PART 4 Neck
13  Embryology and Anatomy of the Neck
Wael Abdalla and Vera R. Sperling
EMBRYOLOGY OF THE NECK
Accurate diagnosis and successful treatment of congenital anomalies
and masses of the neck are dependent on an understanding of the
complex embryologic development of this region and the anomalies
that result from abnormal development.
This chapter will focus on the embryology of the neck
and the oral cavity. The embryology of the orbit, face and
sinuses, temporal bone, and ear are addressed in Chapters 4, 8,
9, and 18.
Many of the structures of the head and neck form from an
interaction between somitomeres, somites, the mesenchyme, and
the branchial apparatus.
Development of the Mesenchyme
The mesenchyme is derived from three main sources:
1. The lateral plate mesoderm, which forms the laryngeal
cartilages and regional connective tissue
2. The neural crest cells, whose migration initiates the formation
of the pharyngeal arch skeletal structures and regional bone,
cartilage, tendons, and glandular stroma
3. The ectodermal placodes, from which originate the fifth,
seventh, ninth, and tenth cranial nerves (CNs)
Development of the Mesoderm, Somitomeres,
and Somites
After neurulation occurs, the mesoderm subdivides into the
lateral, intermediate, and paraxial mesoderm. The lateral meso-
derm forms most of the throat and larynx. The intermediate
mesoderm does not form any part of the head and neck. The
paraxial mesoderm forms the 7 somitomeres and 42 to 44 paired
somites. The five most rostral somites are involved in the forma-
tion of head and neck musculature (Fig. 13.1). The somitomeres
and somites form before the development of the branchial
apparatus.
The branchial apparatus, that is, the branchial arches, clefts,
pouches, and membrane, begin to form late in the third week of
gestation. The buccopharyngeal membrane breaks down, and the
mesodermal branchial bars begin to form six pairs of branchial
arches. The fifth arch is rudimentary and disappears.
The fourth somitomere invades the first branchial arch and
generates the formation of the muscles of mastication, that is, the
masseter, pterygoid, and temporalis muscles. These muscles are
innervated by the trigeminal nerve (CN V).
The seventh somitomere interacts with the third brachial arch
to form the stylopharyngeus muscle, which is innervated by the
glossopharyngeal nerve (CN IX).
The first four occipital somites invade the fourth and sixth
brachial arches and thus stimulate the formation of the extrinsic
and intrinsic laryngeal muscles innervated by the vagus nerve
(CN X) and the cranial segment of the spinal accessory nerve
(CN XI).
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13
The third through seventh somites form the sternocleidomastoid
muscle and trapezius and are innervated by the spinal accessory
nerve (CN XI).
The intrinsic and extrinsic tongue muscles are likely derived
from the second through fourth occipital somites and are innervated
by the hypoglossal nerve (CN XII).
The contribution of the somitomeres and somites to the
formation of muscles and their distinct innervation is unchanged
throughout growth and development. Thus although many
muscles migrate in location, their nerve supply is maintained
and hence their branchial arch origin can always be identified
(see Fig. 13.1).
Development of the Branchial Apparatus
Formation of the branchial apparatus occurs between the fourth
through seventh weeks of development. The pharynx constitutes
much of the foregut during the first few weeks of development.
Formation of the five branchial arches (I, II, III, IV, and VI) results
from the breakdown of the buccopharyngeal membrane and
segmentation of the mesoderm. Migration of neural crest cells to
this location stimulates growth and development. Each arch has
its own outer epithelial lining of ectoderm separated by five clefts
and an inner epithelial lining of endoderm with five corresponding
pouches and a central cartilaginous core, which is a mesenchymal
derivative that participates in the formation of the characteristic
skeletal, muscular, ligamentous, vascular, and neural components
of each arch.
Shortly after formation of the branchial arches, the first and
second arches undergo mesodermal proliferation, thus creating
the epicardial ridge, which contains the mesodermal precursor
of the sternocleidomastoid, the trapezius, and the infrahyoid
and lingual muscles. The nerves of the epicardial ridge are the
hypoglossal (CN XII) and spinal accessory (CN XI) nerves. The
proliferation of mesenchyme overgrows branchial arches II, III,
and IV and narrows branchial clefts II, III, and IV. Subsequently,
an ectodermal pit is formed—the cervical sinus of His—which
obliterates with further development; failure of obliteration
results in formation of branchial sinus, clefts, or cysts of types II,
III, or IV.
Branchial Apparatus and Its Contribution to the
Structures of the Neck
Branchial Arches. The first branchial arch (Fig. 13.2) is composed
of a dorsal segment known as the maxillary process and a ventral
segment known as Meckel cartilage or the mandibular process;
both involute. The ossification around Meckel cartilage is the
precursor of the mandible and the sphenomandibular cartilage in
the neck. The muscle derivatives of the first arch are the muscles
of mastication (the masseter, pterygoid, and temporalis muscles),
the tensor tympani and tensor veli palatine muscles, the anterior
belly of the digastric muscle, and the mylohyoid muscle. The
trigeminal nerve (CN V) provides motor and sensory innervation
to the first branchial arch.
97
98 SECTION 2  Head and Neck

