Deep cervical fascia

Deep cervical fascia: 

Deep cervical fascia Dr. Pankaj Maheria

Layers of deep cervical fascia: 

Layers of deep cervical fascia Investing layer of deep cervical fascia Pretracheal fascia Prevertebral fascia

Investing fascia: 

Investing fascia

Investing fascia: 

Investing fascia It lies under cover of the platysma and is remarkable for the frequency with which it splits into two Attachments : Behind In front Above (from behind forwards) Below (from behind forwards)

TRACINGS : Horizontal extent: 

TRACINGS : Horizontal extent

TRACINGS : Vertical extent: 

TRACINGS : Vertical extent Trace above Submandibular gland Parotid gland

TRACINGS : Vertical extent: 

TRACINGS : Vertical extent Trace above Submandibular gland Parotid gland Trace below Suprasternal space ( Space of Burns)

TRACINGS : Vertical extent: 

TRACINGS : Vertical extent Trace above Submandibular gland Parotid gland Trace below Suprasternal space ( Space of Burns) Supraclavicular space

To sum up : 

To sum up Two Splits to enclose t wo muscles Trapezius and sternomastoid Forms roof of two triangles, Anterior and Posterior Splits to enclose two glands Submandibular and Parotid Splits to enclose two spaces Suprasternal and supraclavicular ;

To sum up : 

To sum up Thickened twice to form the Parotido-masseteric fascia and stylomandibular ligament; Forms two fascia slings Inferior belly of omohyoid and for intermediate tendon of digastric Gives origin to two fascial processes Pretrachial and prevertebral fasciac .

Pretracheal fascia : 

Pretracheal fascia

Tracing : 

Tracing Horizontal extent

Tracing : 

Tracing Horizontal extent Vertical extent

Prevertebral fascia: 

Prevertebral fascia

PowerPoint Presentation: 

Horizontal extent

PowerPoint Presentation: 

Horizontal extent Vertical extent

Special features of deep cervical fascia : 

Special features of deep cervical fascia Carotid sheath is formed by both pretracheal and prevertebral fasciae. Axillary sheath is formed by the tubular prolongation of prevertebral fascia. Spinal part of accessory nerve passes obliquely across the posterior triangle between the investing and prevertebral fasciae. Following structures run entirely beneath the prevertebral fascia dorsal scapular nerve, long thoracic nerve and phrenic nerve

Special features of deep cervical fascia : 

Special features of deep cervical fascia Cervical part of the sympathetic trunk lies behind the carotid sheath but in front of the prevertebral fascia. Recurrent laryngeal nerve passes upward in the tracheo ocsophageal groove. Usually the nerve passes behind the ligament of Berry; sometimes the nerve passes through or in front of that ligament. Retropharyngeal space is situated between the buccopharyngeal fascia and the prevertebral fascia.

Carotid sheath : 

Carotid sheath

PowerPoint Presentation: 

Tubular investment of deep cervical fascia Contains common and internal carotid arteries, Internal jugular vein Vagus nerve.

Carotid sheath : 

Carotid sheath Anterior wall: pretracheal fascia, Posterior wall: prevertebral fascia. Rami of the ansa cervicalis are embedded in the anterior wall of the sheath. The sheath extends downward along the vessels from the base of the skull to the arch of aorta.

Structures piercing the carotid sheath: 

Structures piercing the carotid sheath External carotid artery ; Most of the tributaries of internal jugular vein Glossopharyngeal, accessory, hypoglossal and cervical branches of the vagus nerves

Applied importance: 

Applied importance The carotid sheath is frequently exposed in block dissection of the neck during surgical removal of deep cervical lymph nodes.

Retropharyngeal space: 

Retropharyngeal space It is a potential or dead space behind the pharynx and acts as a bursa to allow expansion of pharynx during deglutition

Boundaries: 

Boundaries In front Behind, On each side Above Below

Contents: 

Contents Loose areolar tissue Retropharyngeal lymph nodes Pharyngeal plexus of vessels and nerves.

Applied anatomy: 

Applied anatomy Pus may be collected in this space due to acute pyogenic infection. The abscess may be expressed in one of the following sites: May extend downward into the mediastinum of thorax May extend laterally behind the carotid sheath and appear at the posterior border of the sternomastoid Sometimes the pus projects forward through the posterior wall of the pharynx on one side of the middle line and produces swelling.

Applied anatomy: 

Applied anatomy If the pus is collected behind the prevertebral fascia due to caries spine of cervical vertebrae and forms a cold abscess, the pus appear in the following sites : It may project forward through the posterior wall of pharynx producing a median swelling ; Pus may appear in the axilla following the axillary sheath and through that it may reach the bend of the elbow.

Lateral pharyngeal space: 

Lateral pharyngeal space It is an wedge-shaped space lined with areolar fascia and situated on each side of the pharynx. The base is directed above and fromed by base of skull and auditory tube ; its apex is directed below and extends up to the level of hyoid bone.

Boundaries: 

Boundaries Medially Postero -laterally Anterior laterally Posteriorly

Contents: 

Contents Branches of maxillary nerve and maxillary vessels; A quantity of fibro-fatty tissue.

Applied anatomy: 

Applied anatomy Infection may spread to this space from the palatine tonsil. The infected material may extend to the parotid and submandibular spaces. This is the possible route of forming Ludwig's angina from parapharyngeal abscess.

Thank you………: 

Thank you………