introduction of neck and boundaries of neck , superficial fascia and structures present with in it, deep cervical fascia types and most importantly spaces with in it mainly about Retro-pharyngeal spaces and applied anatomy along with incision markings.

1. Deep fascia of the neck

2. Contents
 Introduction
 Boundaries
 Superficial fascia
 Layers of Deep fascia
 Spaces around the neck
 Applied anatomy

3. Introduction
 Neck is the transition and conducting zone between
head and rest of the body
 It holds important viscera of the endocrine, respiratory
and digestive systems
 The structure occupying the neck are crowded : as
there is no bony covering or cage, these structures also
are prone to injury and damage.

4. Contd.
 The subcutaneous tissue nerves, veins of the neck,
 The main anatomical potential space in the neck
which lead to Spread of infections to the mediastinum.
 Four major fascial compartments of the neck
 Where the viscera of the neck are located.

6. The Neck
• lies between lower margin of mandible above & base of cranium
• suprasternal notch & upper border of clavicle below/ superior thoracic aperture
It is strengthened by cervical part of vertebral column,
• is convex forward
• supports skull.
Behind the vertebrae is …………..a mass of extensor muscles
In front is ………………………………..a smaller group of flexor muscles .
In central region are :…………………parts of respiratory system,
larynx & trachea,
behind are parts of alimentary system, pharynx & esophagus.

7. Cutaneous nerves and superficial veins
External jugular vein
Anterior jugular vein
Lesser occipital n.
Greater auricular n.
Transverse nerve of neck
Supraclavicular n.

8. 4 Compartments
 The midline visceral compartments
 Midline musculo-skeletal compartment
 Right and left neuro-vascular compartment

9.  At sides of these structures are vertically running :
1. carotid arteries,
2. internal jugular veins,
3. vagus nerve,
4.deep cervical lymph nodes

10. Landmarks of the neck
 Sternocleidomastoid
 Suprasternal fossa
 Greater supraclaviclar fossa

11. Landmarks of the neck
 Hyoid bone
 Thyroid cartilage
 Cricoid cartilage

12. The natural line of cleavage of the skin are
constant and run almost horizontally
around the neck

13. Fascia of Neck

14. 1-Superficial Fascia
2-deep Fascia

15. Superficial Fascia

16. Superficial Fascia
o forms a thin layer and has no specific features
o Antero-lateral aspects on both sides encloses Platysma muscle.
embedded in it are :
 cutaneous nerves,
 superficial veins,
 superficial lymph nodes.
 Especially in females fat tissue present.

19. Ext. jugular
Int. jugular
Ant. jugular
Sup. thyroid
Middle
thyroid
Inf. thyroid

20. Structures in neck:
 are surrounded by a layer of subcutaneous tissue (superficial fascia)
 are compartmentalized by layers of deep cervical fascia.
 fascial planes determine direction in which an infection in neck may spread.
Cervical Subcutaneous Tissue &Platysma
 superficial cervical fascia
 is a layer of fatty connective tissue
 lies between dermis of skin & investing layer of deep cervical fascia
 It is usually thinner than in other regions, anteriorly.
 Platysma……..Anterolaterally

21. external jugular vein (EJV)
• Descending from angle of mandible to middle of clavicle
• are superficial to main cutaneous nerves of neck.
• covers anterolateral aspect of neck.
• Help to measure CVP

22. Platysma/Musculus platysma myoids/subcutaneous
collis/Tetragonus.
• Flat plate is a broad, thin sheet of muscle in subcutaneous tissue
of neck and it is a remnant of Panniculosus carnosus.
• is supplied by cervical branch of CN VII.
• Its fibers arise in deep fascia covering superior parts of deltoid &
pectoralis major muscles
• sweep superomedially over clavicle to inferior border of mandible
and merge with fascia of the face.
 anterior borders of the two muscles decussate over chin
blend with facial muscles.
Inferiorly, fibers diverge, leaving a gap anterior to larynx & trachea

23. • tenses skin,
 producing vertical skin ridges
 Expression of horror, tension and stress
 releasing pressure on superficial veins.
• use in shaving
• It is a muscle of grimace.
• depress the mandible and draw corners of mouth inferiorly
• Acting its inferior attachment
Its superficial to all structures. 2 bones and doesn’t cover upper
part of the anterior triangle but lower part covers and the posterior
triangle.

