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

6. 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.

7. Superficial fascia

8. Platysma

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

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

11. 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

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

13. Investing Layer
Attachments: Superior

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

15. INVESTING LAYER
ATTATCHMENTS
INFERIOR-

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

17. INVESTING LAYER
ATTATCHMENTS
ANTERIOR-

18. INVESTING LAYER
ATTATCHMENTS
POSTERIOR-

19. Posteriorly – the seventh cervical spine and ligamentum nuchae .

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

22. VERTICAL EXTENT OF INVESTING LAYER
ABOVE Splits to enclose Submandibular Parotid gland gland

23. At the lower border of submandibular gland

24. 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

25. At lower pole of Parotid gland

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

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

28. Suprasternal space (of burn’s)

29. 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 anterior surface of suprasternal notch
Attached to posterior surface of suprasternal notch

30. Supraclavicular space
Investing layer

31. Supra clavicular space
At Middle 1/3 of clavicle
Splits into
Superficial Deep
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

32. RULE OF TWO

33. 2 muscles enclosed- trapezius & sternocleidomastoid

34. 2 triangle’s roof- anterior & posterior

35. 2 Gland enclosed- parotid & submandibular salivary gland

36. 2 Spaces enclosed- suprasternal(Space of BURN’s) & supraclavicular space

37. 2 Thickenings formed - parotidomasseteric fascia & stylomandibular ligament

38. 2 fascial slings- digastric & omohyoid muscles

39. 2 lamina given - for pretracheal & prevertebral fascia

40. 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

41. 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

42. PRE-TRACHEAL FASCIA

43. 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

44. 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

46. Applied anatomy
Ligament of berry

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

48. Carotid sheath

50. 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

51. PREVERTEBRAL FASCIA Tough membrane
Lies in front of Pre-vertebral muscles
Forms the tubular sheath for vertebral column & muscles associated with it

52. disappears undercover of Trapezius – forms Floor of Posterior 
Prevertebral: horizontal extent
From undercover of SCM
Forms posterior wall of Carotid sheath
Covers the cervical vertebra & prevertebral muscles
Continuous with similar layer of opposite side
disappears undercover of Trapezius – forms Floor of Posterior 

53. Prevertebral: vertical extent
Above
Attached to bones of base of the skull
Alar fascia
Buccopharyngeal fascia
Below
Splits into
Anterior (Alar) Posterior layer C2
Posterior layer C3 C4 C5
Enters thorax
Blends with anterior longitudinal ligament of T3 vertebra C6
Blends with buccopharyngeal fascia C7 T1
Antr.longituidianal ligament T2 T3

54. Special feature Covers cervical & brachial plexus nerves
4 superficial branches of cervical plexus pierce the fascia
Between Sc. Anterior & medius - Axillary sheath around cords of Br.plexus and Subclavian artery
Pus from an abscess posterior to the prevertebral layer may extend laterally posterior to SCM

55. RETROPHARYNGEAL SPACE
Potential space behind the pharynx
Acts as bursa to allow the expansion of pharynx during deglutition
Retro pharyngeal space

56. Anteriorly: buccopharyngeal fascia Posteriorly: alar fascia
Boundaries:
Anteriorly: buccopharyngeal fascia
Posteriorly: alar fascia
Above: Limited by base of the skull
Below: continuous as retroesophageal space which extends into mediastinum and ends at T1-T2 where the space is obliterated by the fusion
Contents:
Retropharyngeal lymph nodes.
Loose areolar tissue, pharyngeal plexus of vessels and nerves
Alar fascia
Buccopharyngeal fascia
Posterior layer
Retropharyngeal space
Retroesophageal space

57. Clinical significance:
Route through which the infections of mouth & throat reach the mediastinum
Infection can break through the posterior wall of space and can enter danger space
Fatal haemorrhage could result from an extension of retropharyngeal abscess to the deep vessels of neck.
Retropharyngeal abscess –dysphagia,dysarthria.

58. Imp questions Investing layer of deep cervical fascia?
Pre tracheal fascia.
Retropharyngeal space.

59. Thank you