10/8/2020 Deep cervical fascia - Investing layer - Prevertebral layer - Pretracheal layer - carotid sheath - AnatomyQA

 poonam.kdc@gmail.com

Deep Cervical Fascia

January 5, 2017 Anatomy, Head and Neck carotid sheath, Deep cevical fascia, investing
layer, neuroanatomy, pretracheal layer, prevertebral layer

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Contents [show]

 Name the layers of  Deep Cervical Fascia.

Deep cervical fascia or fascia colli invests the muscles of the neck, forms
capsules of the glands and protective sheath around neurovascular structures.

It is arranged in three layers, from outside inwards they are:

Investing layer
Pre-vertebral layer
Pre-tracheal layer and 
Carotid sheath (around the neurovascular bundle)

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The arrangement of deep cervical fascia divides the neck into following compartments:

One Vertebral – posterior to prevertebral layer

Two Neurovascular – laterally , enclosed in carotid sheaths
One Visceral – anteriorly between pretracheal and prevertebral layers.

Horizontal disposition of Deep Cervical Fascia

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Vertical disposition of Deep Cervical Fascia

Describe the attachment and structures enclosed by investing layer of Deep

Cervical Fascia.
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It encircles the neck like a collar deep to super cial fascia.
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 Extent and Attachment:

Superiorly:  It is attached to the external occipital protuberance, superior

nuchal line, mastoid process, base of mandible (between angle of
mandible and mastoid process it enclose parotid gland).
Inferiorly: It is attached to the spine of scapula, acromion process, clavicle
and manubrium sterni.
Posteriorly: It is attached to the ligamentum nuchae and spine of seventh
cervical vertebra.
Anteriorly: It is attached to the symphysis menti, hyoid bone and is
continuous with the fascia of the opposite side.

Structures enclosed: It encloses the following structures:

Two muscles – sternocleidomastoid and trapezius

Two glands – parotid and submandibular
Two spaces – suprasternal and supraclvicular 

Describe the attachment of Pretracheal Fascia.

It covers the front and sides of trachea and splits to enclose the thyroid gland
and forms its false capsule. 

Attachments:
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Superiorly:  It is attached to the hyoid bone, oblique line of thyroid

cartilage and cricoid cartilage.
Inferiorly: It blends with the adventitia of arch of aorta and  brous
pericardium.
Laterally: It merges with the carotid sheath

A brous band termed ligament of Berry is the extension of this fascia which
attaches the capsule of the lobe of the thyroid gland to the cricoid cartilage.

Applied Anatomy

Thyroid gland moves up and down during deglutition

The pretracheal fascia which forms the false capsule of thyroid gland Is
thickened posteriorly to form the suspensory ligament of Berry. The
ligament connects the medial surface of lateral lobes of thyroid gland to
cricoid cartilage. Therefore, the gland moves up and down with larynx
during deglutition.

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Describe attachment of Prevertebral Fascia

It lies in front of the cervical and upper three thoracic vertebrae and
prevertebral muscles. It forms the oor of posterior triangle.

Attachments:

Superiorly: It is attached to the base of skull in front of foramen magnum.

Inferiorly:  It is attached to the anterior longitudinal ligament and body of
T3 vertebra.
It covers the muscles forming oor of the posterior triangle.
Cervical and brachial plexus lie deep to it.
The trunks of brachial plexus and the subclavian artery emerge between
the scalenus anterior and medius muscles (covered by per-vertebral fascia)
and carry a sheath (axillary sheath) of this fascia along with them to the
axilla.
The space behind it and in front of vertebrae is prevertebral space.
The space in front of it and behind the pharynx is retropharyngeal space.
It contains loose areolar tissue and retropharyngeal lymph nodes.

Applied Aspects

Pus collected in the prevertebral space usually arise from the caries of
cervical vertebrae. It may project/travel: 

Forward and cause midline bulge in the posterior pharyngeal 

wall. 

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Laterally rst into the posterior triangle and then along axillary
sheath into the axilla.
Downwards into superior mediastinum limited by fusion
of prevertebral fascia to T3 vertebra.

Pus from the neck infections in front of the prevertebral fascia i.e. in
the retropharyngeal space (from suppuration of the retropharyngeal
lymph nodes) may project/travel:

 Forward in the paramedian position (due to fusion of

buccopharyngeal fascia to prevertebral fascia in the median plane).
May extend down into the superior mediastinum to posterior
mediastinum.

Describe brie y Carotid Sheath.

 Carotid sheath is a tubular condensation of deep cervical fascia around

common and internal carotid arteries, internal jugular vein and vagus
nerve.

 It extends from the base of skull to the arch of aorta.

 It is thick around the common and internal carotid arteries and thin
around internal jugular vein.
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Ansa cervicalis is embedded in the anterior wall of the carotid sheath.

Cervical part of sympathetic chain lies behind the carotid sheath and in
front of prevertebral fascia.

 Contents of Carotid Sheath are:

Common carotid artery till the upper border of thyroid cartilage and

internal carotid artery above this level.
Internal jugular vein in the entire extent.
Vagus nerve in the entire extent (it is posterior to the carotid arteries and
internal jugular vein). The superior and inferior cervical cardiac branches,
pharyngeal and superior laryngeal branches of vagus arise inside the
carotid sheath.

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