Escolar Documentos
Profissional Documentos
Cultura Documentos
by
Prem Nikomchaiprasert
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Trigeminal n. (CN5)
V1. Opthalmic n. :
superior orbital fissure
sensory n.
V2. Maxillary n. :
foramen rotundum
sensory n.
V3. Mandibular n. :
foramen ovale
mixed n. (motor +
sensory
18/8/49
components)
3
Trigeminal n. (CN5)
V1. Opthalmic n. : sensory n.
Frontal n.
Supraorbital n. : scalp, upper eyelid
Supratrochlear n. : forehead, upper
eyelid
Lacrimal n. : sphenopalatine gg.
Nasociliary n. :
Long ciliary n. : eyeball, upper
eyelid
Communicating br.: Ciliary gg.
Posterior ethmoidal n. :
spenoid/ethmoid sinus
Infratrochlear n. : lacrimal
apparatus, nasion
Anterior ethmoidal n. :
Internal nasal br. Nasal cavity,
ethmoidal aircelsl
External nasal br. : dorsum/ tip of
nose
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Trigeminal n. (CN5)
V2. Maxillary n. : sensory n.
Meningeal n. : dura mater
Pterygopalatine n. :
sphenopalatine gg.
Zygomatic n. :
Zygomaticotemporal n. :
(zygomaticotemporal foramen)
: temporal area
Zygomaticofacial n. :
(zygomaticofacial for.) : cheek
Posterior alveolar n.:
maxillary sinus, upper molar
Infraorbital n. : upper molar,
lower eyelid, side of nose,
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upper lip 5
Trigeminal n. (CN5)
V3. Mandibular n. : Mixed n.
Branch of Trunk.
Meningeal br. : dura mater
Medial terygoid n. : medial
pterygoid m., tensor tympani
m., tensor veli palatini m.
Anterior division br. :
Masseteric n. : masseter m.
Ant. Deep temporal n. :
temporal m.
Post. Deep temporal n. :
temporal m.
Lateral pterygoid n. : lat.
Ptergoid m.
Buccal n. : skin of buccal area,
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buccal mucosa
Trigeminal n. (CN5)
V3. Mandibular n. : Mixed n.
Posterior division br. :
Auriculotemporal n. :
scalp, skin of preauricular
& temporal area, otic
ganglion
Lingual n. : somatic
sensation ant. 2/3 tongue,
submandibular gg. (chorda
tympani), taste buds ant
2/3 (chorda tympani)
Inferior alveolar n.
Dental br. : inferior alveolar
Mental n. : chin
Mylohyoid n. : mylohyoid m.,
ant. belly of digastric m.
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* Retracting submandibular gland to posteroinferior direction :
lingual n., wharton’s duct, hypoglossal n.
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Facial n. (CN7)
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Facial n. (CN7)
Geniculate ganglion :
1
2
greater superficial petrosal 3
n., lesser superficial 4
petrosal n.
Tympanic segment :
1
nerve to stapedius m. 2
3
Mastoid segment : chorda t4
ympani n.
Extracranial segment : post
auricular n., nerve to poster
ior of digastric m., pes anse
rinus 18/8/49 10
Facial n. (CN7)
Facial n. : Facial
expression
Temporal br. : m. เหนือ
zygoma
Zygomatic br. : กล้ ามเนือ้
บริ เวณ infraorbital
Buccal br. : buccinator
m., upper lip
Marginal mandibular
br. : lower lip,
Cervical br. :
plastysma
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pes anserinus
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Stylomastoid
foramen
->tympanomastoid
fis. (lateral surface o
f tympanic bone) .
•Facial n. is usually
located ~1-1.5 cm Tragal pointer
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Parotid Salivary Gland
Parotid gland : between
zygomatic arch, ramus
of mandible, masseter
m., mastoid, styloid
process
Duct : Stensen's
duct :~ 1.5 cm below
zygomatic arch, along
transverse facial a.,
buccal br. (CN VII)
crosses masseter,
pierces buccinator,
opening 2nd molar
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Parotid Salivary Gland
In gland : Facial n.
