Cervical fascia

Deep fascia of neck

1. Deep cervical fascia

2. Neck
•Region of the body
•Lies between
–Above
•Lower border of mandible
•Mastoid process
•Superior nuchal line &
•External occipital
protuberance
–Below
•Suprasternal notch
•upper border of clavicle
•Acromion process
•Spine of scapula and
•C7 spine

3. Lateral view of Neck
•In lateral view neck is a
quadrilateral area
•2 big muscles present
–Sternocliedomastoid
–Trapezius

4. Landmarks of the neck
•Bone & cartilages
•Anterior midline structures
–Mental protuberance
–Hyoid bone
–Laryngeal prominence
•Thyroid cartilage
–Cricoid cartilage
–Trachea
–Suprasternal notch

5. Landmarks of Neck
•Suprasternal fossa
•Sternocleidomastoid
•Supraclavicular fossa

6. Deep fascia of Neck
•Otherwise fascia colli
•Lies deep to
–Skin
–Superficial fascia
•Platysma
•Arranged in 3 layers
–Investing layer
–Pretracheal
–Prevertebral

7. Deep fascia of Neck
•Forms compartments
–Visceral compartment
•Between pretracheal&
prevertebral layeres
•Trachea, oesophagus& thyroid
& parathyroid glands
–Neurovascular compartment
•Within carotid sheath
–Vertebral compartment
•Cervical vertebra & associated
muscles
Four compartments are enclosed by musculofascialcollar

8. Investing layer -
Attachments
•Above
–External occipital
protuberance
–Mastoid process
–External acoustic meatus
–Base of the mandible
•Below
–Spine of scapula
–Acromion process
–Clavicle
–Manubrium sterni

9. Investing layer -
Attachments
•Front
–Symphysis menti
–Hyoid Bone
–Upper border of
manubrium sternum
•Behind
–7
th
Cervical Vertebra
–LigamentumNuchae
•Across the midline
–They are continuous

10. Investing layer –Horizontal Tracing
•Investing = complete covering
•Surrounds entire neck
•Deep to skin and subcutaneous
tissue
–Splits into superficial and deep
layers
•To enclose
–Trapezius &
Sternocleidomastoid

11. Investing layer –Horizontal Tracing
•From behind
–Ligamentumnuchae
•Splits
–Enclose trapezius
•Forms
–Roof for Post triangle
•Splits
–Enclose sternocleidomastoid
•Forms
–Roof for Ant triangle
•Anteriorly
–Continues with opposite fascia

12. Investing layer
–Vertical Tracing
•Above
–Splits to enclose
•Sumandibular& Parotid glands
–At lower border of mandible
•Splits into
–Superficial & deep lamia
–Superficial lamina attaches
»Lower border of mandible
–Deep lamina attaches
»Mylohyoid line

13. Investing layer
–Vertical Tracing
•At lower pole of parotid
–Splits into
•Superficial & deep layers
–Superficial layer
•Covers parotid
•Attaches to
–Zygomatic arch & blends with
Masseter
–Forms
»Parotido-masseteric fascia
•Strong & tight
•Any inflammation
•Gives severe
pain

14. Investing layer
–Vertical Tracing
•Deep layer
–Loose & passes deep to
gland
–Attaches to
•Lower border of tympanic
plate & styloid process
–Stylomandibularligament
•Portion of deep layer
attached to
–Styloid process and angle
of mandible
•Separates
–Parotid from
submandibular glands

15. Investing layer –Vertical Tracing
•In lower part splits near
sternum & clavicle
•Suprasternal space
•Space of Burns
•Splitting of investing layer
–At upper border of sternum
–Gets attached to
•Anterior & posterior border of
supra-sternal notch
•Contents
–Inter-clavicular ligament
–Sternal head of
Sternocleidomastoid muscle
–Jugular Venous arch

