ENT - Deep neck space infections part 01 16-12-2011 Self-learning tutorial

Deep neck space infections most commonly arise from a septic focus of the mandibular teeth, tonsils, parotid gland, deep cervical lymph nodes, middle ear, or sinuses. These deep cervical space infections have become relatively uncommon in the postantibiotic era. Consequently, many clinicians are unfamiliar with these conditions. In addition, with widespread use of antibiotics and/or profound immunosuppression, the classic manifestations of these infections, such as high fever, systemic toxicity, and local signs of erythema, edema, and fluctuance, may be absent The muscles, vessels, and visceral structures of the neck are enveloped by the cervical fascia, which has a superficial and deep. The superficial cervical fascia consists of the subcutaneous tissues of the neck, which completely enclose the head and neck and is continuous with the platysma anteriorly. The deep cervical fascia has three layers: superficial, middle, and deep, which can be thought of as defining a series of cylindrical compartments that extend longitudinally from the base of the skull to the mediastinum. • The superficial or investing layer of the deep cervical fascia encloses all of the deeper parts of the neck, beginning at the nuchal line and extending anteriorly, dividing to enclose the trapezius, sternocleidomastoid, and strap muscles as well as the submaxillary and parotid glands. • The middle or pretracheal fascia encloses the cervical viscera including the pharynx, esophagus, larynx, trachea, thyroid, and parathyroid glands. • The deep or prevertebral fascia arises from the nuchal ligament and encloses the vertebral column and muscles of the spine. The prevertebral fascia originates posteriorly on the spinous processes and encircles the splenius, erector spinae, and semispinalis muscles (figure 1 and figure 2). Prior to completing its circle anterior to the vertebral bodies, it fuses to the transverse processes. At this point, it is split into two layers: the alar fascia anteriorly and the prevertebral fascia posteriorly

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