LXXVI The Lateral Pharyngeal Cleft

Abstract

There is considerable question concerning the boundaries and relations of the lateral pharyngeal cleft. The purpose of this work is to determine the boundaries of this region, its relations with sur rounding spaces, and the existence of any direct communications between the lateral pharyngeal cleft and contiguous spaces. The results are based on the dissection of approximately 3 5 half heads. DESCRIPTION The lateral pharyngeal cleft is enclosed by a definite and discrete fascial boundary. Medially, it is bounded by the fascia on the lateral surface of the tensor veli palatini muscle, the fascia of the pharynx wall, and the fascia of the styloglossus muscle. Its lateral confine is the medial pterygoid and the interpterygoid fasciae.Anteriorly, above the level of the retromolar trigone, the cleft is closed by the attachment of the fused medial and interpterygoid fasciae to bucci nator fascia. Anteriorly, below the level of the retromolar trigone, where the styloglossus is contiguous with the pharynx wall, it is closed by the fascia sweeping lateralward to attach to the mandible at the junction of the body and ramus. A plane of fascia between the pharynx, the styloid process, and the posterior border of the man dibular ramus limits the cleft posteriorly. This potential space is limited above by the base of the skull, below by a fascial bridge be tween the pharynx and the mandibular ramus. With this general delineation we can consider the boundaries in greater detail.Covering the superficial surface of the superior constrictor is a fascial sheet, the peripharyngeal fascia (also identified as visceral or buccopharyngeal fascia (Figs. 1, 3, 4, 7 and 8). This sheet affixes

Head and neck fascia and compartments: No space for spaces

“…Several cadaver dissection studies, some of which have incorporated the injection of colored gelatin, have shown free communication between the submandibular and parapharyngeal spaces . However, other dissection studies and clinical and radiologic observations do not support such a communication…”

“…It is commonly described as an inverted pyramid, cone, funnel, or triangle with the skull base superiorly and the greater cornu of the hyoid bone or mandible inferiorly, although this concept has been challenged . Laterally, it is bordered by the medial pterygoid muscle and parotid gland, posteriorly by the prevertebral muscles or carotid sheath (depending on the definition), and medially by the visceral fascia covering the pharyngeal muscles . Some authors subdivide the space into the anterior (prestyloid) and posterior (poststyloid) compartments .…”

“…Considering the first of these controversies, numerous structures have been suggested to subdivide the parapharyngeal space: the styloid muscles and posterior belly of digastric (the so‐called “styloid diaphragm”); the tensor veli palatini and its fascia; the “stylopharyngeal aponeurosis”; and the levator veli palatini and its fascia . To compound the confusion, some authors have added a further subdivision, namely a third medial compartment (retropharyngeal) or a posterior hypoglossal compartment .…”

The Transcervical Approach for Parapharyngeal Space Pleomorphic Adenomas: Indications and Technique

“…[1] This complex space is anatomically surrounded by numerous structures [2] and divided by the styloid process into the pre- and post-styloid spaces. [3] The rationale behind this subdivision is that the different structures occupying these subspaces can be the source of various tumors with an anatomic space of origin suggestive of their nature.…”

III The Parotid Compartment

“…17 The area occupied by the stylomandibular fascia has been designated the orifice préstylien by Faure, 12 boutonnière rétrocondylienne by Rouviere, 42 and the stylomandibular tunnel by Patey and Thackray. In this vicinity the stylopharyngeus muscle passes deep to the medial wall and the fascia continues inferi orly to sweep between the posterior border of the stylomandibular membrane and the stylohyoid muscle.…”