Cervical Fascia Flashcards
Give an overview of the neck
the neck is the most sophisticated region
• Contents: blood vessels, verves, viscera, muscle and true/pseudo spaces
Extent: (superiorly- mandible, mastoid, occiput) and (inferior-sternum, clavicle and spine of scapula)
• Neck connects the head to the rest of the body
• Connects respiratory tract and oral cavity to the GIT
• Pharynx becomes the oesophagus
• Pharynx’s opens into larynx which turns into trachea
Fascial layers of the neck
- Superficial
- Deep
○ Investing-superficial layer
○ Pre-tracheal- middle layer
○ Prevertebral- deep layer
○ Carotid sheath
- Deep
Give an overview of the tissue layers
• Outmost layer=skin-keratinized stratified squamous epithelium
• After skin is the superficial fascia which has platysma (gives neck wrinkles)
• After superficial fascia is deep facia
• deep fascia which has 3 layers: Investing layer, Pre tracheal and Pre vertebral
○ Investing layer= around neck
○ Pre tracheal= envelops the tranche (lies anterior the trachea))
○ Pre vertebral= envelops veritable column and the stutters of it
• Trapezius and sternocleidomastoids muscle is in the deep facias
• Pre tracheal muscles also envelop the Infrahyoid group of muscles
• Below hyoid Hyde’s = infrahyoid muscles
• Above hyoid= suprahyoid muscles
• Above hyoid is surrounded by investing fascia
• Investing ,Pre tracheal and Pre vertebral Are Also known as Superficial, Middle and deep (respectively)
Give an overview of the role of the fascia
- Connective tissue that provides framework to organise, support and protect
- This compartmentalization allows for:
- Ease of movement during movement- swallowing
- Formation of natural planes of tissue packing
- Determination of spread of infection
- Border potential and true spaces
- Natural lines of tissue separation – to allow tissue blood free exploration during surgery
- Need to be separate to prevent the spread of infection and to allow the movement of the oesophagus
What is the superficial fascia?
- superficial fascia is the first fascia under the skin-if you cut the skin then there will be the superficial fascia right underneath
- Surrounds all the whole neck
- strarts from the namdible (so also surounds sturctures above the hyoid/syrahiodmuscles)
- Thin layer of connective tissue between the dermis of the skin and deep cervical fascia.
- Cutaneous nerves of cervical plexus, blood vessels, lymphatics and Platysma Functions:
○ Main plane of resistance to deep neck spread of cellulitis
○ Allows mobility of skin over deep neck structures
○ Easily separated when raising neck flaps
What is Platysma?
• Is a muscle
• Superiorly: face muscles
• Inferiorly: clavicle and fascia over deltoid and pectoralis muscles
• Supplied by the facial nerve (cervical branch)
• Just below the skin
What is deep fascia?
- Investing fascia=superficial layer if deep fascia
- Pre-tracheal fascia= middle layer if deep fascia
○ Muscular layer-strap muscles
○ Visceral layer-thyroid, pharynx, larynx, trachea and oesophagus - Prevertebral fascia=deep layer of deep fascia
○ Alar layer-border retropharyngeal and danger space
○ Prevertebral layer-paraspinal muscle - investing= envelop sternocleidomastoid muscle
- Pre-tracheal= strap muscles ….
- Carotid sheath = contain internal jugular vein, carotid artery
- Prevertebral= vertebral column and other muscles
- Pre-tracheal fascia= middle layer if deep fascia
What is Investing fascia?
• Part of the deep fascia
• Extent/ attachment
○ Posteriorly : ligamentum nuchae and spine
○ Anteriorly : mandible and sternum and clavicle
• Contents
○ Trapezius, sternocleidomastoid, both bellies of digastric and suprahyoid muscles
○ Hypoid bone
○ Enclose submandibular gland
○ Thicken to make stylomandibular ligament
○ Merges with parotid masseter fascia
○ At superior edge of sternum it splits to form suprasternal space of Burns
What is Pre-tracheal fascia?
- Part of the deep fascia
- Extent/ attachment
○ Hyoid to Clavicle
○ Blends with pericardium
○ Above hyoid it wraps around the posterior sides of pharynx forming buccopharyngeal fascia - Contents
○ Infrahyoid muscles
○ Trachea
○ Oesophagus
○ Thyroid and parathyroid glands - Inferior blends with pericardium
- Surrounds trachea/respiratory organs of the neck and the thyroid
- Extent/ attachment
What is Prevertebral fascia?
- Part of the deep fascia
- Extent/attachments
○ Superiorly: Cranial base, pterygomandibular raphe and pharyngeal aponeurosis, pharyngeal tubercle
○ Inferiorly: Endothoracic fascia
○ Axillary sheath is a continuation of prevertebral fascia - Contents
○ Vertebral column
○ Muscles of the Paravertebral Region - Surrounds the vertebral column and the muscles around it
- Extent/attachments
What is Alar layer?
• Part of the deep fascia
• Thin fascial membrane that joins the two carotid sheaths
○ It is deployed in the transverse plane
• It intervenes between the
○ Muscular Compartment of the neck &
○ Visceral Compartment of the neck
• Divides that space into 2 Subdivision
○ Space between Alar Fascia and visceral layer
○ Space between muscular layer & Alar Fascia
• Also fascia fives visceral compartment from muscular compartment and divides the space into two
• This one toward the trachea=retropharyngeal space
• The one always from the trachea = danger space
What is Carotid sheath?
• Part of the deep fascia
• It is condensation of all the three layers of deep cervical fascia
• Extent:
○ Base of skull
○ First rib and sternum and blends with arch of aorta (adventitia)
• Contents:
○ CCA, ICA, IJV & Vagus nerve
○ Ansa cervicalis anteriorly
○ Sympathetic chain posteriorly
• Surrounds common carotid and eternal jugular vein
What are the spaces in the oral cavity?
• Pretracheal space between the investing layer of cervical fascia covering the posterior surface of the infrahyoid muscles and the pretracheal fascia (covering the anterior surface of the trachea and the thyroid gland)
• Retropharyngeal space between the buccopharyngeal fascia (on the posterior surface of the pharynx and esophagus) and the alar fascia (on the anterior surface of the transverse processes and bodies of the cervical vertebrae),
• Third/Danger space: within the prevertebral layer covering the anterior surface of the transverse processes and bodies of the cervical vertebrae.
• Parapharyngeal space immediately lateral to Oropharynx and Nasopharynx
• Pharyngeal mucosal space – mucosa and muscles of the nasopharynx and oropharynx. Waldeyer’s ring -adenoids and the palatine and lingual tonsils
• ParaPharyngeal space- fat-containing space lateral to the PMS with inferior extension into the submandibular space.
• Submandibular space Between mandible and hyoid bone with roof formed by floor of oral cavity
• Masticator Space anterolateral to PPS and contains the muscles of mastication, posterior body and ramus of the mandible and the mandibular nerve
• Parotid space contains the parotid gland, facial nerve, retromandibular vein, and branches of the external carotid artery. is
• Spaces around maxilla and mandible are connected to each other and extreme into the neck
• Spaces are filled with fat
