Layer Of Deep Cervical Fascia Research Articles

Deep cervical fascia as an anatomical landmark of lingual lymph nodes: An anatomic and histologic study

ObjectivesWe aimed to discuss the definition of lingual lymph nodes based on the deep cervical fascia anatomy. MethodsA total of 11 cadavers were histopathologically evaluated. Specimens were dissected into serial stepwise cross-sections. The deep cervical fascia and lymph nodes were evaluated by staining the cross-sections with Elastica van Gieson and hematoxylin and eosin stains, respectively. The gross anatomy of the deep cervical fascia was evaluated in 1 cadaver after bilateral dissection. ResultsA single severely degenerated medial lingual lymph node (MLLN) was identified in the lingual septum of 1 cadaver. A single lateral lingual lymph node (LLLN) was identified in 1 cadaver, between the genioglossus and the hyoglossus. The superficial layer of deep cervical fascia (SLDF) was found to split into two layers encapsulating the submandibular gland. The deeper portion of this fascia was in close contiguity with the hyoglossus and formed the boundary between the mouth and the neck. The SLDF was found to be discontinuous with the area between the sublingual space and the submandibular gland. ConclusionsThe SLDF could serve as an anatomical landmark for lingual lymph nodes, since it is considered to be the demarcating boundary during neck dissection. When lymph nodes that are located deeper than the SLDF were defined as lingual lymph nodes, 1 MLLN and 1 LLLN were identified.

Duraplasty with Cervical Fascia Autograft to Reduce Postoperative Complications of Posterior Fossa Tumor Surgery with Suboccipital Midline Approach

The suboccipital midline approach is common dealing with posterior fossa tumors but has a high risk of postoperative complications, such as pseudomeningocele, cerebrospinal fluid (CSF) leak, and meningitis. Neurosurgeons used various kinds of method to lower its rate. A retrospective, single-center review of patients diagnosed with posterior fossa tumor underwent a suboccipital midline approach. Compare the rates of pseudomeningocele, CSF leak, and meningitis between 2 groups (artificial dura mater or cervical fascia autograft). We get the cervical fascia autograft from the superficial layer of deep cervical fascia just above the trapezius. Our retrospective review involved 123 patients matching the inclusion criteria between January 2009 and April 2019. The complication rate of pseudomeningocele, CSF leak and meningitis were 8.9%, 4.9%, and 17.9%, respectively. The presence of pseudomeningocele or CSF leak for group "artificial" was 11 of 75 (14.67%) and for group "autograft" it was 3 of 48 (6.25%). The rate of meningitis for group "artificial" (24.0%, 18 of 75) was significantly higher (P= 0.027) than the one for group "autograft" (8.33%, 4 of 48). Multivariate regression analysis suggested that the age was negatively correlated with postoperative pseudomeningocele or CSF leak (P= 0.006), with meningitis (P < 0.001). Using cervical fascia autograft decreased the rate of meningitis (P= 0.021) while showing no statistically significant clinical impact on pseudomeningocele or CSF leak. Applying the cervical fascia autograft to reconstruct the dura during posterior fossa surgery is a simple and effective method to reduce the rate of meningitis as compared with artificial dura mater.

