Investing layer of deep cervical fascia contents interiors
Superficial fascia layers can sometimes include muscle fibers to create all types of structures in the body. A few examples include the platysma muscle in the neck, the external anal sphincter, and the dartos fascia in the scrotum.
Deep Fascia Deep fascia surrounds bones, muscles, nerves, and blood vessels. It is commonly has a more fibrous consistency and rich in hyaluronan as compared to the other subtypes. Deep fascia tends to be highly vascularized and contain well developed lymphatic channels. In some instances, deep fascia can even contain free encapsulated nerve endings, such as Ruffini and Pacinian corpuscles. There are 2 subtypes of deep fascia: Aponeurotic fascia It forms into sheets of pearly-white fibrous tissue to attach muscles needing a wide area of attachment.
Aponeurosis can thin into a tendon and become a point of origin or insertion for other muscles. Some examples of aponeurotic fascia include the fascia of limbs, thoracolumbar fascia, and rectus sheath. It is the thicker of the 2 subtypes that are normally easily separated from the underlying muscle layer. It is comprised of 2 to 3 parallel collagen fiber bundles.
Epimysial fascia Also known as the epimysium, this is the connective tissue sheath surrounding skeletal muscle and can, in some cases, connect directly to the periosteum of bones. Some major muscle groups enveloped in epimysium include muscles of the trunk, pectoralis major, trapezius, deltoid, and gluteus maximus.
It is the thinner of the 2 subtypes, on average, and is more tightly connected to the muscle via septa that penetrate the muscle layer. Visceral Fascia Visceral fascia surrounds organs in cavities like the abdomen, lung pleura , and heart pericardium.
Parietal Fascia Parietal fascia is a general term for tissues that line the wall of a body cavity just outside of the parietal layer of serosa. The most commonly known parietal fascia is found in the pelvis. In many places in the body, superficial and deep fascial layers are connected by fibrous septa and create a connection network that weaves in between fat lobules that make up the deep adipose tissue layer.
They can provide support for surrounding tissues, help reduce friction, and play a supportive role for the tissues and organs. Fascia can transmit mechanical tension generated by muscular activity or external forces. The biomechanical regulatory system of the fascia is currently being studied further. In a healthy state, fascia is a relaxed and wavy connective tissue that can lose its malleability when damaged via local trauma or inflammation.
This can then cause fascial layers to tighten and restrict the movement of underlying tissues leading to pain, hindered range of motion, or decreased blood flow. The distinct feature of fascia is that it possesses strength because it is tightly packed with bundles of collagen and wrapped tightly. The fibers are usually oriented in one direction so that the structure does not become loose or lax. Fascia is quite flexible and able to resist tension.
The function of the fascia depends on its location. There is also some evidence that certain fascial layers, particularly in the cervical and cranial neck, derive from the ectoderm. Cleft palate is a failure of fusion of the segments of the palate.
The following stages may occur Fig. Inclusion dermoids may form along the lines of fusion of the face. The most common of these is the external angular dermoid at the lateral extremity of the upper eyebrow. Occasionally, this dermoid extends through the skull to attach to the underlying dura. At the apex of this groove is a shallow depression, the foramen caecum, marking the embryological origin of the thyroid see page ; Fig. Immediately in front of the sulcus lies a row of large vallate circumvallate papillae.
The lingual nerve and the lingual artery are medial to the vein but not visible. More laterally can be seen a fringed fold of mucous membrane termed the plica fimbriata. On either side of the base of the frenulum can be seen the orifice of the submandibular duct on its papilla. Inspect this in a mirror and note the discharge of saliva when you press on your submandibular gland just below the angle of the jaw. These papillae particularly the vallate bear the taste buds.
Small glands are scattered throughout the submucosa of the dorsum; these are predominantly serous anteriorly and mucous posteriorly. The tongue is divided by a median vertical fibrous septum, as indicated on the dorsum by a shallow groove. On each side of this septum are the intrinsic and extrinsic muscles of the tongue Fig. The intrinsic muscles are disposed in vertical, longitudinal and transverse bundles; they alter the shape of the tongue.
