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CT anatomy of Neck Spaces RV

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CT anatomy of Neck Spaces RV

  1. 1. Dr Roshan Valentine PG Resident Dept of Radiodiagnosis St Johns Medical College CT ANATOMY OF NECK SPACES
  2. 2. NORMAL ANATOMY • Neck has a complex anatomy • Compartmentalisation of anatomic structures Superiorly : Mandible & mylohyoid anteriorly Skull base posteriorly Inferiorly: Thoracic inlet centrally Scapula posteriorly
  3. 3. INTRODUCTION • Clinicians : anterior and posterior triangles • Anatomists : pioneered the work on fascial spaces and anatomy • Cross sectional imaging helped clinicians , anatomists and surgeons in dividing it into fascial compartments
  4. 4. • Basis for dividing neck into spaces and compartments : arrangement of superficial and deep layers of cervical fascia • The importance of this spaces is that they may limit to some degree the spread of most infections and some tumors • A proper understanding of their anatomy will also aid in the diagnosis of various conditions INTR0DUCTION
  5. 5. NECK SPACES Described in relation to the hyoid bone. • Suprahyoid Spaces. • Infrahyoid Spaces. • Spaces extending up to the entire length of the neck.
  6. 6. SUPRAHYOID SPACES • Sublingual Space. • Submandibular Space. • Buccal Space. • Masticator Space. • Parotid Space. • Pharyngeal mucosal Space. • Parapharyngeal Space
  7. 7. INFRAHYOID SPACES • Visceral Space. • Anterior cervical Space. • Posterior cervical Space.
  8. 8. SPACES COMMON TO BOTH • Carotid Space. • Retropharyngeal Space. • Prevertebral Space. • Danger Space.
  9. 9. Fascia Superficial Deep Superficial Middle Deep CERVICAL FASCIAE
  10. 10. SUPERFICIAL FASCIA • Composed of subcutaneous tissues that encircle the neck like a collar. • Encircles the deep fascia • Components: • Platysma and muscles of facial expression. • Subcutaneous veins , nerves and fat • Superficial lymph nodes.
  11. 11. SUPERFICIAL LAYER/INVESTING LAYER • Complete collar around the neck • Attachments • Splits to cover SCM and Trapezius • Capsule : parotid and Submandibular gland • Spaces : Masticator space ,parotid space, submandibular space and sublingual space. DEEP CERVICAL FASCIAE
  12. 12. SUPERFICIAL LAYER/INVESTING LAYER
  13. 13. MASTICATOR SPACE  Formed by splitting of the SLDCF.  Extends from skull base to the inferior edge of the mandible.  Contents: mandible, muscles of mastication, and mandibular division of the Vth nerve.
  14. 14. MASTICATOR SPACE M T L
  15. 15. PAROTID SPACE • Boundary : Investing fascia(SLDCF) splitting at the angle of mandible. • Extends : Superiorly external acoustic meatus Inferiorly up to the mandible. • Contents: Parotid Gland, proximal part of the parotid duct, intraparotid lymph nodes and vessels. • Parotid gland is divided by facial nerve into superficial and deep. • Division identified on imaging by retromandibular vein.
  16. 16. PAROTID SPACE
  17. 17. PAROTID SPACE
  18. 18. BOUNDARY • Investing fascia splitting at angle of mandible EXTENT • Sup:EAM • Inf : Mandible CONTENTS • Parotid gland • Facial N • Retromandibular vein • ECA • LN PAROTID SPACE
  19. 19. SUBMANDIBULAR SPACE • Extend : Mylohoid superiorly & hyoid bone inferiorly. • Communicates freely with sublingual space. • Contents : superficial portions of the Submandibular gland,submental and submandibular LNs, facial artery and vein, fat and ant belly of digastric.
  20. 20. SUBMANDIBULAR SPACE
  21. 21. SUBMANDIBULAR SPACE
  22. 22. Extent : Above the mylohyoid muscle Contents : Sublingual gland and their ducts , LNs, hypoglossal muscle , lingual artery and vein , hypoglossal N and deeper portion of submandibular gland. SUBLINGUAL SPACE
  23. 23. SUBLINGUAL SPACE
  24. 24. Visceral /pretracheal layer Extent: Hyoid bone to sup mediastinum SHN : Continues as buccopharyngeal fascia(BPF) Contents : Trachea, esophagus , larynx , thyroid and parathyroid gland Spaces : Pharyngeal mucosal space , retropharyngeal space , parapharyngeal space and buccal space MIDDLE LAYER OF DCF
  25. 25. MIDDLE LAYER OF DCF
  26. 26. MIDDLE LAYER OF DCF- SPACES
  27. 27. PHARYNGEAL MUCOSAL SPACE • Located on the airway side of the Buccopharyngeal fascia in the nasopharynx and oropharynx. • No fascial boundaries on the airway side. • Extend from skull base to the Cricoid cartilage. • Contents: Mucosa, lymphoid tissue of Waldeyer’s ring, minor salivary glands, and pharyngeal constrictor muscles.
  28. 28. PHARYNGEAL MUCOSAL SPACE
  29. 29. PARAPHARYNGEAL SPACE • Central fat filled spaces in lateral SHN. • Extends on the either side of neck from the skull base to the submandibular space inferiorly • Surrounded by PMS , MS , PS , CS AND RPS.
  30. 30. • Contents : Mainly fat , pharyngeal venous plexus , Mandibular N , Int mammary A , ascending pharyngeal artery. • Direction of displacement of PPS – space of origin of the lesion PARAPHARYNGEAL SPACE
  31. 31. PARAPHARYNGEAL SPACE
  32. 32. BUCCAL SPACE • Extent : Medially - Buccinator and max alveolar ridge Post Laterally : Masticator space • Contents: Buccal fat pad
  33. 33. BUCCAL SPACE
  34. 34. • Extent : Skull base to T4 level • 2 parts • Ant : True RPS • Post : Danger space • Contents : • SHN : LN and fat • IHN : Fat • pathway for spread of infections / tumors into the mediastinum from the neck. RETROPHARYNGEAL SPACE
  35. 35. RETROPHARYNGEAL SPACE
  36. 36. RETROPHARYNGEAL SPACE
  37. 37. DANGER SPACE • Posterior to the RPS. • Bounded by the Alar fascia anteriorly and Prevertebral portion proper posteriorly. • Extends from the skull base up to the diaphragm. • Content : loose areolar tissue which provides easy pathway for the spread of infections.
  38. 38. • Extent : skull base to superior mediastinum T4 level. • Encircles : Paravertebral and paraspinal muscles, vertebral body , vertebral A and Vn , phrenic nerve and brachial plexus trunk • Spaces : involve both SHN and IHN – CS , RPS, DS , PVS and posterior cervical space. : Involving only IHN - Visceral spaces and anterior cervical space DEEP LAYER OF DCF(Prevertebral fascia)
  39. 39. • Paired tubular structure traversing SHN and IHN • Skull base to superior mediastinum • Lateral to RPS • Enveloped by carotid sheath : all 3 layers of DCf • Contents : SHN – ICA IJV , CN9-12, :IHN - CCA, IJV , CN10 trunk ( vagus) CAROTID SPACE
  40. 40. CAROTID SPACE
  41. 41. CAROTID SPACE IHN SHN
  42. 42. CAROTID SPACE
  43. 43. • Posterior midline space of SHN and IHN • Enclosed by deep layer of DCF • Extent : base of skull to level of coccyx • 2 compartments : Prevertebral and Paraspinal PERIVERTEBRAL SPACE
  44. 44. PERIVERTEBRAL SPACE- CONTENTS
  45. 45. CERVICAL SPACES • ANTERIOR CERVICAL SPACE : Hyoid to clavicle • Content : Only fat • POSTERIOR CERVICAL SPACE : Extend from the skull base to the clavicles. • Deep and posterior to sternocledomastoid • Content : fat, spinal accessory nerves and spinal accessory chain of deep cervical lymph nodes.
  46. 46. CERVICAL SPACES
  47. 47. CERVICAL SPACES

