Cervical fascia refers to the fibrous connective tissue in the neck region. There are two types - superficial fascia just below the skin, and deep fascia surrounding muscles, blood vessels and organs in the neck. The deep cervical fascia forms layers around structures like the pretracheal fascia around the trachea and thyroid, and the prevertebral fascia in front of the vertebrae. It also forms sheaths like the carotid sheath containing blood vessels. Infections can potentially spread between neck spaces bounded by these fascial layers, like from the retropharyngeal space to the danger space or prevertebral space. The fascial planes are clinically important for spread of infections and sur

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