Monday, May 24, 2021

DEEP CERVICAL FACIA / INVESTING LAYER OF DEEP CERVICAL FACIA / SUPRA CLAVICULAR SPACE / SUPRA STERNAL SPACE / PRETRACHEAL LAYER / PREVERTEBRAL LAYER / CAROTID SHEATH

 * Deep cervical fascia of the neck forms many facial spaces in the neck.

* It also forms coverings around many muscles , vessels , nerves .

* Deep cervical fascia mainly contain three layers .

1) Investing layer of deep cervical fascia

2) Pretracheal fascia 

3) Prevertebral fascia 


*  INVESTING LAYER OF DEEP CERVICAL FACIA :

* This layer encloses the neck like a collar.

* This layer is present deep to platysma and superficial fascia.


* Attachments of deep cervical fascia: 1) Superior attachments : 

* It is attached to external occipital protuberance

* superior nuchal lines

* mastoid and styloid process *Tympanic plate 

* Base of mandible

2) Inferior attachments : 

* it is attached inferiorly to clavicle . 

* Manubrium

* Spine of scapula 

* Acromion process of scapula

3) Anterior attachments : 

* It is attached to symphysis menti

4) Posterior attachments :

* It is attached  to ligamentum nuchae 

* Spine of C7 vertebra

* Fascia splits to enclose two spaces of neck they are : 

1) Suprasternal space or space of burns 

2) Supraclavicular space

* Muscles enclosed by this fascia are , trapezius  and sternocleidomastoid. *Glands covered by this fascia are ,  parotid gland and submandibular gland.


* Contents of suprasternal space or space of burns :

1) sternal head of sternocleidomastoid 2) jugular venous Arch 

3) interclavicular ligament

4)  lymph nodes.


* Contents of supraclavicular space : 1)Terminal part of external jugular vein 

2) Suprascapular nerve

* Investing layer forms pulley to anchor the temdons of digastric and omohyoid muscle.

* Investing layer forms roof of anterior and posterior triangles of neck.

* Investing layer of deep cervical fascia thickens to  form  stylomandibular ligament and paretidomasseteric facia.


* PRETRACHEAL FACIA : 

* This layer of fascia covers anterior and lateral sides of the neck.

* Superior attachemnts :

* It is attached to hyoid bone , oblique line of thyroid cartilage and cricoid cartilage .

* Inferior attachments : 

* It  encloses thyroid gland forming false capsule and it blends with apex of  fibrous pericardium.

* Ligament of Berry : 

* It is derived from pretracheal fascia and connects lateral lobe of thyroid gland with cricoid cartilage.


* PREVERTEBRAL FACIA : 

* This is the most strongest facia.

* It lies in front of vertebral muscles.

* Superior attachments :

* It is attached to base of Skull 

* Inferior attachments :

* It is attached to anterior longitudinal at level of upper thoracic vertebra.

* Prevertebral facia covers the following muscles :

* scalene muscles , levator scapulae and splenius capitis .

* From this fascia axillary sheath is derived .

* The prevertebral facia is seperated from wall of pharynx and bucco pharyngeal facia by space called " retropharyngeal space ".

* Retropharyngeal space has retro pharyngeal lymph nodes .

 

* CAROTID SHEATH :

* It is derivative of deep cervical facia.

* It is present between pretracheal , investing layer and prevertebral layer of deep cervical facia.

* This sheath is present around internal jugular vein , vagus nerve , common carotid artery and internal carotid artery .

Relations of carotid sheath :

* It is anteriorly related to ansa cervicalis.

* It is posteriorly related to cervical sympathetic chain.

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