PARAPHARYNGEAL AND RETROPHARYNGEAL SPACES: NORMAL ANATOMY AND CASE DISCUSSION

<h3>Background</h3> 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 involvement of the parapharyngeal space (PPS) and the retropharyngeal space (RPS) poses significant diagnostic and therapeutic problems. The PPS extends from the skull base to the superior cornu of the hyoid bone, connecting posteromedially with the retropharyngeal space, inferiorly with the submandibular space, and laterally with the masticator space. The carotid sheath courses through this space into the chest. RPS lies between the visceral division of the middle layer of the deep cervical fascia around the pharyngeal constrictors and the alar division of the deep layer of deep cervical fascia posteriorly. PPS contains mainly fat and the pterygoid venous plexus, whereas the RPS contains retropharyngeal lymphatics. <h3>Clinical and Radiologic Findings</h3> We outline the normal anatomy of the PPS and the RPS on images derived from cone beam computed tomography (CBCT), medical computed tomography (CT), and magnetic resonance imaging (MRI) data sets. Then we present unique case studies exhibiting pharyngeal retention cyst in the tonsil, Tornwaldt cyst in the nasopharynx, nasopharyngeal carcinoma with invasion of the PPS, incidental retropharyngeal internal carotid arteries that can be mistaken for a pseudomass, large goiter with retropharyngeal extension, retropharyngeal air in barotrauma, and retropharyngeal lymphadenopathy occupying the PPS. <h3>Discussion/Conclusions</h3> Displacement of the PPS laterally implicates a lesion in the pharyngeal mucosa posteriorly, the masticator space anteriorly, and the carotid space anterolaterally. Medial displacement implies that the lesion resides in the parotid space. Infection may enter the retropharyngeal airspace directly, as with traumatic perforations of the posterior pharyngeal wall or esophagus, or indirectly, from the parapharyngeal space A fundamental skill set is required for the diagnosis and management of these potentially life-threatening illnesses.

Direct Drop-Down Anterior Approach to Subaxial Cervical Spine

Background: Subaxial cervical spine comprises C3-C7 levels. Southwick and Robinson’s is most commonly used surgical approach for subaxial cervical spine. We are describing a new technique of approaching cervical vertebrae using same planes as in classical approach by Southwick and Robinson. Material and Methods: A total of 35 cases with cervical spine pathologies requiring anterior cervical approach were included in the study. Patients requiring posterior based surgeries, &gt;2-disk level anterior exposure and with history of any previous anterior based cervical spine surgery were excluded from the study. Surgical Technique: The patients were positioned supine on operating table. A 3 cm transverse skin incision is given starting from midline and extending laterally at desired vertebral level. Langenbeck’s retractor of appropriate size is used by surgical assistant to apply gentle constant lateral traction on trachea. The esophagus being invaginated by same pretracheal layer of deep cervical fascia, moves along with trachea. Soft tissue is bluntly dissected with peanut sponge. Steps are repeated till vertebra is reached. Result: Of the 35 cases included in the study, maximum cases (19) were traumatic cervical spine fractures. The average surgical time, intraoperative blood loss in negative suction drains, postoperative hospital stays in this group of cohort was similar to the cohort in which typical traditional approach was used. Discussion: Perceived advantages include—smaller skin incision, less chances to damage carotid sheath and its contents, safe, easy and less time-consuming technique, cosmetically better due to smaller incision size along Langer’s lines.

Anatomic Relationship Between Right Recurrent Laryngeal Nerve and Cervical Fascia and Its Application Significance in Anterior Cervical Spine Surgical Approach.

An anatomic study of anterior cervical dissection of 42 embalmed cadavers. The aim was to study the anatomic relationship between recurrent laryngeal nerve (RLN) and cervical fascia combined with the requirements in anterior cervical spine surgery (ACSS). There has been no systematic research about how to avoid RLN injury in anterior cervical spine surgical approach from the aspect of the anatomic relationship between RLN and cervical fascia. Forty-two adult cadavers were dissected to observe the relationships between RLN and different cervical fascia layers. RLN pierced out the alar fascia from the inner edge of the carotid sheath in all cases, and the piercing position in 22 cases (52.4%) was located at the lower segment of T1. The enter point into visceral fascia of RLN was located at C7-T1 in 25 cases (59.5%). The middle layer of deep cervical fascia exhibited the most stable anatomic relationship with RLN at the carotid sheath confluence site. Pulling visceral sheath leftwards would significantly increase the RLN tension. Using the close and stable relationship between RLN and cervical fascia could help to avoid RLN injury in anterior cervical spine surgical approach. 4.