The second branchial arch is also known as Reichert cartilage. nerve (CN VII), which is primarily motor. The main sensory
It gives rise to the upper body and lesser cornu of the hyoid bone, component is the chorda tympani branch that is carried with
the styloid process, and stylohyoid ligament. The muscle derivatives a branch of the trigeminal nerve (CN V3) to supply taste to
include the platysma, the posterior belly of the digastric, and the the anterior two-thirds of the tongue. The artery of the second
stylohyoid. The nerve of the second brachial arch is the facial brachial arch is the stapedial artery, which normally regresses
aside from some contributions to the internal and external
carotid arteries.
The third branchial arch cartilage derivatives include the greater
cornu and inferior body of the hyoid. The muscle derivatives
include the stylopharyngeus and superior and middle pharyngeal
constrictors. The nerve of the third brachial arch is the glosso-
pharyngeal nerve (CN IX). The neural crest cells of the third
Ocular 1 branchial arch also form the carotid bodies. The artery of the
muscles 2 third branchial arch contributes to the common carotid artery
and the internal and external carotid arteries.
3
Somitomeres
The fourth and sixth branchial arch cartilage derivatives fuse to
4 form the larynx and the laryngeal cartilages (the thyroid, cricoid,
First arch
arytenoid, corniculate, and cuneiform). Muscle derivatives include
5 the cricothyroid muscle, the levator veli palatini, and the inferior
pharyngeal constrictors. The muscle derivatives of the sixth arch
Second arch 6 are the remaining intrinsic muscles of the larynx. The nerve of the
fourth arch is the superior laryngeal nerve, and the nerve of the
Third arch 7 sixth arch is the recurrent laryngeal nerve. Both are branches of
the vagus nerve (CN X). The artery of the fourth branchial arch
Tongue 1 contributes to the aortic arch on the left and the subclavian artery
on the right. The artery of the sixth branchial arch becomes the
Larynx 2 ductus arteriosus and the pulmonary artery. Between the branchial
Somites arches lie the paired branchial pouches and clefts.
3

4 Branchial Pouches. The first branchial pouch does not contribute

5 rise to the palatine tonsils and tonsillar fossa. The third branchial
Figure 13.1.  Embryology. A sagittal section shows the relationship of
somitomeres and somites and their corresponding derivatives. (From
Som P, Curtin H. Head and neck imaging, 4th ed, Philadelphia, PA:
Mosby; 2003.)
to the structures of the neck. The second branchial pouch gives
pouch gives rise to the inferior parathyroids and thymus. The
early embryologic connections to the pharynx normally are
obliterated. The fourth branchial pouch gives rise to the superior
parathyroid glands and the ultimobranchial body, which contains
the parafollicular cells (C cells) of the thyroid gland. The fifth
branchial pouch degenerates. The branchial clefts do not contribute
to any neck structures and are obliterated as development occurs
(Tables 13.1 and 13.2).

