The deep spaces of the head and neck refer to compartments delimited by the deep cervical fascia. After locating the aforementioned anatomic areas on mr images. Apr 29, 20 the parapharyngeal space is a deep potential neck space, with inverted pyramid in shape and extends from the base of the skull to the hyoid bone below. A bluish cyst was seen anterior to the anterior pillar of left tonsil.
The pps is an inverted pyramid with its base against the skull base and its apex. 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. Salivary gland neoplasms benign to malignant ratio 3. Parapharyngeal dissection for papillary thyroid cancer. Old text books divided this space into prestyloid and post stymoid compartments. Management of parapharyngeal tumors is challenging due to the complex anatomic nature of the space and the wide range of pathologies encountered. Deep neck spaces anatomy of the cervical fascia anatomy of the deep neck spaces relevance to neck infections 3. Parapharyngeal space spatium parapharyngeum is space lateral and dorsolateral to pharynx, medially continues into retropharyngeal space boundaries. Organized by regional anatomy, handbook of head and neck imaging, second edition, will be valuable to radiologists, otolaryngologists, and other medical imaging professionals.
The poststyloid compartment contains the carotid sheath and cervical sympathetic chain. Separation of the masticator space from the parapharyngeal. 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. As seen above, due to the complex anatomy of pps, many surgical approach.
Its borders include the nasopharynx and oropharynx medially, the masticator space anterolaterally, the deep lobe of the parotid gland posterolaterally, and the retropharyngeal space posteromedially fig. The present paper briefly discusses the preoperative evaluation and surgical approaches used in 36 patients. Deep spaces of the head and neck radiology reference. To demonstrate diagnostic approach of pps lesions by using ct and mr techniques. This space is most commonly involved in neck space infections.
A new case of a branchial cyst of the parapharyngeal space. Health, general cysts care and treatment medicine otolaryngology practice pharynx surgery. Pta commonly occurs in adolescents or young adults as a complication of acute tonstillitis. Approaches to the parapharyngeal space plastic surgery key. Deep neckspaces anatomy and infections drahmed bahnassyassistant professor of radiology qassim university 2. 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 imaging anatomy of the parapharyngeal space pps. Contents fat main component trigeminal nerve cn v internal maxillary artery ascending pharyngeal artery. Parapharyngeal definition of parapharyngeal by medical. A combined neurosurgical approach is indicated for tumors.
Infratemporal fossa, masticator space and parapharyngeal. 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. Head and neck clinic, case study by ear, nose and throat journal. The boundaries of the parapharyngeal space are as fol. Anatomy of the parapharyngeal space pps, as depicted by magnetic resonance imaging mri. The importance of the parapharyngeal space also lies in its relationship with the other spaces of the neck. This is part of the throat and, by extension, the digestive system. Peritonsillar abscess and tonsillitis may result in parapharyngeal abscess. Parapharyngeal space is one of potential facial planes for neoplasms and infections and represents less than 1% of all head and neck tumours.
Behind both the parapharyngeal space and carotid space lies the retropharyngeal space, and deep to this a potential space known as the danger space. The parapharyngeal space is often described to be a deep potential neck space shaped as an inverted pyramid. Deep neck infections knowledge for medical students and. An objective description of advantages and limitations of the surgical routes is lacking. The separation of the masticator and parapharyngeal spaces is somewhat ambiguous. The masticator and parotid spaces are located laterally, the pharyngeal mucosal space is. Pdf parapharyngeal space is a suprahyoid neck space.
Approach to masses in head and neck spaces springerlink. Pdf role of imaging in the diagnosis of parapharyngeal space. The base of the pyramid is at the skull base and the apex is at the greater cornu of the hyoid bone. The parapharyngeal space is divided into two compartments by a fascia, which extends from the styloid process to the tensor veli. Title summary field provided by blackwell north america, inc. The diagnosis of tumor in this space is essentially made by understanding the anatomy of this space. The preferred means of accessing the parapharyngeal space in all patients was. A stepbystep logical approach with surgical considerations.
The displacement patterns of pps fat that are essential for accurate diagnosis and appropriate treatment of pathology arising in this region. It has clinical importance in otolaryngology due to parapharyngeal space tumours and parapharyngeal abscess developing in this area. Parapharyngeal space the parapharyngeal space is shaped like a pyramid, inverted with its base at the skull base, with its apex inferiorly pointing to the greater cornu of the hyoid bone. Parapharyngeal space article about parapharyngeal space by. Pdf pleomorphic adenomas of the parapharyngeal space. Transoral endoscopic anatomy of the parapharyngeal space. Parapharyngeal space synonyms, parapharyngeal space antonyms. The parapharyngeal space has also been referred to in the literature as the lateral pharyngeal, peripharyngeal, pharyngomaxillary, pterygopharyngeal, pterygomandibular, and pharyngomasticatory space, and its boundaries have been described with more variation than those of any other space of the neck. 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. It is classed as one of the suprahyoid fascial spaces because it is situated on the lateral aspect of the pharynx and is continuous with the retropharyngeal space posteriorly and the submandibular space anteriorly. Clinically, the styloid process divides the parapharyngeal space into two segments. 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.
