cervical fascia

anatomy of fascia around neck

1. CERVICAL FASCIA Dr. Rana Pratap Singh JRII Surgery M.L.B. MEDICAL COLLEGE JHANSI

2. CERVICAL FASCIA Fascia means fibrous connective tissue which binds together various structures of the body 2 types- superficial fascia & deep fascia Superficial fascia is subcutaneous- present just below the skin. Deep fascia is present around muscles blood vessels & organs of the neck

3. SUPERFICIAL CERVICAL FASCIA The superficial cervical fascia is typically a thin lamina covering the platysma muscle. It is hardly demonstrable as a separate layer but may contain considerable amounts of adipose tissue especially in females.

4. DEEP CERVICAL FASCIA Deep fascia around the neck is known as deep cervical fascia or fascia colli as it forms a collar around the neck Lies deep to platysma muscle in the interval b/w muscles, vessels & organs of the cervical region. Gives various extensions or laminae around various structures of the neck

5. MODIFICATIONS OF DEEP CERVICAL FASCIA Investing layer Pretracheal layer Prevertebral layer Carotid sheath Buccopharyngeal fascia Alar fascia .

6. INVESTING LAYER Above- external occipital protuberance,mastoid process, external acoustic meatus , base of the mandible Below - spine of scapula, acromion process, clavicle, manubrium sterni Front- hyoid bone & continuous with the fascia of the the opposite side

7. Post- 7th cervical vertebra, ligamentum nuchae

8. HORIZONTAL TRACING- Encloses 2 muscles- trapezius & sternocleidomastoid Forms roof of 2 triangle- anterior & posterior Gives 2 lamina for pretracheal & prevertebral fascia

9. Forms 2 fascial slings for omohyoid and diagastric ;

10. VERTICAL TRACING Encloses 2 gland- parotid & submandibular salivary gland Encloses 2 spaces- suprasternal space & supraclavicular space Forms 2 thickenings- parotidomassaeteric fascia & stylomandibular ligamen

11. ENCLOSES 2 SPACES- Supraclavicular space 1.SUPRACLAVICULAR SPACE splitting of investing layer medial 3rd of clavicle & gets attatched to anterior & posterior border of upper surface of clavicle Content of the space Supraclavicular nerves, external jugular vein

12. 2.SUPRASTERNAL SPACE Splitting of investing layer at the upper border of sternum which gets attatched to anterior & posterior border of supra- sternal notch known as space of burns Content of the space Inter- clavicular ligament, sternal head of sternocleidomastoid muscle, jugular venous arch, loose areolar tissue

13. CLINICAL ANATOMY Because of the presence of thick tough parotido-masseteric fascia which covers the parotid gland swellings of the parotid gland (mumps, parotitis) are very painfull

14. PRETRACHEAL FASCIA IT Is one of the lamina of deep cervical fascia that arises deep to sternocleidomastoid muscle

15. HORIZONTALLY the fascia encloses thyroid gland trachea(ant) oesophagus(post) infrahyoid muscle and then becomes continuous with the fascia of the opposite side.

16. VERTICALLY The fascia is attached to hyoid bone & then downwards it encloses thyroid gland & runs downwards into sup mediastinum & finally gets attached to pericardium of the heart.

17. CLINICAL ANATOMY The fascia forms the outer false capsule of thyroid gland, posterior part of which is thin & not well defined. Hence thyroid swellings grows posteriorly & may compress the oesophagus causing dysphagia.

18. Thyroid gland moves with deglutition as the posterior aspect of the gland is attatched to the cricoid cartilage by a thickening of pretracheal fascia known as ligament of berry or suspensory ligament of thyroid gland. During thyroid surgeries the ligament of berry has To be cut to mobilise the thyroid gland.

19. Continuity of pretracheal fascia with the mediastinum leads to spread of infection to mediasinum from the neck & vise versa Pretracheal fascia provides a free slippery base for the movement of the trachea during swallowing

20. PREVERTEBRAL FASCIA It is one of the lamina of deep cervical fascia that arises deep to sternocleidomastoid muscle Lies in front of cervical vertebrae & muscles in front of it

21. In front of vertebral column fascia is prominent and split in two layers of fascia. Anterior- alar fascia . Posterior- prevetebral Space created by spliting is danger space which is part of prevertebral space.

22. Attachments Superior- Skull base. Inferior attachments- T3. Posterior attachments-- Spinous processes of cervical and thoracic vertebrae. Lateral attachments Transverse processes of cervical and thoracic vertebrae.

23. Horizontally It forms the floor of the posterior triangle & finally extends upto axilla as axillary sheath enclosing the axillary vessels and nerves

24. Vertically it extends from the skull base upto the 3rd thoracic vertebra

25. CLINICAL ANATOMY Due the extension of prevertebral fascia as axillary fascia infections of vertebrae- caries spine (tuberculosis of vertebrae) may lead to spread of pus to the axilla , the pus may also point as an absess in the region of the posterior triangle

26. Prevertebral fascia forms the posterior wall of retropharyngeal space Retropharyngeal absess causes dysphagia

27. CAROTID SHEATH It is a fascial sheath situated deep to sternocleidomastoid muscle on each of the front of the neck Formation Anterior wall- by pretracheal layer of deep cervical fascia Posterior wall- by prevertebral layer of deep cervical fascia

28. CONTENT Internal jugular vein laterally, coImmon carotid artery ( in the lower part) & internal carotid artery ( in the upper part) medially, vagus nerve in b/w them in a posterior plane Relations- Anteriorly - ansa cervicalis Posteriorly – sympathetic trunk

29. BUCCOPHARYNGEAL FASCIA It is posterior to the esophagus, which separates the esophagus from the vertebral cervical fascia and forms the anterior border of the retropharyngeal space.

30. ALAR FASCIA The alar layer lies between the prevertebral layer and the buccopharyngeal fascia . The alar fascia separates the retropharyngeal and danger spaces and covers the cervical sympathetic trunk.

31. RETROPHARYNGEAL SPACE Posterior to pharynx and esophagus Anterior to alar layer of prevertibral fascia. Extends from skull base to T1-T 2

32. Pediatrics Cause— suppurative process in lymph nodes Nose, adenoids, nasopharynx , sinuses Adults Cause—trauma, instrumentation, extension from adjoining deep neck space

33. Danger Space Anterior border- alar fascia Posterior border- prevertebral layer Extends from skull base to diaphragm and is so named because it contains loose areolar tissue and offers little resistance to the spread of infection .

34. Danger Space infection from extension from retropharyngeal, prevertebral or parapharyngeal space Danger space infection may spread up to mediastinum

35. PREVERTEBRAL SPACE Anteriorly by prevertebral fascia Posteriorly by is vertebral bodies Extends along entire length of vertebral column.

36. Prevertebral space infection from Infection of the vertebral bodies Penetrating injuries. Tuberculosis of the spine may breach the space and form a Pott’s abscess.

37. Thanks