3. INVESTING LAYER OF DEEP CERVICAL FASCIA
This is the deep fascia of the neck, underneth the
superficial fascia (note: superficial fascia contains
platysma, lower portions of supraclavicular nerves
and much of the upper part of external jugular vein.)
Upper attachment: external occipital protuberance,
superior nuchal line, mastiod process, lower border
of mandible and symphysis menti where it becomes
continuous with the similar fascia of opposite side.
Anterior limit: becomes continuous fellow of
opposite side in midline.
4. Lower attachment: Upper border of manubrium
sterni ,upper border of clavicle acromion process
and spine of scapula.
Posterior limit: Attached to cervical spine
Special feature:
1. it splits to enclose parotid gland . The superficial
layer is called parotid fascia (thick and dense)
(acute pain in parotitis).
2. Deep split lamina forms a thickened band called
stylomandibular ligament (from lateral surfaceof
styloid process near its tip to posterior border angle
of mandible.
5. It split to enclose submandibular salivary gland.
This superficial split lamina is attached to lower
border of mandible and deep split lamina to
mylohyoid line.
During operation surgeon to be careful about cervical
part of facial artery and External carotid artery closely
related to lower end of stylomandibular ligament.
Posteriorly the investing layer splits to enclose
trapezius.
Between sternomastoid and trapezius it forms fascia
of roof of posterior triangle anf is perforated by
supraclavicular nerveand external jugular vein.
6. Just above clavicle it splits into a superficial layer
which is attached to upper border of clavicle and a
deep layer attached to lower margin of posterior
surface of clavicle.
Within these two layer or found the supraclavicular
nerve. Above the upper border of manubrium sterni
it splits to enclose suprasternal space of Burn’s.
This space contains pointed sternal end of
sternomastoid, lower end of anterior jugular vein,
jugular arch, interclavicular ligament and lymph
nodes.
7. A loop like condensation forms a sling over the
intermediate tendon of digastric
A similar condensation holds the intermediate
tendon of omohyoid in position exactly opposite to
internal jugular vein at the level of cricoid cartilage.
Anteriorly before reaching the midline it splits to
enclose sternomastoid.
8. PREVERTEBRAL LAYER OF DEEP CERVICAL
FASCIA.
This prevertebral fascia exist in front of prevertebral
muscle and cervical vertebral column.
Upper extent attached to the base of the skull.
Lower extent upto the level of T4.
Anterior relation: Anteriorly buccopharyngeal fascia
and posterior pharyngeal wall. It is seperated from
the retropharyngeal space, however it is firmly
attached to the centre of the retropharyngeal part of
buccopharyngeal fascia along a vertical line. This
midline attachment divides the retropharyngeal
space into right and left halves.
9. Traced laterally it becomes scalene fascia thus the
scalene fascia comes in the floor of posterior
triangle.
At the level of 6th or 7th cervical vertebra the
prolongation of prevertebral fascia is dragged
laterally and downwards to form a fascial tube
around subclavian artery and trunks of brachial
plexus. This tube becomes axillary sheath.
Note: the subclavian vein and axillary vein will not
enclose in this sheath.
The cervical nerves forming cervical plexus lie
posterior to prevertebral and scalene fascia
10.
11.
12. A retropharyngeal abcess will produce a swelling in
the posterior pharyngeal wall on either side of
midline whereas an abcess behind the prevertebral
fascia due to cervical caries will produce a swelling
in the midline.
A prevertebral fascial abcess can be trapped down
into the superior mediastinum.
Similarly a prevertebral abcess can be trapped
down into the auxillary sheath producing a swelling
in the supraclavicular portion.
13.
14. carotid sheath : It is a tube of deepcervical fascia enclosing
common,externaland internal carotid arteries,internal jugular
vein,vagus nerve and parts of 9,10&11th cranial nerve
Upperlimit: base of skull-around jugular foramen
Lower limit: sternoclavicular joint
Content: mentioned already.
Relations:- Superficial-sterrnocleidomastoid
Medial:-pharynx,larynx,oesophagus&trachea
Posterior:-transverse process of cervical vertebrae,longus
capitus,origin of scalenous anterior,lowerpart of longus
cervicis and sympathetic trunk which is outside the carotid
sheath
15.
16. FASCIAL SPACES IN THE NECK
1.Prevertebras space-betweencervical vertebrae
and prevertebral muscles on one hand and
prevertebral fascia on the other
2.Retropharyngeous space
3.Suprastrernal space of Burns
4.Posterior triangle space-between fascia of roof
and fascia of floor
5.Axillary sheath space
6.A space bounded internally by pharyngeal wall
and externally by ramus of mandible and parotid
gland and sternomastoid
