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Good morning. Deep Cervical Fascia. DR.QUDSIA SULTANA. The Neck. The Neck. The region of the body that lies between: The lower border of mandible ,mastoid process, sup nuchal line & ext occipital protuberance.

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  1. Good morning

  2. Deep Cervical Fascia DR.QUDSIA SULTANA

  3. The Neck

  4. The Neck • The region of the body that lies between: • The lower border of mandible ,mastoid process, sup nuchal line & ext occipital protuberance. • The suprasternal notch , upper border of the clavicle , acromion process, spine of scapula and C7 spine

  5. Skin • The natural lines of cleavage are constant and run almost horizontally around the neck (an incision along a cleavage line heals as a narrow scar) • Supplied by cutaneous nerves from cervical plexus.

  6. Superficial fascia

  7. Platysma

  8. Superficial Fascia • Thin layer of connective tissue • Encloses platysma • Contains: • cutaneous nerves- cervical plexus • superficial veins – ext jugular veins and its tributaries. • superficial lymphatics

  9. Deep cervical fascia Fascia colli Surrounds the neck like a collar

  10. Deep Cervical Fascia Deep fascia around the neck is known as deep cervical fascia or fascia colli as it forms the collar around the neck It lies deep to platysma muscle in the interval between muscles, vessels & organs of the cervical region And it gives various extensions or lamina around various structures

  11. DEEP CERVICAL FASCIA • INVESTING LAYER • PRETRACHEAL FASCIA • PREVERTEBRAL FASCIA • CAROTID SHEATH • BUCCOPHARYNGEAL FASCIA • PHARYNGOBASILAR FASCIA

  12. Investing Layer Attachments: Superior

  13. Superiorly • External occipital protuberance, superior nuchal line • Mastoid process • Cartilagenous part of external ear • Lower margin of zygomatic arch • Lower border of mandible

  14. INVESTING LAYER ATTATCHMENTS INFERIOR-

  15. Inferiorly • Spine and acromial process of scapula • Upper surface of clavicle • Manubrium

  16. INVESTING LAYER ATTATCHMENTS ANTERIOR-

  17. INVESTING LAYER ATTATCHMENTS POSTERIOR-

  18. Posteriorly – the seventh cervical spine and ligamentumnuchae .

  19. HORIZONTAL EXTENT OF INVESTING LAYER Ligamentumnuche & C7 spine Enclose trapezius roof of posterior  Sternocleidomastoid  roof of anterior  Meet opposite side

  20. VERTICAL EXTENT OF INVESTING LAYER ABOVE Splits to enclose SubmandibularParotid gland gland

  21. At the lower border of submandibular gland

  22. At the lower border of submandibular gland Splits into Superficial deep layer Covers its lower surface Attached to lower border of body of mandible Covers its medial surface Attached to mylohoid line of mandible

  23. At lower pole of Parotid gland

  24. To lower border of tympanic plate & styloid process Thickened to form STYLOMANDIBULAR LIGAMENT At lower pole of Parotid gland Splits into Superficial layerDeep layer To lower margin of zygomatic arch Blends with masseter PAROTIDO-MASSETERICFASCIA Investing layer of deep fascia

  25. TRACED BELOW... Supra sternal space [Space of Burn’s] Supra clavicular space Splits to enclose 2 spaces

  26. Suprasternal space (of burn’s)

  27. Supra sternal space Triangular space above the manubrium sternii Splits into Superficial Deep • Contents: • Sternal head of SCM • Jugular venous arch • Interclavicular lig • Fat… Attached to posterior surface of suprasternal notch Attached to anterior surface of suprasternal notch

  28. Investing layer Supraclavicular space

  29. At Middle 1/3 of clavicle Splits into SuperficialDeep Supra clavicular space • Contents:Terminal part of EJV • Supraclavicular nerves Attached to posterior border of upper surface of clavicle Attached to anterior border of upper surface of clavicle Encloses inferior belly of omohyoid Omohyoid fascia

  30. RULE OF TWO

  31. 2 muscles enclosed- trapezius & sternocleidomastoid

  32. 2 triangle’s roof- anterior & posterior

  33. 2 Gland enclosed- parotid & submandibular salivary gland

  34. 2 Spaces enclosed- suprasternal(Space of BURN’s) & supraclavicular space

  35. 2 Thickenings formed - parotidomasseteric fascia & stylomandibular ligament

  36. 2 fascial slings- digastric & omohyoid muscles

  37. 2 lamina given - for pretracheal & prevertebral fascia

  38. summarize - Investing layer • Sternocleidomastoid & trapezius. • Roof of anterior & posterior triangle. • Submandibular & parotid gland • Suprasternal & supraclavicular spaces. • Parotido-masseteric fascia & stylomandibular ligament • Fascial sling for inferior belly of omohyoid & intermediate tendon of digastric • Origin of pretracheal & prevertebral fasciae

  39. Applied anatomy surrounds muscles, blood vessels, and nerves, binding those structures together Limit the spread of infections natural cleavage planes for tissues, direct spread of pathology (fluid/growth) Provide slipperiness – allows the structures to move & pass over one another Ext jugular vein if cut remains retracted-attachment to cervical fascia-air embolism

  40. PRE-TRACHEAL FASCIA

  41. Pretracheal: horizontal extent From undercover of SCM Forms anterior wall of Carotid sheath Splits to enclose Thyroid In front of trachea Continuous with similar layer of opposite side

  42. Pretracheal: vertical extent Below Passes behind bracheocephalic veins in front of Trachea Blends with the apex of fibrous pericardium Above Attached to Hyoid bone - midline and to oblique line of thyroid cartilage- on each side

  43. Applied anatomy Ligament of berry

  44. Pus in front of pretracheal fascia • Bulge in suprasternal area • Extend in anterior mediastinum

  45. Carotid sheath

  46. 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 CONTENTS • INTERNAL JUGULAR VEIN LATERALLY, COMMON 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 CERVICALIS • POSTERIORLY – SYMPATHETIC TRUNK

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