(cervicofacial,
temporofacial),
retromandibular v.,
external carotid a.
maxillary a., superficial
temporal a. , deep parotid
LN
Surrounded : parotid
fascia (superficial layer of
deep 18/8/49
fascia)
15
Frey syndrome
(Gustatory sweating)
denervated postganglionic
parasympathetic fibers
growing and innervating
the sweat gland after
removal of the parotid
Facial n. injury
Direct anastomosis
Interposition graft
Hypoglossal-facial nerve
anastomosis
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Accessory n. (CN.11)
Nucleus : nucleus
ambigus + C1-C5
Branch
Spinal part : SCM,
trapezius m.
Accessory part :
join vagus n.
(pharyngeal m.,
larynx, soft palate)
Course : Jugular foramen ->Posterior IJV, run obliquely
inferior/posterior SCM (Erb’s point : posterior border of SCM that
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greater auricular n. turn around)
Hypoglossal n. (CN.12)
Nucleus : Hypoglossal
nucleus (medulla)
Hypoglossal canal
Distribution : All muscle
of tongue (except
palatoglossus CN10)
Course : cross
superficial both ICA &
ECA, ~1.5 cm above
carotid bifurcation
CN XII ECA ICA
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Cervical Plexus
The cervical nerve
plexus
- Cervical spinal nerve C1-
C4
1. Cutaneous branches
2. Ansa cervicalis (ansa
hypoglossi)
3. Phrenic nerve
4. Communicating branches
5. Muscular branches
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Cervical Plexus
1. Cutaneous Branches :
sensation of cervical
skin
1. Lesser occipital n.
(C2,3) : auricle,
postauricular area
2. Great auricular n.
(C2,3) : auricle, skin
(mastoid, paroitid area)
3. Transverse cervical n.
(C2,3) : anteroir triangle
4. Supraclavicular n.
(c3,4) : posterior triangle,
manubrium sterni
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Cervical Plexus
2 Ansa cervicalis (Ansa
hypoglossi) :
• Loop : Superior
Ramus (C1,2) and
Inferior Ramus(C2,3)
• Motor : Group of
infrahyoid m.
[sternohyoid,
sternothyroid,
omohyoid m. ;except :
thyrohyoid m. (C1)]
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Cervical Plexus
3 Phrenic nerve :
• Origin : ventral
rami C3,4,5
• Tract : anterior
scalenus m. to
thoracic inlet
• Supply : pleura,
pericardium,
diaphragm
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Cervical Plexus
4 Communicating branches
1. C2,3 and CN XII :
Sternocleidomastoid
2. C3,4 and CN XII :
Trapezius
5 Muscular branches
nerve root C1-C4 :
prevertebral m. (rectus
capitis, longus capitis,
longus coli, scalenes,
levator scapulae
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Montgomery : 110
Phenic
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n. , cervical plexus : Deep to the fascial carpet 24
The Autonomic Nervous System
1. Sympathetic
2. Parasympathetic
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Sympathetic nervous system
1. Sympathetic nervous system
Origin : T1-T5
Ganglion
1.1 Superior cervical
sympathetic ganglion
1.2 Middle cervical
sympathetic ganglion
1.3 Inferior cervical
sympathetic ganglion
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Sympathetic nervous system
1.1 Superior cervical
sympathetic ganglion
Origin : Sympathetic
gg. C1-C4
Site : transverse
process C2
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Sympathetic nervous system
Branches :
Communicating br. : CN9, CN 12
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Sympathetic nervous system
1.3 Inferior Cervical Sympathetic Ganglion
• Origin : C7-C8
• Site : transverse process C7
• 82% รวมกับ thoracic sympathetic 1st : Cervicothoracic
gg. (Stellate gg.)
• Branches :
1. Gray rami Communicantes : spinal cord C6-T1
2. Ansa subclavia : middle cervical sympathetic gg.
3. Inferior cervical cardiac n. : cardiac plexuses
4. Vertebral plexuses : nerve plexuses (vertebral
a., basilar a., cerebral a., cerebellar a.)
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Sympathetic nervous system
Note :
• Cervical sympathetic gg. injury :
Horner’s syndrome (ptosis, miosis,
facial anhidrosis)
• Stellate Ganglionectomy :
ลด vasospasm of upper limb artery in
Raynaud’s disease
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Parasympathetic nervous system
2. Parasympathetic Nervous System
2.1 Ciliary gg. : CN3
: ciliary m.,spincter
pupillae m.
