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
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