Neck space anatomy

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  • Dr.A.GANESH BALA M.S ENTASSOCIATE PROFESSOR

    VMMC - KARAIKAL

  • Completely encloses the head and neckand is generally considerd to represent a continuous sheeth of fatty connective tissue (thin layer of subcutaneous connective tissue) extending from the head and neck into the thorax , shoulders & maxilla.

    In the head , this layers encases the voluntary layer of face and scalp.

    In the neck , this layer encases the platysma , External jugular vein,and Sup. Lymph nodes.

  • Lies between the dermis of the skin and the deep cervical fascia

    Also contains a varying amount of fat -its distinguishing characteristic

    A potential fascial space within the fatty tissue superficial to the platysma as well as between the latter and the deep fascia termed as Space I of Grondinisky & Holyoke.

    http://iris3.med.tufts.edu/headneck/invest2.htm

  • the most superficial Deep Fascial Layer

    Surrounds the structures of the neck

    Lies between the superficial cervical fasciaand the muscles

    Splits into superficial and deep layers to enclose trapezius, SCM, submandibular gland and fibrous capsule of parotid gland

    Covers the posterior as well as the anterior triangle of the neck

    http://iris3.med.tufts.edu/headneck/supf.htm

  • Superiorly it attaches to

    Superior nuchal line of occipital bone (a)

    Spinous processes of cervical vertebrae and nuchalligament(b)

    Mastoid processes of temporal bones(c)

    Zygomatic arches(d)

    Inferior border of mandible(e)

    Hyoid bone(f)

  • Inferiorly it attaches to

    Manubrium(g)

    Clavicles(h)

    Acromion(i)

  • Continuous posteriorly with periosteum covering C7 spinous process and ligamentum nuchae an extension of the supraspinous ligament that forms a median fibrous septum between the muscles of the two sides of the neck

    Just above the sternum this layer splits around the anterior and posterior surfaces of the manubrium forming the Suprasternal Space (k). Contains the anterior jugular veins

    Folds to form the stylomandibular ligament(j)

  • a- investing layer of deep cervical fasciab- platysma muscle

  • Surrounds infrahyoid (strap) muscles: Sternohyoid, Sternothyroid, Omohyoid, Thyrohyoid

    Thickens to form a pulley through which the intermediate tendon of the digastric muscle passes, suspending the hyoid bone

    MIDDLE LAYER OF DEEP CERVICAL FASCIAA DERIVATIVE OF INVESTING FASCIA

    http://iris3.med.tufts.edu/headneck/invest2.htm

  • Also tethers the omohyoid muscle, redirecting the course of the muscle between the two bellies

    Fused with the Investing layer of fascia that lies on the Deep surface of SCM

    MIDDLE LAYER OF DEEP CERVICAL FASCIAA DERIVATIVE OF INVESTING FASCIA

    http://iris3.med.tufts.edu/headneck/invest2.htmhttp://iris3.med.tufts.edu/headneck/invest2.htm

  • (a)- middle layer of deep cervical fascia(b)- strap muscles

    MIDDLE LAYER OF DEEP CERVICAL FASCIAA DERIVATIVE OF INVESTING FASCIA

    http://iris3.med.tufts.edu/headneck/invest2.htm

  • Visceral Layer of Deep Cervical Fascia

    Lies deep to the infrahyoid muscles, following them to their origin behind the sternum, and splits to enclose the thyroid, trachea, pharynx, and esophagus

    Attached superiorly to the cricoid cartilage(e), thyroid cartilage(d), and hyoid bone(f)

    Attached posteriorly to the (Pre)Vertebral Fascia

    VISCERAL AND PHARYNGEAL LAYER OF DEEP CERVICAL FASCIA

    http://iris3.med.tufts.edu/headneck/vertib.htm

  • Visceral Layer of Deep Cervical Fascia

    Blends laterally with the carotid sheath and inferiorly with the fibrous pericardium

    Blends posteriorly and superiorly with pharyngeal fascia of the pharynx

    Continuous with Investing Fascia at lateral borders of infrahyoid muscles

    Is refered to pretracheal anteriorly(a) and retrovisceral(c) posteriorly.

    VISCERAL AND PHARYNGEAL LAYER OF DEEP CERVICAL FASCIA

  • Visceral Layer of Deep Cervical Fascia

    Thin layer on the pharynx itself

    Often broken down into Retropharyngeal(b), Lateral Pharyngeal and Buccopharyngeal components as it posteriorly to anteriorly envelops the pharynx

    Retropharyngeal fascia is considered continuous below (T2) with the visceral fascia on the esophagus(Retrovisceral/Retroesophageal Fascia)

    Separates the muscular wall of the pharynx from certain potential spaces that largely surround it.