To illustrate the radiological anatomy of the parapharyngeal space pps. The international federation of head and neck oncologic societiescurrent concepts in head and neck surgery and oncology 2012 parapharyngeal space tumors jatin p. Access to parapharyngeal space vula university of cape town. Anatomy and common pathology of the parapharyngeal space. Mar 18, 2019 transcervical excision of parapharyngeal and retropharyngeal lymph nodes requires a thorough understanding of the anatomy of the neck and parapharyngeal space, along with a stepwise surgical technique to safely expose the parapharyngeal space. The parapharyngeal space ps is defined as the deepest space in the neck and it consists of the pre and poststyloid regions.
Synonyms for parapharyngeal space in free thesaurus. This article is within the scope of wikiproject anatomy, a collaborative effort to improve the coverage of anatomy on wikipedia. Both benign and malignant tumors may arise from any of the structures contained within the parapharyngeal space pps. Since the introduction of antibiotics, the incidence of parapharyngeal abscess secondary to tonsillitis and peritonsillar abscess has decreased dramatically.
Mid this article has been rated as midimportance on the. Links to movies, ppt slideshows and any other multimedia files are not. 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. It occupies the space between muscles of mastication and the muscles of deglutition. Also known as the lateral pharyngeal or pharyngomaxillary space, the parapharyngeal space is an inverted pyramid shaped. It consists largely of fat, neurovascular structures, and, in. Background the pps is defined as the deepest space in the neck and it consists of the pre. Tumours of the parapharyngeal space are rare lesions. We present five cases of parapharyngeal abscess resulting from tonsillitis and peritonsillar.
Anteriorly and inferiorly this space communicates with the spaces associated with the floor of the mouth. Parapharyngeal space tumors are rare and account for 0. The parapharyngeal space is described as a potential space located in the head and neck, particularly at the pharynx. Anatomical complexity and etiology article pdf available in the medical journal of malaysia 625. Mar 23, 2020 the parapharyngeal space is described as a potential space located in the head and neck, particularly at the pharynx. Parapharyngeal space medical definition merriamwebster.
This article provides a detailed description of the infratemporal fossa and parapharyngeal space anatomy in cadaveric specimens and offers a neurosurgical perspective on a surgical approach that allows wide exposure and complete resection of giant tumors in this location. Parapharyngeal space an overview sciencedirect topics. Treatment of these tumors is surgical through an external neck approach. Tumors of parapharyngeal space iowa head and neck protocols. The anatomy of the parapharyngeal space is described in detail.
The complex anatomy and wide variety of pathology make the management of these tumours very challenging. The parapharyngeal space also termed the lateral pharyngeal space, is a potential space in the head and the neck. Histopathologic classification of parapharyngeal space tumors. The anatomical location of the parapharyngeal space is rather unique. Common differentials of true pps lesions and their imaging features. Branchial cleft cysts extending to the lateral wall of the pharynx are rare. A rare case of large schwannoma of the parapharyngeal space.
Can the radiologist and surgeon speak the same language. Occurrence of the pleomorphic adenoma in the parapharyngeal space is a rarity. The parapharyngeal space extends from the temporal and sphenoid bones of the skull base superiorly to the hyoid bone inferiorly. The pyramid is based in the skull base, and its top extends to the greater horn of the hyoid bone. Anatomic specimens were dissected to define better the fascial layer representing the medial wall of the masticator space. A modified method for locating parapharyngeal space neoplasms on. Zygomatictransmandibular approach for giant tumors of the. Anatomy and common pathology of the parapharyngeal space epos. The involvement of the parapharyngeal space pps and the retropharyngeal space rps poses significant diagnostic and therapeutic problems. The parapharyngeal space is an inverted pyramidshaped area of the deep tissues of the neck. To describe the imaging features of a variety of disease processes that may occur in the pps. An eight year old female child presented with a cystic swelling in the left parotid region.
