deep neck spaces and infection ent
TRANSCRIPT
DEEP NECK SPACES & INFECTION
RAHEEF ALATASSI
OBJECTIVES
• Anatomy of the Deep Neck Spaces
• Deep neck infections
DEEP NECK SPACES
•Described in relation to the hyoid
A.Entire length of the neck
B.Suprahyoid
C.Infrahyoid
Deep
Neck spaces
Entire
length
1.Retropharyng
eal Space
2.Danger Space
3.Prevertebral
Space
4.Visceral
Vascular Space
Suprahyoi
d
1.Submandibula
r Space
2.Parapharyng
eal Space
3.Peritonsillar
Space
Infrahyoid
1.Anterior
Visceral Space
DEEP NECK SPACES
A)Entire Length of
Neck: Superficial
Space
• Surrounds platysma
• Contains areolar
tissue, nodes, nerves
and vessels
• Involved with
cellulitis and
superficial abscesses
DEEP NECK SPACES
A)Entire Length of
Neck:
1.Retropharyngeal Space
• Posterior to pharynx
and esophagus
• Anterior to alar layer of
deep fascia
• Extends from skull base
to T1-T2
DEEP NECK SPACES
A)Entire Length of Neck:
2.Danger Space•Anterior border is alar layer of deep
fascia
• Posterior border is prevertebral layer
• Extends from skull base to diaphragm and is so named because it contains loose areolar tissue and offers little resistance to the spread of infection.
DEEP NECK SPACESA)Entire Length of Neck:
3.Prevertebral Space• Anterior border is prevertebral fascia
• Posterior border is vertebral bodies
• Extends along entire length of vertebral column.
• Infection in this space tends to stay somewhat localized due to the dense fibrous attachments between the fascia and the deep muscles.
DEEP NECK SPACES
A)Entire Length of Neck: 4.Visceral Vascular Space
• Carotid Sheath• It is termed the “Lincolin’s highway”
of the neck . • It extends from the base of skull
into the mediastinum and because it receives contributions from all three layers of deep fascia it can become secondarily involved by infection in any other deep neck space by direct spread.
DEEP NECK SPACES
B)Suprahyoid:
1.Submandibular Space
•Anterior/Lateral—mandible
• Superior—mucosa
• Inferior—superficial layer of
deep fascia
• Posterior/Inferior--hyoid
DEEP NECK SPACES
B)Suprahyoid :
1.Submandibular Space comprises
• Sublingual Space• Areolar tissue
• Hypoglossal and lingual nerves
• Sublingual gland
• Wharton’s duct
• Submylohyoid Space• Anterior bellies of digastrics
• Submandibular gland
• (These two subdivisions freely communicate around the posterior border of the mylohyoid. )
DEEP NECK SPACES
B)Suprahyoid2.Parapharyngeal Space (pharyngomaxillary
space )
• Superior—skull base-petrous portion of temporal bone
• Inferior—hyoid• Anterior—ptyergomandibular raphe• Posterior—prevertebral fascia• Medial—buccopharyngeal fascia• Lateral—superficial layer of deep fascia,medial
pterygoid and parotid .
• The parapharyngeal space communicates with submandibular , retropharyngeal, parotid and masticator spaces with important implications in spread of infection .
DEEP NECK SPACES
B)Suprahyoid:
3.Peritonsillar Space• Medial—capsule of palatine tonsil
• Lateral—superior pharyngeal constrictor
• Superior—anterior tonsil pillar
• Inferior—posterior tonsil pillar.
• This space contains loose areolar tissue, primarily in the area adjacent to the soft palate, which explains why the majority of peritonsillar abscesses will localize to the superior pole of the tonsil.
DEEP NECK SPACES
C)Infrahyoid:
1.Anterior Visceral Space
• Formed by middle layer of deep fascia
• Contains thyroid, trachea, esophagus.
This potential space runs from the
thyroid cartilage into the anterior
superior mediastinum to the arch of
the aorta.
• Below the level of the thyroid gland
this space communicates laterally with
the retropharyngeal space .
DEEP NECK INFECTION
A.PARAPHARYNGEAL SPACE INFECTIONS
• Parapharyngeal space infections are potentially life-threatening ?
• The diagnosis of parapharyngeal space involvement is often delayed.
• Infection of the parapharyngeal space may arise from :
• 1- Dental infections most common
• 2- peritonsillar abscess.
• 3- parotitis, otitis, or mastoiditis (Bezold's abscess) Rarly.
• Infection of the anterior compartment of the parapharyngeal space is
more common than the posterior compartment
CLINICAL FEATURES
The cardinal clinical features of parapharyngeal
space infections are:
1)Trismus
2)Induration and swelling below the angle of the
mandible
3)Medial bulging of the pharyngeal wall
4)Systemic toxicity with fever
DIAGNOSIS
1) High dose of IV
broad spectrum
antibiotics.
2) Surgical drainage.
TREATMENT
1) CT scan
2) MRI
B.RETROPHARYNGEAL SPACE INFECTION
• It’s the most serious of deep space infections ??? Risk of Acute
necrotizing mediastinitis. Much more common in children and infants
than in adults.
Clinical features:
1) Dysphagia & airway obstruction (stridor)
2) Croupy cough, fever with preceding URTI.
3) Torticollis: stiff neck & extended head.
4) Unilateral bulging in posterior pharyngeal wall on one side of the
midline.
DIAGNOSIS
1) High dose of IV broad
spectrum antibiotics.
2) Surgical drainage.
3) Tracheostomy
TREATMENT
1) X-ray (neck lateral view):
Widening of prevertebral
space.
Presence of gas.
1) CT scan
2) MRI
COMPLICATIONAcute necrotizing mediastinitis:
• Most feared complication of a retropharyngeal space infection.
• An infection in the "danger" space may drain by gravity into the posterior
mediastinum, resulting in mediastinitis and empyema.
• Clinically, onset of acute necrotizing mediastinitis is rapid and is
characterized by the following:
1. Widespread necrotizing process extending the length of the posterior
mediastinum.
2. Rupture of mediastinal abscess into the pleural cavity with empyema.
3. Pleural or pericardial effusions, frequently with tamponade
• The mortality of acute necrotizing mediastinitis in adults is high.
Aspiration pneumonia is another potential complication of retropharyngeal
MCQ
• The danger space refer to that space just posterior to the
retropharyngeal space and anterior to the prevertebral space. It
is called this because infection involving this space can lead to
which of the following?
a) Torticollis.
b) Airway obstruction.
c) Pneumonia.
d) Mediastinitis.
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