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The retropharyngeal space (RPS) is a potential space in the deep neck, located posterior to the pharynx and anterior to the prevertebral fascia. It is clinically important as an avenue for the spread of infections and tumors from the pharynx to the mediastinum.
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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
| Anterior | Buccopharyngeal fascia (covering posterior pharyngeal wall & esophagus). |
|---|---|
| Posterior | Alar fascia (a subdivision of deep cervical fascia). |
| Lateral | Carotid sheaths and parapharyngeal spaces. |
| Superior | Skull base (clivus). |
| Inferior | Fusion of alar fascia with buccopharyngeal fascia at ~T2 vertebral level. |
Compartments
| True Retropharyngeal Space | • Between buccopharyngeal fascia and alar fascia. • Contains retropharyngeal lymph nodes (Nodes of Rouvière) – drain nasopharynx, adenoids, posterior nasal cavity, middle ear. • Nodes regress after age 4–5 years. | | --- | --- | | Danger Space | • Between alar fascia and prevertebral fascia. • Extends from skull base to diaphragm → major route for infection spread from neck to mediastinum (descending necrotizing mediastinitis). |
| Infections | Retropharyngeal abscess: • Common in children due to suppurative lymphadenitis. • Symptoms: fever, sore throat, dysphagia, stridor, neck stiffness. • Imaging: CT shows rim-enhancing fluid collection with mass effect on airway. • Complications: airway compromise, mediastinitis (via danger space), jugular vein thrombosis, carotid erosion. | | --- | --- | | Neoplasms | • Spread of nasopharyngeal carcinoma, lymphoma, metastases. • Direct invasion from parapharyngeal or vertebral tumors. | | Trauma | Hematomas (e.g., after cervical spine injury or anticoagulation). | | Other | Foreign body migration. Post-surgical or post-intubation infections. |