Pharyngeal mucosal space
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The pharyngeal (or superficial) mucosal space is a deep compartment of the head and neck, located between the fascia of the pharyngeal constrictor muscles (buccopharyngeal or visceral fascia) and the mucosal surface of the nasopharynx, oropharynx, and hypopharynx.
Not a true anatomic fascial space, the pharyngeal mucosal space was coined in the radiology literature to complete the spatial map of the neck 4. The concept may be confusing in two ways. First, pathology involving the pharyngeal "mucosal space" is not limited to the mucosa and can be primarily submucosal 5,7. Second, the proximal and distal limits are unclear: various authors have arbitrarily expanded or limited the pharyngeal mucosal space to include the oral cavity and/or exclude all or part of the hypopharynx as it is inferior to the hyoid bone 4-7. In the latter definitions, the visceral space is the infrahyoid continuation that includes most of the hypopharynx 5,6.
Rather than citing the pharyngeal mucosal space in radiology reporting and communications with surgeons, a practical alternative is localizing pathology to the "nasopharynx", "oropharynx", or "hypopharynx" and their anatomic subsites.
The pharyngeal mucosal space is the deepest compartment (closest to the airway) of the head and neck, circumscribed by the middle (visceral, buccopharyngeal, pretracheal, pharyngomucosal) layer of the deep cervical fascia 1,4. It extends from the base of the skull to the cricoid cartilage 2.
- squamous mucosa
- lymphoid tissue of Waldeyer's ring (adenoidal, palatine, and lingual tonsils)
- minor salivary glands
- cartilaginous portion of the Eustachian tube
- superior pharyngeal constrictor
- middle pharyngeal constrictor
- levator veli palatini
- medial to the parapharyngeal space 3
- anterior to the retropharyngeal space 3
- includes the peritonsillar space 4
The pharyngeal mucosal space is internal to the middle layer of deep cervical fascia:
- superior margin: merging of the middle layer of deep cervical fascia with the aponeurosis of the superior pharyngeal constrictor muscle 2
- inferior margin: cricoid cartilage
- 1. Harnsberger HR, Osborn AG. Differential diagnosis of head and neck lesions based on their space of origin. 1. The suprahyoid part of the neck. AJR Am J Roentgenol. 1991;157 (1): 147-54. doi:10.2214/ajr.157.1.2048510 - Pubmed citation
- 2. Kanekar S, Mannion K. Imaging of Head and Neck Spaces for Diagnosis and Treatment, An Issue of Otolaryngologic Clinics, (The Clinics: Internal Medicine). Saunders. ISBN:B00ALK44II. Read it at Google Books - Find it at Amazon
- 3. Mahmood Mafee, Minerva Becker. Imaging of the Head and Neck. (2012) ISBN: 9783131505316
- 4. Parker GD, Harnsberger HR, Jacobs JM. The pharyngeal mucosal space. (1990) Seminars in ultrasound, CT, and MR. 11 (6): 460-75. Pubmed
- 5. Guidera AK, Dawes PJ, Fong A, Stringer MD. Head and neck fascia and compartments: no space for spaces. (2014) Head & neck. 36 (7): 1058-68. doi:10.1002/hed.23442 - Pubmed
- 6. Wippold FJ. Head and neck imaging: the role of CT and MRI. (2007) Journal of magnetic resonance imaging : JMRI. 25 (3): 453-65. doi:10.1002/jmri.20838 - Pubmed
- 7. Bernadette L. Koch, Bronwyn E. Hamilton, Patricia A. Hudgins, H. Ric Harnsberger. Diagnostic Imaging: Head and Neck E-Book. (2016) ISBN: 9780323443142