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The alar fascia is a thin fibroareolar membrane separating the (anterior) true retropharyngeal space from the (posterior) danger space. It is the ventral component of the deep layer of the deep cervical fascia.
Notably, in the well patient, the alar fascia is not usually visible on cross-sectional imaging, and the two spaces are typically identified as a single space. The alar fascia may however become apparent on contrast-enhanced CT or MRI as a thin membrane in the retropharyngeal space in patients presenting with extensive regional edema or a collection.
- location: between the visceral and prevertebral fascia, dividing radiological retropharyngeal space in a coronal plane
- superior: level of C1, where it may fuse posteriorly with the prevertebral fascia 1 or transition to loose areolar tissue 2
- inferior: level of T2, where it fuses anteriorly with visceral fascia
- lateral: carotid sheaths bilaterally
Superiorly, the prevertebral fascia extends until the level just above the C1 anterior tubercle, where it either fuses with prevertebral fascia posteriorly1, or narrowed to a median raphe before transitioning to loose areolar tissue 2. It does not connect to the skull base as a distinct layer.
Laterally, the alar fascia fuses with the lateral wall of each carotid sheath. Additionally, some fibers are contributed by the medial raphe extensions of the posterior middle pharyngeal constrictor 2. Although the alar fascia has a well defined attachment in the midline at the level of C1, it does not attach to the skull base laterally, which is a potential point of entry into the danger space posteriorly 4.
Anteriorly, the alar fascia delimits the posterior margin of the true retropharyngeal space.
Posteriorly, the alar fascia delimits the anterior margin of the danger space.
The alar fascia is made of loose areolar tissue. Some authors state that, in addition, the substance of the alar fascia contains the sympathetic chain, superior cervical ganglion, and superior laryngeal nerve 3.
Alar fascia is not usually resolved on imaging; however, it may be visible on contrast-enhanced CT as a thin membrane in the retropharyngeal space in patients with extensive regional edema e.g. post-radiation therapy 2.
- alar fascia represents the anterior boundary of the danger space, itself a potential space through which an infective process from the pharyngeal region can extend into the mediastinum
- 1. Gavid M, Dumollard JM, Habougit C, Lelonge Y, Bergandi F, Peoc'h M, Prades JM. Anatomical and histological study of the deep neck fasciae: does the alar fascia exist?. (2018) Surgical and radiologic anatomy : SRA. 40 (8): 917-922. doi:10.1007/s00276-018-1977-5 - Pubmed
- 2. Scali F, Nash LG, Pontell ME. Defining the Morphology and Distribution of the Alar Fascia: A Sheet Plastination Investigation. (2015) The Annals of otology, rhinology, and laryngology. 124 (10): 814-9. doi:10.1177/0003489415588129 - Pubmed
- 3. Ozlugedik S, Ibrahim Acar H, Apaydin N, Firat Esmer A, Tekdemir I, Elhan A, Ozcan M. Retropharyngeal space and lymph nodes: an anatomical guide for surgical dissection. (2005) Acta oto-laryngologica. 125 (10): 1111-5. doi:10.1080/00016480510035421 - Pubmed
- 4. Kamalian S, Avery L, Lev M, Schaefer P, Curtin H, Kamalian S. Nontraumatic Head and Neck Emergencies. (2019) RadioGraphics. 39 (6): 1808-1823. doi:10.1148/rg.2019190159 - Pubmed