Spaces of H&N

Question 1

primary vs secondary spaces

Answer 1

• primary= direct relationship with source

* secondary= no direct relationship with source

Question 2

what are some primary spaces?

Answer 2

Maxillary

• caniine
• buccal (bridging)
• infratemporal

Mandibular

• buccal (bridging)
• submental
• sublingual
• submandibular

Question 3

what are some secondary spaces?

Answer 3

masticator
pterygomandibular
retropharyngeal
parotid
prevertebral

Question 4

primary MX canine space boundaries

Answer 4

superior= levator labii superioris
inferior= levator anguli oris

Question 5

primary MX canine space communications

Answer 5

buccal space

Question 6

primary MX canine space infection

Answer 6

• max canine or 1st maxillary premolar

* can erode superiorly toward the orbit

Question 7

primary MX infratemporal space boundaries

Answer 7

• superior: infratemporal surface of greater wing of sphenoid
• inferior: lateral pterygoid
• lateral: temporalis
• medial: lateral pterygoid plate
• anterior: maxillar
• posterior: lateral pterygoid

Question 8

primary MX infratemporal space communications

Answer 8

• buccal space
• temporal space
• pterygomandibular space

Question 9

primary MX infratemporal space infection

Answer 9

• rare
• *MX 3rd molar infection
• close to pterygoid plexus

Question 10

primary MX infratemporal space boundaries

Answer 10

• superior: infratemporal surface of greater wing of sphenoid
• inferior: lateral pterygoid
• later: temporalis
• medial- lateral pterygoid plate
• anterior: maxilla
• posterior: lateral pterygoid

Question 11

primary MX infratemporal space communications

Answer 11

• buccal space
• temporal space
• pterygomandibular spac

Question 12

primary MX infratemporal space infection

Answer 12

• rare
• MX 3rd molar infection
• close to pterygoid plexus

Question 13

Primary MX/MD buccal (bridging) space boundaries

Answer 13

• superior: zygomatic process
• inferior: mandible
• lateral: skin & superficial fascia
• medial: buccinator
• anterior: mouth
• posterior: masseter

Question 14

Primary MX/MD buccal (bridging) space communicatiosn

Answer 14

• canine space
• pterygomandibular space
• infratemporal space
• submassateric space

Question 15

Primary MX/MD buccal (bridging) space infection

Answer 15

• MX molars

* MD molars

Question 16

primary MD submental boundaries

Answer 16

• between the mylohyoid muscle and superficial layer of deep cervical fascia
• bounded laterally by the anterior digastric muscle

Question 17

primary MD submental communications

Answer 17

submandibular space

Question 18

primary MD submental infection

Answer 18

mandibular anterior teeth

Question 19

primary MD submandibular boundaries

Answer 19

• between the mylohyoid muscle and superficial layer of deep cervical fascia
• between the anterior and posterior bellies of digastirc

Question 20

primary MD submandibular communications

Answer 20

• sublingual space
• buccal space
• pterygomandibular space

Question 21

primary MD submandibular infections

Answer 21

1, 2, and 3rd MD molars

Question 22

primary MD sublingual boundaries

Answer 22

• between the mucosa and mylohyoid muscle
• superior: mucosa on floor of oral cavity
• inferior: mylohyoid m
• lateral AND anterior: mandible
• posterior: musclles along base of tongue

Question 23

primary MD sublingual communications

Answer 23

• submandibular space

* pterygomandibular space

Question 24

primary MD sublingual infection

Answer 24

MD premolars and molars

Question 25

Secondary route from source MX anterior (usually canines) to ______? *Symptomes?

Answer 25

to palatal and canine spaces | *swelling along lateral nose, swollen eyelids, palatal abscess

Question 26

Secondary route from source MD anterior to ______? | *Symptomes?

Answer 26

to submental space | *chin swells

Question 27

Secondary route from source MX premolars/molars to ______? | *Symptomes?

Answer 27

to buccal, infratemporal, or palatal space; maxillary sinus | *trismus, swelling of cheek, swelling of palate

Question 28

Secondary route from source MD premolar/molars to ______? | *Symptomes?

Answer 28

to sublingual, submandibular, buccal, or pterygomandibular spaces *swelling in floor of mouth, elevated tongue, difficulty speaking, neck swelling

Question 29

Secondary route from source MX (maybe and MD 3rd molars to ______? *Symptomes?

Answer 29

to parapharyngeal space then RPS | *pain, trismus, deviated uvula, difficulty swallowing/breathing

Question 30

what is Ludwig's Angina? commonly caused by? do what ASAP?

Answer 30

* severe cellulitis from bacterial infection in the floor of oral cavity * 2nd to sublingual or submandibular infections (molar abscess) * may spread to neck and block airway--- intubate ASAP * more common in kids * can spread contralaterally bc there is no midline boundary

Question 31

anatomical 'real space' vs anatomical 'potential space'?

Answer 31

* real= subarachnoid space | * potential= retropharyngeal space

Question 32

superficial fascia is immediately ___ to the skin and contains?

Answer 32

deep to skin | *contains losse C.T.; emergining cutaneous nerves, superficial vessels, and platysma

Question 33

what are the 3 layers of deep fascia?

Answer 33

superficial, intermediate, deep

Question 34

what comprises the carotid sheath?

Answer 34

all 3 layers of deep fascia

Question 35

what is found in the carotid sheath?

Answer 35

internal carotid or common carotid artery, internal jugular vein, and vagus nerve, with ansa vericalis intimately attached to the out fascia layer

Question 36

describe the superifical layer of deep fascia AKA investing layer? what are the borders?

Answer 36

continuous sheet encapsulating the neck * superior border= inferior border of MD, inferior border of zygo, mastoid process, ligamentum buchae, and external occipital protuberance * inferior borders= sternum, clavicle, acromion, scapular spine

Question 37

the intermediate layer of deep fascia is divided into what two portions?

Answer 37

1) muscular - -surrounds strap muscles 2) visceral - -surrounds thyroid, trachea, and esophagus

Question 38

alar fascia is an extension of?

Answer 38

prevertebral fascia

Question 39

alar fascia splits the retropharegneal space into?

Answer 39

1) true retropharengeal space - bounded by alar and buccopharyngeal fascia 2) danger space - between alar and prevertebral

Question 40

alar fascia spans the base of the skull to the superior mediastinum to merge with? WHERE? this separates???

Answer 40

buccopharyngeal fascia at T2 | ***separates the true RPS from the 'danger space' which extends down to the diaphragm

Question 41

what all drains into retropharyngeal tonsils?

Answer 41

nasopharyxn, middle ear, and paranasal sinuses; drain caudally through the deppjugular chain towards the superior mediatinum

Question 42

what are possible complications for danger space? 1) posterior 2) lateral 3) anterior 4) inferior

Answer 42

1) posterior- discitis osteomyelitis 2) lateral- carotid or IJV thrombosis 3) anterior- airway compression 4) inferior- mediastinitis * generalized sepsis