Deep spaces of the head and neck
The deep spaces of the head and neck refer to compartments delimited by the deep cervical fascia. While these concepts overlap with traditional anatomical description, their existence highlights the importance of fascia in confining various pathologies.
A knowledge of these spaces not only allows for better communication between radiologists and specialists familiar with imaging of this region but also aid in diagnosis as each space has a distinct group of pathologies.
Gross anatomy
Three layers of deep cervical fascia form the boundaries of the deep spaces in the neck 5,6:
- superficial layer: investing fascia of the sternocleidomastoid and trapezius muscles, fascia of the muscles of mastication, fascia between the hyoid and mandible that forms the floor of the submandibular space, at least some of the fascia covering the parotid gland
- middle layer: strap muscle fascia, visceral fascia that encloses the thyroid gland and aerodigestive tract (pharynx, larynx, trachea, esophagus)
- deep layer: perivertebral fascia of the prevertebral and paraspinal muscles, alar fascia
All three layers contribute to the carotid sheath.
Contents
The compartmental definitions vary somewhat by source 1,5-7. The neck spaces are often divided into the suprahyoid (between the base of the skull and hyoid bone) and infrahyoid (between the hyoid bone and clavicles) spaces, as the anatomy of the deep cervical fascia is slightly different above and below the hyoid bone. Some spaces cross the hyoid bone and course the entire neck.
- suprahyoid neck
- parotid space
- masticator space, including or contiguous with buccal space
- submandibular space, including or contiguous with sublingual space and submental space
- parapharyngeal space (or prestyloid parapharyngeal space 6,7)
- suprahyoid and infrahyoid neck
- carotid space (or poststyloid parapharyngeal space in the suprahyoid neck, carotid sheath in the infrahyoid neck 7)
- visceral space (infrahyoid in some definitions 7), including or contiguous with pharyngeal mucosal space (suprahyoid)
- retropharyngeal space, including or contiguous with danger space
- perivertebral space, including prevertebral space
- posterior cervical space
- infrahyoid neck
Relations
- parapharyngeal space lies in a central location on each side of the deep face and suprahyoid neck
- visceral/pharyngeal mucosal space is medial to the parapharyngeal space
- submandibular space is anterior to the parapharyngeal space
- masticator space is anterolateral to the parapharyngeal space
- parotid space is lateral to the parapharyngeal space
- carotid (poststyloid parapharyngeal) space is posterior to the parapharyngeal space
- retropharyngeal space is posteromedial to parapharyngeal space
- perivertebral space is posterior to the retropharyngeal space
Related pathology
Many of the disease states that affect the deep structures of the head and neck are confined to one compartment. However, there are some diseases that are trans-spatial. A list of differentials for related pathology can be found in the article for each individual space.
Related Radiopaedia articles
Anatomy: Head and neck
- skeleton of the head and neck
-
cranial vault
- scalp (mnemonic)
-
sutures
- calvarial
- facial
- frontozygomatic suture
- frontomaxillary suture
- frontolacrimal suture
- frontonasal suture
- temporozygomatic suture
- zygomaticomaxillary suture
- parietotemporal suture (parietomastoid suture)
- occipitotemporal suture (occipitomastoid suture)
- sphenofrontal suture
- sphenozygomatic suture
- spheno-occipital suture (not a true suture)
- lacrimomaxillary suture
- nasomaxillary suture
- internasal suture
- basal/internal
- skull landmarks
- frontal bone
- temporal bone
- parietal bone
- occipital bone
- skull base (foramina)
-
facial bones
- midline single bones
- paired bilateral bones
- cervical spine
- hyoid bone
- laryngeal cartilages
-
cranial vault
- muscles of the head and neck
- muscles of the tongue (mnemonic)
- muscles of mastication
- muscles of facial expression
- muscles of the middle ear
- orbital muscles
- muscles of the soft palate
- pharyngeal muscles
- suprahyoid muscles
- infrahyoid muscles
- intrinsic muscles of the larynx
- muscles of the neck
- deep cervical fascia
-
deep spaces of the neck
- anterior cervical space
- buccal space
- carotid space
- danger space
- deep cervical fascia
- infratemporal fossa
- masticator space
- parapharyngeal space
- parotid space
- pharyngeal (superficial) mucosal space
- perivertebral space
- posterior cervical space
- pterygopalatine fossa
- retropharyngeal space
- suprasternal space (of Burns)
- visceral space
- surgical triangles of the neck
- orbit
- ear
- paranasal sinuses
- nose
- oral cavity
- pharynx
- larynx
- viscera of the neck
- blood supply of the head and neck
-
arterial supply
-
common carotid artery
- carotid body
- carotid bifurcation
- subclavian artery
- variants
-
common carotid artery
- venous drainage
-
arterial supply
- innervation of the head and neck
-
cranial nerves
- olfactory nerve (CN I)
- optic nerve (CN II)
- oculomotor nerve (CN III)
- trochlear nerve (CN IV)
-
trigeminal nerve (CN V) (mnemonic)
- trigeminal ganglion
- ophthalmic division
- maxillary division
- mandibular division
- abducens nerve (CN VI)
- facial nerve (CN VII)
- vestibulocochlear nerve (CN VIII)
- glossopharyngeal nerve (CN IX)
-
vagus nerve (CN X)
- superior laryngeal nerve
- recurrent laryngeal nerve (inferior laryngeal nerve)
- (spinal) accessory nerve (CN XI)
- hypoglossal nerve (CN XII)
- parasympathetic ganglia of the head and neck
- greater occipital nerve
-
cervical plexus
- muscular branches
- longus capitis
- longus colli
- scalenes
- geniohyoid
- thyrohyoid
-
ansa cervicalis
- omohyoid (superior and inferior bellies separately)
- sternothyroid
- sternohyoid
- phrenic nerve
- contribution to the accessory nerve (CN XI)
- cutaneous branches
- muscular branches
- brachial plexus
- pharyngeal plexus
-
cranial nerves
- lymphatic drainage of the head and neck