Cervical Fascia

  • Superficial cervical fascia:
    • Primarily includes the:
      • Platysma and
      • Subcutaneous fat and vessels:
        • However:
          • As with other fascia in the body:
            • The use of the terminology of the superficial cervical fascia has declined in favor of:
              • Subcutaneous tissue:
                • Thus, an unspecified reference to cervical fascia:
                  • Mainly refers to the deep cervical fascia
  • The deep cervical fascia:
    • Consists of three separate but related fascial layers:
      • That encircle structures in the neck and
      • Allow anatomic compartmentalisation into:
        • The deep spaces of the head and neck
      • Each layer contributes:
        • To the carotid sheath
    • Layers of the deep cervical fascia:
      • Superficial layer of the deep cervical fascia
      • Middle layer of the deep cervical fascia
      • Deep layer of the deep cervical fascia
  • The superficial layer of the deep cervical fascia:
    • Also known as:
      • The investing layer / fascia
    • Is the one of three layers of the deep cervical fascia:
      • That surrounds all of the neck:
      • That is deep to the platysma
      • The layer includes:
        • The masticator fascia
        • Submandibular fascia, and
        • Sternocleidomastoid-trapezius fascia
        • The fascia that superficially covers the parotid gland:
          • May also be derived from this layer:
            • But this inclusion is controversial
    • Gross anatomy – attachments:
      • Posteriorly:
        • Ligamentum nuchae
        • Cervical vertebral spinous processes
        • External occipital protuberance
      • Superiorly
        • Mandible:
          • The layer thickens to form the extrinsic ligaments of the mandible:
            • Sphenomandibular ligament and
            • Stylomandibular ligament
        • Mastoid process and styloid process
        • Central skull base
        • Zygomatic arch
        • Superior temporal line or temporal ridge
    • Inferiorly
      • Manubrium
      • Clavicle
      • Acromion and spine of the scapula
    • Contents:
      • The superficial layer of the deep cervical fascia:
        • Encircles everything in the neck:
          • Apart from the skin and superficial cervical fascia (subcutaneous tissue)
      • In addition, it splits to enclose the following structures:
        • Two salivary glands
          • Submandibular gland
          • Parotid glands
        • Two spaces:
          • Masticator space
          • Suprasternal space
        • Two muscles (other than those in the masticator space):
          • Sternocleidomastoid muscle
          • Trapezius muscle
    • In addition:
      • All layers of the deep cervical fascia:
        • Contribute to the carotid sheath
  • The middle layer of the deep cervical fascia:
    • Is the one of the three layers of the deep cervical fascia:
      • It most closely surrounds:
        • The visceral organs
    • This layer consists:
      • Anteriorly of the:
        • Strap muscle fascia:
          • Comprised of the:
            • Sterno-omohyoid layer and
            • Sternothyroid layer
            • Thyrohyoid layer
      • Posteriorly:
        • Visceral fascia:
          • Also commonly known as the:
            • Pharyngobasilar and
            • Buccopharyngeal fascia
              • Particularly in the suprahyoid neck, or, less commonly:
                • Pharyngomucosal fascia
          • The alternative term:
            • Pretracheal fascia:
              • May refer to either:
                • The visceral fascia or
                • The sternothyroid-thyrohyoid layer of strap muscle fascia:
                  • Which lies anterior to the trachea
    • Gross Anatomy – attachments:
      • Superiorly:
        • Skull base
      • Anteriorly:
        • Hyoid bone
        • Thyroid cartilage
        • Manubrium
      • Inferiorly:
        • Fibrous pericardium
        • Adventitia of the aortic arch
    • Contents:
      • Infrahyoid (strap) muscles:
        • Sternohyoid
        • Omohyoid
        • Sternothyroid
        • Thyrohyoid
      • Visceral space and pharyngeal mucosal space:
        • Buccinator muscle
        • Pharynx and pharyngeal constrictor muscles:
          • Superior pharyngeal constrictor muscle
          • Middle pharyngeal constrictor muscle, and
          • Inferior pharyngeal constrictor muscle
        • Cervical esophagus
        • Thyroid gland* and parathyroid glands
        • Trachea*
        • Larynx*
        • Visceral lymph nodes
        • Recurrent laryngeal nerve
          • *Some sources consider these structures to have their own fascia not derived from the middle layer of the deep cervical fascia:
            • But they are nevertheless considered part of the visceral space
    • In addition:
      • All layers of the deep cervical fascia:
        • Contribute to the carotid sheath:
          • However:
            • In the suprahyoid neck:
              • Above the carotid bifurcation:
                • The contribution of the middle layer is inconsistent
  • The deep layer of the deep cervical fascia:
    • Is one of the three layers of the deep cervical fascia:
      • It encases the:
        • Paravertebral muscles and
        • Forms the perivertebral space
      • It consists of the:
        • Perivertebral fascia:
          • The anterior part of which is called:
            • The prevertebral fascia and
            • The alar fascia
    • Gross Anatomy – attachments:
    • Medially:
      • Ligamentum nuchae
      • Cervical vertebral spinous processes and transverse processes
    • Laterally:
      • Carotid sheath
      • First rib:
        • From a portion of the layer called:
          • Sibson fascia
      • Axillary sheath
    • Superiorly
      • The skull base
    • Inferiorly
      • Coccyx:
        • For the prevertebral fascia)
      • Endothoracic fascia:
        • For the alar fascia
    • On each side:
      • A flap attaches to the transverse processes of the cervical vertebrae and:
        • Divides the peri-vertebral spaces into:
          • A pre-vertebral compartment:
            • Anteriorly and
          • A para-spinal compartment:
            • Posteriorly
    • Anteromedial to the scalene muscles:
      • The deep layer splits into two leaves:
        • The ventral leaf being:
          • The alar fascia, and
        • The dorsal leaf being:
          • The prevertebral fascia:
            • With the prevertebral space:
              • Space between the prevertebral fascia and the spine
          • The space between the alar fascia and the prevertebral fascia:
            • Is the danger space
          • The space between the alar fascia and the posterior aspect of the middle layer of the deep cervical fascia:
            • Is the retropharyngeal space
    • Contents:
      • Danger space:
        • Space between prevertebral and alar fascia
      • Prevertebral space:
        • Space between the prevertebral fascia and the spine:
          • Anterior component:
            • Of the perivertebral space
      • Longus colli and capitis muscles
      • Rectus capitis anterior and lateralis muscles
      • Scalenus anterior, medius, and posterior muscles
      • Sheath for subclavian artery and vein, brachial plexus
      • Vertebral column
      • Spinal cord and associated thecal sac, nerve roots, and vessels
      • Vertebrae and associated discs and ligaments
      • Paraspinal / paravertebral space:
        • Posterior component:
          • Of the perivertebral space
      • Levator scapulae
      • Deep cervical back muscles
      • Pierced by the four cutaneous branches of the cervical plexus:
        • Greater auricular nerve
        • Lesser occipital nerve
        • Transverse cervical nerve
        • Supraclavicular nerve
    • In addition:
      • All layers of the deep cervical fascia:
        • Contribute to the carotid sheath

#Arrangoiz #HeadandNeckSurgeon #CancerSurgeon #SurgicalOncologist #Teacher

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