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Cervical Fascia

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DEEP FASCIA

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SUPERFICIAL FASCIA

Superficial Cervical Fascia

Envelopes

The superficial cervical fascia is a connective tissue layer lying just below the dermis. It incorporates the SMAS. The potential space between the superficial and deep cervical fascial layers contains sensory nerves, superficial veins, and a variable amount of adipose tissue. 

Boundaries

Significance

Superior: Zygomatic Process Inferior: Clavicle

Platysma

Platysma Muscles of Facial Expression

Main plane of resistance to deep neck spread of cellulitis. Allows mobility of skin over deep neck structures

The superficial cervical fascia is a connective tissue layer lying just below the dermis. It incorporates the SMAS and extends inferiorly to involve the platysma. The potential space between the superficial and deep cervical fascial layers contains sensory nerves, superficial veins, and a variable amount of adipose tissue. 

The superficial cervical fascia is a connective tissue layer lying just below the dermis. It incorporates the SMAS and extends inferiorly to involve the platysma . The potential space between the superficial and deep cervical fascial layers contains sensory nerves, superficial veins, and a variable amount of adipose tissue. 

Creates the Masticator Space superiorly.

SCM

Trapezius SCM Submandibular & Parotid Glands Muscles of Mastication

This layer is also known as investing fascia.  

Superior: mandible and zygoma Inferior: Clavicles, sternum, scapula, acromion  Anterior: hyoid bone Posterior: mastoid process, superior nuchal line

Forms stylomandibular ligament.

Seperates parapharyngeal and submandibular spaces 

Masticator Space  ↓ The masticator space is created from the superficial layer of the deep cervical fascia surrounding the masseter laterally and the pterygoid muscles medially. It contains masseter muscle, pterygoid muscles, inferior tendon of the temporalis muscle, ramus, and posterior body of the mandible, internal maxillary artery, and the inferior alveolar neurovascular bundle. 

Splits anteroinferiorly to form Suprasternal Space of Burns.

Suprasternal Space of Burns  ↓ The superficial layer of the deep cervical fascia divides into anterior and posterior leafs to attach to the respective borders of the suprasternal (jugular) notch, forming a small space ~2cm superior to the manubrium.  This space contains: - Anterior Jugular Vein Anastomoses (bridging veins)- Lymph Nodes

Stylomandibular Ligament 

Superficial Layer of Deep Cervical Fascia

Stylomandibular Ligament ↓  Seperates parapharyngeal and submandibular spaces 

Masticator Space  ↓ The masticator space is created from the superficial layer of the deep cervical fascia surrounding the masseter laterally and the pterygoid muscles medially. It contains masseter muscle, pterygoid muscles, inferior tendon of the temporalis muscle, ramus, and posterior body of the mandible, internal maxillary artery, and the inferior alveolar neurovascular bundle. 

Suprasternal Space of Burns  ↓ The superficial layer of the deep cervical fascia divides into anterior and posterior leafs to attach to the respective borders of the suprasternal (jugular) notch, forming a small space ~2cm superior to the manubrium.  This space contains: - Anterior Jugular Vein Anastomoses (bridging veins)- Lymph Nodes

Strap Muscles

Muscular Division

Buccinator Pharyngeal Constrictors Larynx Trachea Esophagus Thyroid Parathyroid glands

Visceral Division

Visceral Division

Strap Muscles

Buccopharyngeal Fascia

Trachea

Forms pretracheal fascia over the trachea. Forms the buccopharyngeal fascia.

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Middle Layer of Deep Cervical Fascia

Thyroid

This layer is can be divided into Muscular & Visceral divisions.  This layer extends from the skull base to the mediastinum. 

Muscular Division

Esophagus

Muscular Division

Strap Muscles

Visceral Division

Buccopharyngeal Fascia

Buccopharyngeal Fascia

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Alar Fascia

Retropharyngeal Space

The visceral division also contributes the buccopharyngeal fascia posterior to the esophagus, which separates the esophagus from the deep layer of deep cervical fascia and forms the anterior border of the retropharyngeal space. The buccopharyngeal fascia forms two raphae: Midline raphe: adheres to the alar layer of the deep layer,pterygomandibular raphe of the lateral pharynx. 

The visceral division also contributes the buccopharyngeal fascia posterior to the esophagus, which separates the esophagus from the deep layer of deep cervical fascia and forms the anterior border of the retropharyngeal space. The buccopharyngeal fascia forms two raphae: Midline raphe: adheres to the alar layer of the deep layer,pterygomandibular raphe of the lateral pharynx. 

Alar Fascia

Extends from Skull Base ‚Üí Mediastinum

Alar Layer

Prevertebral Layer = floor of the postrior triangle

Extends from Skull Base ‚Üí Coccyx

Prevertebral Layer

Anterior Scalene Muscle & Phrenic N.

Danger Space is formed between alar and prevertebral layers.

Prevertebral Layer

Sympathetic Trunk

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Sympathetic Trunk

Prevertebral Space is between the prevertebral layer and vertebrae

Vertebral Bodies Paraspinous Muscles Scalene Muscles Phrenic Nerve

This layer is sometimes called prevertebral fascia; however, it can be divided into Alar Layer and Prevertebral Layer. 

Alar Layer

Deep Layer of Deep Cervical Fascia

Longus colli muscle

DANGER SPACE

The danger space is a potential space that extends from the skull base to the diaphragm. It is called the “danger space” because of the potential for rapid inferior spread of infection to the posterior mediastinum. The alar layer forms its anterior border, and the prevertebral layer forms its posterior border. Laterally, the transverse processes of the vertebrae enclose the danger space. This space normally contains loose areolar tissue connecting the prevertebral and alar layers. The sympathetic trunk courses through this space. Infectious spread from the retropharyngeal, parapharyngeal, or prevertebral spaces are the primary routes to the danger space. 

The prevertebral space is enclosed by prevertebral fascia, vertebral bodies and transverse processes. It extends from the skull base to the coccyx. In addition to the paraspinous, prevertebral, and scalene muscles, it contains the vertebral artery and vein, brachial plexus, and phrenic nerve. The main pathways of spread to the prevertebral space are from infection of the vertebral bodies and penetrating injuries. Tuberculosis of the spine may breach the space and form a Pott’s abscess. 

PREVERTEBRAL SPACE

Envelopes

Carotid Artery Internal Jugular Vein Vagus Nerve

Carotid Artery

Infection from the surrounding parapharyngeal space, penetrating trauma, or intravenous drug use may potentiate spread into this space. When this occurs, infection can spread very rapidly, thus why some refer to it as “The Lincoln Highway of the Neck”. 

Internal Jugular Vein

The carotid sheath fascia is comprised of all three layers of the deep cervical fascia.

Carotid Sheath Fascia

Vagus N.

Carotid Artery

Internal Jugular Vein

The carotid sheath fascia is comprised of all three of layers of the deep cervical fascia.