25. Contents
 Platysma
 Superficial veins
 Anterior jugular v.
 External jugular v.
 Cutaneous nerves
 Lesser occipital n.
 Greator auricular n.
 Transverse nerve of neck
 Supraclavicular n.
 Cervical branch of facial n.

26. Regions of neck
 Neck
 Anterior region of neck
 Sternocleidomastoid region
 Lateral region of neck

27. Triangles of posterior (lateral) region of
neck
Occipital triangle
supraclavicular triangle
(greater supraclavicular fossa)

29. Deep Cervical
Fascia / colli

30. Deep Cervical Fascia:
1.Investing Layer
2.Pretracheal layer
3.Prevertebral layer.

31. support :
1. Viscera (thyroid gland)
2. Muscles
3. Vessels
4. Deep lymph nodes
condenses around : ……… to form carotid sheath
 Common carotid arteries,
 Internal jugular veins (IJVs)
 Vagus nerves
form natural cleavage planes
 tissues may be separated during surgery,
• limit the spread of abscesses (collections of pus)
Afford slipperiness
allows structures in neck to move and pass over one another without difficulty,
swallowing and turning the head and neck.

32. Deep Cervical Fascia:
1.Investing layer

35. Investing Layer/external layer/lamina superficialis
Investing = complete covering
most superficial fascial layer,
surrounds entire neck deep to skin and subcutaneous tissue.
splits into superficial and deep layers to enclose (invest) :
1. Trapezius &
2. Sternocleidomastoid (SCM) muscles.
Superiorly, attaches to :
 External occipital protuberanace,Superior nuchal line of occipital bone.
 Mastoid processes of temporal bones.
 Zygomatic arches.
 Inferior border of mandible.
 Hyoid bone.
 Spinous processes of cervical vertebrae.
also splits to enclose :
submandibular gland;
Posterior to mandible,it splits to form fibrous capsule of parotid gland.

36. Investing Layer
stylomandibular ligament is a thickened modification
Inferiorly, attaches to :
 manubrium,
 clavicles, &
 acromions
 spines of scapulae.
continuous posteriorly
with :
 Periosteum covering C7 spinous process
 nuchal ligament
 a triangular membrane
 forms a median fibrous septum between muscles of two sides of
neck

37. Horizontal disposition
 This traced from posterior attachment, it splits to enclose the trapezius and it
form a single layer that forms the roof of the posterior triangle
 In its lower attachment it splits twice to enclose 2 spaces
 Above the manubrium sterni it splits into 2
 Anterior layer attaches to anterior border of manubrium sterni and posterior
layer to posterior border
 Space called supra-sternal space of Burns.
contents :- sternal head of SCM and anterior jugular vein, jugular
venous arch , fat and lymph node .
• above the clavicle near the lower part of roof of the posterior triangle
• Splits into 2 antero-lateral aspect of the clavicle
posterior aspect of the clavicle
Space called Supra- clavicular space
contents :- EJV. Subclavian vein, supra- clavicular nerves.

38. Vertical disposition
 Traced upwards it covers sub-mandibular region and enclose
the gland
 Attaches to lower border of mandible and deep layer of
mylohyoid line of mandible
 Posterior to the gland again splits into enclose the parotid gland
and attach to zygomatic arch to form parotido masseteric fascia
deeper layer goes to Tympanic plate
 Between angle of mandible and styloid process form stylo-
mandibular ligament
 Spinal XI nerve closely related to this layer.