2.2 Sphenopalatine gg. : CN7
: lacrimal gl., nasal
cavity, hard/soft palate
2.3 Submandibular gg. : CN7
: Submandibular gl.,
sublingual gl.
2.4 Otic gg. : CN9
: Parotid gl.
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The Lymphatic System
The Lymphatic System
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Cervical Lymph Node Groups
The six level of the neck
Level I : Submental and
Submandibular group
Level II : Upper jugular
group
Level III : Middle jugular
group
Level IV : Lower jugular
group
Level V : posterior triangle
group (supraclavicular node)
Level VI : Anterior
compartment group
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The six level of the neck
Level IA
Boundaries
Superior : Symphysis o
f mandible
Inferior : body of hyoid
Medial/Lateral : Anterior
bellies of bilateral diga
stric m.
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The six level of the neck
Level IA
LN : Submental nodes
Afferent :FOM, ant.
tongue, anterior
mandibular alveolar
ridge, lower lip
Efferent : Level
IB,II,III
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The six level of the neck
Level IB
Boundaries
Superior : Body of
mandible
Inferior : Posterior belly
of digastric muscle
Medial : Anterior belly of
digastric m.
Lateral : stylohyoid m.
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The six level of the neck
Level IB
LN : Submandibular LN
Afferent : oral cavity,
ant. nasal cavity,
midface, submandibular
gland
Efferent : Level II,III
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The six level of the neck
Level II
Boundaries IIA
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The six level of the neck
Boundaries IIB
Superior : Skull base
Medial : Accessory n.
Lateral : lateral border
of SCM
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The six level of the neck
LN Level IIA & IIB: upper
jugular group,
Afferent Level IIA & IIB :
Oral cavity, base of tongue,
nasal cavity, nasopharynx,
oropharynx, hypopharynx,
larynx, parotid gland
Efferent Level IIA & IIB :
Level III, IV
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The six level of the neck
Level III
Boundaries
Superior : Horizontal plane defi
ned by inferior border of hyoi
d
Inferior : Horizontal plane defin
ed by inferior border of cricoi
d cartilage
Medial : Lateral border of
sternohyoid m.
Lateral : lateral border of SCM
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The six level of the neck
Level III
LN :Middle jugular group
Afferent : Oral cavity,
nasopharynx, oropharynx,
hypopharynx, larynx
Efferent : Level IV
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The six level of the neck
Level IV
Boundaries
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The six level of the neck
Level IV
LN : Lower jugular group,
inferior deep cervical LN
Afferent : Hypopharynx,
thyroid gland, cervical
esophagus, larynx
Efferent : jugular
lymphatic trunk
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The six level of the neck
Level VA
Boundaries
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The six level of the neck
Level VB
Boundaries
Superior : Horizontal plane defin
ed by lower border of cricoid
cartilage
Inferior : Clavicle
Medial : post. border of SCM
Lateral : ant. border of trapezius
m.
LN : transverse cervical chain,
supraclavicular nodes
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The six level of the neck
Afferent :Level VA & VB :
Nasopharynx, oropharynx
cutaneous of posterior scalp &
neck, aerodigestive tract
(Supraclavicular nodes )
Efferent :Level VA & VB : Level I
V, jugular lymphatic trunk, Right
lymphatic duct, thoracic duct (Lt)
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The six level of the neck
Level VI
Boundaries
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Neck Dissection
Classification
1. Radical neck dissection
2. Modified radical neck dissection
3. Selective neck dissection
4. Extended neck dissection
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Neck Dissection
Radical Neck Disse
ction Procedure r
emoval :
Ipsilateral
cervical lymph
node groups I-V,
spinal accessory
n., IJV, SCM
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Neck dissection
Modified Radical ND
Level I-V LN group
Preservation of one
cumming
2627B
or more :
Spinal accessory n.
Internal jugular v.
SCM
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Neck dissection
Selective Neck Dissection
En bloc removal one or more LN groups that are risk
for harboring metastatic cancer
Extended Neck Dissection
Any of node dissection classification with remove
either LN, vascular, neural, muscular structure
( retropharyngeal LN, hypoglossal n., levator
scapulae m., carotid a.)
