The former is responsible for providing the face with its deep structures. Imaging of parapharyngeal space lesions focus on the prestyloid compartment ji hoon shin 1, ho kyu lee 1, sang yoon kim 2, choong gon choi 1 and dae chul suh 1. Review and selfassessment module mauricio castillo american journal of roentgenology. Mass lesions originating in the surrounding pharyngeal mucosal, masticator, parotid, and carotid spaces. To describe the imaging features of a variety of disease processes that may occur in the pps. Parapharyngeal space article about parapharyngeal space by. It has clinical importance in otolaryngology due to parapharyngeal space tumours and parapharyngeal abscess developing in this area. Prestyloid muscular compartment medialtonsillar fossa lateralmedial pterygoid contains fat, connective tissue, nodes poststyloid neurovascular compartment carotid sheath cranial nerves ix, x, xi, xii sympathetic chain stylopharyngeal aponeurosis.
The patient was a 32 yr old male with chief complaints of difficulty in swallowing and swelling in the neck since last 4 years. Bs buccal space, ica internal carotid artery, ijv internal jugular vein, ms masticator space, pms pharyngeal mucosal space, pps parapharyngeal space, ps parotid space, pvs prevertebral space, rps retropharyngeal space, sms submandibular space, t torus tubarius. Tumors of parapharyngeal space iowa head and neck protocols. Anatomy of the parapharyngeal space potential space inverted pyramid with floor at skull base, tip at hyoid, and bounded by the pharyngeal wall medially and the mandible2012 laterally 4. Trismus, drooling, dysphagia, and odynophagia also are. We retrospectively studied tumors of the parapharyngeal space treated at the baylor college of medicine affiliated hospital system, houston, from 1972 to 1985. Tumour passing through stylomandibular tunnel to parapharyngeal space arrow indicates styloid process intraoperative location of facial nerve. Parapharyngeal space is a potential space in the neck extending from skull base to the greater cornu of hyoid bone. Graphic representation of the axial spatial anatomy of the suprahyoid neck and the pps. The pharyngeal mucosa of the left lateral pharyngeal wall was effaced owing to mass effect figure, a. Vagal schwannoma in parapharyngeal space anatomical perspective. It is divided in prestyloidand poststyloid compartment by the fascia joining styloid process to tensor veli palatini. This retrospective study over a period of 7 years concerned 16 patients hospitalized in an ent and head and neck surgery department for parapharyngeal abscess. Anatomy, head and neck, retropharyngeal space statpearls.
Branchial cleft cysts are the most common neck masses in adults. Pmspharyngeal mucosal space, psparotid space, smssubmandibular space, slssublingual space, ocoral cavity. The parapharyngeal space is a deep potential neck space, with inverted pyramid in shape and extends from the. The separation of the masticator and parapharyngeal spaces is somewhat ambiguous. Anatomical complexity and etiology med j malaysia vol 62 no 5 december 2007 415 medial displacement of the lateral pharyngeal wall and tonsil is a hallmark of a parapharyngeal space infection. It consists largely of fat, neurovascular structures, and, in some definitions, the. It sits posterior to the buccopharyngeal layer of middle cervical fascia which covers the esophagus and the pharynx and is anterior to the alar fascia. Introduction less then 1% of head and neck neoplasms 7080% are benign radiological imaging very important for diagnosis surgical excision is the primary treatment morbidity of surgery should be considered along with natural history of disease in making a treatment plan. Because serious infections of teeth can spread down this space into the posterior mediastinum, it is often confused with the danger space. Salivary gland neoplasms benign to malignant ratio 3.
The prevertebral space, retropharyngeal space rps and poststyloid pps traverse the neck from the skull base down to the mediastinum. The retropharyngeal space is a potential space of the head and neck, bounded by the buccopharyngeal fascia anteriorly and the alar fascia posteriorly. What is the anatomy of the parapharyngeal space relevant. The parapharyngeal space pps is a complex anatomic space that is commonly described as an inverted pyramid, with the temporal bone located at the base and the hyoid bone at the apex. The parapharyngeal space pps is a space in the suprahyoid neck that contains fat and is surrounded by several other spaces defined by the fascial layers of the neck. The hyoid bone is the main anatomical structure that limits the spread of infection. The parapharyngeal space may be divided into two compartments on the basis of its relationship to the styloid process or, more precisely, to the tensorvascularstyloid fascia fig. Pdf transoral endoscopic anatomy of the parapharyngeal. To study the circumstances of diagnosis, predisposing factors, bacteriology and therapeutic management of parapharyngeal abscesses. The retropharyngeal space rps is an anatomical region that spans from the base of the skull to the mediastinum. A bluish cyst was seen anterior to the anterior pillar of left tonsil. Anatomical complexity and etiology article pdf available in the medical journal of malaysia 625. Retromandibular portion of the deep lobe of the parotid glandthe parotid gland minor or ectopic salivary gland cn v branch to tensor veli palatini musclecn v branch to tensor veli palatini muscle ascending pharyngeal artery and venous plexus most fat. Pps masses are rare, accounting for approximately 0.
