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Deep Cervical Fascia

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Deep Cervical Fascia DEEP CERVICAL FASCIA BY DR.M.MD.MUSTAFA SHARIFF DEPT OF ANATOMY SENIOR LECTURER SRMDC&H DEEP CERVICAL FASCIA • It is also called FASCIA COLLI • The deep cervical fascia of neck is clinically very important for it forms various fascial spaces in the neck. • It also provides capsule to the glands and invests the muscles in the region. • It forms protective sheaths around neurovascular structures. • The layers of deep cervical fascia forms planes to direct the spread of infection or pus in the neck. INVESTING LAYER • It lies deep to the platysma and surrounds the neck like a collar. • It forms the roof of the posterior triangle of the neck. • It encloses the sternocleidomastoid and trapezius the two large superficial muscles of the neck on either side. ATTACHMENTS SUPERIORLY: o External occipital protuberance o Superior nuchal line o Mastoid process o Lower border of mandible ▪ Anterior and superiorly it is attached to the lower border of the mandible. ▪ Anteroinferiorly it is attached to the clavicle and manubrium sterni. Posteriorly: ▪ It is attached to the ligamentum nuchae , spine of the C7 vertebrae, spine of scapula , acromian process of the scapula. ▪ The investing layer encloses two salivary glands namely the parotid and submandibular gland. ▪ Tracing the fascia upwards from the clavicle to the lower border of the mandible , it divides into two layers. ▪ Superficial layer is attached to the lower border of mandible and deep layer attached to mylohyoid line. ▪ Between the two layers the submandibular salivary gland and the lymph glands are enclosed. • Near the angle of mandible the investing layer divides into two layers to enclose the parotid gland. • The superficial layer covers the gland and it is called as masseteric fascia. • It is superiorly attached to the zygomatic arch. • The deep layer of the fascia after covering the parotid gland goes towards the base of the skull. • Between the angle of mandible and styloid process of temporal bone this fascia is thickened to form the stylomandibular ligament. • The investing layer encloses two fascial spaces. • Along the lower part of the roof of the posterior triangle the fascia splits to enclose a space. • Near the lower part of the midline of the neck, the fascia splits to enclose a space called (Suprasternal space or space of Burn’s). Contents of suprasternal space • Jugular venous arch • Anterior jugular veins • Two heads of sternocleidomastoid muscle • Interclavicular ligament Clinical anatomy LUDWIGS ANGINA: o It is a triangular swelling due to infection in the submandibular region. o It is limited laterally by two halves of mandible and posteriorly by hyoid bone. o This is because of the attachments of investing layer of deep cervical fascia to the base of mandible and hyoid bone. MUMPS: o Infection of parotid gland is painful due to thick and strong fascia covering it. COLLAR STUD ABSCESS: o The deep cervical lymph nodes are the site of tuberculus infection. o Abscess penetrates the deep cervical fascia and form a swelling under the skin. PRETRACHEAL FASCIA • Superiorly it extends upto the hyoid bone. • Inferiorly it extends into the thorax and joins the fibrous pericardium. • Laterally it fuses with the carotid sheath and through this sheath it is continuous with the investing layer of deep cervical fascia. • Medially it divides and encloses the thyroid gland. • It forms the false capsule for the thyroid gland. • The posterior capsule of the thyroid is thin and hence enlargement of the thyroid are directed posteriorly. • The pretracheal fascia invest the infra hyoid muscles. • This fascia is attached to the thyroid and cricoid cartilages and suspensory ligament of Berry. • This ligament binds the thyroid gland to larynx. Clinical anatomy o The thyroid gland and all thyroid swellings move with deglutition because the thyroid is attached to the larynx by the suspensory ligaments of Berry. o The abscess present infront of pretracheal fascia descends in the superior mediastinum. o The abscess present behind the pretracheal fascia descends in the superior mediastinum to the posterior mediastinum. PREVERTEBRAL FASCIA • Superiorly it extends to the base of the skull. • Inferiorly it extends into the posterior mediastinum and even extends into the abdomen. • Hence a pus collection under this fascia may track down from the base of the skull to the abdomen. • Laterally it extends to the carotid sheath , via it is connected to the investing layer of deep cervical fascia on the medial surface of the sternocleidomastoid muscle. Function: o To provide a fix base for gliding movements of pharynx, oesophagus and carotid sheath during movements of neck and during swallowing. o The abscess formed behind the prevertable fascia travel down into superior mediastinum upto T3-T4. o The abscess formed infront of prevertbral fascia to superior mediastinum and then the posterior mediastinum. CAROTID SHEATH • It is anteriorly formed by the pretracheal fascia and posteriorly formed by prevertebral fascia. • It extends from the base of the skull to the root of the neck. • On the surface of the carotid sheath the ansa- cervicalis is situated. • This sheath encloses the internal carotid artery, common carotid artery, internal jugular vein and vagus nerve. • The entire sheath is accompanied by the deep cervical group of lymph node. BUCCOPHARYNGEAL FASCIA • It is delicate and distensible layer of fascia that covers the constrictor muscles of pharynx and buccinator muscle. • The buccopharyngeal fascia extends from the base of the skull to the esophagus. PHARYNGOBASILAR FASCIA • This fascia is especially thickened between the upper border of superior constrictor muscle and the base of the skull. • It lies deep to the pharyngeal muscles. RETROPHARYNGEAL SPACE o It is potential or dead space behind the pharynx and acts as a bursa to allow expansion of pharynx during deglutition. Boundaries: o In front , buccopharyngeal fascia which covers the constrictor muscles of pharynx. o Behind , prevertebral fascia which covers the cervical vertebrae, pre and para vertebral muscles On each side o Carotid sheath and its contents. o Above, limited by the base of the skull o Below, the space is open and continuous with the superior mediastinum. o In the midline a fibrous septum connecting the raphe of the pharynx with the prevertebral fascia divide the space incompletely into two compartments. Contents o Loose areolar tissue and retropharyngeal lymph node. o Pharyngeal plexus of vessels and nerves. CLINICAL ANATOMY o Neck infections in front of the prevertebral fascia in the retropharyngeal space usually arise from suppuration, i,e. formation of pus in the retropharyngeal lymph nodes. o It is frequently exposed in block dissection of the neck during surgical removal of deep cervical lymph nodes. o Division of the external jugular vein in the supraclavicular space may cause air embolism and consequent death because the cut ends of the vein are prevented from retraction and closer by the fascia attached firmly to the vein. REFERENCES o EXAM-ORINTED ANATOMY SHOUKAT N.KAZI o HEAD & NECK AK DATTA 5TH EDITION o GRAYS ANATOMY STUDENTS EDITION o CLINCAL ANATOMY SNELL 8TH EDITION o CLINICAL ANATOMY MOORE 5TH EDITION o HEAD & NECK BD CHAURASIA’S 4TH EDITION o HEAD & NECK DR.AS.MONI o TEXT BOOK OF ANATOMY HEAD NECK AND BRAIN VOL III VISHRAM SINGH .
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