Non responding Ludwig’s angina due to starvation and PEM: review of literature and a case report

&lt;p class="abstract"&gt;&lt;span lang="EN-IN"&gt;Relationship between starvation and immunosuppression was initially suggested on the basis of increased rate of infectious disease during famine. Latter on this was confirmed by thorough studies of immune response in starved and malnourished patients. There are numerous defense mechanisms to protect human host from infection. Starvation leads to immunosuppression due to its damaging effects over these defense mechanisms, thereby increasing chance of opportunistic infections e.g. Ludwig’s angina. Not only this, it also alters the natural course and drug response of disease. Ludwig’s angina is infection of submandibular space which lies between mucous membrane of floor of mouth on one side and superficial layer of deep cervical fascia on other. It is surgical emergency that is potentially life threatening unless early recognized and aggressively treated. Although most reported cases follow an odontogenic infection, it can occur in persons with no co-morbid disease and individuals with starvation and protein energy malnutrition also are at increased risk of developing it due to immunosuppression. Here we report a case of female who was starved for 14 days as she fell in well and presented with Ludwig’s angina, resistant to standard treatment protocol. The aim of this paper was to review literature supporting relationship between starvation and immunosuppression and present a case of starved female presenting with Ludwig’s angina resistant to treatment. We emphasize about the proper history tacking after counselling in cases resistant to treatment. It is important to assess the nutritional status of the patient in every case of Ludwig’s angina. This is important because Ludwig’s angina associated with other etiologies also develop restricted mouth opening thereby decreasing oral intake which further leads to nutritional deficiency and PEM.&lt;/span&gt;&lt;/p&gt;

Treatment and prognosis of deep neck infections.

Deep neck infections could have serious threats for life of patients, if not noticed adequately. Early diagnosis and correct treatment planning can save the patient's lives and prevent complications of disease extension and also surgical procedures that in some instances may be performed in an emergent situation with higher complication rates. Herein, we have studied 815 cases of deep neck abscesses and infections with especial consideration to treatment and prognosis. In a retrospective case review, we studied 815 cases admitted in our medical center from 1998 until the year 2013. Only patients with abscesses or infections deeper than superficial layer of deep cervical fascia were included in this study, based on the review of their medical records. From 815 cases (485 males and 330 females) surgery was indicated and performed in 428 cases and the rest were treated medically. In cases with dental infections as the etiologic factor, dental procedures were performed as early as possible (extraction in almost all cases). Tracheostomy was performed in five cases. All of the patients in medical treatment group and most of the surgically managed patients were discharged while were stable with relative or complete resolution of their symptoms. One of our patients, a 15year old boy died with symptoms suggestive for mediastinitis and air way compromise. Early diagnosis and medical management can be effective in treating deep neck infections. Dental infections and also procedures are the major cause in our patients, although tonsillitis and peritonsillar abscess also were important leading causes with almost equal numbers in our series. Extraction of the infected tooth as early as possible while medical treatment is continued can be very helpful. In some cases it may be necessary to perform surgical exploration of the neck more than once, and finally, malignant neoplasia, somewhere in the head and neck should be considered in some cases, as in one of our patients with left side submandibular abscess whose underlying disorder was tongue SCC with neck metastasis. Prognosis can be excellent in both medically and surgically managed groups if started and designed early and promptly.

Esthetic and functional surgery and reconstruction after oral cancer ablation

Oral cancer ablation surgery results in tissue defects with functional loss. Accompanying neck dissection results in facial nerve weakness and dysmorphic changes. To minimize the complications after oral cancer surgery, accurate dissection without damaging facial nerve and vital structures are mandatory. Marginal mandibular branch of facial nerve should be dissected or contained in the superficial layer of deep cervical fascia to minimized facial palsy after operation. Reconstruction after cancer ablations is routine procedures and free flap reconstruction is the most commonly used. Radial forearm free flap is the most versatile flap to reconstruct soft tissue defects and it is easy to design according to the defect size and shape. However, donor site scar and secondary skin graft from thigh result in unesthetic and cumbersome wounds. Double layered collagen graft in the donor site could reduce secondary donor site for skin graft. In conclusion, oral and maxillofacial surgeon should know the exact anatomy of the face and neck during neck dissection. Radial forearm free flap is most versatile flap for soft tissue reconstruction and double collagen graft can reduce postoperative scar and there is no need for secondary skin graft.