Tumors of parapharyngeal space are uncommon,comprising of less than 1% of all head and neck neoplasms. Jul 04, 2016 1 narayana hridayalaya multispeciality, bangalore, india surgical anatomy and pathology the parapharyngeal space is an imaginary space situated lateral to the pharyngeal tube containing vital neurovascular bundles. Lateral and inferior to the parapharyngeal space is the carotid sheath, containing the internal carotid artery and cranial nerves ix, x and xi. Parapharyngeal space cysts, besides salivary gland origin may be derived from the first and dorsal portions of the second pharyngeal pouches. All patients were treated by intravenous antibiotics and steroids for 57 days. Schwannoma is a rare tumor in the parapharyngeal space. Tumors and surgery of the parapharyngeal space olsen.
The parapharyngeal space is a deeply situated space on either side of head. Parapharyngeal space spatium parapharyngeum is space lateral and dorsolateral to pharynx, medially continues into retropharyngeal space boundaries. Contents 1 prestyloid part of parapharyngeal space. It occupies the space between muscles of mastication and the muscles of deglutition. Illustrated anatomical parts with images from e anatomy and descriptions of anatomical structures. Parapharyngeal space parotid space carotid space retropharyngeal space perivertebral space axial graphic of the normal parapharyngeal space at the level of the nasopharynx demonstrates the complex fascial margins and the fatonly contents. A thyroid tumor extending to the parapharyngeal space bmc. Due to the complex anatomy of this region, they are often managed by head and neck surgeons. Pdf lymphatic malformation of the parapharyngeal space. Eighty percent of the parapharyngeal space neoplasms were benign.
Management of parapharyngeal space cysts the journal of. The medial and lateral pterygoid plates were removed. This article presents the spatial anatomy of the pps and describes the displacement patterns of the pps fat that are essential for accurate diagnosis and appropriate. The parapharyngeal space is shaped like an inverted pyramid. The parapharyngeal space was accessed endonasally by removal of the medial and posterior walls of the maxillary sinus. Schwannoma originating from the peripheral nerves is a rare lesion of the parapharyngeal space. Anatomic specimens were dissected to define better the fascial layer representing the medial wall of the masticator space. Between buccinator muscle and masseter muscle, inferior to zygomatic arch, superior to mandible. Ct scan showed the cyst extending into left parapharyngeal space. The parapharyngeal space also termed the lateral pharyngeal space, is a potential space in the head and the neck. The parapharyngeal space is a potential space occupied by adipose tissue, cranial nerves v, ix, xi, and xii, the deep cervical lymph nodes, and the ascending pharyngeal and maxillary arteries. The metastasis of papillary thyroid carcinoma to the parapharyngeal space is rare and discussed in the english literature before. The parapharyngeal space also termed the lateral pharyngeal space or prestyloid parapharyngeal space, shaped like a cone or a pyramid, inverted with its base at the sphenoid bone, with its apex inferiorly pointing to the greater cornu of the hyoid bone.
The case presented here is a 22yearold woman who was referred to our clinic with complaints of painless neck mass, dysphagia and. Understanding the anatomy of the parapharyngeal space is important to understand the advantages, limitations, and risks of the different surgical approaches to the parapharyngeal space. Fiftyseven percent 3154 were of neurogenic origin, 30% 1654 were of salivary origin, and % 754. May 11, 2020 the retropharyngeal space is a fascial space that transverses the length of the neck in its entirety. Anatomy and common pathology of the parapharyngeal space. Management of parapharyngeal and retropharyngeal space infections. Identify hypoglossal nerve, vagus nerve, carotid artery and internal jugular vein before tumour dissection. Apr 02, 2017 the parapharyngeal space pps is a space in the suprahyoid neck that contains fat and is surrounded by several other spaces defined by the fascial layers of the neck. Parapharyngeal space definition of parapharyngeal space by.
