Deep cervical fascia (fascia colli)
- 1. DEEP CERVICAL FASCIA DR. SURAJIT KUNDU SR. LECTURER DEPT. OF ANATOMY MAITRI INSTITUTE OF DENTAL SCIENCES & RESEARCH CENTRE ANJORA, DURG, CHHATTISHGARH
- 2. INTRODUCTION FASCIA MEANS FIBROUS CONNECTIVE TISSUE WHICH BINDS TOGETHER VARIOUS STRUCTURES OF THE BODY ALWAYS OF 2 TYPES- SUPERFICIAL FASCIA & DEEP FASCIA SUPERFICIAL FASCIA IS SUBCUTANEOUS- PRESENT JUST BELOW THE SKIN DEEP FASCIA IS PRESENT ARROUND MUSCLES BLOOD VESSELS & ORGANS OF THE BODY
- 3. DEEP CERVICAL FASCIA DEEP FASCIA ARROUND THE NECK IS KNOWN AS DEEP CERVICAL FASCIA OR FASCIA COLLI AS IT FORMS A COLLAR ARROUND THE NECK LIES DEEP TO PLATYSMA MUSCLE IN THE INTERVAL B/W MUSCLES, VESSELS & ORGANS OF THE CERVICAL REGION GIVES VARIOUS EXTENSIONS OR LAMINAE ARROUND VARIOUS STRUCTURES OF THE NECK
- 5. MODIFICATIONS/ LAMINAE/EXTENSIONS OF DEEP CERVICAL FASCIA HAS 7 MODIFICATIONS INVESTING LAYER PRETRACHEAL LAYER PREVERTEBRAL LAYER CAROTID SHEATH BUCCOPHARYNGEAL FASCIA TEMPORAL FASCIA PHARYNGOBASILAR FASCIA
- 7. INVESTING LAYER ATTATCHMENTS ABOVE - EXTERNAL OCCIPITAL PROTUBERANCE,MASTOID PROCESS, EXTERNAL ACOUSTIC MEATUS, BASE OF THE MANDIBLE BELOW - SPINE OF SCAPULA, ACROMION PROCESS, CLAVICLE, MANUBRIUM STERNI FRONT - HYOID BONE & CONTINUOUS WITH THE FASCIA OF THE FASCIA OF THE OPPOSITE SIDE BEHIND - 7 TH CERVICAL VERTEBRA, LIGAMENTUM NUCHAE
- 8. INVESING LAYER TRACINGS HORIZONTAL TRACING- ENCLOSES 2 MUSCLES- TRAPEZIUS & STERNOCLEIDOMASTOID FORMS INTERMEDIAE FOR DIGASTRIC & OMOHYOID MUSCLES FORMS ROOF OF 2 TRIANGLE- ANTERIOR & POSTERIOR GIVES 2 LAMINA FOR PRETRACHEAL & PREVERTEBRAL FASCIA VERTICAL TRACING ENCLOSES 2 GLAND- PAROTID & SUBMANDIBULAR SALIVARY GLAND ENCLOSES 2 SPACES- SUPRASTERNAL SPACE & SUPRACLAVICULAR SPACE FORMS 2 THICKENINGS- PAROTIDOMASSAETERIC FASCIA & STYLOMANDIBULAR LIGAMENT
- 10. SUPRASTERNAL SPACE FORMED BY SPLITTING OF INVESTING LAYER OF DEEP CERVICAL FASCIA AT THE UPPER BORDER OF STERNUM WHICH GETS ATTATCHED TO ANTERIOR & POSTERIOR BORDER OF SUPRA-STERNAL NOTCH ENCLOSES A SPACE KNOWN AS SUPRA-STERNAL SPACE OR SPACE OF BURNS CONTENT OF THE SPACE INTER-CLAVICULAR LIGAMENT, STERNAL HEAD OF STERNOCLEIDOMASTOID MUSCLE, JUGULAR VENOUS ARCH, LOOSE AREOLAR TISSUE