TABLE 13.1  Derivatives of the Branchial Arches

Arch Nerve Muscles Skeletal Structures Ligaments Artery
First (mandibular) Trigeminal nerve Muscles of mastication, Malleus incus Anterior ligament of Maxillary artery
(CN V) (maxillary mylohyoid,; anterior malleus,
and mandibular belly of digastric, sphenomandibular
branches only) tensor tympani, tensor ligament
veli palatine
Second (hyoid) Facial nerve (CN VII) Muscles of facial Stapes, styloid process, Stylohyoid ligament Stapedial artery (rarely)
expression, stapedius, lesser cornu and upper
stylohyoid, posterior body of the hyoid
belly of digastric bone
Third Glossopharyngeal Stylopharyngeus, Greater cornu and lower Contributions to the
nerve (CN IX) superior and middle part of body of the carotid arteries
pharyngeal hyoid bone
constrictors
Fourth and sixth Superior laryngeal Cricothyroid, levator veli Thyroid, cricoid, The artery of the fourth
branch of vagus palatine, inferior arytenoid, corniculate, arch contributes to
nerve (CN pharyngeal cuneiform cartilages the subclavian artery
X)—fourth arch; constrictors, intrinsic on the right and the
recurrent muscles of larynx, aortic arch on the
laryngeal branch striated muscles of the left; the artery of the
of vagus nerve esophagus sixth arch forms the
(CN X)—sixth ductus arteriosus and
arch the pulmonary artery
CN, Cranial nerve.
Adapted from Moore KL, Persaud MG, Torchia MG. Before we are born, Philadelphia, PA: Saunders/Elsevier; 2008.

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 CHAPTER 13  Embryology and Anatomy of the Neck 99

Left optic 13
vesicle

Left nasal Seessel's

placode pocket
Oropharyngeal
Maxillary
membrane
process

Auditory First
Oropharyngeal vesicle pharyngeal
membrane pouch
First branchial
First
cleft
branchial
arch
First Thyroid
branchial diverticulum
cleft

Fourth branchial
arch
Fourth branchial
cleft Lung buds

First cervical
Esophagus
somite

A B

Mandibular
nerve
Muscular
element
First branchial
arch cartilage
First aortic arch
Facial nerve
Pharyngeal
cavity

Glosso-
pharyngeal
nerve
Vagus nerve
(fourth branchial
arch)
Recurrent laryn-
geal branch of
vagus nerve
(fifth–sixth branchial
arch)