Separation of the masticator space from the parapharyngeal. Tumors in the parapharyngeal space pps are uncommon, 1 4 accounting for only 0. A determination of the optimal approach to the parapharyngeal space, known as surgical access is most often performed through a standard parotid approach. The special traits of the presented case included the following. Case example deep lobe parotid tumor parapharyngeal space pleomorphic adenoma pleomorphic adenoma. Imaging approach is discussed in terms of the effect it has on differential diagnosis and diagnosis by the otolaryngologist. These lesions could be classified as being either hypervascular glomus tumors or metastatic kidney, thyroid, or venous hemangiomas or hypovascular salivary gland tumors, neurogenic tumors, lymphomas, sarcomas. Behind both the parapharyngeal space and carotid space lies the retropharyngeal space, and deep to this a potential space known as the danger. Lecturer of radiodiagnosis slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. In most cases, these abscesses arise as a consequence of a severe tonsil, throat, or respiratory tract infection. Trismus, drooling, dysphagia, and odynophagia also are observed commonly. To illustrate the radiological anatomy of the parapharyngeal space pps. Excision of tumors in the parapharyngeal space using an.
Comm w canine space, pterygomandibular space, and space of body of mandible. It is also a key anatomic landmark for localizing disease processes in the surrounding spaces of the neck. The authors present imaging anatomy of the parapharyngeal space. Branchial cleft cysts extending to the lateral wall of the pharynx are rare. Approximately 70% to 80% of tumors originating from the pps are benign. Abscesses provide a space for bacteria to thrive and potentially spread to nearby blood vessels and lymph nodes. Trismus, drooling, dysphagia, and odynophagia are also commonly observed. Postpharyngeal space definition of postpharyngeal space by. Our series consists of 12 patients with parapharyngeal space schwannomas. The facial nerve is usually explored by prograde dissection. A detailed understanding of the anatomy of the neck and the propagation of infection between neck spaces is imperative when formulating a safe and successful treatment plan. Prestyloid compartment masticator space fat retromandibular parotid lymph nodes2012. A parapharyngeal abscess is a collection of infected, swollen, inflamed tissue deep within the neck.
Anatomical relations of presty loid pps and contralateral pleomorphic adenoma, to medial pterygoid, submandi bular salivary gland, and hyoid bone. Partially covered by platysma muscle, contains buccal fat pad. Medical definition of parapharyngeal space merriamwebster. The schwannoma arose from the cervical sympathetic chain in 5 patients, and the vagus was the nerve of origin in 7 patients. A stepbystep logical approach with surgical considerations. The pharynx is a 5 inches long tube which runs behind the nasal cavity, the oral cavity and into the upper esophagus and respiratory tract. Anatomy of the parapharyngeal space potential space inverted pyramid with floor at skull base, tip at hyoid, and bounded by the pharyngeal wall medially and the mandible2012 laterally. A 27yearold female patient reported with a swelling in the throat and difficulty in swallowing of 6 months duration. Tumors of the parapharyngeal space pps, a potential space lateral to the upper pharynx, are uncommon, comprising less than 1% of all head and neck neoplasms. Parapharyngeal space is divided by styloid septum, which runs from stylohyoid lig. Mr, ct, head and neck, anatomy, education, abscess.
Background the pps is defined as the deepest space in the neck and it consists of the pre. Both benign and malignant tumors may arise from any of the structures contained within the parapharyngeal space pps. Tumors of the parapharyngeal space jama otolaryngology. Parapharyngeal space an overview sciencedirect topics. The importance of the parapharyngeal space also lies in its relationship with the other spaces of the neck. As fatty areolar tissue is the main component of the retropharyngeal space, it has a density consistent with fat on ct and a signal consistent with fat on mri. The masticator and parotid spaces are located laterally, the pharyngeal mucosal space is. To allow better visualization and increased triangulation of a bimanual dissection technique, a sublabial canine fossa antrostomy was created. Feb 14, 2017 anatomy of neck spaces and levels of cervical lymph nodes by dr. Because primary parapharyngeal space tumors are rare, it is difficult to obtain surgical experience in this region. It is continuous with the parapharyngeal space anteriorly and the sublingual space. It is an inverse triangle where the base is formed by base of skull, while apex is formed by hyoid bone. Parapharyngeal space mass laryngology jama otolaryngology.
