2. Clinical importance:
Various spaces in the neck
18 spaces: suprahyoid and infrahyoid
Clinically important
Intercommunication
infection spreads rapidly: cranial cavity, mediastinum

3. Clinical importance cont.:
If not tackle:- Life threatening conditions
Acute laryngeal oedema
Upper airway compression
Involvement of great vessels, cranial nerves
Severe odynophagia

4. Important Deep Neck Spaces:
1. Peritonsillar space
2. Submaxillary space: sublingual space
submandibular space
3. Retropharyngeal space
4. Parapharyngeal space
5. Parotid space
6. Masseteric space
7. Pre-epiglottic & para-glottic space.

5. Peritonsillar space:
Boundary: laterally : superior constrictor
medially : tonsillar capsule
Infection: peritonsillitis-> Abscess (quinsy)
Pathology : as an complication &
: de novo

6. Peritonsillar space cont.:
s/s:
Pain more severe & unilateral
Muffled sound (hot potatoes sound)
Trismus
Drooling of saliva
Inflamed soft palate
Buried tonsils
Enlarged and tender JD node

7. Management of
peritonsillitis:
Diagnosis: clinically, aspiration of abscess
Treatment: I/V Ampicillin + cloxacillin & metronidazole
Anti-inflammatory: Ibuprofen & paracetamol
Locally antiseptic mouth wash
If abscess: I & D of abscess (site of drainage)
If second attack: tonsillectomy.

11. Submaxillary space:
Boundary:
Superior : mucosa of floor of mouth
Inferior : deep fascia of neck
Divided by myelohyoid muscle
Content: submandibular and sublingual
salivary glands, lymph nodes.

12. Sub maxillary space cont:
Ludwigs angina (inflammation of floor of
mouth):- Browny Induration
Pathology:
Dental origin(80%)
Inflammation of submandibular salivary gland
Lymphadenitis
Trauma floor of mouth

13. Ludwig’s Angina

14. Submaxillary space cont.:
S/S:
pain
Swelling of floor of mouth
Submandibular & submental region
Trismus
Diagnosis: clinically
Treatment:
Conservative : Antibiotics
: Anti-inflammatory
: local antiseptic mouth wash

15. Submaxillary space cont.:
Surgical treatment:
Incision and drainage: wide incision
Greety sensation
No pus: usually inflammatory fluid & necrotic tissue
NB: always pierce myelohyoid muscle.

17. Retropharyngeal space:
Boundary:
Superior : base of skull
Inferior : posterior mediastinum
Posterior : pre-vertebral fascia
Anterior : bucopharyngeal fascia
Content: Lymph nodes, loose aerolar tissues.
Pathology:suppuration RP lymph node (Rouviere)
:Koch’s spine
:Pharyngeal trauma
:From other neck spaces

18. Retropharyngeal space cont:
S/S:
Pain, fever
Odynophagia
Drooling of saliva
Stertor: respiratory obstruction
o/e: bulging of posterior pharyngeal wall
X-ray soft tissues neck lateral view: increase prevertebral
soft tissue density.

19. Retropharyngeal space cont:
Treatment:
Conservative:
Antibiotics
Anti-inflammatory+ supportive therapy
Surgical: I&D of most bulging area through trans-oral
route
Anaesthesia: blanket anaesthesia
Position: head down and lateral position

21. Parapharyngeal space:
Boundary:
Superior : base of skull
Inferior : Hyoid bone
Medial : pharynx
Lateral : mandible
content: great vessels, last 4 cranial nerves, lymph
nodes, deep lobe of parotid.

22. Parapharyngeal space cont:
S/S:
 Pain, fever, odynophagia
Drooling of saliva
Stertor - respiratory obstruction
O/E: lateral neck swelling
bulging of lateral pharyngeal wall
pseudo enlargement of tonsils

23. Parapharyngeal space cont:
Treatment:
Conservative:
Antibiotics
Anti-inflammatory + supportive therapy
Surgical: I&D of most bulging area lateral side of
neck (external route)
Anaesthesia: LA or GA
Position: head turn and lateral position