C
Figure 13.2.  Embryology. Relationship of (A) branchial arches and (B) clefts and (C) subsequent derivative
structures. (From Som P, Curtin H. Head and neck imaging, 4th ed, Philadelphia, PA: Mosby; 2003.)
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100 SECTION 2  Head and Neck
EMBRYOLOGY OF THE TONGUE
The tongue forms from the first four branchial arches. Two
lateral and one central swelling, the tuberculum impar, form
from the first branchial arch. A second central swelling, the
copula/hypobranchial eminence, forms from the second, third,
and fourth branchial arches. A third central swelling from the
fourth branchial arch forms the epiglottis. Thus the anterior
two-thirds or body of the tongue forms from the first branchial
arch, whereas the root of the tongue forms from the second,
third, and fourth branchial arches. The groove formed where the
anterior and posterior portions of the tongue fuse is called the
terminal sulcus.
The hypoglossal nerve (CN XII) innervates all the intrinsic
tongue muscles and all extrinsic tongue muscles but the palatoglos-
sus. Sensory innervation is by the lingual branch of CN V3, the
chorda tympani branch of CN VII, the lingual branch of CN IX,
and the recurrent laryngeal branch of CN X.
EMBRYOLOGY OF THE THYROID GLAND
The thyroid gland originates from a median endodermal thickening
in the floor of the primitive pharynx in the third to fourth week
of development. The thyroid primordium develops between the
tuberculum impar and the copula of the first and second pouches.
The foramen cecum is the remnant of the thyroid primordium in
this location, between the anterior two-thirds and the posterior
one-third of the tongue. The thyroid gland passes anterior to
the hyoid and laryngeal cartilages and descends anterior to the
thyrohyoid membrane and the strap muscles. The thyroid gland
reaches its final position by the seventh week of development.
During its inferior migration, the thyroid anlage is connected to
the tongue by the normally transient thyroglossal duct. Innervation
TABLE 13.2  Derivatives of the Branchial Pouches
Pouch Derivatives
First Eustachian tube, middle ear, portions of
mastoid bone
Second Palatine tonsils, tonsillar fossa
Third Inferior parathyroids, thymus
Fourth and sixth Superior parathyroids, parafollicular cells of
thyroid
Adapted from Moore KL, Persaud MG, Torchia MG. Before we are
born, Philadelphia, PA: Saunders/Elsevier; 2008.
Subdivisions of the
anterior triangle
Digastric muscle
Digastric
Submental
Carotid
Muscular
Sternomastoid
muscle
Figure 13.3.  Traditional triangular division of neck spaces.
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of the thyroid gland is primarily by the sympathetic middle cervical
ganglion.
EMBRYOLOGY OF THE SALIVARY GLANDS
The common pathway for salivary gland development is the
ingrowth of surface epithelium (primarily ectoderm, but also
endoderm for minor salivary gland formation) into the underlying
mesenchyme.
The precursors of the parotid gland appear between the fourth
to sixth weeks of gestation, and the submandibular and sublingual
glands appear between the sixth to eighth weeks of gestation. The
minor salivary glands do not develop until the twelfth week of
gestation.
A process of proliferation, division, and canalization occurs.
Interaction with and stimulation by the autonomic nervous system
is essential for normal salivary gland development and function.
The final process of encapsulation occurs in reverse to the order
of development and growth. Encapsulation of the parotid gland
occurs after formation of the lymphatic system, accounting for
the presence of intraparotid lymph nodes.
The parotid gland is innervated by CN IX, the submandibular
and sublingual glands are innervated by CN VII, and the minor
salivary glands are innervated by CN V.
ANATOMY OF THE NECK
Clinical evaluation and classic anatomy divides the neck into
triangles. The largest are the anterior and posterior triangles,
which are defined and separated by the sternocleidomastoid muscles.
The anterior triangle is further subdivided into the paired carotid
and submandibular triangles (separated by the posterior belly of
the digastric muscle) and the single midline submental and
infrahyoid muscular triangles. The posterior triangle consists of
the paired occipital and subclavian triangles, which are separated
by the inferior belly of the omohyoid muscle (Fig. 13.3). The
central cavity is divided into the nasopharynx, oropharynx,
hypopharynx, and oral cavity.
This approach to neck anatomy does not reflect anatomy as
defined by the fascial layers, that is, the superficial and deep cervical
fascia of the head and neck. The deep cervical fascia is composed
of three layers:
1. The superficial layer of the deep cervical fascia (SL-DCF),
also known as the investing fascia, which defines the mastica-
tor, parotid, and submandibular spaces; it also contributes
to the carotid space
Trapezius muscle
Subdivisions of the
posterior triangle
Occipital
Subclavian
 CHAPTER 13  Embryology and Anatomy of the Neck 101

2. The middle layer of the deep cervical fascia (ML-DCF),

also known as the visceral fascia, which primarily forms the 13
buccopharyngeal and pharyngobasilar fascia and the fascia
of the tensor veli palatine; it also contributes to the carotid
space
3. The deep layer of the deep cervical fascia (DL-DCF),
also known as the prevertebral fascia, which forms the
perivertebral space and then is subdivided into the anterior BS
prevertebral and posterior paraspinal compartments; the
alar fascia is a small component of the DL-DCF and also PMS MS
contributes to the carotid sheath

