The spaces may be divided into three categories:
- Blind or Intrafascial spaces: formed by splitting of fascial layers
- Intercommunicating spaces: surrounding the pharynx and lying between
fascial laminae and the pharyngeal walls
- Blind "spaces": potential only, within the pharyngeal wall deep to
the buccopharyngeal fascia.
#4 (already described)
- formed by a splitting of the prevertebral layer of
cervical fascia into prevertebral and alar layers
- extending from the base of the skull into the thorax
The other intrafascial spaces related to the upper part of
the neck are all formed by a splitting of the superficial layer of cervical
fascia to attach to the skull, as well as to surround glands and muscles
- Potential spaces do not communicate with each other: infections within them
can spread only through rupture of their walls.
- The only one of these four spaces containing any appreciable quantity of
loose connective tissue is that associated with the muscles of mastication.
- Potential cleavage plane between the fascia and the bone.
- Limited anteriorly by superfical investing fascia and the attachment of
the anterior belly of the digastric
- Limited posteriorly by investing fascia and the
attachment of the medial pterygoid to the jaw
- Inferiorly closed by the continuity of the fascial layers
- Superiorly closed by the attachment of fascial layers to the inferior border
of the body of the mandible.
- Formed by the attachment of the superficial layer of
fascia to both the outer and inner surfaces of the body of the mandible
- attachment to the outer surface is at the lower border of the mandible
- attachment to the inner surface can be elevated from the mandible up to
the origin of the mylohyoid muscle
2. Clinical: An infection here may remain localized
or may spread to the masticator space.
- Anterior element of the peripharyngeal fascial spaces
(Continuous with the lateral pharyngeal space.
Infection under the tongue and the floor of the mouth can fill the submandibular
space, and pass posterior to the lateral pharyngeal space)
- Limited above by oral mucous membrane and the tongue
- Inferior boundary is the superficial layer of cervical
fascia (suprahyoid deep investing fascia) as it extends from the hyoid bone
to the mandible
- Posteriorly – continuous with the lateral pharyngeal
- Subdivided into two compartments:
- Mylohyoid muscle, stretching across the floor of the
mouth, divides the submandibular space into a portion
above this muscle: Sublingual
and a portion below: Submaxillary Spaces
- These two subdivisions can communicate by infection or
injection along the free (posterior) edge of the mylohyoid muscle and about
the submandibular gland, which lies partly above and partly below the posterior
portion of the mylohyoid
- Sublingual space
- Contains the sublingual gland, the duct for the submandibular
gland, and the accessory submandibular gland, Lingual Nerve, and the hypoglossal
nerve appearing deep
- Consist of the loose connective tissue lying between
the muscles of the tongue and about the sublingual gland, the lingual and
hypoglossal nerves, and a portion of the submandibular gland and its duct.
- Paired but the two sides communicate anteriorly
- Subdivided based upon their relationships to the genioglossus
and geniohyoid muscles
- Clinical: Infection will pass down to the submandibular
space or can pass directly through the mylohyoid muscle
- Submaxillary space is divided
into subsidiary submental and submaxillary spaces by attachment of the superficial
layer of fascia to the anterior belly of the digastric muscle. A cross
section reveals that the submental space represents a median space that
separates the two submaxillary spaces.
- Corresponding to the triangle of the same name,
lies medial to the anterior belly of the digastric
- Contains Submandibular Gland with its fascial covering,
Facial Artery and Vein, Hypoglossal Nerve, Vena hypoglossi commitantes
- These spaces consist only of an easy line of cleavage
between the fascia and the muscles, unless they are abnormally distended.
- The roots of the third, second, and first molars are
all below the level of the mylohyoid. Infection of these teeth pass through
the root, directly into the submaxillary space and then to the lateral pharyngeal
space. Patient can present with problems in their airway. Never give a nerve
block if there is an infection of the submandibular space. Infection can
be passed by way of a needle tract infection to a deeper area of the body.
The investing layer of fascia splits to form a capsule around
the submandibular or submaxillary gland which encloses this space
- Submandibular gland and its associated lymph nodes are
embedded in and fused with the fascial capsule.
- The outer layer of the capsule: the continuation
upward of the main portion of the superficial layer of the cervical fascia,
- the inner layer is thinner and is perforated by the
duct of the gland
infections arising in the region
of the gland generally break inward
Lateral Pharyngeal Space
- Lateral portions of the Retropharyngeal space that extend
around the pharynx
- Bounded posteriorly by the carotid sheath which separates
it from the retropharyngeal space
- Deep to medial pterygoid
- Medial to the masticator space
- Lateral to where pharynx attaches to mandible
- Bounded medially by the pharyngeal fascia covering the
fascia of the pharynx itself, laterally by the pterygoid muscles and the sheath
of the parotid gland.
