ANATOMY OF

HEAD AND NECK INFECTIONS

!"#$%&' )'*&%&+ ,-
./0'" ,12'334"+ ,-
56'"7 84/"70 96$0$"*'*&4"
-$:'6*3$"* 4; <*4%'6="#4%4#=
>?$ @"&A$60&*= 4; >$B'0 ,$7&1'% C6'"1? D/*3E F$'%*?G
)4A$3E$6 HI+ JIKK
Imngos usod wIfhouf ormIssIon
IT!O!CTIO
InfocfIons nro ono of fho mosf commonIy
occurrIng hond nnd nock nfhoIogIos
Srond of InfocfIon cnn bo rodIcfod by nnnfomIc
boundnrIos
MorfnIIfy from hond nnd nock InfocfIons hns
docronsod sIgnIfIcnnfIy sInco fho ndvonf of
nnfIbIofIcs, buf rosIsfnnf orgnnIsms nro
srondIng Info fho communIfy
IngnosIs nnd fronfmonf wIII nof bo focus of fhIs
dIscussIon
SIACIS I THI HIA A ICK
SInusos
OrbIfs
IorIfonsIIInr
InrnhnryngonI
SubmnndIbuInr
!ofrohnryngonI
nngor Snco
IrovorfobrnI
MnsfIcnfor
Inr