The advent of cross-sectional imaging enabled a new approach PS

DS/RPS CS
to neck anatomy defined by the concept of dividing the neck into
the suprahyoid and infrahyoid compartments, with further subdivi- PPS
sion of each compartment into fascially defined spaces (Figs. 13.4 PVS
and 13.5). The resultant refined approach to differential diagnosis,
combined with the use of surgically and pathologically defined
common terminology and nomenclature, has improved communica- A
tion between radiologists and clinicians.
The pharyngeal mucosal space, which is located in the
suprahyoid neck, is the surface of pharynx. It encompasses the
nasopharyngeal, oropharyngeal, and hypopharyngeal mucosa. SLS
Centrally located, it is posterior to the retropharyngeal space SMS
and lateral to the parapharyngeal space. It is not a true fascially
enclosed space because only its deep margin is bound by the
ML-DCF. PMS
MS
The parapharyngeal space is located in the suprahyoid neck;
it extends from the skull base to the submandibular space. The PS
medial fascial boundary is the visceral/buccopharyngeal fascia. CS
The pterygomandibular raphe and masticator space is its anterior PPS
DS/RPS
boundary. Laterally and posteriorly, it is bounded by the carotid
PVS
and retropharyngeal space.
The carotid space, which is located in both the suprahyoid and PCS
infrahyoid neck, extends from the skull base to the aortic arch.
All three layers of deep cervical fascia form the carotid sheath.
B
The carotid sheath is better defined in the infrahyoid neck and
more loosely formed in the suprahyoid neck.
The retropharyngeal space, which is located in both the
suprahyoid and infrahyoid neck, extends from the skull base to
T3. The ML-DCF constitutes the anterior wall, and the DL-DCF VS
constitutes the posterior wall. The lateral wall is the alar fascia, a
small fragment of the DL-DCF. It is posterior to the pharyngeal CS
mucosal space in the suprahyoid neck and the visceral space in
the infrahyoid neck, anterior to the danger space posterior, and DS/RPS
medial to the carotid space.
The masticator space, which is located in the suprahyoid neck,
PCS
extends from the superior aspect of suprazygomatic masticator
space/temporal fossa at the level of parietal bone to the inferior PVS
aspect of the infrazygomatic masticator space/undersurface of the
posterior body of the mandible. It is bounded by a sling of the
SL-DCF that extends from the inferior mandible to the skull base
and zygomatic arch. It is anterior to the parotid space, anterolateral C
to the parapharyngeal space, and lateral to the pharyngeal mucosal
Figure 13.4.  Fascial compartments of the neck. (A) Spaces and
space. Superior to it is the skull base, including the foramina ovale
investing fascia of the suprahyoid neck and the level of the nasopharynx.
and spinosum.
(B) Spaces and investing fascia of the suprahyoid neck at the level of
The parotid space, which is located in the suprahyoid neck,
the oropharynx. (C) Spaces and investing fascia of the infrahyoid neck.
extends superiorly from the external auditory canal and mastoid
BS, Buccal space; CS, carotid space; DS, danger space; MS, masticator
tip to below angle of mandible. It is enclosed by the SL-DCF.
space; PCS, posterior cervical space; PMS, pharyngeal mucosal space;
The perivertebral space, which is located in both the suprahyoid
PPS, parapharyngeal space; PS, parotid space; PVS, perivertebral space;
and infrahyoid part of the neck, extends from the skull base to
RPS, retropharyngeal space; VS, visceral space. (Redrawn from Harns-
T4 and consists of a prevertebral and a paraspinal component.
berger HR, Hudgins P, Wiggins R, et al. Diagnostic imaging: head and
It is enveloped by the DL-DCF. The perivertebral space is
neck, Salt Lake City, UT: Amirsys Inc; 2004.)
posteromedial to the carotid space and medial to the posterior
cervical space.
The visceral space, which is located in the infrahyoid neck,
lies anterior to the retropharyngeal space in the midline and is
enclosed by the ML-DCF.

