anatomy of neck spaces and levels of cervical

ANATOMY OF NECK SPACES AND LEVELS OF CERVICAL

LYMPH NODES

NECK SPACES

Deep Neck Space Anatomy

• Space Involving Entire Length Of Neck

• Space Limited To Above The Hyoid Bone

• Space limited To Below The Hyoid Bone

Cervical fascial planes

Space Involving Entire Length Of Neck

1. Retropharyngeal Space

2. Prevertebral Space

3. Carotid Sheath Space

Retropharyngeal Space

• Between visceral division of middle layer and alar division of deep layer

• Extend from skull base to T2 level

• More common in children due to presence of retropharyngeal node

Retropharyngeal space• Lateral soft tissue X-ray (extension, inspiration) abnormal

findings:• 1. C2-post pharyngeal soft tissue >7mm• 2. C6–adults >22mm, peads >14mm• 3. STS of post pharyngeal region >50% width of vertebral

body

Prevertebral space

• Potential space posterior to prevertebral division and anterior to vertebral bodies

• Extends from skull base to the coccyx

Carotid sheath Space

• Made up from all deep cervical fascia

• Infection from any deep fascia can spread to this space.

Space Limit To Above The Hyoid Bone

1. Parapharyngeal Space

2. Submandibular Space

3. Masticator Space

4. Temporal Space

5. Parotid Space

Parapharyngeal Space(Lateral pharyngeal Space)

Boundary

• Superiorly : Skull base• Inferiorly : Hyoid bone• Laterally : Medial pterygoid m.• Medially :Buccopharyngeal fascia• Anteriorly : Submandibular space• Posteromedialy : Prevertebral fascia

and retrophryngeal space

Submandibular Space

Divided into 2 spaces by mylohyoid m.

1. Sublingual space (above mylohyoid m.)

2. Submaxillaly space (below mylohyiod m.)

• These 2 spaces can communicate each other by mylohyoid cleft

Masticator Space• Between masticator m.

and superficial layer of deep cervical fascia

(Masticator m. = massestor m.,medial and lateral pterygoid m. and temporalis muscle)

• Locate anterior and lateral to parapharyngeal space

Parotid Space

• Between parotid gl. and superficial layer of deep cervical fascia

• Infection can spread easily to parapharyngeal space due to uncompleted encircle at upper inner surface of parotid gland.

Space Limit To Below The Hyoid Bone

Anterior Viseral Space (Pretracheal Space)

• Between trachea, esophagus and middle layer of deep cervical fascia

• Extend from hyoid bone to superior mediastinum

• A 27 year old patient has had a sore throat for the past 10 days.

• On Follow up

• He does have pain on the left side of his neck along a swollen lymph node. It hurts for him to turn his head to the left.

• On exam, his throat is red, but there is no pus and his airway is patent.

• There are several swollen and tender lymph nodes in the neck.

• He complains of pain turning his head to the left side. He doesn’t have any signs of meningitis. Nothing else seems abnormal on his physical exam

LEVELS OF CERVICAL LYMPH NODES

Deep Lymph Nodes1. Submental2. Submandibular (Submaxillary)

Anterior Cervical Lymph Nodes (Deep)3. Prelaryngeal4. Thyroid5. Pretracheal6. Paratracheal

Deep Cervical Lymph Nodes7. Lateral jugular8. Anterior jugular9. Jugulodigastric

Inferior Deep Cervical Lymph Nodes10. Juguloomohyoid11. Supraclavicular (scalene

Level I

Submental and submandibular nodes

Level I A

Submental nodes, between the medial margins of the anterior bellies of the digastric muscles.

Level I B

Submandibular nodes, lateral to level I A nodes and anterior to the back of the submandibular salivary gland.

Level II

Upper internal jugular nodes, posterior to the back of the submandibular salivary gland, anterior to the back of the sternocleidomastoid muscle and above the level of the bottom of the body of the hyoid bone.

Level III

Middle jugular nodes, between the level of the bottom of the body of the hyoid bone and the level of the bottom of the cricoid arch, anterior to the back of the sternocleidomastoid muscle.

Level IV Low jugular nodes, between the level of the bottom of the cricoid arch and the level of the clavicle, anterior to a line connecting the back of the sternocleidomastoid muscle and the posterolateral margin of the anterior scalene muscles; they are lateral to the carotid arteries.

Level V

Posterior triangle nodes, posterior to the back of the sternocleidomastoid muscle, and posterior to the line described in level IV.

• Level V A Above the level of the bottom of the cricoid arch.

• Level V B Between the level of the bottom of the cricoid arch and the level of the clavicle

Level VI Upper visceral nodes, between the carotid arteries from the level of the bottom of the body of the hyoid bone to the level of the top of manubrium.

Level VII Superior mediastinal nodes, between the carotid arteries below the level of the top of the manubrium and above the innominate vein.

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