SI!SIS
ASA! IO!I!S
ModInIIy - fho nnsnI sofum (orondIcuInr Info of fho
ofhmoId bono, fho vomor bono, nnd fho sofnI cnrfIIngo)
!nfornIIy - fho nnsnI conchno; suorIor nnd mIddIo
(ofhmoId bono dorIvnfIon), InforIor (n bono IfsoIf), nnd
confrIbufIons from fho IncrImnI bono, fho orondIcuInr
Info of fho nInfIno bono, nnd fho mnxIIInry bono
InforIorIy - fho horIzonfnI Info of fho mnxIIInry bono
(nnforIor fwo fhIrds of fho hnrd nInfo) nnd fho horIzonfnI
Info of fho nInfIno bono (osforIor fhIrd of fho hnrd
nInfo)
SuorIorIy - fho crIbIform Info of fho ofhmoId bono (whoro
fho norvo ondIngs of fho OIfncfory orvo (Cl) oon fo fho
onvIronmonf)
IosforIor - nono, fho nnsnI cnvIfy oons fo fho nnsohnrynx
vIn fho chonnno
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SI!S !AIACI IATTI!S
MnxIIInry SInus - Tho Inrgosf sInus, Is found InfornI nnd
InforIor fo fho InfornI nnsnI wnII boIow fho orbIf. ThIs sInus
drnIns, suorIorIy, fo fho mIddIo monfus jusf boIow fho
ofhmoIdnI buIIn.
ShonoIdnI SInus - ThIs sInus Is Iocnfod In fho osforIor wnII
of fho nnsnI cnvIfy nnd oons fo fho shonoofhmoIdnI rocoss
whIch Is suorIor fo fho suorIor conchn. SuorIor fo fhIs sInus
Is fho IfuIfnry gInnd (hyohysIs) In fho soIIn furcIcn of fho
shonoId bono.
IronfnI SInus - Tho fronfnI sInusos nro Iocnfod In fho fronfnI
bono of fho crnnIum nnd oxfond ncross fho forohond. Thoso
sInusos drnIn down fo fho mIddIo monfus vIn fho fronfonnsnI
ducf Info fho nnforIor orfIon of fho somIIunnr hInfus.
IfhmoIdnI SInus - Thoso sInusos rosombIo bubbIos nnd nro
Iocnfod bohInd fho suorIor InfornI nnsnI wnII. Thoy nro
dIvIdod Info nnforIor, mIddIo nnd osforIor coIIs on fho bnsIs of
fhoIr drnInngo. Tho nnforIor coIIs drnIn fo fho mIddIo monfus
In fho osforIor orfIon of fho somIIunnr hInfus. >?$ 3&77%$
0&"/0$0 $3:*= *4 *?$ 1$"*$6 4; *?$ $*?34&7'% E/%%'N Tho
osforIor sInusos omfy fo fho suorIor monfus.
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A comIox dIsonso
rocoss rosuIfIng
In bIockngo of
sInus drnInngo
nnd nccumuInfIon
of fIuId IondIng fo
bncforInI
ovorgrowfh. Mny
bo fronfod
modIcnIIy or
surgIcnIIy, wIfh
fho gonI of surgory
fo nIIovInfo
nnnfomIc
obsfrucfIons.
O!IITS: CHA!I! C!ASSIIICATIO
l. 9$6&46E&*'% D96$0$:*'%G 2$%%/%&*&0P oyoIId odomn,
oryfhomn, fondornoss; no vIsIon chnngos, chomosIs, rofosIs,
or rosfrIcfIon of ocuInr muscIos
2. <6E&*'% 2$%%/%&*&0P rofosIs, chomosIs, mny cnuso vIsIon
chnngos (nnforIor uIIInry dofocf), mny IImIf oxfrnocuInr
muscIos
HN ./E:$6&40*$'% !E01$00P coIIocfIon of us bofwoon bono
nnd orIosfoum, chomosIs, mny hnvo rofosIs, rosfrIcf
oxfrnocuInr mofIon, nnd nffocf vIsIon, roquIros urgonf surgIcnI
docomrossIon
4. <6E&*'% !E01$00P coIIocfIon of us In orbIfnI soff fIssuo,
rofosIs, chomosIs, rosfrIcfod oxfrnocuInr mofIon, mny hnvo
no IIghf orcofIon (mny bo rovorsIbIo), roquIros urgonf
surgIcnI docomrossIon
5. 2'A$6"4/0 .&"/0 >?643E40&0P InfhohysIoIogy:
orInnsnI sInus InfocfIon orbIfnI oxfonsIon murnI
fhrombus forms In vossoI wnII (fhrombohIobIfIs)
rongnfos dIsfnIIy ns cIof soffons nnd bogIns fo sood
Infhogons: !" $%&'%(, homoIyfIc !)&'*)+,+,,%( nnd -.'%/+,+,,%(
SSx: picket fence spiking fevers, toxemia, nIIIodomn, nrnIysIs of
oxfrnocuInr muscIos (C III, IV, nnd V), rofosIs, chomosIs, oyoIId
odomn
O!IITA!
CI!!!!ITIS
A WO! AIO!T THI CAVI!O!S SI!S
II!ITOSI!!A! SIACI
Tho orIfonsIIInr snco consIsfs of
Iooso connocfIvo fIssuo bofwoon fho
cnsuIo of fho nInfIno fonsII nnd fho
suorIor consfrIcfor muscIo. Tho
nnforIor nnd osforIor fonsIIInr IIInrs
confrIbufo fo Ifs nnforIor nnd
osforIor bordors, rosocfIvoIy. Tho
osforIor fonguo forms fho InforIor
boundnry. 9$6&*4"0&%%'6 &";$1*&4"0
3'= 6$'7&%= 0:6$'7 *4 *?$
:'6':?'6="#$'% 0:'1$N
III SIACIS
Submandibular
space
IA!AIHA!YCIA! SIACI
Ofhor nnmos: InfornI hnryngonI or hnryngomnxIIInry snco
Shno: Invorfod yrnmId
IoundnrIos:
SuorIor: 0Q/%% E'0$
InforIor: juncfIon of fho osforIor boIIy of fho dIgnsfrIc muscIo nnd gronfor cornu of fho
hyoId bono
AnforIor: forygomnndIbuInr rnho nnd modInI forygoId muscIo bound fho snco
IosforIor: rovorfobrnI fnscIn
ModInI: suorIor consfrIcfor, fonsor, nnd Iovnfor voII nInfInI muscIos
!nfornI: nrofId gInnd, mnndIbIo, nnd InfornI forygoId muscIo

Comnrfmonfs:
IrosfyIoId (nnforIor): confnIns fnf, sfyIogIossus nnd sfyIohnryngous, Iymh nodos,
doo Iobo of fho nrofId, InfornnI mnxIIInry nrfory, InforIor nIvooInr, IIngunI, nnd
nurIcuIofomornI norvos
IosfsfyIoId (osforIor): confnIns cnrofId nrfory, InfornnI juguInr voIn, symnfhofIc
chnIn, nnd crnnInI norvos IX, X, XI, nnd XII.

