Danger Space #4 (already described)

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

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

• 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.

• Submental space containing submental lymph nodes

• Corresponding to the triangle of the same name, lies medial to the anterior belly of the digastric

• Submaxillary space lateral and posterior to it

• 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, is strong
  • the inner layer is thinner and is perforated by the duct of the gland
  • Clinical: infections arising in the region of the gland generally break inward

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

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.

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

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.
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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