The document discusses the deep fascia of the neck, including its boundaries and layers. It notes that the deep fascia is composed of three layers - the investing layer, pretracheal layer, and prevertebral layer. These layers surround and help compartmentalize the structures of the neck. The document also discusses the spaces that can form around the neck between the fascial layers, including the retropharyngeal space and parapharyngeal spaces.
3. Introduction
Neck is the transition andconducting zone between
head and rest of thebody
It holds importantvisceraof theendocrine, respiratory
and digestivesystems
The structure occupying the neck are crowded : as
there is no bonycovering orcage, thesestructuresalso
are prone to injury anddamage.
4. Contd.
The subcutaneous tissue nerves, veinsof the neck,
The main anatomical potential space in the neck
which lead to Spread of infections to themediastinum.
Four major fascial compartmentsof the neck
Where thevisceraof the neck are located.
5.
6. The Neck
• lies between lower margin of mandible above & base of cranium
• suprasternal notch & upper border of clavicle below/ superior thoracicaperture
It is strengthened bycervical partof vertebral column,
• is convex forward
• supports skull.
Behind thevertebrae is …………..a massof extensormuscles
In front is ………………………………..asmallergroupof flexor muscles .
In central regionare :…………………partsof respiratorysystem,
larynx & trachea,
behind are partsof 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 visceralcompartments
Midline musculo-skeletalcompartment
Right and left neuro-vascularcompartment
16. Superficial Fascia
o forms a thin layerand has no specific features
oAntero-lateral aspects on both sidesencloses Platysma muscle.
embedded in it are:
cutaneous nerves,
superficial veins,
superficial lymph nodes.
Especially in females fat tissuepresent.
20. Structures in neck:
are surrounded bya layerof subcutaneous tissue (superficial fascia)
are compartmentalized by layers of deepcervical fascia.
fascial planes determine direction in which an infection in neck mayspread.
Cervical Subcutaneous Tissue&Platysma
superficial cervical fascia
is a layerof fattyconnectivetissue
lies between dermisof skin & investing layerof deepcervical fascia
It is usually thinnerthan in otherregions, anteriorly.
Platysma……..Anterolaterally
21. external jugular vein(EJV)
• Descending from angleof mandible to middleof clavicle
• are superficial to main cutaneous nerves ofneck.
• covers anterolateral aspect of neck.
• Help to measureCVP
22. Platysma/Musculus platysma myoids/subcutaneous
collis/Tetragonus.
• Flat plate isa broad, thin sheetof muscle in subcutaneous tissue
of neck and it is a remnant of Panniculosuscarnosus.
• is supplied by cervical branch of CNVII.
• Its fibers arise in deep fasciacovering superiorparts of deltoid &
pectoralis major muscles
• sweep superomediallyoverclavicle to inferior borderof mandible
and merge with fascia of theface.
anterior borders of the two musclesdecussate overchin
blend with facial muscles.
Inferiorly, fibers diverge, leaving agapanteriorto larynx & trachea
23. • tenses skin,
producing vertical skinridges
Expression of horror, tension and stress
releasing pressure on superficialveins.
• use inshaving
• It is a muscle ofgrimace.
• depress the mandibleand drawcornersof mouth inferiorly
• Acting its inferiorattachment
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.
24.
25. Contents
Platysma
Superficial veins
Anterior jugularv.
External jugularv.
Cutaneous nerves
Lesser occipital n.
Greator auricularn.
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)
31. support :
1. Viscera (thyroid gland)
2. Muscles
3. Vessels
4. Deep lymph nodes
condenses around : ……… to form carotidsheath
Common carotidarteries,
Internal jugular veins(IJVs)
Vagus nerves
form natural cleavageplanes
tissues may be separated duringsurgery,
• limit the spread of abscesses (collections ofpus)
Afford slipperiness
allowsstructures in neck to move and pass overone anotherwithoutdifficulty,
swallowing and turning the head and neck.
35. Investing Layer/external layer/lamina superficialis
Investing = completecovering
most superficial fascial layer,
surroundsentire neck deep toskin and subcutaneous tissue.
splits intosuperficial and deep layers toenclose (invest) :
1. Trapezius &
2. Sternocleidomastoid (SCM) muscles.
Superiorly, attaches to:
External occipital protuberanace,Superiornuchal lineof occipital bone.
Mastoid processes of temporal bones.
Zygomatic arches.