Notas do Editor

  • Extend from mandible to thoracic inlet and from base of skull to scapulae
  • Skullbase , mandible, hyoid , clavicle , sternum , scapula
    Posteriorly : Ligamentum nuchae and cervical spinous process
  • Contrast enhanced CT 1 Parapharyngeal space. 2 Masticator space. 3 Carotid space 4 Parotid space. 5 Mucosal space. 6 Perivertebral space (anterior portion). 7 Retropharyngeal space (virtual at this level).
  • Boundary : Investing fascia(SLDCF) splitting at the angle of mandible.
    Extends : Superiorly external acoustic meatus
    Inferiorly up to the mandible.
    Contents: Parotid gland Facial N Retromandibular vein ECA LN
    Parotid gland is divided by facial nerve into superficial and deep.
    Division identified on imaging by retromandibular vein.
  • Contrast enhanced CT 1 Parapharyngeal space. 2 Masticator space. 3 Mucosal space. 4 Carotid space 4 Parotid space. 5 Mucosal space. 6 Perivertebral space (anterior portion). 7 Retropharyngeal space (virtual at this level).
  • Pharyngeal mucosal , parapaharyngeal , retropharyngeal and buccal
  • Ant : nasal cavity by post choanae, laterally : Eustachian tube opening and torus tubaris
    Contents : pharyngeal mucosa , lingular and palatine tonsils , adenoids , minor salivary glands
  • Boundaries : PPS-PMS : Bucopharyngeal fascia, PPS-MS : SLDCF , PPS- PVS: Prevertebral fascia

  • PMS mass lesion pushes PPS laterally
    MS mass lesion pushes PPS posteriorly
    PS mass lesion pushes PPS medially
    CS mass lesion pushes PPS anteriorly
    Lateral retropharyngeal space mass (nodal) pushes PPS anterolaterally
    The PPS is a crescent-shaped fat-filled space in craniocaudal dimension extending
  • Ant : Pharynx and esophagus , posteriorly : cervical and upper thoracic spine
  • AT THE LEVEL OF THYROID , iHN , danger s[pace between true and prevertrbral space
  • DS; danger space
  • (Left) Lateral graphic of the cervical neck shows the tubular carotid space (CS) extending from the skull base (carotid canal and jugular foramen) to the aortic arch.
    RIGHT: Axial graphic of the skull base viewed from below shows the carotid space abutting the skull base. The ICA enters the carotid canal , while the jugular foramen gives rise to the internal jugular vein. Notice CN 9-11 exiting the jugular foramen. CN12 is more medial as it leaves the hypoglossal canal.

  • Contents : SHN – ICA IJV , CN9-12,
    :IHN - CCA, IJV , CN10 trunk ( vagus)
  • LEFT : outside ijv , ica , styloid process
    Right : IJV ( big) cca (small)
  • Pre : prevertebral and scalene muscles , br plexus roots , vert A and V , Phrenic N
    Paraspinal : paraspinal muscle , vertebral lamina and spinous process
  • 2) superficial (yellow) and deep (light blue) layers of the DCF that surround the PCS are depicted.

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