Pretracheal Space

spatium pretracheale

The pretracheal space is the compartment within the pretracheal fascial sleeve anterior to the trachea and below the thyroid isthmus, providing the pathway for thyroid goitre extension into the superior mediastinum and for the spread of infection from neck to anterior mediastinum. It is bounded by the pretracheal fascia anteriorly and laterally, and the tracheal fascia posteriorly.

Region: Neck

Clinical Relevance

Clinical Notes

The pretracheal space is the passage through which large goitres extend retrosternally into the superior mediastinum — the majority of substernal goitres are extensions of cervical thyroid tissue through this space. Most substernal goitres can be delivered through a cervical incision by finger dissection in the pretracheal space; only a minority require sternotomy. Pretracheal space infections from thyroid abscess or deep neck infection can descend into the anterior mediastinum, producing anterior mediastinitis. Tracheostomy is performed in the pretracheal space between the strap muscles and the tracheal rings at the level of the second and third tracheal rings.

Pathology

Common Injuries & Conditions

Substernal Goitre Extending Through Pretracheal Space

Thyroid goitre enlarging through the pretracheal space into the superior mediastinum produces tracheal and oesophageal compression with dyspnoea and dysphagia; CT characterises the extent of mediastinal extension, and the majority are removed through a cervical incision alone by dividing the pretracheal attachments and gentle blunt digital delivery from the mediastinum.