The extrinsic muscles move the tongue as a whole. They pass to the tongue from the symphysis of the mandible, the hyoid, styloid process and the soft palate; respectively, the genioglossus, hyoglossus, styloglossus and palatoglossus. The functions of the individual extrinsic muscles can be deduced from their relative positions Fig. Genioglossus protrudes the tongue, styloglossus retracts it and hyoglossus depresses it.
Palatoglossus is, in fact, a palatal muscle and helps to narrow the oropharynx in swallowing. Blood supply Blood is supplied from the lingual branch of the external carotid artery. Note two points. A few fibres of the internal laryngeal branch of the superior laryngeal nerve branch of X carry sensory fibres from the very posterior part of the tongue.
All the muscles of the tongue except palatoglossus are supplied by the hypoglossal nerve XII ; palatoglossus, a muscle of the soft palate, is innervated by the pharyngeal branch of the vagus X. Development Fig. This is soon covered over by the lingual swellings, one on each side, derived from the first branchial arch. The tongue muscles develop from the occipital myotomes, which migrate forwards, dragging with them their nerve supply XII, the hypoglossal nerve.
If the unconscious or deeply anaesthetized patient is laid on his back, the posterior aspect of the tongue drops back to produce a laryngeal obstruction. Although lymphatics pierce the floor of the mouth i. It seems that the nodes are involved by lymphatic emboli and not by a permeation of the lymphatic channels.
The floor of the mouth The floor of the mouth is formed principally by the mylohyoid muscles. These stretch as a diaphragm from their origin along the mylohyoid line on the medial aspect of the body of the mandible on each side, to their insertion along a median raphe and into the hyoid bone. The mylohyoid muscle is an important surgical landmark insofar as it constitutes the boundary between the neck and oral region.
On the lower aspect of this diaphragm, on each side, are the anterior belly of the digastric muscle, the superficial part of the submandibular gland and the submandibular lymph nodes, all covered by the investing layer of deep cervical fascia and platysma. Lying above mylohyoid are the tongue muscles, as a central mass, with the sublingual salivary gland and the deep part of the submandibular gland and its duct lying beneath the mucosa of the mouth floor on either side.
The infection spreads above the mylohyoid; oedema forces the tongue upwards; and the mylohyoid itself is pushed downwards so that there is swelling both below the chin and within the mouth. There is considerable danger of spread of infection backwards with oedema of the glottis and asphyxia. Drainage is carried out by a deep incision below the mandible that must divide the mylohyoid muscle. The pharynx The pharynx is a musculofascial tube, incomplete anteriorly, which extends from the base of the skull to the oesophagus and which acts as a common entrance to the respiratory and alimentary tracts.
From above downwards, it is made up of three parts Fig. The nasopharynx The nasopharynx lies above the soft palate, which cuts it off from the rest of the pharynx during deglutition and therefore prevents regurgitation of food through the nose. Two important structures lie in this compartment. Under anaesthesia, it can be palpated by a finger passed behind the soft palate. The nasopharyngeal tonsils adenoids are prominent in children but usually undergo atrophy after puberty.
The Eustachian tube provides a ready pathway of sepsis from the pharynx to the middle ear and accounts for the frequency with which otitis media complicates infections of the throat. The middle ear can be intubated through a catheter passed into the Eustachian tube.
The catheter is passed along the nasal floor to the posterior wall of the nasopharynx. Its curved tip is then rotated laterally so that it lies in the pharyngeal recess; it is then withdrawn over the Eustachian cushion to slip into the orifice of the auditory tube. The oropharynx This part of the pharynx lies behind the mouth and tongue.
Its anterior boundaries are the right and left palatoglossal arches anterior pillars of the fauces and it extends from the uvula of the soft palate above to the tip of the epiglottis below. Its most important contents are the palatine tonsils, situated in the lateral wall on either side.
The palatine tonsils The palatine tonsil lies in the tonsillar fossa between the palatoglossal and palatopharyngeal arches anterior and posterior pillars of the fauces, respectively. The anterior pillar, or palatoglossal arch, forms the boundary between the buccal cavity and the oropharynx; it fuses with the lateral wall of the tongue and contains the palatoglossus muscle.
