1. Surface anatomy Plan fascia of the neck
Dr. H.A.Jaafar
Al-Nahrain University-
college of Medicine
Dept. Of Anatomy

2. Objectives:
we should be able to know :
The subcutaneous tissue nerves, veins of the neck,
The main anatomical potential space in the neck which lead to Spread Infections to the mediastinum.
Three major fascial compartments of the neck
Where the viscera of the neck are located.

3. It is strengthened by cervical part of vertebral column,
The Neck
lies between lower margin of mandible above &
suprasternal notch & upper border of clavicle below.
It is strengthened by cervical part of vertebral column,
is convex forward
supports skull.
Behind the vertebrae is ………………….a mass of extensor muscles
in front is …………………………………..a smaller group of flexor muscles .
In central region are :…………………parts of respiratory system,
larynx & trachea,
behind are parts of alimentary system, pharynx & esophagus.
At sides of these structures are vertically running :
carotid arteries,
internal jugular veins,
vagus nerve,
deep cervical lymph nodes

4. Landmarks of the neck Sternocleidomastoid Suprasternal fossa
Greater supraclaviclar fossa

5. Landmarks of the neck
Hyoid bone
Thyroid cartilage
Cricoid cartilage

6. lines of cleavage of skin are constant
Skin of Neck
lines of cleavage of skin are constant
run …..horizontally …..around neck.
an incision :
along a cleavage line will heal as a narrow scar,
crosses lines will heal as a wide or heaped-up scar.

7. The natural line of cleavage of the skin are constant and run almost horizontally around the neck

8. Fascia of Neck

9. 1-Superficial Fascia 2-deep Fascia

10. 1-Superficial Fascia

11. Superficial Fascia forms a thin layer encloses platysma muscle.
embedded in it are :
cutaneous nerves,
superficial veins,
superficial lymph nodes.

12. Cervical Subcutaneous Tissue &Platysma
Structures in neck:
are surrounded by a layer of subcutaneous tissue (superficial fascia)
are compartmentalized by layers of deep cervical fascia.
fascial planes determine direction in which an infection in neck may spread.
Cervical Subcutaneous Tissue &Platysma
superficial cervical fascia
is a layer of fatty connective tissue
lies between dermis of skin & investing layer of deep cervical fascia
It is usually thinner than in other regions, anteriorly.
It contains :
cutaneous nerves,
blood & lymphatic vessels,
superficial lymph nodes
variable amounts of fat.
Platysma……..Anterolaterally

13. external jugular vein (EJV)
descending from angle of mandible to middle of clavicle
are superficial to main cutaneous nerves of neck.
covers anterolateral aspect of neck.

14. Platysma
flat plate is a broad, thin sheet of muscle in subcutaneous tissue of neck
is supplied by cervical branch of CN VII.
Its fibers arise in deep fascia covering superior parts of deltoid & pectoralis major muscles
sweep superomedially over clavicle to inferior border of mandible.
anterior borders of the two muscles decussate over chin
blend with facial muscles.
Inferiorly, fibers diverge, leaving a gap anterior to larynx & trachea

15. tenses skin, producing vertical skin ridges
releasing pressure on superficial veins.
use in shaving
in a grimace.
depress the mandible and draw corners of mouth inferiorly
Acting its inferior attachment
convey tension or stress.

17. Contents Platysma Superficial veins Cutaneous nerves
Anterior jugular v.
External jugular v.
Cutaneous nerves
Lesser occipital n.
Greator auricular n.
Transverse nerve of neck
Supraclavicular n.
Cervical branch of facial n.

18. Regions of neck Neck Anterior region of neck
Sternocleidomastoid region
Lateral region of neck

19. Triangles of posterior (lateral) region of neck
Occipital triangle
supraclavicular triangle
(greater supraclavicular fossa)

21. 2-Deep Cervical Fascia

22. Deep Cervical Fascia: investing, pretracheal, & prevertebral.

23. condenses around : ……… to form carotid sheath
support :
viscera (thyroid gland),
muscles,
vessels, &
deep lymph nodes.
condenses around : ……… to form carotid sheath
common carotid arteries,
internal jugular veins (IJVs), &
vagus nerves
form natural cleavage planes
tissues may be separated during surgery,
limit the spread of abscesses (collections of pus)
afford slipperiness
allows structures in neck to move and pass over one another without difficulty,
swallowing and turning the head and neck.

24. Deep Cervical Fascia: investing,

25. most superficial deep fascial layer,
Investing Layer
most superficial deep fascial layer,
surrounds entire neck deep to skin and subcutaneous tissue.
splits into superficial and deep layers to enclose (invest) :
trapezius &
sternocleidomastoid (SCM) muscles.
Superiorly, attaches to :
Superior nuchal line of occipital bone.
Mastoid processes of temporal bones.
Zygomatic arches.
Inferior border of mandible.
Hyoid bone.
Spinous processes of cervical vertebrae.
also splits to enclose :
submandibular gland;
posterior to mandible, it splits to form fibrous capsule of parotid gland.