16. Investing layer –Vertical Tracing
Supraclavicular space
•Splitting of investing
layer
–At middle 3
rd
of clavicle
–Attached to anterior &
posterior border of upper
surface of Clavicle
•Contents
–Terminal part of external
jugular vein
–Supraclavicular nerves

17. Investing layer –Fascial slings
•Forms fascial slings
–To Inferior belly of
omohyoid(H)
–To intermediate tendon of
Digastric (C)

18. 2 muscles enclosed-trapezius &
sternocleidomastoid
-1

19. 2 Triangle’s roof-anterior & posterior
-2

20. 2 Glands enclosed
parotid & submandibular salivary glands
-3

21. 2 Spaces enclosed-suprasternal (Space of
Burn’s) & supraclavicular space
-4

22. 2 Thickenings formed -parotidomasseteric
fascia & stylomandibularligament
-5

23. 2 fascial slings -digastric & omohyoid
muscles
-6

24. Pretracheallayer
•Layer of deep cervical
fascia
•Deep to investing layer
•Covers front and sides of
trachea

25. Pretracheallayer
•Horizontal extent
–From fascia under cover of
SCM muscle
–Forms ant. Wall carotid
sheath
–Splits to enclose thyroid &
infrontof trachea
•Fascia covering posterior
surface of thyroid
–Ill defined
–Enlargmentof thyroid
•Obstructs oesophagus
•Dysphagia

26. Pretracheallayer
•Vertical extent
•Above
–Hyoid in mid line
–Oblique line of thyroid
car.( thy. Moves up &
down during deglutition)
•Below
–Blends with apex of
fibrous pericardium
–Also cont. with supra
pleural membrane

27. Pretracheallayer
•Ligament of Berry
–Between
•Thyroid lobe & cricoid
cartilage

28. Prevertebral Fascia
•Covers
–Cervical vertebrae & prevertebral
muscles
–Levatorscapulae
–Scalenusanterior & medius
–Splenius capitis
•Forms
–Floor of posterior triangle
•Structures beneath it
–Cervical & brachial plexus
•Structures piercing
–Cutaneous branches of cervical
plexus
•Extends as
–Axillary sheath between Scalenus
anterior & medius
•Contains
–Cords of brachial plexus &
subclavian artery
Subclavian vein lies outside the axillary sheath

29. Prevertebral Fascia
•Horizontal tracing
–Forming post. wall of carotid
sheath
–Covers cerv. Vertebrae &
prevertebral muscles
•Vertical tracing
–Above-base of skull
–Below-fascia splits
•Anterior layer
–Known as alar ligament
–Blends with
buccopharyngealfascia
•Posterior layer
–Enter thorax
–Blends with
»Ant longitudinal lig
•Of T1 –T3
Pre vertebral fascia
Buccopharyngealfascia
Anterior lamina
Posterior lamina

30. Carotid sheath
•Tubular sheath of deep
cervical fascia
•Extent
–From
•Base of skull
–Margins of carotid canal &
jugular fossa
–To
•Arch of aorta
•Formation
–Anterior wall
•Pretrachealfascia
–Posterior wall
•Prevertebral fascia

31. Carotid sheath
•Contents
–Common & Internal carotid artery
(medial)
–Internal jugular vein (lateral)
–Vagusnerve (posterior & inbetween
artery & vein)
•Properties
–Thick over arteries
–Thin over veins
•Relations
–Posterior
•Sympathetic trunk
•Structure on anterior wall
–Ansa cervicalis

32. Buccopharyngealfascia
•Delicate fascia
•Covers
–Buccinator&
constrictors of pharynx
•Extent
–From –Base of skull
–To -oesophagus

33. Retropharyngeal space
•Potential space behind
pharynx
•Boundaries
–Anteriorly
•Buccopharyngealfascia
–Posteriorly
•Prevertebral fascia
–Superior
•Base of the skull
–Inferior
•Superior mediastinum
•Contents
–Pharyngeal plexus of vessels &
nerves
•Applied anatomy
–Infections of teeth can spread
down this space into the
posterior mediastinum