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Neck dissection
Oral cavity cancer :
Supraomohyoid neck
dissection (SOHND)
SND (Level I-III) (+ Cumming
level IV in tongue 2628 116-9
cancer)
; Nodal metas I-III : SND
(I-IV)
; N2c : Contralateral ND
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Neck dissection
CA oropharynx, hypopha
rynx and larynx :
Lateral neck dissection :
SND (Level II-IV)
; Cancer involving 116-12
pharyngeal wall : SND (II-I
V, retropharyngeal nodes)
; Cancer extendind below the
glottis : SND (II-IV and VI)
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Neck dissection
CA posterior scalp
and upper neck :
Posterolateral neck
dissection : SND(II-V, p 116-14
ostauricular and subocc
ipital )
preauricular, ant.
Scalp, temporal region :
SND (parotid and facial
nodes, level IA, IB, II a
nd III)
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Neck dissection
Midline structures of
anterior lower neck
CA thyroid, advanced
glottic cancer, subglottic l
arynx cancer, advanced p
yriform sinus cancer, cervi
116-15
cal esophageal/tracheal c
ancer
Anterior neck dissection or
central compartment
dissection
SND (level VI)
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Neck dissection
Midline structures of
anterior lower neck
; Metas below 116-16
suprasternal notch :
SND (IV, superior
mediastinal nodes)
; CA Thyroid cancer
with nodal metas Lev
el V : SND (VI and II-
V)
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The Lymphatic System
Superficial group
Head & Face
Neck
Deep group
Lymphatic channels
Right lymphatic duct
Thoracic duct
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The Lymphatic System
Superficial
group
Face & Head
– Occipital nodes
– Retroauricular
nodes
– Anterior
auricular nodes
– Superficial
parotid nodes
– Facial nodes
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The Lymphatic System
Superficial
group
Neck
Submental nodes
Submandibular
nodes
External Jugular
nodes
Anterior jugular
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The Lymphatic System
Deep group
– Accessory Chain
– Transverse
Cervical chain
– Juxtavisceral
Nodes
– Deep cervical
Nodes
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The Lymphatic System
Deep group
Juxtavisceral Nodes
Infrahyoid group : thyrohyoid membrane
Prelaryngeal group : cricothyroid ligament
Pretracheal group : along inferior thyroid artery
Paratracheal group :along recurrent laryngeal
n.
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The Lymphatic System
Deep group
4. Deep Cervical Nodes
4.1 Superior Deep
Cervical Nodes
Retropharyngeal
Nodes
Deep parotids Nodes
Jugulo-digastric
Node
Jugulo-omohyoid
Node
4.2 Inferior Deep
Cervical Nodes
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Lymphatic Channels
Right Lymphatic Duct
Origin :
• Jugular lymphatic trunk (Rt) (inferior deep cervical LN,
Transverse cervical chain)
• Subclavian lymphatic trunk (Rt)
• Bronchomediastinal lymphatic trunk (Rt)
Distal End : Right Subclavian v. หรื อ รอยต่ อระหว่ าง
Right Subclavian v. กับ Right Internal Jugular v.
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Lymphatic Channels
2. Thoracic Duct
Origin :
Lumbar lymphatic trunk
(Rt&Lt)
Intestinal lymphatic trunk
Jugular lymphatic trunk
(Lt), transvercervical
lymphatic trunk (Lt),
subclavian lymphatic trunk
(Lt)
Distal End : รอยต่ อระหว่ าง Left
Subclavian v. กับ Left
Internal
18/8/49 Jugular v. 71
Tissue plane and space
of
face & neck
Cervical fascia
1. Superficial cervical fascia
2. Deep cervical fascia
- Superficial layer
- Middle layer
- Deep layer
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Superficial cervical
fascia
• deep to dermis
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Superficial cervical fascia
Superficial musculoaponeurosis
(SMAS)
Fibromuscular fascia
Invests the muscles of facial
expression
Boundary
Superior zygomatic arch
Inferior platysma
Posterior SCM
Anterior orbicularis oris
Melolabial crease,upper lip
Ant sup orbicularis oculi
zygomatic major&minor
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Superficial cervical fascia
Superficial
musculoaponeurosis
(SMAS)
Branch of CN VII deep to
SMAS
Lower cheek br CN VII deep
to masseteric fascia
Potential space between SMAS
& masseteric fascia(avascular
plane) : safely dissect
Important to Rhitidectomy
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SMAS FACE LIFT
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Superficial cervical fascia
Superficial musculoaponeurosis
(SMAS)
Temporal br.:
- most superficial br,exist superior
parotid gl crossed junction ant 1/3
& post 2/3 zygomatic arch
- Dissect: forhead lift+face lift
Zygomatic br :
- lie drawn targusmalar eminence
- injury mild synkinesis lower eye
lid
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Superficial cervical fascia
Superficial musculoaponeurosis
(SMAS)
Buccal br :
- exist ant parotid,on to surface
massester m.deep to fascia pass
buccal fat
- injury sagging upper lip
Mandibular br:
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Superficial layer of
the deep cervical fascia
Rule of two
- envelopes 2 m : trapezius,
SCM
; masticator m. (masseter m.,
pterygoid m., tempolaris m.), ant.