English

The thyroid gland is brownish-red and highly vascular gland which is placed anteriorly in the neck at the level of fifth cervical to the first thoracic vertebrae and is covered by the pre- tracheal layer of the deep cervical fascia. It has two lateral lobes which are connected by a narrow median isthmus giving an 'H' shaped appearance to the gland. Congenital malformations and morphological variations of the thyroid gland are commonly reported in literature which has numerous clinical and surgical implications. In this case absence of isthmus was observed during routine dissection of a 60 yrs old male cadaver. The lateral lobes were positioned normally and a pyramidal lobe attached to the left lobe was seen. Moreover levator glandulae thyroideae extending from the hyoid bone to the apex of the pyramidal lobe was also observed. Agenesis of isthmus or presence of pyramidal lobe usually has no impact on thyroid functions and can be diagnosed by scintigraphy, ultrasonography, CT scan and MRI. However if the diagnoses is made during routine imaging or accidently, the patient must be thoroughly screened for other associated thyroid anomalies like autonomous thyroid nodule, thyroiditis, primary carcinoma, infiltrative diseases like amyloidoses etc. INTRODUCTION: The thyroid gland, brownish-red and highly vascular, is a palpable endocrine gland placed anteriorly in the neck and its position extends from the fifth cervical to the first thoracic vertebrae. It is covered by the pre-tracheal layer of deep cervical fascia. The two lobes are connected by a narrow median isthmus. The normal size of each lobe of the thyroid gland has been described to be 5 cm long, its greatest transverse and antero-posterior extent being 3 cm and 2 cm respectively. The isthmus measures about 1.25 cm transversely as well as vertically and is usually placed anterior to the second and third tracheal cartilages1. The anomalies of the development of the thyroid gland distort the morphology of the gland, and may cause clinical functional disorders and various thyroid illnesses 2 . Besides, such anomalies can pose diagnostic and surgical challenges in addition to non-invasive and invasive airway management during emergency and surgical interventions3. The incidence of isthmus agenesis varies from 5-10%4. This absence can be explained as an anomaly of embryological development and can be associated with other types of dys- organogenesis, such as the absence of a lobe or the presence of ectopic thyroid tissue. Phylo- genetically, in some species in which the thyroid follicles are organized in a gland, this gland can acquire a bi-lobed shape, in which the lobes join together in front of the upper part of the trachea by an isthmus or bridge of thyroid tissue. The isthmus may be missing, as happens in amphibians, birds and among the mammals, in the monotrema, certain marsupials, cetaceans, carnivores and rodents.

Composite platysmofascial flap in reconstruction following partial vertical laryngeal resections

The superficial layer of deep cervical fascia represents a valuable material for the reconstruction of defects secondary to partial vertical laryngeal resections. However, there are drawbacks to the use of this flap, which include possible weakness and subsequent instability of the laryngeal wall. To overcome this problem, we included platysma along with the superficial layer of deep cervical fascia to form a composite soft tissue flap that will meet all reconstructive needs following partial vertical laryngeal resection. Inclusion of platysma yields more durable and adequately vascularized flap resistant to saliva, seroma formation, and infection. Because of segmental blood supply of strap muscles and their indirect perforating vessels, medially based horizontal composite flap is better supplied with blood in comparison with cranially based vertical flap. Medial insertion of the horizontal flap is much more convenient than lateral, due to ancillary blood supply from the contralateral side and easier pursuance of ipsilateral neck dissection. The method of our choice for laryngeal reconstruction after partial vertical laryngeal resections is paramedially based horizontal platysmofascial composite flap with the insertion opposite to the side of the primary laryngeal tumor.