The posterior pillar, or palatopharyngeal arch, blends with the wall of the pharynx and contains the palatopharyngeus Fig. The floor of the tonsillar fossa is formed by the superior constrictor of the pharynx separated from the tonsil by the tonsillar capsule, which is a thick condensation of the pharyngeal submucosa the pharyngobasilar fascia.
This capsule is itself separated from the superior constrictor by a film of loose areolar tissue. This epithelium is pitted by crypts, up to twenty in number, and often bears a deep intratonsillar cleft in its upper part. The lymphoid material may extend up to the soft palate, down to the tongue or into the anterior faucial pillar. From late puberty onwards this lymphoid tissue undergoes progressive atrophy.
Blood supply is principally from the tonsillar branch of the facial artery entering at the lower pole of the tonsil, although twigs are also derived from the lingual, ascending palatine and ascending pharyngeal arteries. The venous drainage passes to the pharyngeal plexus.
An important constant vein, the paratonsillar vein, descends from the soft palate across the lateral aspect of the tonsillar capsule. It is nearly always divided in tonsillectomy and may give rise to troublesome haemorrhage. Lymphatic drainage is via lymphatics that pierce the superior constrictor muscle and pass to the nodes along the internal jugular vein, especially the tonsillar or jugulodigastric node at the angle of the jaw.
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The deep fascia of the neck lies deep to the superficial cervical fascia, a layer that is integral to the subcutaneous tissue and invests the platysma muscle. The deep fasciae of the neck are anatomic structures with crucial clinical significance for both surgical procedures and in the spread of infection and neoplasia. Structure and Function Anatomy of the Deep Cervical Fascia The investing, or external layer attaches to the ligamentum nuchae and vertebral spines posteriorly and extends out laterally and around the neck, encircling it.
Anteriorly, it attaches to the hyoid bone and courses further superiorly to enclose the submandibular salivary gland near where it attaches to the inferior surface of the mandible. In this suprahyoid region, between the hyoid bone and the mandible, this layer envelopes the digastric and stylohyoid muscles.
Extensions of the investing fascia course superiorly to envelope the parotid gland. It attaches to the skull along a continuous line along the superior nuchal line and mastoid processes of the occipital bone. This line of attachment continues anteriorly, just inferior to the boney external auditory meatus, to the zygomatic process of the temporal bone.
The investing fascia of the neck envelopes the sternocleidomastoid SCM muscles anteriorly and trapezius muscles posteriorly. Inferiorly, this facial layer is continuous with the fascia of the pectoralis major anteriorly and with the thoracic portion of the trapezius and latissimus dorsi, posteriorly. The existence of the investing fascia across the anterior of the neck, between the SCM muscles, in the area corresponding to the anterior triangles, has been disputed.
Superiorly this layer attaches to the hyoid bone and thyroid cartilage. Inferiorly, on the anterior aspect of the neck, it is continuous with the clavipectoral fascia that surrounds the subclavius, pectoralis minor and serratus anterior muscles, [1] with attachments to the manubrium and clavicles, posterior the attachment site of the external layer of deep fascia. Its superior attachment anteriorly is to the thyroid cartilage. The posterior segment of this fascia, spanning between each carotid sheath, running behind the esophagus and the posterior portion of the lateral lobes of the thyroid gland, is referred to as the buccopharyngeal fascia.
This posterior segment derives its name from its anatomic relation to the pharyngeal and buccinators muscles. It extends superiorly to cover the pharyngeal constrictor muscles and runs anteriorly at this level from the pharynx to cover the buccinators muscle of the face.
Posterior to the buccopharyngeal fascia lies the retropharyngeal space. Its superior attachment is to the bones of the base of the skull. Inferiorly this layer is continuous with the fibrous pericardium. The buccopharyngeal fascia continues as the thoracic covering of the esophagus and trachea. The prevertebral, or deep layer of the deep cervical fascia, like the investing fascia, attaches to the ligamentum nuchae and fully encircles the vertebrae, muscles associated with the vertebral column and the cervical portion of the sympathetic trunk ganglia.
It extends laterally from its attachment at the ligamentum nuchae to encircle the vertebrae and associated muscles, attaching to the transverse processes of the cervical vertebrae as it courses anteriorly to overlie the scalene muscles anterior to the vertebrae. This layer joins back up with itself anterior to the vertebral bodies, situated posteriorly to the buccopharyngeal fascia. The muscles that lie within the prevertebral fascial layer can be thought of in terms of their location respective to the cervical vertebrae.
