Parapharyngeal space

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Parapharyngeal space
Lateral head anatomy detail.jpg
Lateral head anatomy detail
Gray380.png
Muscles of the pharynx and cheek.
Details
Identifiers
Latin spatium lateropharyngeum,
spatium pharyngeum laterale,
spatium parapharyngeum
MeSH D000080886
TA98 A05.3.01.117
TA2 2883
FMA 84967
Anatomical terminology

The parapharyngeal space (also termed the lateral pharyngeal space), is a potential space in the head and the neck. It has clinical importance in otolaryngology due to parapharyngeal space tumours and parapharyngeal abscess developing in this area. It is also a key anatomic landmark for localizing disease processes in the surrounding spaces of the neck; the direction of its displacement indirectly reflects the site of origin for masses or infection in adjacent areas, and consequently their appropriate differential diagnosis. [1]

Contents

Anatomical boundaries

The parapharyngeal space is shaped like an inverted pyramid. Lateral and inferior to the parapharyngeal space is the carotid sheath, containing the internal carotid artery and cranial nerves IX, X and XI. Behind both the parapharyngeal space and carotid space lies the retropharyngeal space, and deep to this a potential space known as the danger space. The danger space serves as an important pathway for complicated infections of the posterior pharynx to enter the chest and spinal column. Anterior to the parapharyngeal space is the masticator space which contains the lower dental row, muscles of mastication, the inferior alveolar nerve as well as branches of cranial nerve V. Lateral to the parapharyngeal space lies the parotid space, which contains the parotid gland, the external carotid artery and cranial nerve VII. [1] Although initial evaluation is typically by physical exam and endoscopy, follow up with CT and MRI usually is needed if surgical intervention is planned. [2]

Bony anatomy around the space includes the skull base superiorly, and the greater cornu (or greater horns) of the hyoid bone the apex, inferiorly. The superior aspect is the base of skull, namely the sphenoid and temporal bones. This area includes the jugular and hypoglossal canal and the foramen lacerum (through which the internal carotid artery passes superiorly across).

The medial aspect is made up of the pharynx. Anteriorly it is bordered by the pterygomandibular raphe. Posteriorly it is bordered by carotid sheath posteriolaterally and the retropharyngeal space posteriomedially. The lateral aspect is more involved, and is bordered by the ramus of the mandible, the deep lobe of the parotid gland, the medial pterygoid muscle, and below the level of the mandible, the lateral aspect is bordered by the fascia of the posterior belly of digastric muscle. These anatomical boundaries make it continuous with the retropharyngeal space. It also communicates with other cervical and cranial fascial spaces, as well as the mediastinum.

Divisions

The parapharyngeal space is divided into 2 parts by the fascial condensation called the aponeurosis of Zuckerkandl and Testut (stylopharyngeal fascia - see diagram), [3] joining the styloid process to the tensor veli palatini. These two compartments are named the pre-styloid and post-styloid (retrostyloid) [4] compartments or spaces. However, some classification schemes call the pre-styloid compartment the parapharyngeal space and the post-styloid compartment the carotid space, [5] which can be a source of confusion.

Contents

It includes the maxillary artery and ascending pharyngeal artery. [6]

  1. Glossopharyngeal nerve (IX)
  2. Vagus nerve (X) together with
  3. Internal carotid artery
  4. Internal jugular vein in the carotid sheath
  5. Accessory nerve (XI)
  6. Hypoglossal (XII)
  7. Sympathetic trunk and superior cervical ganglion of the trunk
  8. Ascending pharyngeal artery
  9. Deep cervical lymph nodes

Clinical significance

First bite syndrome is a rare complication of a surgery involving the parapharyngeal space, especially removal of the deep lobe of the parotid gland. It is characterized by facial pain after the first bite of each meal, and is thought to be caused by autonomic dysfunction of salivary myoepithelial cells.

Related Research Articles

Articles related to anatomy include:

<span class="mw-page-title-main">Glossopharyngeal nerve</span> Cranial nerve IX, for the tongue and pharynx

The glossopharyngeal nerve, also known as the ninth cranial nerve, cranial nerve IX, or simply CN IX, is a cranial nerve that exits the brainstem from the sides of the upper medulla, just anterior to the vagus nerve. Being a mixed nerve (sensorimotor), it carries afferent sensory and efferent motor information. The motor division of the glossopharyngeal nerve is derived from the basal plate of the embryonic medulla oblongata, whereas the sensory division originates from the cranial neural crest.

<span class="mw-page-title-main">Parotid gland</span> Major salivary gland in many animals

The parotid gland is a major salivary gland in many animals. In humans, the two parotid glands are present on either side of the mouth and in front of both ears. They are the largest of the salivary glands. Each parotid is wrapped around the mandibular ramus, and secretes serous saliva through the parotid duct into the mouth, to facilitate mastication and swallowing and to begin the digestion of starches. There are also two other types of salivary glands; they are submandibular and sublingual glands. Sometimes accessory parotid glands are found close to the main parotid glands.

