The parapharyngeal space (also termed the lateral pharyngeal space), is a

potential space In anatomy, a potential space is a space between two adjacent structures that are normally pressed together (directly apposed). Many anatomic spaces are potential spaces, which means that they are potential rather than realized (with their realiz ...

in the head and the neck. It has clinical importance in

otolaryngology Otorhinolaryngology ( , abbreviated ORL and also known as otolaryngology, otolaryngology–head and neck surgery (ORL–H&N or OHNS), or ear, nose, and throat (ENT)) is a surgical subspecialty within medicine that deals with the surgical an ...

due to parapharyngeal space tumours and

parapharyngeal abscess A parapharyngeal abscess is a deep neck space abscess of the parapharyngeal space (or pharyngomaxillary space), which is lateral to the superior pharyngeal constrictor muscle and medial to the masseter muscle. This space is divided by the stylo ...

developing in this area. It is also a key anatomic landmark for localizing disease processes in the surrounding spaces of the neck; the direction of its displacement indirectly reflects the site of origin for masses or infection in adjacent areas, and consequently their appropriate differential diagnosis.

Anatomical boundaries

The parapharyngeal space is shaped like an inverted pyramid. Lateral and inferior to the parapharyngeal space is the

carotid sheath The carotid sheath is a condensation of the deep cervical fascia enveloping multiple vital neurovascular structures of the neck, including the common and internal carotid arteries, the internal jugular vein, the vagus nerve (CN X), and ansa c ...

, containing the

internal carotid artery The internal carotid artery is an artery in the neck which supplies the anterior cerebral artery, anterior and middle cerebral artery, middle cerebral circulation. In human anatomy, the internal and external carotid artery, external carotid ari ...

and

cranial nerves Cranial nerves are the nerves that emerge directly from the brain (including the brainstem), of which there are conventionally considered twelve pairs. Cranial nerves relay information between the brain and parts of the body, primarily to and f ...

IX, X and XI. Behind both the parapharyngeal space and carotid space lies the

retropharyngeal space The retropharyngeal space (abbreviated as "RPS") is a potential space and deep compartment of the head and neck situated posterior to the pharynx. The RPS is bounded anteriorly by the buccopharyngeal fascia, posteriorly by the alar fascia, and l ...

, and deep to this a potential space known as the

danger space The danger space or alar space, is a region of the neck. The common name originates from the risk that an infection in this space can spread directly to the thorax, and, due to being a space continuous on the left and right, can furthermore allow ...

. The danger space serves as an important pathway for complicated infections of the posterior pharynx to enter the chest and spinal column. Anterior to the parapharyngeal space is the

masticator space Fascial spaces (also termed fascial tissue spaces or tissue spaces) are potential spaces that exist between the fasciae and underlying organs and other tissues. In health, these spaces do not exist; they are only created by pathology, e.g. the spre ...

which contains the lower dental row, muscles of mastication, the

inferior alveolar nerve The inferior alveolar nerve (IAN) (also the inferior dental nerve) is a sensory branch of the mandibular nerve (CN V3) (which is itself the third branch of the trigeminal nerve (CN V)). The nerve provides sensory innervation to the lower/mandibu ...

as well as branches of cranial nerve V. Lateral to the parapharyngeal space lies the parotid space, which contains the parotid gland, the

external carotid artery The external carotid artery is the major artery of the head and upper neck. It arises from the common carotid artery. It terminates by splitting into the superficial temporal and maxillary artery within the parotid gland. Structure Origin T ...

and

cranial nerve VII The facial nerve, also known as the seventh cranial nerve, cranial nerve VII, or simply CN VII, is a cranial nerve that emerges from the pons of the brainstem, controls the muscles of facial expression, and functions in the conveyance of tast ...

. Although initial evaluation is typically by physical exam and

endoscopy An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...

, follow up with CT and

MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and rad ...

usually is needed if surgical intervention is planned.

Bony Bony may refer to: * Adjective relating to bone People * Bony Dashaco, Cameroonian businessman * Bony King, Belgian singer-songwriter * Bony Pierre (born 1991), Haitian footballer * Bony Ramirez (born 1996), Dominican-born American painter and ...

anatomy around the space includes the skull base superiorly, and the

greater cornu The hyoid-bone (lingual-bone or tongue-bone) () is a horseshoe-shaped bone situated in the anterior midline of the neck between the chin and the thyroid-cartilage. At rest, it lies between the base of the mandible and the third cervical verteb ...

(or greater horns) of the hyoid bone the apex, inferiorly. The superior aspect is the

base of skull The base of skull, also known as the cranial base or the cranial floor, is the most Anatomical terms of location#Superior and inferior, inferior area of the human skull, skull. It is composed of the endocranium and the lower parts of the Calvaria ...

