Clinical importance:

Various spaces in the neck18 spaces: suprahyoid and infrahyoidClinically importantIntercommunicationinfection spreads rapidly: cranial cavity, mediastinum

Clinical importance cont.:

If not tackle:- Life threatening conditions

Acute laryngeal oedemaUpper airway compressionInvolvement of great vessels, cranial nervesSevere odynophagia

Important Deep Neck Spaces:

1. Peritonsillar space2. Submaxillary space: sublingual space submandibular space3. Retropharyngeal space4. Parapharyngeal space5. Parotid space6. Masseteric space7. Pre-epiglottic & para-glottic space.

Peritonsillar space:

Boundary: laterally : superior constrictor

medially : tonsillar capsule Infection: peritonsillitis-> Abscess (quinsy)Pathology : as an complication &

: de novo

Peritonsillar space cont.:

s/s: Pain more severe & unilateralMuffled sound (hot potatoes sound)TrismusDrooling of salivaInflamed soft palateBuried tonsilsEnlarged and tender JD node

Management of peritonsillitis:

Diagnosis: clinically, aspiration of abscessTreatment: I/V Ampicillin + cloxacillin & metronidazole

Anti-inflammatory: Ibuprofen & paracetamol

Locally antiseptic mouth washIf abscess: I & D of abscess (site of drainage)If second attack: tonsillectomy.

Submaxillary space:

Boundary:

Superior : mucosa of floor of mouth

Inferior : deep fascia of neckDivided by myelohyoid muscleContent: submandibular and sublingual

salivary glands, lymph nodes.

Sub maxillary space cont:

Ludwigs angina (inflammation of floor of mouth):- Browny Induration

Pathology:Dental origin(80%)Inflammation of submandibular salivary glandLymphadenitisTrauma floor of mouth

Ludwig’s Angina

Submaxillary space cont.:S/S: painSwelling of floor of mouth

Submandibular & submental regionTrismusDiagnosis: clinically Treatment: Conservative : Antibiotics

: Anti-inflammatory : local antiseptic mouth wash

Submaxillary space cont.:

Surgical treatment:

Incision and drainage: wide incisionGreety sensationNo pus: usually inflammatory fluid & necrotic tissueNB: always pierce myelohyoid muscle.

Retropharyngeal space:Boundary:

Superior : base of skullInferior : posterior mediastinumPosterior : pre-vertebral fasciaAnterior : bucopharyngeal fascia

Content: Lymph nodes, loose aerolar tissues.Pathology:suppuration RP lymph node (Rouviere)

:Koch’s spine:Pharyngeal trauma:From other neck spaces

Retropharyngeal space cont:

S/S: Pain, feverOdynophagiaDrooling of salivaStertor: respiratory obstruction

o/e: bulging of posterior pharyngeal wallX-ray soft tissues neck lateral view: increase prevertebral

soft tissue density.

Retropharyngeal space cont:

Treatment: Conservative:

AntibioticsAnti-inflammatory+ supportive therapy

Surgical: I&D of most bulging area through trans- oral route

Anaesthesia: blanket anaesthesiaPosition: head down and lateral position

Parapharyngeal space:

Boundary:

Superior : base of skull

Inferior : Hyoid bone

Medial : pharynx

Lateral : mandiblecontent: great vessels, last 4 cranial nerves, lymph

nodes, deep lobe of parotid.

Parapharyngeal space cont:

S/S: Pain, fever, odynophagiaDrooling of salivaStertor - respiratory obstruction

O/E: lateral neck swelling bulging of lateral pharyngeal wall pseudo enlargement of tonsils

Parapharyngeal space cont:

Treatment:Conservative:

AntibioticsAnti-inflammatory + supportive therapy

Surgical: I&D of most bulging area lateral side of neck (external route)

Anaesthesia: LA or GAPosition: head turn and lateral position