Parotid space

Dr Henry Knipe and Dr Jeremy Jones et al.

The parotid space is one of the seven deep compartments of the head and neck and as the name suggests is mostly filled with the parotid gland. It is the most lateral major suprahyoid neck space.

The parotid space is a roughly pyramidal space, the broad elongated base facing laterally, formed by the superficial layer of the deep cervical fascia overlying the superficial lobe of the parotid gland, and its apex pointing medially. It is traversed by the external carotid artery (ECA), retromandibular vein and facial nerve. 

Contents 
Relations
  • lateral to the parapharyngeal space 1 
  • medial to superficial space and subcutaneous tissue
  • anterior to the carotid space 
    • posterior belly of the digastric muscle forms a variable portion of the posteromedial border of the parotid space and at times this muscular band helps to differentiate a deep-lobe parotid space lesion to one arising in the carotid space 2
  • posterior to the masticator space
Boundaries

The space is circumscribed by the superficial layer of the deep cervical fascia 1:

  • superior margin: external auditory canal; apex of the mastoid process 3
  • inferior margin: inferior mandibular margin (although the parotid tail can extend further inferiorly below the angle of the mandible) 1
  • anterior margin: masticator space
Ultrasound
  • with the parotid gland filling around two-thirds of the parotid space, US findings will reflect those of the parotid gland 3
  • intraparotid lymph nodes (may number up into the twenties) are also evident as rounded/bean-shaped hypoechoic structures with an echogenic central fatty hilum within the hyperechoic parotid gland 6 
    • most frequently located in the pre-auricular region and they provide lymphatic drainage of the external ear and lateral scalp 3
  • external carotid artery and retromandibular vein will be found posteriorly 7
    • retromandibular vein crosses the superficial lobe of the parotid gland and continues longitudinally until it reaches the inferior margin of the parotid gland to join with the external jugular vein
    • external carotid artery travels in the same route, however, it is a larger structure and is found in a deeper plane to the retromandibular vein
  • facial nerve is not visualised on US, but is inferred to be located lateral to the retromandibular vein 8  
CT
  • lower attenuation in comparison to muscle due to the combination of fat and glandular tissue
  • allows for good visualisation of deep lesions as well as reliable assessment of size, location, margins, extracapsular extension, involvement of adjacent structures, and areas of necrosis, haemorrhage, calcification of cysts 5
  • CT is preferred for tender, recurrent parotid masses that are likely to be inflammatory whereas MRI is better for assessment of a painless parotid lump
MRI
  • T1: higher signal than muscle
  • T2: lower signal than muscle 2
  • MRI is preferred for imaging the parotid space in children 2
    • neonates and young children have limited amounts of fat within the parotid gland which decreases the amount of natural contrast available on CT, which increases the difficulty to perceive a mass lesion and define its margins.  
    • MRI is significanlty less affected by the relative lack of native fat

Any mass originating from the parotid space will be centered within the parotid gland.

A large mass arising within the deep lobe of the parotid will medially displace fat in the parapharyngeal space and cause posteromedial displacement of the posterior belly of the digastric muscle and carotid space.  There is also often associated widening of the stylomandibular notch 1, 2

  • congenital 
    • agenesis
    • first branchial cleft cyst
    • hemangioma
    • cystic hygroma/lymphangioma
  •  salivary gland tumours
    • benign tumour
    • primary malignant tumour
    • metastatic malignant tumour
  • metastatic adenopathy
  • lymphoma
  • parotid cysts
  • inflammatory
    • sialadenitis
    • chronic granulomatous parotitis
    • abscess/cellulitis
    • Sjogren's syndrome/autoimmune
    • Benign lymphoepithelial cysts (AIDS)
    • Nodular fascitis
    • Reactive adenopathy

Head and neck anatomy
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Article Information

rID: 10465
System: Head & Neck
Section: Anatomy
Tag: cases
Synonyms or Alternate Spellings:

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Cases and Figures

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    Figure 1: in light purple on annotated MRI
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    Parotid space: annotated MRI
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