Lying mostly anterior to the vertebrae, the muscles that lie within this fascial layer are the longus capitis, scalene muscles, and longus coli. Posteriorly, the muscles within this layer are those of the longissimus, semispinalis and splenius muscle groups.
The levator scapulae also lie deep to this fascia. The rectus capitis and obliquus muscles, as well as the deep spinal muscles, lie within this layer. The prevertebral fascia sends extensions inward investing all of these muscles which lie deep to it. Superiorly, its attachment is the base of the skull both anteriorly and posteriorly.
Some sources report that the prevertebral fascia is continuous with the muscular division of the pretracheal layer and that posteriorly the inferior aspect of this singular fascia is continuous with the fascia of the rhomboid major, rhomboid minor and the serratus posterior muscles with boney attachment to the scapulae. As it descends it also gives off fibers which blend with the fibers of the suprapleural membrane, also known as Sibson fascia. Laterally, it gives off fibers that form the axillary sheath.
The prevertebral fascia is continuous with the transversalis fascia of the thorax and abdomen. The prevertebral fascia functions to help in allowing the esophagus, pharynx, and carotid sheaths to glide unobstructed by the longus coli and scalene muscles during neck flexion, extension, and rotation. The alar fascia is a distinct facial layer that is attached to and lies anteriorly to the prevertebral fascia.
It is attached laterally to the prevertebral fascia, where they both attach to the transverse vertebral processes. The alar fascia spans the midline, anterior to the prevertebral fascia and posterior to the buccopharyngeal fascia. Posterior to the buccopharyngeal fascia and anterior to the alar fascia lies the retropharyngeal space. Posterior to the alar fascia and anterior to the prevertebral fascia lies the danger space of the neck. The alar fascia attaches to the base of the skull, like the prevertebral fascia which it overlies anteriorly.
Inferiorly the alar fascia joins the buccopharyngeal fascia at about the level of the first or second thoracic vertebra. Fibers from all three deep cervical fascial layers - the investing, pretracheal and prevertebral - give fibers that blend with the carotid sheath. Some sources consider the carotid sheath to be a distinct division of the deep cervical fascia, while others consider it to be a "facial sheath," separate from the true deep cervical fascia.
Deep Spaces of the Neck The spaces in reality they are compartments, not true spaces bound by these fasciae represent important clinical correlates of this basic anatomy topic and have been addressed previously by several authors.
The hyoid bone represents an essential boundary for anterior deep spaces of the neck, dividing these spaces into sub- and suprahyoid regions. Other spaces, more posterior, are not interrupted by the hyoid bone and extend the entire length of the neck. Importantly, many of these spaces extend into the mediastinum.
The platysma is a broad superficial muscle which lies anteriorly in the neck. It has two heads, which originate from the fascia of the pectoralis major and deltoid. The fibres from the two heads cross the clavicle, and meet in the midline, fusing with the muscles of the face.
Superiorly, the platysma inserts into the inferior border of the mandible. Innervation to the platysma is via the cervical branch of the facial nerve. This fascia is organised into several layers. These layers act like a shirt collar, supporting the structures and vessels of the neck. We shall now look at the layers of the deep cervical fascia in more detail superficial to deep : Investing Layer The investing layer is the most superficial of the deep cervical fascia.
It surrounds all the structures in the neck. Where it meets the trapezius and sternocleidomastoid muscles, it splits into two, completely surrounding them. The investing fascia can be thought of as a tube; with superior, inferior, anterior and posterior attachments: Superior - attaches to the external occipital protuberance and the superior nuchal line of the skull. Anteriorly - attaches to the hyoid bone.
Inferiorly - attaches to the spine and acromion of the scapula, the clavicle, and the manubrium of the sternum. It spans between the hyoid bone superiorly and the thorax inferiorly where it fuses with the pericardium. The trachea, oesophagus , thyroid gland and infrahyoid muscles are enclosed by the pretracheal fascia. Anatomically, it can be divided into two parts: Muscular part — encloses the infrahyoid muscles. Visceral part — encloses the thyroid gland, trachea and oesophagus.