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102 SECTION 2  Head and Neck

Nasal septum

Maxilla
Pharyngobasilar fascia
Medial pterygoid
MLDCF-buccopharyngeal muscle
fascia
Lateral pterygoid
muscle
SL-DCF
Temporalis muscle
Interpterygoid fascia Masseter muscle

Tensor veli palatini

Tensor-vascular- muscle
styloid fascia Eustacian tube
Levator veli palatini
muscle
Stylopharngeal
aponeurosis (aileron) Mandibular ramus

Parotid gland
Sagittal partition Sympathetic chain
(cloison sagittale)
Styloid process
DLDCF-alar
fascia Posterior belly of the
digastric muscle
Mastoid process
DLDCF-prevertebral
fascia Internal carotid artery and
internal jugular vein
Vagus nerve
Sternocleidomastoid muscle
DLDCF
Longus colli muscle and
longus capitus muscle
SL-DCF
C-1
Paraspinal muscles
Skin

A Trapezius muscle
Figure 13.5.  Fascial compartments of the neck. Axial sections at the level of C4 (A), C7 (B), and T1 (C) show
the relationship of the investing fascial layers with anatomic structures. (From Som P, Curtin H. Head and neck
imaging, 4th ed, St. Louis, MO: Mosby; 2003.)

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 CHAPTER 13  Embryology and Anatomy of the Neck 103

SL-DCF
13
MLDCF Strap muscles
Visceral compartment Thyroid cartilage
Inferior pharyngeal
SCF and platysma constrictor muscle
muscle Sternocleidomastoid
muscle
Skin
Internal jugular vein and
Carotid sheath internal carotid artery

DLDCF-alar fascia Vagus nerve

Phrenic nerve
DLDCF-prevertebral
fascia
Sympathetic chain
Longus capitus muscle
DLDCF forming sheath Longus colli muscle
about the brachial plexus Anterior scalene muscle

C-4
SL-DCF
Paraspinal muscles

DLDCF

Trapezius muscle
B Ligamentum nuchae

SL-DCF Trachea
MLDCF Esophagus
Skin Sternohyoid muscle and
sternothyroid muscle
SCF and platysma muscle
Thyroid gland
Visceral compartment
Carotid sheath Sternocleidomastoid
muscle
SL-DCF
Internal jugular vein and
internal carotid artery
DLDCF-alar fascia
Vagus nerve
Phrenic nerve
DLDCF-prevertebral
fascia Sympathetic chain
Omohyoid muscle
Longus capitus muscle
Longus colli muscle
DLDCF Anterior scalene muscle

C-7

Paraspinal muscles

SL-DCF Trapezius muscle

C Ligamentum nuchae
Figure 13.5, cont’d. 

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104 SECTION 2  Head and Neck

