Search Term

Section

Search Cases

Advanced Search

Area of Interest

Procedure

Technique

Special Focus

Case Type

Country

Language

Case Title

Author

Case Number

Anatomy of the supra hyoid spaces

Author(s)

R. Sigal, JP Francke

Clinical History

Imaging Findings

Anatomy of the suprahyoid spaces

Discussion

Modern cross sectional imaging has deeply modified the perception of the anatomy of the head and neck because it permits direct identification of the main deep structures. A reappraisal of the anatomy has been proposed by H.R. Harnsberger (1) and has become common ground among head and neck radiologists (although other descriptions exist (2)). The concept of space is superimposed to the traditional presentation of areas (oropharynx, nasopharynx, oral cavity and pharyngo larynx…). French anatomists originally described these spaces in the nineteenth century (3); they are defined by the course of the three layers of the deep cervical fascia (not directly visualized): superficial layer (investing fascia), middle layer (buccopharyngeal fascia), deep layer (prevertebral fascia). The mucosal space is located on the airway side of the pharynx and therefore is not completely fascia-enclosed. The sublingual and submandibular spaces belong to the oral cavity. The advantage of using this terminology is that it allows describing tumor spread in the deep tissues using precise anatomical landmarks, as well as specific differential diagnoses for each space. Noteworthy is the fact that, in the literature, the term "parapharyngeal space" (or even infratemporal fossa) has been used to describe a large area that includes the carotid space, the masticator space and the small area described by Harnsberger as the parapharyngeal space. This parapharyngeal space is an important landmark with three distinct features: it is central (with respect to the masticator, carotid, and parotid spaces); it is symmetrical, and it is essentially composed of fat, which characteristically exhibits high signal intensity on T1-weighted images and low attenuation on CT. The main characteristic of most of these spaces is their verticality: the carotid, retropharyngeal and perivertebral spaces extend both across the infra and the suprahyoid neck (down to T3 for the retropharyngeal space). The parapharyngeal and masticator spaces are related to the oropharynx and nasopharynx. This substantiates the need to explore any cancer from the skull base to the thoracic inlet. These spaces have been compared to vertical elevator shafts, which represent natural routes for tumor or infectious spread (1). The fascia can be transpierced by malignant tumors; however, these spaces tend, at least initially, to channel tumor growth and to confine even high-grade tumors (4).

Final Diagnosis

References

[1]

Harnsberger HR. Handbook of head and neck imaging. 2nd ed. Mosby, St Louis (1995).
[2]

Som P, Curtin H. Fasciae and spaces. In: Som P, Curtin H, editors. Head and neck imaging. 3rd ed. Baltimore: Mosby; p 738-46.(1996).
[3]

Charpy A. Apon退vroses du cou. In: Poirier P, editor. Trait退 d'anatomie humaine. Paris: L. Bataille et Cie; pp 410-31.(1906).
[4]

Som PM, Curtin HD, Silvers AR.A re-evaluation of imaging criteria to assess aggressive masticator space tumors. Head Neck. 1997 Jul;19(4):335-41..

Citation

R. Sigal, JP Francke (2000, Oct 23).

Anatomy of the supra hyoid spaces, {Online}.

URL: http://www.eurorad.org/case.php?id=601

DOI: 10.1594/EURORAD/CASE.601

ISSN: 1563-4086

To top

Print this case Download as PDF Bookmark this case

Published 23.10.2000
DOI 10.1594/EURORAD/CASE.601
Section Head & Neck Imaging
Case Type Anatomy and Functional Imaging
Views 153927
Language(s)

Figure 1
Extent and content of suprahyoid spaces

a

b

c

The mucosal, parapharyngeal and masticator spaces. Adapted from Ref 1

Area of Interest: unknown; Imaging Technique: Extent and content of suprahyoid spaces;

The parotid, submandibular and sublingual spaces. Adapted from Ref 1

Area of Interest: unknown; Imaging Technique: Extent and content of suprahyoid spaces;

The retroparyngeal, perivertebral and carotid spaces. Adapted from Ref 1

Area of Interest: unknown; Imaging Technique: Extent and content of suprahyoid spaces;
Figure 2
Anatomy of the suprahyoid deep spaces in the coronal plane.

1 Parapharyngeal space. 2 Masticator space. 2* Masticator space (suprazygomatic portion). 3 Mucosal space. 4 Submandibular space. 5 Medial pterygoid muscle. 5’ Lateral pterygoid muscle. 6 Masseter muscle. 7 Ramus of...

Area of Interest: unknown; Imaging Technique: Anatomy of the suprahyoid deep spaces in the coronal plane.;
Figure 3
Anatomy of the suprahyoid deep spaces in the coronal plane.