Belly of digastric, mylohyoid m.
- envelopes 2 glands :
submandibular,parotid
- form 2 spaces :space of
posterior triangle,suprasternal
space of BURN
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Superficial layer of
the deep cervical fascia
Superiorly
Mastoid processes of
temporal bones
Mandible
1. Internal layer:cover
pterygoid mskull
base
2. External layer:cover
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Middle layer of the deep
cervical fascia
Middle layer (DCF)
Muscular division
Viceral division
Muscular division
Surrounds infrahyoid
Inferior: clavicle,sternum
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Middle layer of the deep
cervical fascia
Visceral division
Envelopes : thyroid,
trachea, esophagus
Envelopes : pharyngeal
constrictor & buccinator
bucco-pharyngeal fascia
& form ant.wall
retropharyngeal space
Buccopharyngeal fascia
form midline raphe in
posterior midline adhere to
alar & fuse~ T2cumming*
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Middle layer of the deep
cervical fascia
Visceral division
Posterosuperior:base of Muscular fascia
skull
Anterosuperior:thyroid
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Middle Layer of
the Deep Cervical Fascia
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Deep layer of
the deep cervical fascia
1. Prevertrebral division
2. Alar division
1. Prevertebral division
Anterior: adhere
vertebral body,extend
skull base down length
spine
Posterior:around
scalene m,vertrebral m
Envelops vertrebral vv,
brachial plexus,phrenic
n, subclavian
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vv,axillary
90
sheath
Deep layer of
the deep cervical fascia
Alar division Alar
Between : middle layer division
retropharyngeal space
Extendes : base of skull
to level of T2 (fuses
with visceral fascia)
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Deep Layer of
Deep Cervical Fascia
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Space of neck
Suprahyoid space Infrahyoid space
Submandibular space Suprasternal space
Parotid space
Retropharyngeal space
Danger space
Prevertebral space
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Space of neck
Suprahyoid space
Submandibular space
Parapharyngeal space
Masticator space
Parotid space
Peritonsillar space
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Submandibular space
Mylohyoid devide
submandibular space
- Sublingual space
(supramylohyoid)
- Submaxillary space
(inframylohyoid)
Ant.belly digastric devide
Submaxillary space
- medial: submental space
- lateral : submaxillary space
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Submandibular space
Sublingual space
Boundary :
Superior : floor of mouth
Anterior&Lateral : mandible
Posterior : intrinsic muscle
of base of tongue
Inferior: mylohyoid
Component :