- Like the retropharyngeal portion of this visceral ring,
the lateral pharyngeal space extends upward to the base of the skull, but
it does not extend inferiorly, below the level of the hyoid bone, since it
is limited here by the sheath of the submandibular gland and the attachments
of this sheath to the sheaths of the stylohyoid muscle and the posterior belly
of the digastric.
- This space is traversed by the styloglossus and stylopharyngeus
muscles: both above and below these muscles it opens
medially into the retropharyngeal space
- Anterosuperiorly extends to the Pterygomandibular raphe
- Anteriorly is continuous with the submandibular (submaxillary
- Clinical: Subject to infection from several sources
- Considered to be the route by which infections of diverse
origins may be transmitted. Infection generally does not pass directly into
the lateral visceral space, but pushes the carotid bundle and passes to the
highway-the retropharyngeal space-that in turn leads to the mediastinum.
- Through its connection with the spaces about the tongue
(Sublingual Space), it may receive and transmit to the retropharyngeal space
infections originating here, as from the teeth;
- similarly, it is adjacent to the submandibular gland,
and infections in this gland may spread into the Submaxillary space;
- Both the masticator space and the parotid gland border
the lateral pharyngeal space, and infections within either of these that perforate
deeply instead of superficially will necessarily invade the lateral pharyngeal
- Tonsillar region of the pharynx is the medial wall of
the lateral pharyngeal space, and infections originating about the tonsils
may also involve this space.
- Infections within the petrous portion of the temporal
bone may rupture directly into the lateral pharyngeal space, and infection
at the tip of the mastoid process may follow the mastoid groove and extend
along the styloid and digastric muscles to this space
Formed by the splitting of the Superficial layer of cervical
fascia to enclose the ramus of the mandible, the masseter, the medial pterygoid,
and the lower portion of the temporal muscle.
- Since these structures lie between the fascial layers on the outer surface
of the masseter and the inner surface of the medial pterygoid, the loose connective
tissue and fat about them forms the potential space
- Its largest part is medial to the ramus of the mandible, between this and
the medial pterygoid, and medial and anterior to the lower portion of the
insertion of the temporal muscle.
- Posteriorly, the fascial walls of this space come together behind the ramus
of the mandible.
- Anteriorly, a part of the masseteric fascia attaches to the mandible in
front of the masseter muscle and to the insertion of the temporal muscle along
the anterior border of the ramus,
- Anteriorly, it is limited by another part passes in front of the ramus,
across the outer surface of the buccal fat pad, to attach to the maxilla and
the buccinator fascia below that
- Superiorly, it is limited deep to the temporal muscle by the origin of this
muscle from the skull. (Inferior temporal ridges and lines)
- Superficially, it is limited by the muscle's origin from the temporal fascia.
- Deeply, anterior to the lateral pterygoid plate it extends into the pterygopalatine
fossa. (Superior Temporal Line)
- Lies largely among the muscles of mastication. Those bordering the space
are enclosed by thin fascial layers that separate them from the fat pad and
subdivide the masticator space into compartments that do not freely communicate
with each other.
- It is traversed particularly by the mandibular nerve (V3) and the maxillary
(internal maxillary) vessels
- Largely filled by the buccal fat pad, pterygoid plexus of veins, and its
extends posteriorly, upward, and medially
- Infections of the zygomatic or temporal bones may pass to the masticator
space, and so may abscesses from the lower molar teeth
- Abscesses within this space may apparently point at the anterior aspect
of the masseter muscle, either into the cheek or the mouth, or they may point
posteriorly below the parotid gland.
- Temporalis is covered by both superficial layer of deep investing fascia
and by the masseteric fascia.
- Bounded laterally and medially by deep investing fascia
- Directly inferior it is open and communicates with the masticator space
- Clinical: Infections can pass outward to the cheek, but can also pass medial
to the medial pterygoid muscle or to the parotid gland
- Encloses the parotid gland and its associated lymph nodes and the facial
nerve and great vessels traversing it.
- Attached to its surrounding fascia like the submandibular gland
- Clinical: Though the deep surface of the parotid gland is strong,
infections (usually of the glands or the nodes) may readily pass deeply and
therefore into the important lateral pharyngeal space lying deep to the parotid
When orally palpating and examining
the area, it is important to note that the deep fascia
around the parotid gland is weaker medially than laterally .
Therefore an infection in this space can evidence itself as a bulge that sticks
out medially into the oral cavity.