Due to the complexity of the anatomy of the parapharyngeal space, which contains the carotid artery and numerous cranial nerves, surgical planning is vital. Parapharyngeal space tumors institute for head, neck and. The parapharyngeal space is shaped like an inverted pyramid, with its base at the skull base, with its apex. Parapharyngeal space radiology reference article radiopaedia.
Mostly these cysts arise from second branchial cleft and occur in the neck, anterior to the sternocleidomastoid muscle at the mandibular angle. Sep 05, 2019 tumors of the parapharyngeal space pps, a potential space lateral to the upper pharynx, are uncommon, comprising less than 1% of all head and neck neoplasms. The lesion caused loss of the fat plane between the parapharyngeal space and masticator space with subsequent inflammation of the pterygoid space. Medial displacement of the lateral pharyngeal wall and tonsil is a hallmark of a parapharyngeal space infection. Access to parapharyngeal space vula university of cape town. Even malignant parapharyngeal space tumors can be asymptomatic for a longer time, and even large tumors only produce unspecific symptoms. An eight year old female child presented with a cystic swelling in the left parotid region.
This is part of the throat and, by extension, the digestive system. May 01, 2020 the parapharyngeal space is described as a potential space located in the head and neck, particularly at the pharynx. Multiple approaches have been described in the literature for the extirpation of these tumors. The latter is notable for ascending a side of the pharynx, as well as originating in the external carotid artery, a major blood vessel of the neck and head. Deep neck space infections involving the parapharyngeal space ppsor retropharyngeal space rps are potentially lifethreatening conditions.
Encountering a parapharyngeal mass with cystic appearance on imaging, one should rule out thyroid malignancy as differential diagnosis. The retropharyngeal space is a potential space of the head and neck, bounded by the buccopharyngeal fascia anteriorly and the alar fascia posteriorly it contains the retropharyngeal lymph nodes because serious infections of teeth can spread down this space into the posterior mediastinum, it is often confused with the danger space. Clinical assessment of lesions in this space in very difficult. The retropharyngeal space appears as a small, roughly rectangular space on axial imaging, wider in the mediolateral dimension and thinner in the anteroposterior dimension.
To demonstrate diagnostic approach of pps lesions by using ct and mr techniques. Neoplastic and congenital lesions are discussed along with other neck diseases occurring in this space. The danger space is actually between the alar fascia and the. General anatomy regions of human body regions of head deep spaces of face and neck parapharyngeal space. Transoral endoscopic anatomy of the parapharyngeal space. The prestyloid space contains ectopic salivary tissue, while the poststyloid contains carotid arteries, internal jugular vein. The retropharyngeal space is a potential space which is directly related to the danger space, the pharyngeal mucosal space, the carotid space and the parapharyngeal space. Oct 09, 2012 outline anatomy pathology clinical evaluation imaging with ct, mri, angiography2012 surgical treatment 3. Parapharyngeal space tumors are rare and account for 0. Find out what nerves are found in the parapharyngeal. Diagnosis and treatment considerations of parapharyngeal. Peripharyngeal space spatium peripharyngeum anatomical parts. Tumors of the parapharyngeal space, although mostly benign in their histopathology, present a challenge to the surgeon due to the limited access.
May 11, 2020 the fascial spaces are theoretical spaces that are created between the layers of the deep cervical fascia and are filled with loose areolar connective tissue. Ct scanning and mri investigations is complimentary and. Price, 2016bozza, 2009 inverted pyramid space, base centered on small portion of temporal bone, and the apex at the greater cornu of the hyoid bone. A rare case of large schwannoma of the parapharyngeal space. A fascial layer was found extending from the medial pterygoid muscle to the skull base separating the masticator from the parapharyngeal space. Clinical examination revealed a welldefined solitary mass of size 4. It consists largely of fat, neurovascular structures, and, in some definitions, the retromandibular part of the deep lobe of the parotid gland. They are mucosal or epithelial lined structures with no external or visceral opening and always present on the lateral aspects of the nasopharyngeal wall. If involved in infectiondue to maxillary molarspremolars. The parapharyngeal space, also known as the prestyloid parapharyngeal space, is a deep compartment of the head and neck around which most other suprahyoid fascial spaces are arranged. The imaging findings, the neuroradiologists predicted nerve of origin, and the operatively determined nerve of origin are listed in the table. A dislocated lateral pharyngeal wall with mild inflammatory changes of the oropharyngeal mucosa was observed during.