Fasciae of the Neck

Superficial cervical fascia

Contents:

  1. Platysma muscle
  2. Cutaneous nerves, blood vessels and lymphatics
  3. Superficial lymph nodes
  4. Fat
deep cervical fascia

Deep cervical fascia or Fascia colli

1. Investing layer

  • Mnemonic: Encloses 2 muscles, 2 salivary glands and 2 spaces
  • 2 muscles: Sternocleidomastoid and Trapezius
  • 2 glands: Submandibular and Parotid
  • 2 spaces: Suprasternal and Supraclavicular

2. Pretracheal layer

  • Muscular layer: encloses infrahyoid muscles
  • Visceral layer: encloses thyroid gland (forms false capsule and posteriorly suspensory ligament of Berry), trachea and esophagus
    • Posterior part: form buccopharyngeal fascia (outside pharyngeal muscles)

3. Carotid sheath: Formed anteriorly by pretracheal fascia and posteriorly by prevertebral fascia

Encloses:

  • CCA
  • IJV
  • CN X
  • CN IX, XI and XII also present in upper part, but they pierce out

Relations:

  • Anteriorly: Ansa cervicalis (CN XII + C1, C2, C3 spinal nerves)
  • Posteriorly: Cervical sympathetic chain

4. Pharyngobasilar fascia (deep to pharynx): lines the inner surface of pharyngeal muscles

  • Retropharyngeal space exists between buccopharyngeal fascia and pharyngobasilar fascia

5. Prevertebral layer

  • Encloses vertebrae and prevertebral muscles
  • Forms floor of posterior triangle of neck
  • Extends with brachial plexus as axillary sheath (subclavian and axillary veins lie outside the sheath)
  • Alar fascia: between buccopharyngeal fascia and prevertebral fascia
fascia colli neck

Spread of Infections

1. Infection between investing layer and muscular layer of pretracheal fascia: Upto superior edge of manubirum

2. Infection between investing layer and visceral layer of pretracheal fascia: Into thoracic cavity anterior to pericardium

3. Retropharyngeal space infections (suppuration of retropharyngeal lymph nodes): Through the superior mediastinum into the posterior mediastinum

4. Infection behind prevertebral fascia (vertebral TB): May spread to various directions –

  • Anterior: Chronic retropharyngeal abscess
  • Lateral: Through axially sheath and point in posterior triangle or lateral wall of axilla
  • Inferior: Superior mediastinum


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