, namely the sphenoid and

temporal bone The temporal bone is a paired bone situated at the sides and base of the skull, lateral to the temporal lobe of the cerebral cortex. The temporal bones are overlaid by the sides of the head known as the temples where four of the cranial bone ...

s. This area includes the

jugular The jugular veins () are veins that take blood from the head back to the heart via the superior vena cava. The internal jugular vein descends next to the internal carotid artery and continues posteriorly to the sternocleidomastoid muscle. Struc ...

and

hypoglossal canal The hypoglossal canal is a foramen in the occipital bone of the skull. It is hidden medially and superiorly to each occipital condyle. It transmits the hypoglossal nerve. Structure The hypoglossal canal lies in the epiphyseal junction between ...

and the

foramen lacerum The foramen lacerum () is a triangular hole in the base of the skull. It is located between the sphenoid bone, the apex of the petrous part of the temporal bone, and the basilar part of the occipital bone. Structure The foramen lacerum () is a ...

(through which the internal carotid artery passes superiorly across). The medial aspect is made up of the

pharynx The pharynx (: pharynges) is the part of the throat behind the human mouth, mouth and nasal cavity, and above the esophagus and trachea (the tubes going down to the stomach and the lungs respectively). It is found in vertebrates and invertebrates ...

. Anteriorly it is bordered by the

pterygomandibular raphe The pterygomandibular raphe (pterygomandibular fold or pterygomandibular ligament) is a thin tendinous band of buccopharyngeal fascia. It is attached superiorly to the pterygoid hamulus of the medial pterygoid plate, and inferiorly to the poster ...

. Posteriorly it is bordered by carotid sheath posteriolaterally and the retropharyngeal space posteriomedially. The lateral aspect is more involved, and is bordered by the ramus of the mandible, the deep lobe of the

parotid gland The parotid gland is a major salivary gland in many animals. In humans, the two parotid glands are present on either side of the mouth and in front of both ears. They are the largest of the salivary glands. Each parotid is wrapped around the m ...

, the medial pterygoid muscle, and below the level of the mandible, the lateral aspect is bordered by the fascia of the posterior belly of

digastric The digastric muscle (also digastricus) (named ''digastric'' as it has two 'bellies') is a bilaterally paired suprahyoid muscle located under the jaw. Its posterior belly is attached to the mastoid notch of temporal bone, and its anterior belly ...

muscle. These anatomical boundaries make it continuous with the

. It also communicates with other cervical and cranial fascial spaces, as well as the

mediastinum The mediastinum (from ;: mediastina) is the central compartment of the thoracic cavity. Surrounded by loose connective tissue, it is a region that contains vital organs and structures within the thorax, mainly the heart and its vessels, the eso ...

Divisions

The parapharyngeal space is divided into 2 parts by the fascial condensation called the aponeurosis of Zuckerkandl and Testut (stylopharyngeal fascia - see diagram), joining the styloid process to the

tensor veli palatini The tensor veli palatini muscle (tensor palati or tensor muscle of the velum palatinum) is a thin, triangular muscle of the head that tenses the soft palate and opens the Eustachian tube to equalise pressure in the middle ear. Structure The te ...

. These two compartments are named the pre-styloid and post-styloid (retrostyloid) compartments or spaces. However, some classification schemes call the pre-styloid compartment the parapharyngeal space and the post-styloid compartment the carotid space, which can be a source of confusion.

It includes the

maxillary artery The maxillary artery (eg, internal maxillary artery) supplies deep structures of the face. It branches from the external carotid artery just deep to the neck of the mandible. Structure The maxillary artery, the larger of the two terminal branches ...

and

ascending pharyngeal artery The ascending pharyngeal artery is an artery of the neck that supplies the pharynx. Its named branches are the inferior tympanic artery, pharyngeal artery, and posterior meningeal artery. inferior tympanic artery, and the meningeal branches (i ...

. # Glossopharyngeal nerve (IX) # Vagus nerve (X) together with # Internal carotid artery # Internal jugular vein in the carotid sheath # Accessory nerve (XI) # Hypoglossal (XII) # Sympathetic trunk and

superior cervical ganglion The superior cervical ganglion (SCG) is the upper-most and largest of the cervical sympathetic ganglia of the sympathetic trunk. It probably formed by the union of four sympathetic ganglia of the cervical spinal nerves C1–C4. It is the only ...

of the trunk # Ascending pharyngeal artery # Deep cervical lymph nodes

Clinical significance

First bite syndrome is a rare complication of a surgery involving the parapharyngeal space, especially removal of the deep lobe of the parotid gland. It is characterized by facial pain after the first bite of each meal, and is thought to be caused by autonomic dysfunction of salivary myoepithelial cells.

References

Bibliography

* * {{Authority control Fascial spaces of the head and neck Human throat

Anatomical boundaries

Divisions

Contents

Clinical significance

References

Bibliography