Endoscopic Transaxillary Subfascial Approach for Persistent Muscular Torticollis in Children

The endoscopic approach is a technical innovation for release of the sternocleidomastoid (SCM) fibrosis in muscular torticollis, where operation scars can be hidden at less conspicuous areas, for example, at the axilla and hair-bearing scalp. As the SCM muscle is located beneath the investing layer of deep cervical fascia which is reported to continue to the fascia of the pectoralis major, the aim of the study was to describe and evaluate the preliminary result of transaxillary subfascial approach for persistent muscular torticollis in children. A total of 4 children (2 boys and 2 girls) were included in this study from January to December 2009. Using a 2-port endoscopic technique, the division of the lower end of the fibrotic SCM muscle was performed through the subfascial working cavern. The subfascial dissection was performed under the fascia of the pectoralis major and above the muscular fibers from ipsilateral axilla with the aid of a homemade dissection balloon. The mean operating time was 67.5±11.9 minutes (range: 55 to 80 min). There was no serious operative morbidity and the mean follow-up period was 14.8±5.1 months (range: 9 to 20 mo). All patients had complete unrestricted movement of the head and no recurrence was observed during this period. The transaxillary endoscopic technique, a working cavern created under the fascia of the pectoralis major, offers a safe and straightforward way to surgically manage persistent muscular torticollis while preserving neurovascular structures, exempting extradissection of noninvolved tissues and avoiding the potential for poor cosmesis from any neck scar.

An anatomical study of the different neurosurgical approaches of the cervical spinal cord

IntroductionThere has been long standing controversy about the best approach for the cervical spinal cord, however there is no doubt that the clinical indication and the surgical procedure required will determine for most cases the best surgical approach. ObjectiveThis study was done to study the feasibility of the various neurosurgical approaches of the cervical spinal cord. MethodsTen cadaveric specimens obtained from the dissecting room of the Faculty of Medicine, University of Alexandria were dissected both anteriorly and posteriorly in the cervical region to compare between the anterior and posterior approaches for the cervical spinal cord and to identify the various anatomical structures met with during both approaches. Also various techniques of laminoplasty and laminectomy with lateral mass screw fixation had been performed. ResultsA posterior midline incision cuts through the skin, subcutaneous tissue, trapezius fascia and liqamentum nuchae, bilateral subperiosteal dissection of cervical paraspinal muscles. Keyhole laminoforaminotomy was done by removing the lateral portion of two adjacent laminae to expose foraminal course of the nerve root. Unilateral open door laminoplasty was done using non absorbable sutures, bone graft, or plate and screws. Then the laminae and spinous processes were cut in the midline with either drill or Gigli saw and opened bilaterally, then the defects were filled between the separated laminae by bone grafts and fixed by sutures (bilateral open door laminoplasty). Laminectomy was done to expose the dura mater and the cervical spinal cord. In lateral mass screw fixation the screw entry point was located 1mm medial to the center of each lateral mass. The screws were directed 20° superior and 30° lateral to the screw entry point. The average screw length that can be used for bicortical fixation without injuring the vertebral artery or nerve root was about 13.5mm and average screw thickness was about 3.5mm.After making an anterior incision through the skin and the investing layer of deep cervical fascia, the strap muscles were exposed. The sternomastoid muscle appeared on the lateral side of the neck with the carotid triangle between it and the strap muscles. After peeling off longus colli from the cervical vertebrae, their bodies and the intervening intervertebral disks can be seen. Partial corpectomies and anterior discectomy of the vertebral body and the intervertebral disk was done to expose the dura mater and the cervical spinal cord using either drill or Kerrison rongeurs. ConclusionThe choice of the surgical approach to the cervical spine should be dictated by the site of the primary pathology. Cervical laminoplasty is an alternative to standard laminectomy allowing for a reasonable decompression of the vertebral canal with preservation of the supportive function of the vertebral column posteriorly. For a posterior approach to be successful the cervical lordosis should be intact and if affected the laminectomy must be combined with lateral mass screw fixation. The anterior approach has technical advantage that the decompression, fusion and immediate stabilization can be performed through one exposure, at one operation.

