CERVICAL FASCIA

Dr. Rana Pratap SinghJRII Surgery

M.L.B. MEDICAL COLLEGE JHANSI

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

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.

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

MODIFICATIONS OF DEEP CERVICAL FASCIA

• Investing layer• Pretracheal layer• Prevertebral layer• Carotid sheath• Buccopharyngeal

fascia• Alar fascia.

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

Post-7th cervical vertebra, ligamentum nuchae

HORIZONTAL TRACING-

• Encloses 2 muscles- trapezius & sternocleidomastoid

• Forms roof of 2 triangle- anterior & posterior

• Gives 2 lamina for pretracheal & prevertebral fascia

• Forms 2 fascial slings for omohyoid and diagastric;

VERTICAL TRACING

•Encloses 2 gland- parotid &

submandibular salivary gland

•Encloses 2 spaces- suprasternal space & supraclavicular space•Forms 2 thickenings- parotidomassaeteric

fascia & stylomandibular

ligamen

ENCLOSES 2 SPACES-

• Supraclavicular space1.SUPRACLAVICULAR SPACE

•splitting of investing layer medial 3rd of clavicle & gets attatched to anterior & posterior border of upper surface of clavicleContent of the space

Supraclavicular nerves, external jugular vein

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

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

PRETRACHEAL FASCIA

• IT Is one of the lamina of deep cervical fascia that arises deep to sternocleidomastoid muscle

HORIZONTALLY

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

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.

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.

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.

• 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

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

• 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.

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.

Horizontally• It forms the floor of

the posterior triangle & finally extends upto axilla as axillary sheath enclosing the axillary vessels and nerves

Vertically• it extends from the skull

base upto the 3rd thoracic vertebra

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

• Prevertebral fascia forms the posterior wall

of retropharyngeal space

• Retropharyngeal absess causes dysphagia

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

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 cervicalisPosteriorly – sympathetic trunk

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.

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.

RETROPHARYNGEAL SPACE

Posterior to pharynx and esophagus

Anterior to alar layer of prevertibral fascia.

Extends from skull base to T1-T2

• Pediatrics – Cause—suppurative

process in lymph nodes• Nose, adenoids,

nasopharynx, sinuses

• Adults– Cause—trauma,

instrumentation, extension from adjoining deep neck space

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.

Danger Space infection from – extension from retropharyngeal, prevertebral or

parapharyngeal space

Danger space infection may spread up to mediastinum

PREVERTEBRAL SPACE

• Anteriorly by prevertebral

fascia Posteriorly by is vertebral

bodies Extends along entire length

of vertebral column.

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.

Thanks