Written by faculty members and associates from the distinguished department of radiology at the university of utah school of medicine, the handbooks are organized either by disease state or by anatomy. Anatomical relations of presty loid pps and contralateral pleomorphic adenoma, to medial pterygoid, submandi bular salivary gland, and hyoid bone. Deep neck infections include peritonsillar abscess pta, parapharyngeal abscess ppa, and retropharyngeal abscess rpa. Clinical features include fever, sore throat, dysphagia, a hotpotato voice, and trismus. A fascial layer was found extending from the medial pterygoid muscle to the skull base separating the masticator from the parapharyngeal space. The parapharyngeal space pps is a potential space between the skull base above and the hyoid bone below. The book aims to promote exchanges of ideas between practitioners and institutions in the developing world, to promote appropriate. Infections from this space can easily spread to the carotid and retropharyngeal spaces.
The parapharyngeal space pps is a deep space of the neck shaped as a tilted up pyramid with its. 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 treatment of pathology arising in this region. When dynamic scanning is used, diagnostic angiography or digital venous imaging dvi can be avoided in almost all of these cases. This fascial space is also known as the lateral pharyngeal space. This book is distributed under the terms of the creative commons. The pps represents a triangular fatcontaining space lateral to the. 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. An appreciation of the complex anatomy of potential spaces and fascial planes of the neck is vital to understanding lesions and their potential complications. 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. Anatomy, head and neck, retropharyngeal space statpearls. Surgical and ct examinations of 104 patients, each of whom presented with a parapharyngeal space mass, has resulted in the development of an updated ct protocol designed to provide a preoperative diagnosis. Common routes of infections of parapharyngeal space. Health, general pharyngeal diseases care and treatment case studies diagnosis sarcoma throat diseases.
The danger space serves as an important pathway for. Jul 04, 2016 the prestyloid space contains the deep lobe of the parotid, minor salivary gland, parapharyngeal fat pad, and few lymph nodes. A rare parapharyngeal space branchial cleft cyst ncbi. The second of a fourvolume set, this book covers oral cavity and oropharynx pathology. Some spaces cross the hyoid bone and course the entire neck. This anatomical connection between the pharynx and the mediastinum is. Two surgical procedures have been used by the author to treat 44 tumors in the parapharyngeal space. Infection can spread to mediastinum and cause necrotizing mediastinitis pathophysiology 1. Find out what nerves are found in the parapharyngeal space. Any information contained in this pdf file is automatically generated from digital. A benign, mature, parapharyngeal teratoma presenting in an.
New suggested readings have been added to all chapters to refer readers to indepth resources. Lateral and inferior to the parapharyngeal space is the carotid sheath, containing the internal carotid artery and cranial nerves ix, x and xi. Start this article has been rated as startclass on the projects quality scale. Tumors and surgery of the parapharyngeal space olsen. Retropharyngeal and parapharyngeal abscess retropharyngeal abscess background 1. Masses of the parapharyngeal space are most commonly benign 80%. Parapharyngeal space lesions hong kong journal of radiology. It is also a key anatomic landmark for localizing disease processes in the surrounding spaces of. Ms is a fascial lined space containing all four masticator muscles, the posterior body and ramus of mandible and the mandibular nerve. While these concepts overlap with traditional anatomical description, their existence highlights the importance of fascia in confining various patho.
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. Parapharyngeal space anatomy cummings refers to the pps also as the lateral pharyngeal or pharyngomaxillary space. Ct scan showed the cyst extending into left parapharyngeal space. 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 46. We retrospectively studied tumors of the parapharyngeal space treated at the baylor college of medicine affiliated hospital system, houston, from 1972 to 1985. It is an inverse triangle where the base is formed by base of skull, while apex is formed by hyoid bone. Parapharyngeal abscess may cause lifethreatening complications. Tumors of the parapharyngeal space jama otolaryngology. Abstract background several surgical approaches to the parapharyngeal space pps have been proposed. It is classed as one of the suprahyoid fascial spaces because it is situated on the lateral aspect of the pharynx and is continuous with the retropharyngeal space posteriorly and. The parapharyngeal space is shaped like an inverted pyramid. 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.
Pdf transoral endoscopic anatomy of the parapharyngeal. The parapharyngeal space is a deep potential neck space, with inverted pyramid in shape and extends from the base of the skull to the hyoid. Schwannoma of the parapharyngeal space request pdf. Menachem gross, ron eliashar, in orofacial pain and headache, 2008. Its goal is to become a goto signout resource for head and neck pathology, incorporating anatomy, staging, diagnostic, and prognostic information. The latter facilitates differential diagnosis and is used in this article. Mar 16, 2015 find out what nerves are found in the parapharyngeal space on the full version of this video. 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 retropharyngeal space rps is an anatomical region that spans from the. The parapharyngeal space is a potential space located lateral to the upper pharynx and is shaped like an inverted pyramid. The parapharyngeal space is divided into two parts by styloid process and its attachments. The anatomy of the parapharyngeal space is complex. Diagnosis is primarily based on examination of the pharynx, which demonstrates.
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