Facial Spaces: Anatomical Organization
The facial and maxillofacial region contains multiple distinct fascial spaces that are anatomically delineated by layers of deep cervical fascia, extending from the skull base to the hyoid bone, and these spaces are clinically critical as they serve as potential pathways for infection spread and tumor extension. 1
Primary Classification System
The maxillofacial and anterior neck regions are divided into four major portions based on their relationship to the superficial layer of the deep cervical fascia (SfDCF): 1
1. Superficial Portion (Above SfDCF)
- Located superficial to the deep cervical fascia and its rostral extension to the face 1
- Contains spaces adjacent to the oral cavity that constitute the starting point of deep infections 1
2. Intermediate Portion (Within Split SfDCF)
- Sandwiched by the splitting superficial layer of deep cervical fascia 1
- Spaces lie around the mandible and occupy the position connecting superficial and deep portions 1
- Submandibular and prestyloid spaces function as relay stations conveying infections from superficial to deep portions 1
3. Deep Portion (Below SfDCF)
- Located deep to the superficial layer of deep cervical fascia 1
- Spaces lie near cervical viscera and communicate inferiorly with the superior mediastinum 1
- Poststyloid space serves as a reception center for infections and conveys them into the superior mediastinum via the retrovisceral space and carotid sheath 1
4. Superficial Facial Portion
- Unique to the face where deep structures open on the body surface to form the oral cavity 1
Specific Fascial Spaces by Location
Medial (Midline) Spaces
- Pharyngeal mucosal space: Contains adenoidal tissue; prone to hyperplasias and squamous cell carcinomas 2
- Retropharyngeal space: Contains lymph nodes; susceptible to adenopathies and abscess formation 2
Lateral (Paired) Spaces
Prestyloid Space
Retrostylian (Poststyloid) Space
- Contains lymph nodes, neural structures, and vascular elements 2
- Common location for adenopathies, schwannomas, and paragangliomas 2
Masticator Space
- Includes the masseter muscle, zygomatic arch, outer cortex of mandibular ramus, and temporalis muscle 3
- Pterygopalatine fossa within this space serves as an important communication pathway for locoregional pathologic processes 2
Buccal Space
- Contains facial vessels, mandibular and facial nerves, and the buccal fat pad 4
- Communicates with masticatory space, serving as both reservoir and channel for infections and tumors 4
Parotid Space
- Contains parotid gland, Stensen's duct, facial nerve, external carotid artery, retromandibular vein, and intraparotid lymph nodes 3
Carotid Space (Suprahyoid Region)
- Contains internal carotid artery, internal jugular vein, cranial nerves IX-XII, and sympathetic plexus 3
Submandibular and Sublingual Spaces
Submandibular Space
- Houses submandibular gland, submental and submandibular lymph nodes, and anterior belly of digastric muscle 3
- Contains facial artery and vein, and lower loop of hypoglossal nerve 3
- Most frequently involved space in odontogenic infections (27.1% of cases) 5
Sublingual Space
- Contains sublingual gland, deep portion of submandibular gland and its main excretory duct 3
- Houses hypoglossal nerve (CN XII), lingual nerve (CN V3 branch), glossopharyngeal nerve (CN IX), and lingual vessels 3
- Involved in 18.3% of odontogenic infections requiring hospitalization 5
Submental Space
- Involved in 16.7% of odontogenic infections 5
Frequency of Involvement in Odontogenic Infections
Primary spaces are involved in 86.7% of cases, followed by secondary spaces (8.7%) and cervical spaces (4.6%) 5
The most commonly affected spaces in descending order are: 5
- Submandibular (27.1%)
- Buccal (20.8%)
- Sublingual (18.3%)
- Submental (16.7%)
Clinical Significance
Greater involvement of multiple fascial spaces correlates directly with:
- Higher laboratory inflammatory markers (p < 0.001) 5
- Longer hospitalization stays (p < 0.001) 5
- Increased ICU admission rates (p < 0.001) 5
Spaces communicate freely with each other within portions of the same depth, allowing rapid spread of infection or tumor extension 1. The intermediate portion spaces, particularly submandibular and prestyloid, are critical junctions that can propagate infections from superficial oral cavity sources to deep cervical and mediastinal structures 1.