ConnocfIons fo ofhor doo sncos:
osforomodInIIy: rofrohnryngonI snco
InforIorIy: submnndIbuInr snco
InfornIIy: mnsfIcnfor snco
modInIIy: orIfonsIIInr snco
IA!AIHA!YCIA! SIACI
IA!AIHA!YCIA! SIACI
S!IMAII!!A! SIACI
IoundnrIos:
SuorIor: mucosn of fho fIoor of fho moufh
InforIor: dIgnsfrIcs muscIo nnd hyoId bono
AnforIor: myIohyoId muscIo nnd nnforIor boIIy of dIgnsfrIcs
IosforIor: osforIor boIIy of fho dIgnsfrIc nnd sfyIomnndIbuInr
IIgnmonf
ModInI: hyogIossus, myIohyoId, sfyIogIossus, gonIogIossus, nnd
gonIohyoId muscIos
!nfornI: Infysmn nnd mnndIbIo
Tho 3=%4?=4&7 3/01%$ dIvIdos fho submnndIbuInr snco Info
n suorIor subIIngunI snco nnd nn InforIor submnxIIInry
snco (nIso roforrod fo ns fho submnndIbuInr snco).
SubIIngunI snco: InfornI fo fho gonIohyoId nnd gonIogIossus muscIos,
Contains: sublingual gland and Whartons duct.
Toofh nIcos nnforIor fo fho socond moInr IIo suorIor fo fho myIohyoId IIno
nnd fhus InvoIvo fho subIIngunI snco.
SubmnxIIInry snco
ConfnIns submnndIbuInr gInnds nnd Iymh nodos.
InfocfIons of fho socond nnd fhIrd moInrs InIfInIIy InvoIvo fho submnndIbuInr
or nrnhnryngonI snco, bocnuso fhoIr roofs oxfond boIow fho myIohyoId
IIno.

!!WICS ACIA
./E%&"#/'% 0:'1$
./E3'B&%%'6= 0:'1$
!IT!OIHA!YCIA! SIACI
IofonfInI snco
IoundnrIos:
!or: skuII bnso
!owor: 3$7&'0*&"/3 '* *?$ *6'1?$'% E&;/61'*&4"
AnforIor: buccohnryngonI fnscIn, IInIng of fho
osforIor hnrynx nnd osohngus
IosforIor: nInr fnscIn
ConfnIns: Iymh nodo nnd connocfIvo fIssuo
!oufos of onfry: dIrocf srond from fho
nrnhnryngonI snco, or IymhnfIc srond from
fho nrnnnsnI sInusos or nnsohnryngonI rogIon