Inferior border of mandible.
Hyoid bone.
Spinous processes of cervicalvertebrae.
also splits to enclose:
submandibulargland;
Posteriorto mandible,itsplits to form fibrouscapsuleof parotid gland.
36. Investing Layer
stylomandibular ligament is a thickenedmodification
Inferiorly, attaches to:
manubrium,
clavicles, &
acromions
spines of scapulae.
continuous posteriorly
with :
Periosteum covering C7 spinousprocess
nuchal ligament
a triangularmembrane
formsa median fibrous septum between muscles of two sides of
neck
37. Horizontal disposition
This traced from posterior attachment, it splits to enclose the trapezius andit
form a single layer that forms the roof of the posteriortriangle
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 posteriortriangle
• 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
40.
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 intothorax,
includes a thin muscularpart,
encloses :
infrahyoid muscles, &
a visceralpart,
encloses
thyroid gland,
trachea, &
esophagus
pharynx
iscontinuousposteriorly & superiorlywith buccopharyngeal fascia
of pharynx.
43. In hyoid,
a thickening of pre tracheal fascia formsa
pulley or trochleathrough
intermediate tendon of digastric musclepasses,
suspending hyoid.
tethers two-bellied omohyoid muscle,
redirecting course of muscle betweenbellies.
46. forms a tubular sheath for vertebral column & muscles
associated with it,
such as :
A. longus colli &longus capitisanteriorly,
B. scalenes laterally,
C. deep cervical musclesposteriorly
is fixed to cranial basesuperiorly.
Anterior :- separated from pharynx and BPF byRetro-
pharyngeal space
Inferiorly, it blends with endothoracic fascia .
fuses centrally with anterior longitudinalligament
at approximately T3/T4vertebra
extends laterally as axillarysheath
surrounds axillary vessels & brachialplexus.
sympathetic trunks cervical parts are embedded init
49. Condensation of the connective tissue around great vessel and
tubular fascial investment
extends from cranial base to root ofneck.
blends :
anteriorly with investing and pretracheallayers
Posteriorly with prevertebral layer
contains :
(1) common and internal carotidarteries,
(2) internal jugularvein,
(3) vagus nerve (CN X),
(4) deep cervical lymphnodes,
(5) carotid sinus ,
(6) sympathetic nerve fibers (carotid periarterialplexuses).
carotid sheath and pretracheal fascia communicate freelywith:
mediastinum of thorax inferiorly&
cranial cavitysuperiorly.
representpotential pathways for spread of infection and extravasated blood.
50. Superior :- base ofskull
Inferior :- mergewith covering thearch of
aorta
Posterior :- symphathictrunk
Anterior :- ansacervicalis tocarotid sheath
Str piercing :- ECA,IJV, IX, XI,XII,XCN
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 mandibularfossaand
tonsillarfossa
Above the hyoid are in SM regions of head and pre-
vertebral region
1. Spaces around the lowerjaw
2. Pharyngeal spaces
3. Pre-vertebral 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.
59. It is largest and most important inter-fascial space in neck
It is a potentialspace
Lies between visceral part of prevertebral layer of deepcervical
fascia and pre-vertebral muscles & buccopharyngeal fascia
surrounding pharynx superficially.
Inferiorly, buccopharyngeal fascia is continuous withpretracheal
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:
• formsa furthersubdivisionof retropharyngeal space.
• is attached along midlineof buccopharyngeal fascia from cranium to
level of the C7vertebra.
• itextends laterallyand terminates in carotid sheath.
permits movement of pharynx, esophagus, larynx, and
trachearelative tovertebral column during swallowing.
is closed :
superiorly by cranial baseand
on each side by carotidsheath.
It opens inferiorly into superiormediastinum
Contents :- LCT, retro-pharyngeal LN, pharyngeal
Plexuses and vessels.
A.A :- Cold abscess and para- medianswelling.
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-pharyngealspace
location :- around palatine tonsils and medial surface of
superior constrictor.
64. Pre- tracheal space/ para tracheal space
Location :- behind pre-tracheal fasciaand
infra-hyoid muscle anterior wall of oesophagus
Superior :- infrahyoid muscles to thyroidcartilage
Inferior :- space open into superiormediastinum
Retro- visceral spaces
locaction :- between posterior wall oesophagusand
prevertebral fascia
Superior
Inferior
:- retro-pharyngeal space
:- superiormediastinum
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.