39. Deep Cervical Fascia:
Pretracheal/middle cervical fascia/porter’s fascia/
lamina pretrachealis
Anterior- thin and encloses thyroid gland and stretches in front of
trachea
Superior – hyoid bone, arch of cricoid cartilage and oblique line of
thyroid cartilage
Inferior - passes along the trachea , superior mediastinum and mergs
with fibrous pericardium of heart, movements of thyroid
gland with deglutition, sibson’s fascia .
Laterally – antero-laterally of carotid sheath between 2 lateral limits,
the pretracheal layer encloses the infra- hyoid muscles .
and they have 2 parts
Muscular part and visceral part

41.  Posterosuperiorly :- pre-tracheal layer is continues with of the
pharynx
 Ligament of Berry is derived from this fascia and connects
the lobes of thyroid gland with cricoid cartilage
 Dysphagia :- postero-lateral surface of Thyroid lobe is ill-
defind.

42. It is limited to the anterior part of neck
It extends inferiorly from hyoid into thorax,
includes a thin muscular part,
encloses :
 infrahyoid muscles, &
 a visceral part,
encloses
 thyroid gland,
 trachea, &
 esophagus
 pharynx
is continuous posteriorly & superiorly with buccopharyngeal fascia
of pharynx.

43. In hyoid,
a thickening of pre tracheal fascia forms a
pulley or trochlea through
intermediate tendon of digastric muscle passes,
 suspending hyoid.
tethers two-bellied omohyoid muscle,
redirecting course of muscle between bellies.

44. Prevertebral Layer/ PV
Fascia/lamina prevertebralis

46. forms a tubular sheath for vertebral column & muscles
associated with it,
such as :
A. longus colli &longus capitis anteriorly,
B. scalenes laterally,
C. deep cervical muscles posteriorly
is fixed to cranial base superiorly.
Anterior :- separated from pharynx and BPF by Retro-
pharyngeal space
Inferiorly, it blends with endothoracic fascia .
fuses centrally with anterior longitudinal ligament
at approximately T3/T4 vertebra
extends laterally as axillary sheath
surrounds axillary vessels & brachial plexus.
sympathetic trunks cervical parts are embedded in it

47. Carotid Sheath

48. Submendibular gland
OmohyoidSternohyoid
Sternothyroid
Superior thyroid a.
Cervical plexus
Phrenic n.
Ansa cervicalis
Vagus n.
Hypoglossal n.
Accessory n.Digastric

49. Condensation of the connective tissue around great vessel and
tubular fascial investment
extends from cranial base to root of neck.
blends :
 anteriorly with investing and pretracheal layers
 Posteriorly with prevertebral layer
contains :
(1) common and internal carotid arteries,
(2) internal jugular vein,
(3) vagus nerve (CN X),
(4) deep cervical lymph nodes,
(5) carotid sinus ,
(6) sympathetic nerve fibers (carotid periarterial plexuses).
carotid sheath and pretracheal fascia communicate freely with:
 mediastinum of thorax inferiorly &
 cranial cavity superiorly.
represent potential pathways for spread of infection and extravasated blood.

50.  Superior :- base of skull
 Inferior :- merge with covering the arch of
aorta
 Posterior :- symphathic trunk
 Anterior :- ansa cervicalis to carotid sheath
 Str piercing :- ECA,IJV, IX, XI,XII,X CN
AA:- Block dissection of neck, during surgical removal
of deep cervical LN

51. Spaces around the Neck
 Disposition of various layers of fascia result in the formation of
the potential tissue spaces in the neck
 They are not real spaces but are potential
 In healthy persons- filled with CT
in pathologically secretions are noted and there is no tissue
barrier, spread of infections
 They are 2 groups
1. Supra- hyoid spaces
2. Infra- hyoid spaces

52. Supra- hyoid spaces
 Continuity with regions of head
 Infra temporal fossa, sub mandibular fossa and
tonsillar fossa
 Above the hyoid are in SM regions of head and pre-
vertebral region
1. Spaces around the lower jaw
2. Pharyngeal spaces
3. Pre-vertebral spaces

54. Spaces around lower jaw
 Sub-mental spaces
 Sub-mandibular spaces
 Sub-lingual spaces
 Retro-pharyngeal space
 Peri-pharyngeal spaces
 Peri-tonsilar spaces

57. Sub-mental space :- deep to upper part of inv.layer of
DCF and S/F to mylohyoid muscle bounded by
anterior belly of digastric muscle
Sub- mandibular spaces :- these are paired, deep to
concerned half of mandible and both bellys of
digastric muscle.
Sub-lingual spaces :- lies deep to mylohyoid in the floor
of mouth and paired
its free communication with sub mental space which is
anatomically a cervical tissue space.