    Other Components of Visceral Fascia discussed in detail in Suprahyoid section

    VISCERAL AND PHARYNGEAL LAYER OF DEEP CERVICAL FASCIA

  • Vertebral Layer of Deep Cervical Fascia

    Forms a tubular sheath for the vertebral column and the muscles associated with it extending from the base of the skull to T3 vertebra

    Extends laterally as the axillary sheath surrounds the axillary vessels, brachial plexus, and sympathetic trunks

    Begins from cervical spinous processes(a) and the ligamentum nuchae(b). (Similar to the Investing Layer of Deep Cervical Fascia)

    VERTEBRAL LAYER OF DEEP CERVICAL FASCIA

  • Vertebral Layer of Deep Cervical Fascia

    Initially lies on the outer surface of the back muscles that extend into the neck (nuchal layer) and is immediately deep to the trapezius muscle and its surrounding superficial layer of fascia.

    Covers the floor of the posterior triangle of the neck.

    Is refered to as prevertebral anteriorly.

    The prevertebral layer of fascia attaches to the tranverseprocesses(c) and divides into two layers/laminae as it passes behind the esophagus and in front of the vertebral column.

    VERTEBRAL LAYER OF DEEP CERVICAL FASCIA

  • Alar fascia is the anterior subdivision of prevertebral fascia that bridges between the transverse processes(a).

    It blends with the (retro)Visceral fascia (posterior fascia of the esophagus) at the level of T2 vertebral body.

    This seals inferiorly the (retro)Pharyngeal space.

    It runs from the base of the skull to the superior mediastinum

    ALAR FASCIA ANTERIOR SUBDIVISION OF PREVERTEBRAL FASCIA

  • (a)- tongue

    (b)- inferior concha

    (c)- danger space #4

    (d)- alar fascia

    (e)- oropharynx

    (f)- epiglottis

    ALAR FASCIA ANTERIOR SUBDIVISION OF PREVERTEBRAL FASCIA

  • The anterior triangle of the neck is outlined by the

    anterior border of the sternocleidomastoid muscle laterally,

    the inferior border of the mandible superiorly,

    and the midline of the neck medially

  • BOUNDARIES

    Anteroinferiorly : anterior belly of digastric

    Posteroinferiorly : posterior belly of digastric

    Superiorly or base : base of the mandible and the line joining the angle of the mandible and mastoid process

    CONTENT

    Submandibular gland; submandibular lymph nodes; hypoglossal nerve [XII]; mylohyoidnerve; facial artery and vein

  • BOUNDARIES

    hyoid bone inferiorly, the anterior belly of the digastric muscle laterally, and the midline;

    CONTENTS

    Submental lymph nodes;

    Tributaries forming the anterior jugular vein

  • BOUNDARIES

    Hyoid bone superiorly,

    the superior belly of the omohyoidmuscle, and the anterior border of the sternocleidomastoid muscle laterally,

    and the midline;

    CONTENTS

    Sternohyoid, omohyoid, sternothyroid, and thyrohyoidmuscles; thyroid and parathyroid glands; pharynx

  • BOUNDARIES

    superior belly of the omohyoidmuscle anteroinferiorly,

    the stylohyoid muscle and posterior belly of the digastric superiorly, and

    the anterior border of the sternocleidomastoid muscle posteriorly.

  • Tributaries to common facial vein

    Cervical branch of facial nerve [VII]

    Common carotid artery

    External and internal carotid arteries

    Superior thyroid; ascending pharyngeal; lingual, facial, and occipital arteries

    Internal jugular vein

    Vagus [X], accessory [XI], and hypoglossal [XII] nerves

    Superior and inferior roots of ansa cervicalis

    Transverse cervical nerve

  • MUSCLES SUPERIOR TO THE HYOID

    Suprahyoid muscles

    stylohyoid,

    digastric,

    mylohyoid, and

    geniohyoid;

  • MUSCLES INFERIOR TO THE HYOID

    Infrahyoid muscles

    omohyoid,

    sternohyoid,

    thyrohyoid, and

    sternothyroid.

  • Boundaries:

    Anterior:posterior border of sternocleidomastoid

    Posterior: anterior border of trapezius

    Inferior or base:middle one third of clavicle.

    Apex:lies on the superior nuchal line where the trapezius and sternocleidomastroidmeet.

  • The roof is formed by the investing layer of deep cervical fascia.

    The superficial fascia over the posterior triangle contains (a) the platysma(b) the external jugular and posterior external jugular veins.(c) parts of the supraclavicular,great auricular,transverse cutaneous and lesser occipital nerves,(d) transverse cervical and suprascapular arteries and lymph vessels which pierce the deep fascia to end in the supraclavicular nodes.

  • The floor of the posterior triangle is formed by the prevertebal layer of the deep cervical fascia coverting the following muscles:

    (a) splenius capitus

    (b) levator scapule

    (c) scalenus medius and occasionaly scalenus posterior.

  • STERNO CLEIDO MASTOID

    TRAPEZIUS

    SPLENIUS CAPITIS

    LEVATOR SCAPULAE

    POSTERIOR SCALANE

    MIDDLE SCALANE

    ANTERIOR SCALANE

    OMOHYOID

  • CONTENTS OCCIPITAL TRIANGLE SUBCLAVIAN TRIANGLE

    NERVES 1.Spinal accesory ne