This is a undergraduate lecture slide

3.  Superficial Cervical Fascia
 Deep Cervical Fascia
› Superficial Investing Layer
› Middle Visceral Layer
› Deep Layer
 Prevertebral Layer
 Alar Layer

4.  Extends from head & neck
to thorax & shoulder.
 Contains voluntary muscles
of facial expression &
platysma.

5.  Attachement –
Superiorly – Nuchal Ridge
Inferiorly - Clavicle
 It Invests -
› Muscles
 Sternocleidomastoid
 Trapezius
› Glands
 Submandibular
 Parotid
› Spaces
 Posterior Triangle
 Suprasternal space of Burns
 Parotid Space

6.  Attached from hyoid & skull
base above to sternum below.
 Modified to form
› Bucopharyngeal fascia postr. To
pharynx
› Pretracheal Fascia
› Prethyroid Fascia
 2 Divisions –
› Muscular Division
 Strap Muscles
› Visceral Division
 Thyroid, Trachea, Pharynx,
Larynx, Esophagus

7.  2 Layers
› Alar Fascia
 Lies between middle
visceral layer and
prevertebral layer
› Pre-vertebral Fascia
 Vertebral bodies
 Deep muscles of the
neck

8.  Carotid Sheath
› Formed by all three
layers of deep
fascia.
› Contains carotid
artery, internal
jugular vein, and
vagus nerve

9.  Retropharyngeal Space
 Parapharyngeal Space
 Danger Space

10.  Lies behind pharynx between
Buccopharyngeal Fascia & Alar
Fascia.
 Extends from Base of skull to
Bifurcation of trachea.
 Space is divided by a median
raphe into 2 lateral spaces
called SPACE OF GILLETE.
 Content – Lymph Nodes,
Areolar tissue, Fat

11.  Commonly seen in children below 3yrs.
 Cause – IN CHILDREN - Suppuration of
retropharyngeal nodes
secondary to infection of adenoids.
IN ADULTS – Penetrating Injury by FB
or Rigid esophagoscopy.
Organism – Streptococci/Staphylococci
 Clinical Features –
1. Dysphagia
2. Difficulty Breathing
3. Stridor , Croupy cough
4. Torticollis
5. Bulge in PPW
 Treatment –
1. Transoral I & D. without GA
2. I.V. Antibiotics
3. Tracheostomy

12.  Commonly seen in adults
 Cause – 1. Caries Spine
2. TB of retropharyngeal
nodes
 Clinical Features –
1. Discomfort in throat
2. Neck rigidity
3. Bulge in PPW
Diagnosis – X RAY- widening of RP
space > 3/4th of vertebral body.
 Treatment –
1. I & D through a oblique incision
along antr. Border of SCM
2. Antitubercular Therapy

13.  Pyramidal in shape with its base
at the base of skull & its apex at
the hyoid bone.
 Medial- Buccopharyngeal
fascia.
 Posteriorly – Prevertebral fascia
 Lateral – Medial pterygoid
 Divided into 2 compartments by
Styloid process
1. Anterior/ Prestyloid
2. Posterior/ Poststyloid

14.  Cause - 1. Peritonsillar abscess
2. Tonsillitis, Adenoiditis
3. Dental caries- Lower last molar
4. Bezold Abscess
5. Penetrating injuries of neck
 Clinical Features –
1. Anterior Compartment –
Triad of - 1. Prolapse of Tonsil ,
2. Trismus due to Med.
Pterygoid spasm
3. External swelling
behind angle of jaw
2. Posterior Compartment –
1. Bulge behind postr. Pillar
2. Paralysis of IX, X, XI, XII cranial N.
3. Swelling of Parotid region
 Treatment –
1. IV Antibiotics
2. I & D of abscess by a horz. Incision made
2-3 cm below the angle of mandible

15. › Anterior border is alar layer of
deep fascia
› Posterior border is pre-
vertebral layer
› Extends from skull base to
posterior mediastinum
&diaphragm.
› It is so named because it
contains loose areolar tissue
and offers little resistance to
the spread of infection.

16.  Divided into 2 compartments
by Mylohyoid m.
› Sublingual Space
 Areolar tissue
 Hypoglossal and lingual nerves
 Sublingual gland
 Wharton’s duct
› Submaxillary Space
 Anterior bellies of digastrics
 Submandibular gland
 (These two subdivisions freely
communicate around the
posterior border of the
mylohyoid. )

17.  Infection of Submandibular Space.
 It is usually a cellulitis not abscess so don’t expect
pus.
 Aetiology –
1. Dental Infection – premolar, molar
2. Submandibular Sialoadenitis
3. Fracture Mandible
 Clinical Feature –
1. Odyniophagia , Trismus
2. Tongue pushed up & back
3. Swelling of submandibular region with
tenderness & woody hard feel.
4. Laryngeal edema may appear.
 Treatment -
1. I & D intraoral if sublingual, External
transverse incision if submandibular.
2. IV antibiotics

18.  Collection of pus in peritonsillar space between
capsule of tonsil & superior constrictor.
 Aetiology – Complication of Tonsillitis
 Organism – Mixed
 Clinical Feature –
 Commonly Adult
 Commonly Unilateral
 Symptoms - Fever with Chills, Odynophagia , Trismus,
Hot potato voice , Foul breath, Ipsilateral ear pain
 Signs – Tonsillar pillar swollen
Uvula pushed to opposite side
Cervical lymphadenopathy
Torticollis
Treatment –
1. I & D
2. IV antibiotics
3. H2O2 Gargle
4. Interval Tonsillectomy after 6wks

19.  Infection of Parotid space between superficial &
deep layer of deep cervical fascia.
 Aetiology –
1. Dehydration – Post surgical cases after 5-7 d
2. Infections of oral cavity via stenson’s duct
 Clinical Feature –
1. Parotid area swollen ,tender, indurated
2. No fluctuation
3. Congestion of Stenson’s duct opening with
pus exuding on pressure
4. Fever with chills & rigor
Diagnosis – USG / CT- SCAN
 Treatment -
1. I & D With Lazy S incision & skin flap raise
2. IV antibiotics
3. IV Fluid