58. Retropharyngeal Space

59. It is largest and most important inter-fascial space in neck
It is a potential space
Lies between visceral part of prevertebral layer of deep cervical
fascia and pre-vertebral muscles & buccopharyngeal fascia
surrounding pharynx superficially.
Inferiorly, buccopharyngeal fascia is continuous with pretracheal
layer Sternocleidomastoid
Trapezius
Deep Cervical Fascia
Investing layer of deep cervical fascia
Prevertebral fascia
Pretracheal fascia
(visceral part)
Carotid
sheath
Buccopharyngeal fascia
Alar fascia
Pretracheal fascia
(muscular part)
T
E

60. Alar fascia :
• forms a further subdivision of retropharyngeal space.
• is attached along midline of buccopharyngeal fascia from cranium to
level of the C7 vertebra.
• it extends laterally and terminates in carotid sheath.
 permits movement of pharynx, esophagus, larynx, and
trachea relative to vertebral column during swallowing.
 is closed :
superiorly by cranial base and
on each side by carotid sheath.
 It opens inferiorly into superior mediastinum
 Contents :- LCT, retro-pharyngeal LN, pharyngeal
Plexuses and vessels.
 A.A :- Cold abscess and para- median swelling.

61. Peri-pharyngeal/ para pharyngeal space
 These are paired.
 Location:- on each side of posterolateral aspect of pharynx
 Medially- sup constrictor muscle of pharynx and palatine tonsil
 Antero-laterally- medial pterygoid with ramus of mandible
 Postero-laterally- parotid gland with parotid fascia and
communicates with retro-pharyngeal space
 Posterior – carotid sheath
Contents :-
branch of maxillary nerve and maxillary
artery, fibro-fatty tissue
Peri- tonsillar space :- actually a part of intra-pharyngeal space
location :- around palatine tonsils and medial surface of
superior constrictor.

62. Infra-hyoid spaces
They are
 Pretracheal space,
 Retro-visceral space,
 Pre-vertebral space
 Carotid space

64. Pre- tracheal space/ para tracheal space
 Location :- behind pre-tracheal fascia and
infra-hyoid muscle anterior wall of oesophagus
 Superior :- infrahyoid muscles to thyroid cartilage
 Inferior :- space open into superior mediastinum
Retro- visceral spaces
 locaction :- between posterior wall oesophagus and
prevertebral fascia
 Superior :- retro-pharyngeal space
 Inferior :- superior mediastinum

65. Pre- vertebral space
 Location :- between prevertebral fascia and vertebral column
laterally prevertbral muscle are closely packed
can’t extends laterally
 Superior :- base of skull
 Inferior :- continues posterior mediastinum
 Anterior :- prevertebral fascia weakest especially time of
infection.
Carotid space
 Space around the contents of carotid sheath
 Above and below closed because of adhesion of the fascia to
the adventitia of vessels.

66. Applied anatomy
 Arrangements of layers in neck determine the direction of
spread of infections in and around the neck
 Investing layer :- prevents spread of purulent infection from s/f
aspect of neck to deep areas of thorax,
 Pretracheal muscular part doesn’t spread to thorax but visceral
part spreads down easily.
 In Tuberculosis of cervical vertebrae – pus between
vertebral column and prevertebral fascia and produce median
swelling of posteior wall of pharynx are called chronic
retropharyngeal abscess. Infection spread to prevertebral
muscles and skin of posterior triangle , axilla and axillary
sheath.

67. Contd..,
Collar stud abcess :- in tuberculosis deep cervical LN affected.
pus spread from superficial to deep.
Retro pharyngeal abscess :- retropharyngeal LN gets infected
and BPF also infected.
Ludwig’s angina :- an infection in sub-mandibular region is
limited to a triangular area 2 halves of mandible and hyoid
bone
Parotid fascia ;- is very dense, infection of parotid gland is
very painful.

72. Thank you