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Deep neck spaces are potential fascial compartments within the neck, formed by layers of cervical fascia (superficial, middle, and deep layers). These spaces provide anatomical routes for the spread of infections, tumors, and hemorrhage.

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https://youtu.be/I_CwhL_3i-0

Anatomical Classification

They are broadly classified into:

Suprahyoid Spaces Infrahyoid Spaces
‣ Visceral space
‣ Carotid space
Parotid space Retropharyngeal space
Buccal space Danger space
Temporal space (superficial and deep) Prevertebral space
Perivertebral space

![Fascial layers of the neck. (a) 3D illustration Neck Anatomy: Deep cervical fascial layers defining the deep neck space in the supra- and infra-hyoid head and neck: Investing layer (red), visceral layer (blue) and peri- vertebral or deep layer (orange). In part, these define a series of columns allowing craniocaudal spread of dis- ease. (b) Sagittal section deep cervical fascial layers. Anterior to the vertebral column, the prevertebral and buc- copharyngeal fascia bound the retropharyngeal space; a potential space that may allow cranio-caudal disease spread to the mediastinum. (c) Axial section suprahyoid fascial layers at C2 vertebra. (d) Axial section infrahyoid fascial layers at C7 vertebra.

Images courtesy of Tom Hiscox medical illustrations Head and Neck Imaging: A Multi-Disciplinary Team Approach. Switzerland, Springer International Publishing, 2021.](attachment:f96f9e81-3e14-4839-a1f2-b735f04fb9ae:image.png)

Fascial layers of the neck. (a) 3D illustration Neck Anatomy: Deep cervical fascial layers defining the deep neck space in the supra- and infra-hyoid head and neck: Investing layer (red), visceral layer (blue) and peri- vertebral or deep layer (orange). In part, these define a series of columns allowing craniocaudal spread of dis- ease. (b) Sagittal section deep cervical fascial layers. Anterior to the vertebral column, the prevertebral and buc- copharyngeal fascia bound the retropharyngeal space; a potential space that may allow cranio-caudal disease spread to the mediastinum. (c) Axial section suprahyoid fascial layers at C2 vertebra. (d) Axial section infrahyoid fascial layers at C7 vertebra.

Images courtesy of Tom Hiscox medical illustrations Head and Neck Imaging: A Multi-Disciplinary Team Approach. Switzerland, Springer International Publishing, 2021.

![Sagittal and axial views of the deep and superficial cervical fascial layers. Selected deep neck spaces indicated.

MacIsaac MF, Rottgers SA. Anatomy, Diagnosis, and Clinical Management of Deep Neck Space Infections. FACE. 2024;5(3):425-436. doi:10.1177/27325016241257468](attachment:de930304-0e61-4179-9979-0a0c53465ba9:image.png)

Sagittal and axial views of the deep and superficial cervical fascial layers. Selected deep neck spaces indicated.

MacIsaac MF, Rottgers SA. Anatomy, Diagnosis, and Clinical Management of Deep Neck Space Infections. FACE. 2024;5(3):425-436. doi:10.1177/27325016241257468

Key Deep Neck Spaces: Boundaries and Contents

Space Boundaries Contents
Parapharyngeal Medial: pharynx Lateral: mandible & parotid Posterior: carotid sheath Fat, lymph nodes, minor vessels and nerves
Retropharyngeal Between buccopharyngeal fascia (anterior) and alar fascia (posterior) Fat, lymph nodes (esp. in children)
Danger Space Between alar fascia (anterior) and prevertebral fascia (posterior); extends from skull base to diaphragm No significant structures—acts as a route for infection spread
Carotid Space Bounded by carotid sheath ICA, IJV, vagus nerve (CN X), deep cervical lymph nodes
Masticator Space Muscles of mastication (medial & lateral pterygoid, masseter, temporalis) Inferior alveolar nerve, internal maxillary artery, mandibular ramus
Parotid Space Encased by parotid fascia Parotid gland, facial nerve (CN VII), retromandibular vein, external carotid artery

Common Pathologies

Infections

Tumors