TABLE 13.3  Anatomic Spaces of the Suprahyoid Neck

Space Contents
Pharyngeal mucosal space Mucosa, minor salivary glands and lymphoid tissue, pharyngobasilar fascia, buccopharyngeal fascia, superior
and middle pharyngeal constrictor muscles, levator veli palatini muscle, cartilaginous end of eustachian tube
(torus tubarius)
Parapharyngeal space (prestyloid Deep portion of parotid gland, minor salivary glands, pterygoid venous plexus, internal maxillary artery,
parapharyngeal space) ascending pharyngeal artery, branches of cranial nerve V3, cervical sympathetic chain and fat
Carotid space (retrostyloid Internal carotid artery, internal jugular vein, cranial nerves IX–XII, sympathetic chain, lymph nodes—deep
parapharyngeal space) cervical chain
Retropharyngeal space Fat, lymph nodes—retropharyngeal (medial and lateral)
Masticator space Ramus and posterior body of mandible, muscles of mastication—pterygoid, masseter, and temporalis;
mandibular division trigeminal nerve (V3)—inferior alveolar and lingual nerves, inferior alveolar vein and
artery, pterygoid venous plexus
Parotid space Parotid gland and duct, cranial nerve VII, external carotid artery, retromandibular vein, lymph nodes—
intraparotid and periparotid
Perivertebral space Prevertebral muscles, scalene muscles, vertebral artery and vein, brachial plexus, phrenic nerve
Vertebral bodies and discs
Adapted from Som PM, Curtin HD. Head and neck imaging, 4th ed, St Louis, MO: Mosby; 2003.

TABLE 13.4  Anatomic Spaces of the Infrahyoid Neck
Space
Visceral space
Retropharyngeal space
Carotid space
Perivertebral space
Anterior cervical space
Posterior cervical space
Contents
Larynx, hypopharynx and cervical
esophagus, trachea, thyroid gland,
parathyroid glands, lymph nodes,
recurrent laryngeal nerve (branch
cranial nerve X), third and fourth
branchial apparatus and thyroid/
parathyroid anlage remnants
Fat, remnants of third branchial
apparatus
Common and internal carotid arteries,
internal jugular vein, cranial nerve X,
sympathetic chain, lymph nodes,
carotid body, second branchial
apparatus remnants
Prevertebral, scalene, and paraspinal
muscles, brachial plexus, phrenic
nerve, vertebral artery and vein
Vertebral bodies and discs
Extension of submandibular space of
suprahyoid neck
Composed of fat
Cranial nerve XI, spinal accessory
nodes, preaxillary brachial plexus, fat
TABLE 13.5  Contents of the Submandibular and Sublingual Spaces
Space Contents
Submandibular Submandibular gland, submandibular and
submental lymph nodes, facial artery and vein,
inferior cranial nerve XII, anterior belly of
digastric muscle
Sublingual Hyoglossus muscle (anterior margin), lingual
nerve (sensory branches of cranial nerve V3
and the chorda tympani branch of cranial
nerve VII), distal cranial nerve IX and cranial
nerve XII, lingual artery and vein, sublingual
gland and duct, deep portion of the
submandibular gland and duct
found between the submandibular space, the sublingual space,
and the inferior parapharyngeal space.
The sublingual space, which is located superior and medial to
mylohyoid muscle and lateral to genioglossus-geniohyoid muscle
complex, is not enclosed by fascia (Table 13.5).

KEY POINTS

• Knowledge of embryology and anatomy of the neck is

The posterior cervical space extends from the mastoid tip to
the level of the clavicle. Its superficial boundary is the SL-DCF,
and its deep boundary is the deep cervical DL-DCF. It lies posterior
to the carotid sheath, posteromedial to the sternocleidomastoid
muscle, and anterolateral to the paraspinal component of the
perivertebral space (Tables 13.3 and 13.4).
essential in interpreting imaging studies and formulating an
effective differential diagnosis.
• Cross-sectional imaging has resulted in replacement of the
clinically oriented subdivision of neck structures by fascially
based anatomic spaces that more closely correspond to
surgical and pathologic landmarks.

ANATOMY OF THE ORAL CAVITY

The oral cavity is located anterior to the oropharynx. It is separated
from the oropharynx by the soft palate, anterior tonsillar pillars,
and circumvallate papillae. The mylohyoid muscle separates the
lower oral cavity into the submandibular and sublingual spaces,
and forms the floor of the mouth, arising from the mandible and
attaching to the hyoid.
The submandibular space, which is located inferior and lateral
to the mylohyoid muscle and superior to the hyoid bone, is
enveloped by the SL-DCF. Posteriorly, no fascial separation is
SUGGESTED READINGS
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