The posterior aspect of the visceral fascia is formed by contributions from the buccopharyngeal fascia a fascial covering of the pharynx. It has attachments along the antero-posterior and supero-inferior axes: Superior attachment - base of the skull. Anterior attachment - transverse processes and vertebral bodies of the vertebral column.
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The pretracheal, or middle layer, can be further subdivided into the muscular and visceral divisions. The deep fascia of the neck lies deep to the superficial cervical fascia, a layer that is integral to the subcutaneous tissue and invests the platysma muscle. The deep fasciae of the neck are anatomic structures with crucial clinical significance for both surgical procedures and in the spread of infection and neoplasia.
Structure and Function Anatomy of the Deep Cervical Fascia The investing, or external layer attaches to the ligamentum nuchae and vertebral spines posteriorly and extends out laterally and around the neck, encircling it. Anteriorly, it attaches to the hyoid bone and courses further superiorly to enclose the submandibular salivary gland near where it attaches to the inferior surface of the mandible.
In this suprahyoid region, between the hyoid bone and the mandible, this layer envelopes the digastric and stylohyoid muscles. Extensions of the investing fascia course superiorly to envelope the parotid gland. It attaches to the skull along a continuous line along the superior nuchal line and mastoid processes of the occipital bone. This line of attachment continues anteriorly, just inferior to the boney external auditory meatus, to the zygomatic process of the temporal bone.
The investing fascia of the neck envelopes the sternocleidomastoid SCM muscles anteriorly and trapezius muscles posteriorly. Inferiorly, this facial layer is continuous with the fascia of the pectoralis major anteriorly and with the thoracic portion of the trapezius and latissimus dorsi, posteriorly. The existence of the investing fascia across the anterior of the neck, between the SCM muscles, in the area corresponding to the anterior triangles, has been disputed.
Superiorly this layer attaches to the hyoid bone and thyroid cartilage. Inferiorly, on the anterior aspect of the neck, it is continuous with the clavipectoral fascia that surrounds the subclavius, pectoralis minor and serratus anterior muscles, [1] with attachments to the manubrium and clavicles, posterior the attachment site of the external layer of deep fascia.
Its superior attachment anteriorly is to the thyroid cartilage. The posterior segment of this fascia, spanning between each carotid sheath, running behind the esophagus and the posterior portion of the lateral lobes of the thyroid gland, is referred to as the buccopharyngeal fascia. This posterior segment derives its name from its anatomic relation to the pharyngeal and buccinators muscles.
It extends superiorly to cover the pharyngeal constrictor muscles and runs anteriorly at this level from the pharynx to cover the buccinators muscle of the face. Posterior to the buccopharyngeal fascia lies the retropharyngeal space. Its superior attachment is to the bones of the base of the skull. Inferiorly this layer is continuous with the fibrous pericardium. The buccopharyngeal fascia continues as the thoracic covering of the esophagus and trachea.
The prevertebral, or deep layer of the deep cervical fascia, like the investing fascia, attaches to the ligamentum nuchae and fully encircles the vertebrae, muscles associated with the vertebral column and the cervical portion of the sympathetic trunk ganglia. It extends laterally from its attachment at the ligamentum nuchae to encircle the vertebrae and associated muscles, attaching to the transverse processes of the cervical vertebrae as it courses anteriorly to overlie the scalene muscles anterior to the vertebrae.
This layer joins back up with itself anterior to the vertebral bodies, situated posteriorly to the buccopharyngeal fascia. The muscles that lie within the prevertebral fascial layer can be thought of in terms of their location respective to the cervical vertebrae. Lying mostly anterior to the vertebrae, the muscles that lie within this fascial layer are the longus capitis, scalene muscles, and longus coli.
Posteriorly, the muscles within this layer are those of the longissimus, semispinalis and splenius muscle groups. The levator scapulae also lie deep to this fascia. The rectus capitis and obliquus muscles, as well as the deep spinal muscles, lie within this layer. The prevertebral fascia sends extensions inward investing all of these muscles which lie deep to it. Superiorly, its attachment is the base of the skull both anteriorly and posteriorly.
