotid Sheath |
Internal carotid artery, common carotid artery, internal jugular vein, cranial nerves IX, X, XI, XII, level II, |
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III, and IV lymph nodes, fat |
Space of the Body of the Mandible |
Mandible, fat |
Space of the Submandibular Gland |
Submandibular gland, fat |
Space of the Parotid Gland |
Parotid gland, facial nerve, parotid lymph nodes, external carotid artery, retromandibular (posterior facial) |
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vein, fat |
Submandibular Space |
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Sublingual space |
Sublingual glands, deep portion (including hilum) of submandibular glands, Wharton’s ducts, lingual artery, |
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lingual vein, lingual nerve (sensory V3 and chorda tympani), cranial nerves XI and XII, fat |
Submaxillary space |
Superficial portion of the submandibular gland, anterior bellies of the digastric muscles, level I lymph |
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nodes, facial artery, facial vein, fat |
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Table continued on following page |
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1826 NECK
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Table 34-1 |
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THE SPACES OF THE NECK AND THEIR CONTENTS Continued |
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Space or Anatomic Region |
Major Structures Either Within or Bordering Each Space |
Masticator Space |
Medial pterygoid muscle, lateral pterygoid muscle, masseter muscle, temporalis muscle, ramus of mandible, |
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branches of V3, fat |
Parapharyngeal Space |
Fat, ascending pharyngeal artery, internal maxillary artery, pterygoid venous plexus, branches of V3, cervi- |
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cal sympathetic trunk, minor salivary glands. Deep portion of parotid gland |
Peritonsillar Space |
Fat, palatine tonsil medially, parapharyngeal space laterally |
‘‘Paravertebral’’ Space |
Anterior middle and posterior scalene muscles, levator scapulae muscle, splenius capitus and splenius cervi- |
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cus muscles, brachial plexus (roots), vertebral artery, vertebral vein, fat |
‘‘Posterior Triangle’’ Space |
Fat, cranial nerve XI, brachial plexus (trunks, divisions, and chords), dorsal scapular and long thoracic |
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nerves, cutaneous nerves of the cervical plexus, level V lymph nodes |
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Table 34-2
THE SPACES OF THE NECK AS A BASIS FOR DIFFERENTIAL DIAGNOSIS
Space or Anatomic Region |
Differential Diagnosis |
Superficial Fascia (subcutaneous tissues) |
Keloids; scars; subcutaneous fat necrosis of the newborn; lipomas; obstructed lymphatics and |
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venules from edema, cellulitis, radiation therapy, surgery; schwannomas; neurofibromas, plexiform |
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neurofibromas, pilomatrixoma, Merkel cell tumor; lymphoma, squamous cell and basal cell |
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carcinomas |
Visceral Compartment |
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Retropharyngeal space |
Medial and lateral retropharyngeal lymph adenopathy, cellulitis, phlegm, abscess, extension of goiter, |
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extension of pharyngeal tumor |
Retrovisceral space |
Cellulitis, phlegm, abscess, extension of goiter, extension of esophageal tumor, extension of thyroid |
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tumor |
Pretracheal space |
Tracheal, thyroid, laryngeal, and parathyroid tumors, goiter, recurrent laryngeal nerve or sympathetic |
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trunk schwannomas, level VI lymph adenopathy, cellulitis, phlegm, abscess |
Danger Space |
Phlegm, abscess |
Prevertebral Space |
Cervical vertebral and disc disease, longus coli and longus capitis muscle tumors, phrenic nerve schwan- |
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noma, minor salivary gland tumors, cellulitis, phlegm, abscess |
Carotid Sheath |
Carotid artery arteritis, aneurysm, or dissection, internal jugular vein thrombosis or phlebitis, cranial |
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nerve IX, X, XI, and XII schwannomas, paragangliomas, level II, III, and IV lymph adenopathy, celluli- |
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tis, phlegm, abscess |
Space of the Body of the Mandible |
Mandibular and odontogenic disease, cellulitis, phlegm, abscess |
Space of the Submandibular Gland |
Submandibular gland disease, cellulitis, phlegm, abscess |
Space of the Parotid Gland |
Parotid gland disease, facial nerve schwannoma, parotid lymph adenopathy, external carotid artery aneu- |
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rysm, retromandibular (posterior facial) vein thrombosis and disease |
Submandibular Space (sublingual space) |
Sublingual gland disease, especially ranula, dermoid, lingual artery aneurysm, lingual nerve schwan- |
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noma, cranial nerve XI and XII schwannomas, lymphangioma, level I lymph adenopathy, facial artery |
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and facial vein disease |
Masticator Space |
Medial pterygoid, lateral pterygoid, masseter, and temporalis muscle inflammatory disease and tumors, |
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mandibular disease, V3 retrograde tumor or schwannoma, cellulitis, phlegm, abscess |
Parapharyngeal Space |
Deep portion of parotid gland tumors, V3 schwannomas, cervical sympathetic trunk disease, minor sali- |
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vary gland tumors, paragangliomas, cellulitis, phlegm, abscess |
Peritonsillar Space |
Phlegm, abscess, extension of tonsillar tumor |
‘‘Paravertebral’’ Space |
Anterior middle and posterior scalene muscles, levator scapulae muscle, splenius capitus and splenius |
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cervicus muscle disease, brachial plexus (roots) schwannomas, vertebral artery aneurysm, vertebral vein |
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thrombosis, metastasis |
‘‘Posterior Triangle’’ Space |
Cranial nerve XI or brachial plexus (trunks, divisions, and chords) schwannomas, lymphangioma, level |
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V lymph adenopathy |
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REFERENCES
1.Charpy A. Aponeuroses de cou. In: Poirier P, Charpy A, eds. Traite de anatomic humaine, Vol 12. Paris: Masson, 1912;258–280.
