Fascia of the neck

Question 1

How is the neck viewed in cross-section?

Answer 1

Looking from feet

up to head

Question 2

Where does the neck begin?

Answer 2

Inferior border of mandible

Question 3

Where does the neck end?

Answer 3

Suprasternal notch of manubrium

Upper border of clavicle

Question 4

What structures organise the contents of the neck?

Answer 4

Cervical fascia

Question 5

What are the types of cervical fascia?

Answer 5

Superficial cervical fascia

Deep cervical fascia

Question 6

How many superficial cervical fascia layers are there?

Answer 6

Just one

Question 7

Where is the superficial cervical fascia located?

Answer 7

Just deep to the skin

Question 8

What type of tissue is the superficial cervical fascia made up of?

Answer 8

Loose connective tissue that contains lots of adipose tissue

Question 9

What structures does the superficial cervical fascia contain?

Answer 9

Superficial veins

Cutaneous nerves

Lymph nodes

Platysma

Question 10

What type of tissue is the deep cervical fascia made up of?

Answer 10

Dense connective tissue

Question 11

How many deep cervical fascia layers are there?

Answer 11

Three

Question 12

What are the deep cervical fascia layers?

Answer 12

Investing layer

Pre-tracheal fascia

Pre-vertebral fascia

Carotid sheath

Question 13

How are the deep cervical fascia layers arranged in the neck?

Answer 13

From anterior neck, superficial to deep

• investing layer
• pre-tracheal fascia
• pre-vertebral fascia

Question 14

What does the investing layer contain?

Answer 14

Surrounds the whole neck

Splits to contain the sternocleidomastoid muscle and the trapezius muscle

Question 15

What is the investing layer attached to?

Answer 15

Superiorly attaches to

• inferior border of mandible
• mastoid process
• superior nuschal line
• external occipital protruberance
• nuschal ligament
• spinous processes

Inferiorly attaches to

• superior border of manubrium
• superior surface of clavicle
• acromion of scapula
• spine of scapula

Question 16

Where is the pre-tracheal fascia located?

Answer 16

In the anterior part of the neck

Question 17

What are the parts of the pre-tracheal fascia? How are they arranged?

Answer 17

Muscular layer - anteriorly

Visceral layer - posteriorly

Buccopharyngeal fascia - posterior wall

Question 18

What does the muscular layer of the pre-tracheal fascia contain?

Answer 18

Infrahyoid muscles

Question 19

What does the visceral layer of the pre-tracheal fascia contain?

Answer 19

Thyroid gland

Trachea

Oesophagus

Question 20

What do the muscular and visceral layers of the pre-tracheal fascia attach to?

Answer 20

Superiorly
-hyoid bone

Inferiorly
-fuses with fibrous pericardium

Question 21

What does the buccopharyngeal fascia (pre-tracheal fascia) attach to?

Answer 21

Superiorly
-base of skull

Inferiorly
-diaphragm

Question 22

What forms the carotid sheaths?

Answer 22

Contributions from other three deep cervical fascia layers

Question 23

How many carotid sheaths are there?

Answer 23

Two

Question 24

Where are the carotid sheaths located?

Answer 24

Posteriorly and laterally to pre-tracheal fascia

on each side

Question 25

What does the carotid sheath contain?

Answer 25

Common carotid/internal carotid after the common carotid has bifurcated Internal jugular vein Vagus nerve Cervical lymph nodes

Question 26

How are the contents of the carotid sheath arranged within it?

Answer 26

Common carotid/internal carotid is more medial Internal jugular vein is more lateral Vagus nerve is more posterior

Question 27

Where does the carotid sheath begin and end?

Answer 27

Arch of aorta to base of skull

Question 28

Where is the pre-vertebral fascia located in the neck?

Answer 28

In the posterior part of the neck

Question 29

What does the pre-vertebral fascia contain?

Answer 29

Vertebrae Pre- and para-vertebral muscles

Question 30

What does the pre-vertebral fascia attach to?

Answer 30

Base of skull vertebral bodies, transverse processes up to T3 nuschal ligament up to T3

Question 31

What does the pre-vertebral fascia continue laterally as?

Answer 31

Axillary sheath

Question 32

What does the axillary sheath contain?

Answer 32

Axillary artery Axillary vein Cords of brachial plexus

Question 33

What are the advantages of the deep cervical fascia?

Answer 33

Allows structures to move over each other easily Allows easier separation of structures during surgery

Question 34

What is the retropharyngeal space?

Answer 34

Space between - buccopharyngeal fascia anteriorly - carotid sheaths laterally - pre-vertebral fascia posteriorly

Question 35

What does the retropharyngeal space contain?

Answer 35

Ages 0-4 -lymph nodes Ages 4+ -loose connective tissue

Question 36

What is an advantage of the retropharyngeal space?

Answer 36

Allows the pharynx to expand when swallowing

Question 37

What is a disadvantage of the retropharyngeal space?

Answer 37

If infection develops in it | it could spread into the posterior mediastinum

Question 38

What happens if an infection reaches the posterior mediastinum?

Answer 38

Mediastinum becomes inflamed, mediastinitis

Question 39

Why is mediastinitis a more serious condition?

Answer 39

High mortality rate

Question 40

What usually causes infection in the retropharyngeal space?

Answer 40

Infection in upper respiratory tract first - nasal cavity - nasopharynx - oropharynx

Question 41

What group of people is infection in the retropharyngeal space commonly seen in?

Answer 41

Children under age 5 years

Question 42

What are the signs and symptoms of an abscess in the retropharyngeal space?

Answer 42

Visible bulge Sore throat Difficulty swallowing Stridor Immobility of neck Fever

Question 43

How do retrosternal goitres extend retrosternally in the first place?

Answer 43

Passes down along the pre-tracheal fascia | into the thorax

Question 44

What are the signs and symptoms of a retrosternal goitre?

Answer 44

Stridor Breathlessness Facial oedema

Question 45

What causes stridor and breathlessness with a retrosternal goitre?

Answer 45

Compression of the trachea

Question 46

What causes facial odema with a retrosternal goitre?

Answer 46

Compression of veins | obstructs venous drainage