The Parapharyngeal Space

  • The parapharyngeal space:
    • Also known as the:
      • Prestyloid parapharyngeal space:
        • Is one of the seven deep compartments of the head and neck
  • It consists largely of:
    • Fatty areolar tissue
    • Contains branches of the:
      • Trigeminal nerve
    • Deep blood vessels
  • Two naming conventions exist in the literature:
    • In the first definition:
      • Familiar to most head and neck surgeons, the parapharyngeal space is divided into:
        • The prestyloid compartment and
        • Poststyloid (retrostyloid) compartment
    • In the second definition:
      • Introduced by some radiologists:
        • The prestyloid parapharygeal space is simply termed:
          • The parapharyngeal space, and
        • The poststyloid pharapharygeal space is termed:
          • The carotid space
  • Gross anatomy:
    • The parapharyngeal space:
      • Is shaped like a pyramid:
        • An inverted pyramid with:
          • Its base:
            • At the skull base
          • Its apex:
            • Inferiorly:
              • Pointing to the greater cornu of the hyoid bone
    • Contents:
      • Fat:
        • Main component
      • Deeps blood vessels:
        • Internal maxillary artery
        • Ascending pharyngeal artery
        • Pterygoid venous plexus:
          • Only small portion:
            • Because it is mainly within:
              • The masticator space
      • Nerve:
        • Small branch of the mandibular division of the trigeminal nerve (cranial nerve V):
          • Supplying the tensor veli palatini muscle
      • Salivary glands – depends on the definition:
        • Some say that it contains no salivary glands, others
        • Minor or ectopic salivary gland / rests
        • Retromandibular portion of the deep lobe of parotid gland
      • Lymph nodes
  • Boundaries:
    • The parapharyngeal space has complex fascial margins:
      • Occupying the space between the muscles of mastication and the muscles of deglutition:
        • Superior margin:
          • Base of skull
        • Inferior margin:
          • Greater cornu of the hyoid bone:
            • Although some state the space functionally ends higher:
              • With the styloglossus muscle:
                • At the level of the angle of the mandible
        • Medial margin:
          • Middle (pretracheal) layer of the deep cervical fascia:
            • Covering the:
              • Superior pharyngeal constrictor
              • Levator palatini muscle and
              • Tensor veli palatini muscle
        • Lateral margin:
          • Investing fascia (superficial layer) of the deep cervical fascia:
            • Covering the deep lobe of the parotid
        • Anterior margin:
          • Investing fascia (superficial layer) of the deep cervical fascia:
            • Covering the medial pterygoid muscle
        • Posterior margin:
          • Prevertebral layer of the deep cervical fascia
  • Relations:
    • Medial:
      • To the masticator space
    • Lateral:
      • To the pharyngeal mucosal space
    • Anterior:
      • To the prevertebral space
    • Posterior:
      • To the medial pterygoid

#Arrangoiz #HeadandNeckSurgeon #CancerSurgeon #SurgicalOncologist #Teacher

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