Some sources report that the prevertebral fascia is continuous with the muscular division of the pretracheal layer and that posteriorly the inferior aspect of this singular fascia is continuous with the fascia of the rhomboid major, rhomboid minor and the serratus posterior muscles with boney attachment to the scapulae.
As it descends it also gives off fibers which blend with the fibers of the suprapleural membrane, also known as Sibson fascia. Laterally, it gives off fibers that form the axillary sheath. The prevertebral fascia is continuous with the transversalis fascia of the thorax and abdomen. The prevertebral fascia functions to help in allowing the esophagus, pharynx, and carotid sheaths to glide unobstructed by the longus coli and scalene muscles during neck flexion, extension, and rotation.
The alar fascia is a distinct facial layer that is attached to and lies anteriorly to the prevertebral fascia. It is attached laterally to the prevertebral fascia, where they both attach to the transverse vertebral processes. The alar fascia spans the midline, anterior to the prevertebral fascia and posterior to the buccopharyngeal fascia. Posterior to the buccopharyngeal fascia and anterior to the alar fascia lies the retropharyngeal space.
Posterior to the alar fascia and anterior to the prevertebral fascia lies the danger space of the neck. The alar fascia attaches to the base of the skull, like the prevertebral fascia which it overlies anteriorly. Inferiorly the alar fascia joins the buccopharyngeal fascia at about the level of the first or second thoracic vertebra. Fibers from all three deep cervical fascial layers - the investing, pretracheal and prevertebral - give fibers that blend with the carotid sheath.
Some sources consider the carotid sheath to be a distinct division of the deep cervical fascia, while others consider it to be a "facial sheath," separate from the true deep cervical fascia. Deep Spaces of the Neck The spaces in reality they are compartments, not true spaces bound by these fasciae represent important clinical correlates of this basic anatomy topic and have been addressed previously by several authors. The hyoid bone represents an essential boundary for anterior deep spaces of the neck, dividing these spaces into sub- and suprahyoid regions.
Other spaces, more posterior, are not interrupted by the hyoid bone and extend the entire length of the neck. Carotid sheath around the neurovascular bundle The arrangement of deep cervical fascia divides the neck into following compartments: One Vertebral — posterior to prevertebral layer Two Neurovascular — laterally , enclosed in carotid sheaths One Visceral — anteriorly between pretracheal and prevertebral layers.
It encircles the neck like a collar deep to superficial fascia. Extent and Attachment: Superiorly: It is attached to the external occipital protuberance, superior nuchal line, mastoid process, base of mandible between angle of mandible and mastoid process it enclose parotid gland.
Inferiorly: It is attached to the spine of scapula, acromion process, clavicle and manubrium sterni. Posteriorly: It is attached to the ligamentum nuchae and spine of seventh cervical vertebra. Anteriorly: It is attached to the symphysis menti, hyoid bone and is continuous with the fascia of the opposite side. Structures enclosed: It encloses the following structures: Two muscles — sternocleidomastoid and trapezius Two glands — parotid and submandibular Two spaces — suprasternal and supraclvicular Describe the attachment of Pretracheal Fascia.
It covers the front and sides of trachea and splits to enclose the thyroid gland and forms its false capsule. Attachments: Superiorly: It is attached to the hyoid bone, oblique line of thyroid cartilage and cricoid cartilage. Inferiorly: It blends with the adventitia of arch of aorta and fibrous pericardium. Laterally: It merges with the carotid sheath A fibrous band termed ligament of Berry is the extension of this fascia which attaches the capsule of the lobe of the thyroid gland to the cricoid cartilage.
Applied Anatomy Thyroid gland moves up and down during deglutition The pretracheal fascia which forms the false capsule of thyroid gland Is thickened posteriorly to form the suspensory ligament of Berry. The ligament connects the medial surface of lateral lobes of thyroid gland to cricoid cartilage. Therefore, the gland moves up and down with larynx during deglutition.
Describe attachment of Prevertebral Fascia It lies in front of the cervical and upper three thoracic vertebrae and prevertebral muscles. It forms the floor of posterior triangle. Attachments: Superiorly: It is attached to the base of skull in front of foramen magnum. Inferiorly: It is attached to the anterior longitudinal ligament and body of T3 vertebra. It covers the muscles forming floor of the posterior triangle.
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