2.Grodinsky M, Holyoke E. The fasciae and fascial spaces of the head, neck and adjacent regions. Am J Anat 1938;63:367–408.
3.Maligaigne J. Traite d’anatomie chirugicale. Quoted in Carpy, 1912;1838.
4.Hollinshead W. Fascia and fascial spaces of the head and neck. In: Hollinshead W, ed. Anatomy for Surgeons, Vol 1. New York: Hoeber-Harper, 1954;282–305.
5.Shapiro S. Deep cervical infection following tonsillectomy: report of thirty cases with a review of the literature. Arch Otolaryngol 1930;11:701–735.
6.Cazalas G. Les espaces intra et peri-pharyngiens etude anatomique et experimentale. Lyon: Considerations Medico-Chirugicales, 1938; 168:164.
7.Coller F, Yglesias L. Infections of the lip and face. Surg Gynecol Obstet 1935;60:277–290.
8.Coulouma P. La systematisation des espaces peri, meta et paraamygdaliens. Leur interet clinique. Echo Med Nord 1937;8:649–662.
9.Gaughran G. The lateral pharyngeal cleft. Ann Otol Rhinol Laryngol 1959;68:1082–1096.
10.Hall C. The parapharyngeal space: an anatomical and clinical study. Ann Otol Rhinol Laryngol 1934;43:793–812.
11.Heeneman H, Gilbert J, Rood S. The Parapharyngeal Space: Anatomy and Pathologic Conditions with Emphasis on Neurogenous Tumors, Vol. 79500. Rochester, Minn.: American Academy of Otolaryngology, 1980;1–61.
12.Juvara E. Anatomie de la region pterygo-maxillaire, Vol. Thesis No. 186. Paris: Battaille, 1895;1–65.
13.Lemmon M. Superficial fascia rhytidectomy. A restoration of the SMAS with control of the cervicomental angle. Clin Plast Surg 1983;10:449–478.
14.Paff G. Introduction to the anatomy of the neck. In: Paff G, ed. Anatomy of the Head and Neck. Philadelphia: W.B. Saunders, 1973;1–3.
Chapter 34 Fascia and Spaces of the Neck 1827
15.Rouviere H. Lymphatic system of the head and neck. In: Anatomy of the Human Lymphatic System. Ann Arbor, Mich.: Edwards Brothers, 1938;5–28.
16.Curtin H. Separation of the masticator space from the parapharyngeal space. Radiology 1987;163:195–204.
17.Gaughran G. Fasciae of the masticator space. Anat Rec 1957;129: 383–400.
18.Salasche S, Bernstein G. Superficial musculoaponeurotic system. In: Salasche S, Bernstein G, eds. Surgical Anatomy of the Skin. Appleton and Lange, 1988;89–97.
19.Dean L. The proper procedure for external drainage of retropharyngeal abscesses secondary to caries of the vertebrae. Ann Otol Rhinol Laryngol 1919;28:566–572.
20.Som P, Biller H, Lawson W. Tumors of the parapharyngeal space: preoperative evaluation, diagnosis, and surgical approaches. Ann Otol
Rhinol Laryngol 1981;90:3–15.
21. Weintraub J. A new anatomic and functional systematization of the connective tissues of the neck. Arch Otolaryngol 1941; 33:1–30.
22.Truffert P, Le Cou. Anatomie topographique. Les Aponeuroses-Les Loges. Paris: L. Arnette, 1922;1–142.
23.Pearse HJ. Mediastinitis following cervical suppuration. Ann Surg 1938;108:588–611.
24.Harnsberger H. CT and MRI of masses of the deep face. Curr Probl Diagn Radiol 1987;16:143–173.
25.Harnsberger H. The carotid space. In: Harnsberger H, ed. Handbook of Head and Neck Imaging. 2nd ed. St. Louis: C.V. Mosby, 1995;75–88.
26.Harnsberger H. The parapharyngeal space and the pharyngeal mucosal space. In: Harnsberger H, ed. Handbook of Head and Neck Imaging. 2nd ed. St. Louis: C.V. Mosby, 1995;29–45.
27.Harnsberger H. The perivertebral space. In: Harnsberger H, ed. Handbook of Head and Neck Imaging. 2nd ed. St. Louis: C.V. Mosby, 1995;105–119.
28.Harnsberger H. The infrahyoid neck: normal anatomy and pathology of the head and neck from the hyoid to the clavicles. In: Harnsberger H, ed. Handbook of Head and Neck Imaging. 2nd ed. St. Louis: C.V. Mosby, 1995;150–198.
Copyright © 2003, Mosby, Inc. All rights reserved.