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. C6adults >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 doesnt have any signs of meningitis.
Nothing else seems abnormal on his physical
exam
LEVELS OF CERVICAL LYMPH
NODES
Deep Lymph Nodes
1. Submental
2. Submandibular (Submaxillary)
Anterior Cervical Lymph Nodes (Deep)
3. Prelaryngeal
4. Thyroid
5. Pretracheal
6. Paratracheal
Deep Cervical Lymph Nodes
7. Lateral jugular
8. Anterior jugular
9. Jugulodigastric
Inferior Deep Cervical Lymph Nodes
10. Juguloomohyoid
11. 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.
Thank You