Neck Spaces

Neck spaces

Anatomy
Parapharyngeal space :
Potential space
Extends from the base of skull to superior mediastinum
Bounded medially by buccopharyngeal fascia & laterally by ascending ramus of the mandible ,parotid gland & sternocledomastoid muscle .

Contents:

Carotid arteries & jugular v
Deep cx. Ln.s
Last four cranial n.s
Cx. Sympathetic trunk.

Retropharyngeal space

Potential space lies behind the pharynx

Extends from skull base to T1-T2

Bounded ant. By post. Pharyngeal wall and it`s covering fascia
post. By alar layer of the deep fascia
-- content:
Retropharyngeal Ln.

Parapharyngeal abscess

Aetiology:

• Tonsillitis

• Penetrating foreign body
• Infected lower wisdom tooth

Clinical features

• Sore throat
• Pyrexia and toxaemia
• Trismus
• Tender Swelling of the neck
• Tonsil is pushed medially


investigations

Complications:

• Acute oedema of the larynx
• Thrombophlibitis of the int. jug. V.
• Spread to mediastinum.

Treatment:

Systemic antibiotics
Drainage through the neck.

Retropharyngeal abscess

Pus collected between buccopharyngeal and alar fasciae.

Acute

chronic

Acute ret. Ph. abscess

Aetiology:
- tonsillitis, nasopharyngitis , and rarely
acute sup.o.m.
- strept.pneumonia is the commonest m.o.


- mostly are infants & young children

Clinical features:

• Difficulty in breathing & suckling
• Pyrexia
• Toxaemia
• Stiffness of the neck or torticollis
• Lat. Swelling of the post. Ph.wall
• Spontaneous rupture & aspiration

Investigation:

imaging
Lateral neck plain film
-Normal: 7mm at C-2
-14mm at C-6 for kids,
-22mm at C-6 for adults

Treatment:

Drainage without intubation with head down position
Systemic antibiotics
Tracheostomy may become necessary


Chronic retropharyngeal abscess
Aetiology: tuberculosis
Clinical features:
1. old children & adults
2. sore throat
3. slight dysphagia
4. cold abscess in the post. Wall
5. painless enlarged L.n.

X-ray of cx. Spine shows sign of tuberculosis

.
Treatment:
* incision through the neck

* antituberculus drugs