Suprahyoid Spaces

The spaces may be divided into three categories:

  1. Blind or Intrafascial spaces: formed by splitting of fascial layers
  2. Intercommunicating spaces: surrounding the pharynx and lying between fascial laminae and the pharyngeal walls
  3. Blind "spaces": potential only, within the pharyngeal wall deep to the buccopharyngeal fascia.

INTRAFASCIAL SPACES

Danger Space #4 (already described)

  1. formed by a splitting of the prevertebral layer of cervical fascia into prevertebral and alar layers
  2. 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

Space of the Body of the Mandible

  1. Potential cleavage plane between the fascia and the bone.

  1. Limited anteriorly by superfical investing fascia and the attachment of the anterior belly of the digastric
  2. Limited posteriorly by investing fascia and the attachment of the medial pterygoid to the jaw
  3. Inferiorly closed by the continuity of the fascial layers
  4. Superiorly closed by the attachment of fascial layers to the inferior border of the body of the mandible.
  5. Formed by the attachment of the superficial layer of fascia to both the outer and inner surfaces of the body of the mandible

2. Clinical: An infection here may remain localized or may spread to the masticator space.

Submandibular Fascial Space

  1. 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)
  2. Limited above by oral mucous membrane and the tongue (lingual mucosa)
  3. Inferior boundary is the superficial layer of cervical fascia (suprahyoid deep investing fascia) as it extends from the hyoid bone to the mandible
  4. Posteriorly continuous with the lateral pharyngeal space
  5. Subdivided into two compartments:

Space of "Submaxillary" Gland proper

The investing layer of fascia splits to form a capsule around the submandibular or submaxillary gland which encloses this space

Lateral Pharyngeal Space

  1. Lateral portions of the Retropharyngeal space that extend around the pharynx
  2. Bounded posteriorly by the carotid sheath which separates it from the retropharyngeal space
  3. Deep to medial pterygoid
  4. Medial to the masticator space
  5. Lateral to where pharynx attaches to mandible
  6. 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.
  7. 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.
  8. This space is traversed by the styloglossus and stylopharyngeus muscles: both above and below these muscles it opens medially into the retropharyngeal space
  9. Anterosuperiorly extends to the Pterygomandibular raphe
  10. Anteriorly is continuous with the submandibular (submaxillary portion) space
  11. Clinical: Subject to infection from several sources
  1. 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.
  2. 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;
  3. similarly, it is adjacent to the submandibular gland, and infections in this gland may spread into the Submaxillary space;
  4. 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 space.
  5. 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.
  6. 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

Masticator 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.

  1. 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.
  2. Posteriorly, the fascial walls of this space come together behind the ramus of the mandible.
  3. 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,
  4. 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
  5. Superiorly, it is limited deep to the temporal muscle by the origin of this muscle from the skull. (Inferior temporal ridges and lines)
  6. Superficially, it is limited by the muscle's origin from the temporal fascia.
  7. Deeply, anterior to the lateral pterygoid plate it extends into the pterygopalatine fossa. (Superior Temporal Line)
  8. 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.
  9. It is traversed particularly by the mandibular nerve (V3) and the maxillary (internal maxillary) vessels
  10. Largely filled by the buccal fat pad, pterygoid plexus of veins, and its extends posteriorly, upward, and medially
  11. Clinical

Temperomasseteric Recess

  1. Temporalis is covered by both superficial layer of deep investing fascia and by the masseteric fascia.
  2. Bounded laterally and medially by deep investing fascia
  3. Directly inferior it is open and communicates with the masticator space
  4. Clinical: Infections can pass outward to the cheek, but can also pass medial to the medial pterygoid muscle or to the parotid gland

Space of Parotid Gland

  1. Encloses the parotid gland and its associated lymph nodes and the facial nerve and great vessels traversing it.
  2. Attached to its surrounding fascia like the submandibular gland
  3. 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 gland.
  4. 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.
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