<span class="mw-page-title-main">External carotid artery</span> Major artery of the head and neck

The external carotid artery is the major artery of the head and upper neck. It arises from the common carotid artery. It terminates by splitting into the superficial temporal and maxillary artery within the parotid gland.

<span class="mw-page-title-main">Internal carotid artery</span> Artery of the human brain

The internal carotid artery is an artery in the neck which supplies the anterior circulation of the brain.

<span class="mw-page-title-main">Common carotid artery</span> One of the two arteries that supply the head and neck with blood

In anatomy, the left and right common carotid arteries (carotids) are arteries that supply the head and neck with oxygenated blood; they divide in the neck to form the external and internal carotid arteries.

<span class="mw-page-title-main">Styloglossus</span>

The styloglossus muscle is a bilaterally paired muscle of the tongue. It originates at the styloid process of the temporal bone. It inserts onto the side of the tongue. It acts to elevate and retract the tongue. It is innervated by the hypoglossal nerve.

<span class="mw-page-title-main">Stylopharyngeus muscle</span> Muscle

The stylopharyngeus muscle is a muscle in the head. It originates from the temporal styloid process. Some of its fibres insert onto the thyroid cartilage, while others end by intermingling with proximal structures. It is innervated by the glossopharyngeal nerve. It acts to elevate the larynx and pharynx, and dilate the pharynx, thus facilitating swallowing.

<span class="mw-page-title-main">Carotid sheath</span>

The carotid sheath is a condensation of the deep cervical fascia enveloping multiple vital neurovascular structures of the neck, including the common and internal carotid arteries, the internal jugular vein, the vagus nerve, and ansa cervicalis. The carotid sheath helps protects the structures contained therein.

<span class="mw-page-title-main">Ascending pharyngeal artery</span>

The ascending pharyngeal artery is an artery of the neck that supplies the pharynx.

<span class="mw-page-title-main">Retropharyngeal space</span> Potential space in the neck

The retropharyngeal space is a potential space and deep compartment of the head and neck situated posterior to the pharynx. The RPS is bounded anteriorly by the buccopharyngeal fascia, posteriorly by the alar fascia, and laterally by the carotid sheath. It extends between the base of the skull superiorly, and the mediastinum inferiorly. It contains the retropharyngeal lymph nodes. Its function is to facilitate movements in the superoinferior axis of the larynx, pharynx, and esophagus in relation to the cervical spine.

<span class="mw-page-title-main">Deep cervical fascia</span>

The deep cervical fascia lies under cover of the platysma, and invests the muscles of the neck; it also forms sheaths for the carotid vessels, and for the structures situated in front of the vertebral column. Its attachment to the hyoid bone prevents the formation of a dewlap.

<span class="mw-page-title-main">Submandibular triangle</span>

The submandibular triangle corresponds to the region of the neck immediately beneath the body of the mandible.

<span class="mw-page-title-main">Carotid triangle</span>

The carotid triangle is a portion of the anterior triangle of the neck.

<span class="mw-page-title-main">Cervical lymph nodes</span> Lymph nodes found in the neck

Cervical lymph nodes are lymph nodes found in the neck. Of the 800 lymph nodes in the human body, 300 are in the neck. Cervical lymph nodes are subject to a number of different pathological conditions including tumours, infection and inflammation.

<span class="mw-page-title-main">Prevertebral fascia</span> Layer of deep cervical fascia that surrounds the vertebral column

The prevertebral fascia is the layer of deep cervical fascia that surrounds the vertebral column. It is the deepest layer of deep cervical fascia.

<span class="mw-page-title-main">Outline of human anatomy</span> Overview of and topical guide to human anatomy

The following outline is provided as an overview of and topical guide to human anatomy:

<span class="mw-page-title-main">Sublingual space</span>

The sublingual space is a fascial space of the head and neck. It is a potential space located below the mouth and above the mylohyoid muscle, and is part of the suprahyoid group of fascial spaces.

<span class="mw-page-title-main">Pterygomandibular space</span>

The pterygomandibular space is a fascial space of the head and neck. It is a potential space in the head and is paired on each side. It is located between the lateral pterygoid muscle and the medial surface of the ramus of the mandible. The pterygomandibular space is one of the four compartments of the masticator space.

A parapharyngeal abscess is a deep neck space abscess of the parapharyngeal space, which is lateral to the superior pharyngeal constrictor muscle and medial to the masseter muscle. This space is divided by the styloid process into anterior and posterior compartments. The posterior compartment contains the carotid artery, internal jugular vein, and many nerves.

References

  1. 1 2 Unger, J. M.; Chintapalli, K. N. (1983). "Computed tomography of the parapharyngeal space". Journal of Computer Assisted Tomography. 7 (4): 605–9. doi:10.1097/00004728-198308000-00006. PMID   6863661.
  2. Mödder, U; Lenz, M; Steinbrich, W (1987). "MRI of facial skeleton and parapharyngeal space". European Journal of Radiology. 7 (1): 6–10. PMID   3830193.
  3. Hermans 2006, p. 165
  4. Fakhry 2016.
  5. Jeremy Jones. "Carotid space". radiopaedia.org.
  6. "EURORAD - Radiologic Teaching Files". eurorad.org.

Bibliography