Surgical anatomy of the swine face

In order to develop tissue engineering applications for oral and maxillofacial surgery, the surgical anatomy of the miniature pig's face was investigated in three miniature pig cadavers and three anaesthetized miniature pigs using identical procedures that were previously described for humans. A preauricular incision with a retromandibular and a submandibular extension was initially made through the facial skin and subcutaneous tissues. The underlying tissues were then carefully dissected in order to progressively expose the platysma muscle, the superficial layer of deep cervical fascia, the marginal mandibular branch and buccal branch of the facial nerve, the mental nerve and the mandibular skeleton. The marginal mandibular branch of the facial nerve has an upper and lower division. Stimulation of the facial nerve and its branches showed that the upper division of the marginal mandibular branch innervates muscles and tissues in the upper lip and nose region, and the lower division innervates muscles and tissues in the lower lip region. The gross anatomy of the maxillofacial region in the pigs was found to be similar to that of humans. Although the distributions of the marginal mandibular branch of the facial nerve and the mental nerve are different from that of humans, we concluded that miniature pigs are a suitable experimental model for the preclinical development of tissue engineering applications in oral and maxillofacial surgery.

Desmoid tumor of the head and neck

[corrected] Desmoid tumors are rare benign tumors but have a tendency toward local recurrence after resection because of their infiltrative growth and frequent entrapment of vital structures in the head and neck region. We report 24 desmoid tumors of the head and neck and propose a reasonable approach in the management of such cases. Twenty-four patients (9 male and 15 female; median age, 33 years; range, 0-66 years) with a desmoid tumor of the head and neck (neck, 15 patients; head, 9 patients) treated from 1990 to 2004 were retrospectively analyzed. The size ranged from 0.5 to 13 cm in diameter (mean, 3.6 cm). In the neck, 8 tumors were around the superficial layer of deep cervical fascia, whereas 4 tumors of the neck involved the prevertebral fascia and 2 involved brachial plexus. Twenty patients received complete resection of the tumor, but the section margin was positive in 8 patients, of which 6 patients remained free of disease in a period of 13 to 105 months. Three patients, including 2 with positive section margin and 1 with negative margin, developed recurrences, which were successfully removed again. Two patients underwent partial resection of the tumor because of brachial plexus involvement. One of them achieved regression after postoperative radiotherapy and the other had spontaneous regression. The hypopharygneal tumor in a newborn had spontaneously complete regression, and tracheostomy was closed at the age of 6 years. One patient remained with stable disease for 14 months after biopsy of the tumor without excision. The overall prognosis is still good despite frequent incomplete resection. Surgical resection of the tumor with close observation is suggested even if the section margin is positive. If a desmoid tumor cannot be removed grossly, regression or arrested growth of the remaining tumor is expected. Radiotherapy might be reserved for a growing tumor.

CT and MRI of the normal and diseased perivertebral space.

The perivertebral space is in the midline, in the deep tissues of the neck, and can be identified from the skull base above to the mediastinum below. It is a discrete space completely enclosed by the deep layer of deep cervical fascia. The fascial attachments of the perivertebral space divide it into two areas, the anterior prevertebral and posterior paraspinal portions. We made a retrospective analysis of the radiologic and clinical records of 52 patients with lesions in the perivertebral space, to identify the imaging features that mark a lesion as originating in the perivertebral space and define the spectrum of pathology which occurs in the space. Mass lesions present in the prevertebral or paraspinal portions. In the former they usually involve the vertebral body, displacing the prevertebral muscles anteriorly. Epidural extension from lesions in the perivertebral space proper is common. Masses in the paraspinal perivertebral space usually displace the paraspinal muscles away from the spine. We found 9 inflammatory lesions, 29 malignant and 6 benign tumors, and 8 miscellaneous lesions.

Reconstruction of Laryngotracheal War Injuries with the Median Layer of the Deep Cervical Fascia

Surgical exploration and immediate reconstruction with the median layer of the deep cervical fascia (MLDCF) was performed in 8 of 22 patients with exogenous war injuries of larynx and cervical trachea. A surgical technique of reconstruction with the median layer of the deep cervical fascia is described. The 7 surviving patients had good respiration without signs of stenosis of the larynx and/or the trachea. Four had good and 3 satisfactory, phonation, and none had swallowing difficulties. Owing to the simplicity of the surgical approach, its size and biological properties, the median layer of deep cervical fascia proved itself to be a suitable material in the immediate reconstruction of exogenerous war injuries of the larynx and cervical trachea.