26. Inferiorly, attaches to :
Investing Layer
stylomandibular ligament is a thickened modification
Inferiorly, attaches to :
manubrium,
clavicles, &
acromions
spines of scapulae.
continuous posteriorly
with :
periosteum covering C7 spinous process,
nuchal ligament
a triangular membrane
forms a median fibrous septum between muscles of two sides of neck

28. Deep Cervical Fascia: pretracheal,

30. Pretracheal Layer of Deep Cervical Fascia
is limited to the anterior part of neck
It extends inferiorly from hyoid into thorax,
it blends with the fibrous pericardium covering heart.
includes a thin muscular part,
encloses :
infrahyoid muscles, &
a visceral part,
encloses
thyroid gland,
trachea, &
esophagus
pharynx
is continuous posteriorly & superiorly with buccopharyngeal fascia of pharynx.
blends laterally with carotid sheaths.

31. a thickening of pretracheal fascia forms a pulley or trochlea through
Pretracheal Layer of Deep Cervical Fascia
In hyoid,
a thickening of pretracheal fascia forms a pulley or trochlea through
intermediate tendon of digastric muscle passes,
suspending hyoid.
tethers two-bellied omohyoid muscle,
redirecting course of muscle between bellies.

32. Prevertebral Layer

33. is fixed to cranial base superiorly.
forms a tubular sheath for vertebral column & muscles associated with it,
such as :
longus colli &longus capitis anteriorly,
scalenes laterally,
deep cervical muscles posteriorly
is fixed to cranial base superiorly.
Inferiorly, it blends with endothoracic fascia peripherally
fuses with anterior longitudinal ligament centrally
at approximately T3 vertebra
extends laterally as axillary sheath
surrounds axillary vessels & brachial plexus.
sympathetic trunks cervical parts are embedded in it

34. Carotid Sheath

35. is a tubular fascial investment
extends from cranial base to root of neck.
blends :
anteriorly with investing and pretracheal layers
posteriorly with prevertebral layer
contains :
common and internal carotid arteries,
internal jugular vein,
vagus nerve (CN X),
deep cervical lymph nodes,
carotid sinus nerve,
sympathetic nerve fibers (carotid periarterial plexuses).
carotid sheath and pretracheal fascia communicate freely with:
mediastinum of thorax inferiorly &
cranial cavity superiorly.
represent potential pathways for spread of infection and extravasated blood.

36. Retropharyngeal Space

37. Buccopharyngeal fascia
is largest and most important interfascial space in neck
It is a potential space
consists of loose connective tissue between visceral part of prevertebral layer of deep cervical fascia & buccopharyngeal fascia surrounding pharynx superficially.
Inferiorly, buccopharyngeal fascia is continuous with pretracheal layer
alar fascia :
forms a further subdivision of retropharyngeal space.
is attached along midline of buccopharyngeal fascia from cranium to level of the C7 vertebra.
it extends laterally and terminates in carotid sheath.
permits movement of pharynx, esophagus, larynx, and trachea relative to vertebral column during swallowing.
is closed :
superiorly by cranial base and
on each side by carotid sheath.
It opens inferiorly into superior mediastinum
Sternocleidomastoid
Trapezius
Deep Cervical Fascia
Investing layer of deep cervical fascia
Prevertebral fascia
Pretracheal fascia
(visceral part)
Carotid sheath
Buccopharyngeal fascia
Alar fascia
(muscular part) T E

38. Buccopharyngeal fascia
Sternocleidomastoid
Trapezius
Posterior cervical triangle
Anterior triangles
Suprahyoidmuscles
Infrrahyoidmuscles
Sternocleidomastoid
Trapezius
Deep Cervical Fascia
Investing layer of deep cervical fascia
Prevertebral fascia
Pretracheal fascia
(visceral part)
Carotid sheath
Buccopharyngeal fascia
Alar fascia
(muscular part) T E
Prevertebral muscles
Scalene muscles

39. Trace the pathways for venous drainage from the neck into the brachial veins.
Ext. jugular
Int. jugular
Ant. jugular
Sup. thyroid
Middle
thyroid
Inf. thyroid

40. Platysma

42. Cutaneous nerves and superficial veins
Lesser occipital n.
External jugular vein
Greet auricular n.
Transverse nerve of neck
Supraclavicular n.
Anterior jugular vein

43. Submendibular gland
Digastric
Accessory n.
Hypoglossal n.
Superior thyroid a.
Cervical plexus
Ansa cervicalis
Sternothyroid
Phrenic n.
Sternohyoid
Omohyoid
Vagus n.