1. Anterior extension of hyoglossus m.
6. Wharton’s
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Submandibular space
Submaxillary space
Boundary :
Superior mylohyoid
Anterior SLDF
Inferior hyoid bone
Posterior posterior digastric
Component :
1. Anterior belly of digastric muscle
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Submandibular space
Sublingual continue submandibular via the posterior
margin of the mylohyoid muscle
Source infection: Odontogenic, oral trauma,
submaxillary or sublingual sialadenitis, or abscess of
mandibular teeth 1st molarsublingual
2nd,3rd molarsubmandibular
Clinical:
Ludwig angina
drooling,pain, dysphagia,
submandibular mass, and
dyspnea or airway
compromise
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Parapharyngeal space
Boundary :
superior base of skull
inferior hyoid bone
anterior pterygomandibular
raphe
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Masticator space
Masticator space : 3 space*cumming
masseteric
temporal
Ptrygoid
Component :
1. Muscles of mastication : medial and
lateral pterygoids, masseter muscle
2. Tendon of insertion of temporalis
muscle
3. Branches of CN V3 (Inferior alveolar
nerve)
4. Branches of internal maxillary artery
5. The ramus and posterior body of
mandible
• Clinical : extreme trismus,
edema&tender post. ramus mandible
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Masticator space
Temporal space
Superficial temporal space :
Medially temporalis m
Laterally superficial temporalis
fascia
Deep temporal space :
Medially periosteum of temporal
bone
Laterally temporalis muscle
Infratemporal space
Medially lat.plate pterygoid
Laterally deep temporal space
superior skull base
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Masticator space
Temporal space
Component :
- internal maxillary artery
- mandibular vessels and
nerves
Clinical : pain temporal m
,trismus ,occasional
deviation of jaw to affect
side
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Masticator space
Masseteric space
Boundary :
Lateral masseter m
Medial mandible
Source : spread from
buccal space infection
Clinical : trismus,postero
–inferior face swelling
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Masticator space
Pterygomandibular
space
Boundary
Sup Lateral pterygoid m
Inf Pterygomasseteric
sling
Ant Pterygomandibular
raphae
Post Parotid
Lat
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Masticator space
Pterygomandibular
space
Infection would lead to
trismus,on swelling
Infection most spread
from sublingual
submandibular space
Commonly would lead to
lateral pharyngeal space i
nvolvement.
3 space
(temporal,masseteric,ptery
gomandibuar sp)
communicate freely
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Parotid Space
Bounded by
superficial layer of
deep cervical fascia
Posterior to
masticator and lateral
to PPS
Extend from EAC –>
inferior edge of angle
of mandible
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Parotid space
Component :
1. Parotid gland and proximal duct
2. Facial nerve
without trismus
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Peritonsillar Space
Boundary :
Medially capsule of
tonsil
Laterally superior
constrictor
Ant&Post tonsillar pillars
Component :
- loose connective
tissue
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Peritonsillar space
Source: tonsil,pharynx
Clinical: dysphagia
muffle voice,trismus
tonsil displace,uvular
deviate across midline
to opposite side
Infect involve
juxtrapharyngeal space
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Space of neck
Infrahyoid space
Suprasternal space
Anterior visceral
space
Posterior cervical
space
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Suprasternal space
Suprasternal space of
BURN
SLDF split attach to
anterior and posterior
Suprasternal
surface of manubrium sp.
Component : 2 head of
SCM, lower end of
ant.jugular vein, the
jugular arch, and LN
Closed space
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Anterior Visceral Space
Boundary :
Superior hyoid bone
Inferior mediastinum
Anterior SLDF
Posterior RPS,prevertebral
Lateral PPS,carotid fascia
Component :
Pharynx,larynx,esophagus,
trachea,thyroid¶thyroid gl
RLN, LN
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Anterior Visceral Space
“Pretracheal space”
Source :
most infectionperforate by instrument
FB ,external trauma
Clinical :
Dysphagia,hoarseness,dyspnea,UAO
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Posterior cervical space
Boundary :
Floor deep layer of DCF
Superior superficial layer of DCF
Inferior omohyoid
Extend from skull base clavicle
Posterior triangle portion
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Carotid space
Boundary :
Superior skull base
Inferior aortic arch
Anterior SCM
Posterior prevertebral space
Medial visceral space
Lateral SCM Carotid space
Component
- carotid a
- IJV
- CN X
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Carotid space
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Retropharyngeal Space
Boundary :
Superior skull base
Inferior superior