Fast SE T2 weighted view 1 Parapharyngeal space. 2 Masticator space. 2* Masticator space (suprazygomatic portion). 3 Mucosal space. 4 Submandibular space 4* Parotid space. 5 Medial pterygoid muscle. 5’ Lateral...

Area of Interest: unknown; Imaging Technique: Anatomy of the suprahyoid deep spaces in the coronal plane.;
Figure 4
Anatomy of the suprahyoid deep spaces in the axial plane at the level of the nasopharynx

Contrast enhanced CT 1 Parapharyngeal space. 2 Masticator space. 3 Mucosal space. 4 Carotid space 4 Parotid space. 5 Mucosal space. 6 Perivertebral space (anterior portion). 7 Retropharyngeal space (virtual at this...

Area of Interest: unknown; Imaging Technique: Anatomy of the suprahyoid deep spaces in the axial plane at the level of the nasopharynx;
Figure 5
Anatomy of the suprahyoid deep spaces in the axial plane at the level of the nasopharynx

Fast SE T2 weighted view 1 Parapharyngeal space. 2 Masticator space. 3 Mucosal space. 4 Carotid space 4 Parotid space. 5 Mucosal space. 6 Perivertebral space (anterior portion). 7 Retropharyngeal space (virtual at...

Area of Interest: unknown; Imaging Technique: Anatomy of the suprahyoid deep spaces in the axial plane at the level of the nasopharynx;

Figure 1

Extent and content of suprahyoid spaces

Figure 1a

The mucosal, parapharyngeal and masticator spaces. Adapted from Ref 1

Figure 1b

The parotid, submandibular and sublingual spaces. Adapted from Ref 1

Figure 1c

The retroparyngeal, perivertebral and carotid spaces. Adapted from Ref 1

Figure 2

Anatomy of the suprahyoid deep spaces in the coronal plane.

1 Parapharyngeal space. 2 Masticator space. 2* Masticator space (suprazygomatic portion). 3 Mucosal space. 4 Submandibular space. 5 Medial pterygoid muscle. 5’ Lateral pterygoid muscle. 6 Masseter muscle. 7 Ramus of the mandible. 8 Submandibular gland. 9 Soft palate. 10 Venous plexus of the parapharyngeal space. 11 Levator veli palatini muscle. 12 Tensor veli palatini muscle. 13 Eustsachian tube. 14 Foramen ovale. 15 Cavernous sinus. 16 Sphenoidal sinus. 17 Nasopharynx. 18 Greater wing of the sphenoid bone. 19 Temporal lobe. 20 Root of the zygomatic arch. 21 Temporal muscle

Figure 3

Anatomy of the suprahyoid deep spaces in the coronal plane.

Fast SE T2 weighted view 1 Parapharyngeal space. 2 Masticator space. 2* Masticator space (suprazygomatic portion). 3 Mucosal space. 4 Submandibular space 4* Parotid space. 5 Medial pterygoid muscle. 5’ Lateral pterygoid muscle. 6 Masseter muscle. 7 Ramus of the mandible. 8 Submandibular gland. 9 Soft palate. 10 Venous plexus of the parapharyngeal space. 11 Levator veli palatini muscle. 13 Root of the zygomatic arch. 14 Foramen ovale. 15 Cavernous sinus. 16 Sphenoidal sinus. 17 Nasopharynx. 18 Greater wing of the sphenoid bone. 19 Temporal lobe. 20 Temporal muscle

Figure 4

Anatomy of the suprahyoid deep spaces in the axial plane at the level of the nasopharynx

Contrast enhanced CT 1 Parapharyngeal space. 2 Masticator space. 3 Mucosal space. 4 Carotid space 4 Parotid space. 5 Mucosal space. 6 Perivertebral space (anterior portion). 7 Retropharyngeal space (virtual at this level).

Figure 5

Anatomy of the suprahyoid deep spaces in the axial plane at the level of the nasopharynx

Fast SE T2 weighted view 1 Parapharyngeal space. 2 Masticator space. 3 Mucosal space. 4 Carotid space 4 Parotid space. 5 Mucosal space. 6 Perivertebral space (anterior portion). 7 Retropharyngeal space (virtual at this level).

To top

Home Search Sections Teaching Cases History FAQ Case Archives Contact Login Disclaimer Imprint Switch to MOBILE version

Language:

Any Questions? Contact us here:
epc@eurorad.org

EURORAD Office c/o European
Society of Radiology
Am Gestade 1,
AT-1010 Vienna, Austria

View desktop version

Preferred Language: