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

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

8. 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

9. Post-
7th cervical
vertebra,
ligamentum
nuchae

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

11. • Forms 2 fascial slings for
omohyoid and
diagastric;

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

13. 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

14. 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

15. 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

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

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

18. 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.

19. 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.

20. 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.

21. • 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

22. 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

23. • 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.

24. 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.

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

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

27. 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

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

29. 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

30. 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

32. 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.

33. 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.

34. RETROPHARYNGEAL SPACE
 Posterior to
pharynx and
esophagus
 Anterior to alar
layer of
prevertibral
fascia.
 Extends from
skull base to T1-
T2

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

36. 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.

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

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

39. 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.

40. Thanks