Retropharyngoesophageal abscess associated with a swallowed bone

In spite of diagnostic and therapeutic advances, complications related to perforation of the hypopharynx and cervical esophagus can be fatal. Early recognition of these perforations is essential to minimize the associated morbidity and mortality. Retropharyngoesophageal abscess, a complication developing from trauma to the esophagus, deserves special consideration because of its relative rarity and because of its anatomic relation to the retrovisceral space, which facilitates the spread of the infection. The retropharyngoesophageal (retrovisceral) space lies anterior to the alar layer of deep cervical fascia, posterior to the visceral or middle layer of deep cervical fascia, and extends inferiorly from the base of the skull into the superior mediastinum. The “danger zone” is located between the alar and prevertebral layers of the deep cervical fascia and extends from the base of the skull superiorly into the posterior mediastinum to the diaphragm inferiorly. The prevertebral space extends from the base of the skull to the coccyx and makes it possible for deep neck infections to extend as far inferiorly as the psoas muscle sheath.l*’ A retropharyngoesophageal abscess presents a number of specific signs and symp-

Cervical island skin flap for intraoral repair following cancer surgery

Seventy three patients with oral cancer were operated on using the cervical island skin flap of Farr et al. (1969). Primary sites of the lesions were the tongue, floor of the mouth and lower gingiva. Most of the patients received total doses of 22.5 Gy of radiation and 110 mg bleomycin as a preoperative treatment. Among the 73 patients, complete necrosis of the skin island was observed in 3 cases. There was half necrosis in 4 cases, one quarter necrosis in 6 cases and marginal necrosis in 17 cases. The flaps in 43 patients completely survived. Results were better in the operations undertaken in the last 4 years in which a superficial layer of deep cervical fascia on the sternocleidomastoid muscle was included in the flap.

副咽頭間隙の形態 軸位断ＣＴ像における計測

Parapharyngeal space can be defined as a potential space surrounded by deglutitional and masticator muscles and their covering, superficial and middle layer of deep cervical fascia. It is easily recognized in images provided by modern scanning devices, such as CT and MRI. Parapharyngeal space has traditionally been divided by styloid process and fascia of tensor veli palatini muscle (nasopharyngeal level) or fascia of stylopharyngeus muscle (oropharyngeal level) into two compartments, prestyloid and postsyloid spaces. The latter is often called as carotid space. Prestyloid portion exclusively contains fat tissue, which yields hypoabsorption area in CT films and high density area in MRI. In most of papers in radiological journals, the term of parapharyngeal space is regarded as its prestyloid portion which is clearly identified. Axial CT images of 144 patients without any naso- or oropharyngeal lesions were analyzed. Two reference levels of nasopharynx were adopted for the study. The upper level passes through the plane of fossa of Rosenmuller, and the lower reference level transects soft palate. The following parameters of the space were measured; Length and width of the whole space, length and width of prestyloid fatty space, and furthermore, width of pre- and poststyloid space, that were divided by a imaginary line parallel to the axis of the whole space (the upper level); Length and width of the whole space, length of base and height of a triangle of the prestyloid part (the lower level). While parapharyngeal space was symmetrical in the upper level, the rate of asymmetry amounted to a fourth in the lower level.(ABSTRACT TRUNCATED AT 250 WORDS)

Infection and tumor of the masticator space: CT evaluation.

The masticator space is a distinct deep facial space, bounded by the superficial layer of deep cervical fascia and containing the four muscles of mastication and the ramus and posterior body of the mandible. Trismus often complicates evaluation of masticator space disease. However, computed tomography (CT) clearly delineates the normal and pathologic anatomy of this region. The CT appearance of the masticator space was demonstrated in a retrospective review of 32 patients with either infection or tumor involving this space. Masticator space infections were found to have characteristic CT appearances and patterns of spread. CT was especially useful in differentiating inflammation from frank abscess, detecting mandibular osteomyelitis, and directing surgical drainage to the precise deep-tissue space involved. In cases of tumor, the primary utility of CT was in defining tumor extent accurately and in helping to assess resectability and determine radiation therapy ports.