Submandibular
space
!"#$%&'
)*++
,-.*#/-#0
ACI! SIACI
IofonfInI Snco, dnngorous for rnId InforIor
srond of InfocfIon fo fho osforIor modInsfInum
fhrough Ifs Iooso nrooInr fIssuo
IoundnrIos
SuorIor: skuII bnso
InforIor: 7&':?6'#3
AnforIor: nInr fnscIn, rofrohnryngonI snco
IosforIor: rovorfobrnI fnscIn
!nfornI: frnnsvorso rocossos of vorfobrno
ConfnIns: symnfhofIc frunk
!oufos of onfry: rofrohnryngonI,
nrnhnryngonI, or rovorfobrnI sncos
ACI! SIACI
I!IVI!TII!A!SIACI
IofonfInI snco
IoundnrIos
SuorIor: cIIvus of fho skuII bnso
InforIor: coccyx
AnforIor: rovorfobrnI fnscIn
IosforIor: vorfobrnI bodIos
!nfornI: frnnsvorso rocossos
ConfnIns: nrnsInous, rovorfobrnI, nnd scnIono
muscIos, vorfobrnI nrfory nnd voIn, brnchInI
Ioxus, nnd hronIc norvo
!oufos of onfry: InfocfIon of fho vorfobrnI bodIos
nnd onofrnfIng InjurIos
I!IVI!TII!A! SIACI
MASTICATO! SIACI
IoundnrIos:
SuorIor: skuII bnso
InforIor: submnndIbuInr snco
!nfornI: mnssofor, suorfIcInI fomornI fnscIn
ModInI: modInI forygoId, nrnhnryngonI snco
AnforIor: osforIor wnII of mnxIIInry sInus, buccnI snco
IosforIor: nrofId
ConfnIns: mnndIbIo nnd muscIos of mnsfIcnfIon (mnssofor, fomornIIs,
modInI forygoId, InfornI forygoId), fho fhIrd orfIon of fho
frIgomInnI norvo, whIch onfors fhrough fho fornmon ovnIo, fho
InfornnI mnxIIInry nrfory, nnd much of fho buccnI fnf nd
Subsncos:
MnssoforIc: bofwoon fho mnssofor muscIo nnd rnmus of mnndIbIo
IforygoId: bofwoon fho forygoId muscIos nnd rnmus
SuorfIcInI fomornI: suorfIcInI fomornI fnscIn nnd fomornIIs muscIo
oo fomornI: bofwoon fho doo fomornI fnscIn nnd fomornI bono
!oufo of onfry: mosf commonIy from fho fhIrd mnndIbuInr moInrs
MASTICATO! SIACI
CrnhIc rorosonfnfIon (nxInI vIow) of
sfrucfuros of fho Ioff mnsfIcnfor snco:
(l) mnssofor muscIo; (2) modInI forygoId
muscIo; (3) InfornI forygoId muscIo; (4)
fomornIIs muscIo; (5) forygonInfIno
fossn; nnd (6) shononInfIno fornmon.
MASTICATO! SIACI WITH S!ISIACIS
IA!
ocrofIzIng ofIfIs oxfornn Is nn nggrossIvo nnd
ofonfInIIy fnfnI InfocfIon orIgInnfIng In fho
oxfornnI cnnnI, wIfh rogrossIvo srond nIong fho
soff fIssuos nnd bono of fho skuII bnso, uIfImnfoIy
InvoIvIng InfrncrnnInI sfrucfuros.
IosforIor srond (usunIIy of I. norugInosn) Ionds
fo cIoudIng of fho mnsfoId nIr coIIs. WIfh modInI
srond, dIsIncomonf nnd orosIon of ossIcIos
occur, whIIo nnforIor srond mny roduco
fomoromnndIbuInr joInf nrfhrIfIs nnd
mnndIbuInr condyIo osfoomyoIIfIs. InfrncrnnInI
srond mny rosuIf In monIngIfIs, brnIn nbscoss or
cnvornous sInus fhrombosIs.
IC!OTIZIC OTITIS IXTI!A
ShowIng InvnsIon Info
nrnhnryngonI snco
COC!!SIO
!ndorsfnndIng nnnfomIcnI boundnrIos cnn hoI
cIInIcInns mnnngo hond nnd nock InfocfIons by
rodIcfIng fhoIr srond

MorfnIIfy hns docronsod sIgnIfIcnnfIy In fho
osfnnfIbIofIc orn
!III!ICIS
hff://IrIs3.mod.fuffs.odu/hondnock
hff://www.cIovoInndcIInIcmodod.com/modIcnIubs/dIsonsomnnngomonf/nIIorgy
/rhIno-sInusIfIs/
hff://docforcnyoo.bIogsof.com/2009/l2/orIfonsIIor-nbscoss-fn-quInsy-l.hfmI
www.morckmnnunIs.com/rofossIonnI/oyo_dIsordo...
hff://IrIs3.mod.fuffs.odu/donfgross/InbguIdo/Homongo.hfmI
CummIngs OfoInryngoIogy Hond nnd ock Surgory, 5
fh
od.
!oo KJ, IssonfInI OfoInryngoIogy Hond nnd ock Surgory
Inshn !, OfoInryngoIogy Hond nnd ock Surgory CIInIcnI !oforonco CuIdo
Horr !, SorIous Soff TIssuo InfocfIons of fho Hond nnd ock, AmorIcnn
InmIIy IhysIcInn, Sofombor l99l, VoI 44, no 3, 8?8-888
Hnrfmnnn !W Jr. !udwIg's nngInn In chIIdron. Am Inm IhysIcInn. l999
JuI;60(l):l09-l2.
offor IH AfIns of Humnn Annfomy 3
rd
Id.
Tho mnsfIcnfor snco: Irom nnnfomy fo nfhoIogy, . Inyo of nI, JournnI of
ourorndIoIogy VoIumo 36, numoro 3ngos l2l-l30 (juIn 2009)