mediastinum,
~T2cumming
Anterior pharynx &
esophagus
Posterior alar fascia
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Retropharyngeal space
Component: LN,CNT
Source: infected
nose,NP,adenoid,PNS (most
in child)
in adult :instrument, FB
,trauma
Clincal:unilat midline
abscess pain, dysphagia
,nuchal rigidity,air way
compromise
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Danger space
Boundary :
Superior skull base
Inferior diaphragm
Anterior alar fascia
Posterior prevertebral
fascia
Lateral transverse
process of vertebrae
Component : CNT
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Danger space
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Prevertrebral space
Boundary :
Superior skull base
Inferior coccyx
Anterior prevertebral fascia
Posterior vertebral bodies
Lateral transverse process
of vertebrae
Component
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Imaging
Lateral neck plain film
Screening exam
Normal:
7mm at C-2
14mm at C-6 for kids
22mm at C-6 for adults
Technique dependent
Extension
Inspiration
Sensitivity 83%,
compared to CT 100%
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Surgery
External drainage
Landmarks
Tip of greater horn of
hyoid
Cricoid cartilage
Styloid process
SCM
Transoral drainage
Needle aspiration
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Network of infectious
extension
Submandibular masticater temporal
prevertebral
Ant.cervical mediastinum
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Thank you
References :
Byron J. Bailey et al, Head&Neck surgery-
otolaryngology, 3rdedition 2001
Charles W. Cummings et al, Cummings
Otolaryngology- Head&Neck surgery,4th edition 2005
Jeffrey Buyten, MD Francis B. Quinn, MD UTMB
Department of Otolaryngology, Deep Neck Space
Infections 2005
มีชยั ศรี ใส, ธันวา ตันสถิต, ภาคภูมิ สุ ปิยพันธุ์, บุญเที่ยง ศีติสาร มหการวิภาคประยุกต์
เล่มที่ 2 พิมพ์ครั้งที่ 3 เยียร์บุค๊ พับลิชเชอร์ 2541
เอกสารประกอบการสอน tissue plane space in H&N , พ.ศิริเพ็ญ
เอกสารประกอบการสอน tissue plane space in H&N , พ.พรเทพ
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Important Landmarks
Important Landmarks
Submental Triangle
Anterior Triangle
Submandibular Triangle
Carotid Triangle
Muscular Triangle
Posterior Triangle
Occipital Triangle
Supraclavicular
(Omoclavicular) Triangle
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Important Landmarks
Submental Triangle
Boundaries : Hyoid,
Lt/Rt anterior belly
digastric m.
Contain :
Submental vss.
Submental LN
Mylohyoid m.
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Important Landmarks
Anterior Triangle
Boundaries : Midline of
digastric m.
Posterior belly
of digastric m.
Lower border of
mandible
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Important Landmarks
Submandibular Triangle
Contain
Submandibular gland and Wharton’s duct
Submandibular LN
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Important Landmarks
Carotid Triangle
Boundaries :
Posterior belly of
digastric m.
Superior belly of
omohyoid m.
Anterior border of
sternocleidomastoi
d m.
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Important Landmarks
Carotid Triangle
Contain
Common carotid a., carotid sinus, internal carotid
a., external carotid a. ( and br. : superior thyroid a.,
ascending pharyngeal a., lingual a., facial a.)
Internal jugular v., ( and br. : superior thyroid v.,
sympatheitic
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Important Landmarks
Muscular Triangle
Boundaries :
Midline
Superior belly of
omohyoid m.
Anterior border
of
sternocleidomast
oid m.
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Important Landmarks
Muscular Triangle
Contain
Thyroid gl, parathyroid gl, larynx, trachea, esophagus
laryngeal n.
Infrahyoid LN, paratracheal LN., anterior jugular LN,
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Important Landmarks
Posterior Triangle
Boundaries : posterior
border of
sternocleidomastoid,
anterior border of
trapezius m., middle(1/3)
part of clavicle
Contain
Occipital Triangle
Supraclavicular
(Omoclavicular) Triangle
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Important Landmarks
Ocipital Triangle
Boundaries :
Posterior border of
sternocleidomastoid
Anterior border of
trapezius m.
Inferior belly of
omohyoid m.
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Important Landmarks
Ocipital Triangle
Contain
CN11, lesser occipital n., great auricular n., dorsal
scapular n., transverse cervical n., supraclavicular n.
Transverse cervical a.
external jugular LN
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Important Landmarks
Supraclavicular
Triangle
Boundaries :
Posterior border of
sternocleidomastoid
Inferior belly of
omohyoid m.
Middle(1/3) part of
clavicle
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Important Landmarks
Supraclavicular Triangle
Contain
Subclavian a., thyrocervical trunk, vetebral a.,
internal thoracic a., costocervical trunk,
transverse cervical a., suprascapular a.
Subclavian v., external jugular v.
Brachial plexus
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