- 12. SUPRACLAVICULAR SPACE FORMED BY SPLITTING OF INVESTING LAYER OF DEEP CERVICAL FASCIA AT MIDDLE 3 RD OF CLAVICLE & GETS ATTATCHED TO ANTERIOR & POSTERIOR BORDER OF UPPER SURFACE OF CLAVICLE ENCLOSES A SPACE KNOWN AS SUPRACLAVICULAR SPACE CONTENT OF THE SPACE SUPRACLAVICULAR NERVES, EXTERNAL JUGULAR VEIN
- 13. CLINICAL ANATOMY BECAUSE OF THE PRESENCE OF THICK TOUGH PAROTIDO-MASSEERIC FASCIA WHICH COVERS THE PAROTID GLAND SWELLINGS OF THE PAROTID GLAND (MUMPS, PAROTITIS) ARE VERY PAINFULL
- 14. PRETRACHEAL FASCIA IT IS ONE OF THE LAMINA OF DEEP CERVICAL FASCIA THAT ARISES DEEP TO STERNOCLEIDOMASTOID MUSCLE HORIZONTALLY THE FASCIA ENCLOSES THE THYROID GLAND & THEN BECOMES CONTINUOUS WITH THE FASCIA OF THE OPPOSIDE SIDE VERTICALLY THE FASCIA IS ATTATCHESD TO HYOID BONE & THEN DOWNWARDS IT ENCLOSES THYROID GLAND & RUNS DOWMWARDS & FINALLY GETS ATTATCHED TO PERICARDIUM OF THE HEART
- 16. CLINICAL ANATOMY THE FASCIA FORMS THE OUTER FALSE CAPSULE OF THYROID GLAND, POSTERIOR PART OF WHICH IS THIN & NOT WELL DEFINED. HENCE THYROID SWELLINGS GROWS POSTERIORLY & MAY COMPRESS THE OESOPHAGUS CAUSING DYSPHAGIA THYROID GLAND MOVES WITH DEGLUTTITION AS THE POSTERIOR ASPECT OF THE GLAND IS ATTATCHED TO THE CRICOID CARTILAGE BY A THICKENING OF PRETRACHEAL FASCIA KNOWN AS LIGAMENT OF BERRY OR SUSPENSORY LIGAMENT OF THYROID GLAND DURING THYROID SURGERIES THE LIGAMENT OF BERRY HAS TO BE CUT TO MOBILISE THE TYHROID GLAND ENLARGEMRNT OF THYROID GLAND LEADS TO EMBARRESMENT OF THE HEART AS THE LOWER EXTENSION OF PRETRACHEA; FASCIA IS PERICARDIUM WHICH LEADS TO A TRACTION ON THE FASCIA DUE THE THYROID SWELLING CONTINUITY OF PRETRACHEAL FASCIA WITH THE MEDIASTINUM LEADS TO SPREAD OF INFECTION TO MEDIASINUM FROM THE NECK & VISE VERSA PRETRACEAL FASCIA PROVIDES A FREE SLIPPERY BASE FOR THE MOVEMEN OF THE TRACHEA DURING SWALLOWING
- 17. PREVERTEBRAL FASCIA IT IS ONE OF THE LAMINA OF DEEP CERVICAL FASCIA THAT ARISES DEEP TO STERNOCLEIDOMASTOID MUSCLE LIES IN FRONT OF CERVICAL VERTEBRAE & MUSCLES IN FRONT OF IT HORIZONTALLY IT FORMS THE FLOOR OF THE POSTERIOR TRIANGLE & FINALLY EXTENDS UPTO AXILLA AS AXILLARY SHEATH ENCLOSING THE AXILLARY VESSELS AND NERVES VERTICALLY IT EXTENDS FROM THE SKULL BASE UPTO THE 4 TH THORACIC VERTEBRA
- 19. CLINICAL ANATOMY DUE THE EXTENSION OF PREVERTEBRAL FASCIA AS AXILLARY FASCIA INFECTIONS OF VEREBRAE- CARIES SPINE (TUBERCULOSIS OF VERTEBRAE) MAY LEAD TO SPREAD OF PUS TO THE AXILLA, THE PUS MAY ALSO POIN AS AN ABSESS IN THE REGION OF THE POSTERIOR TRIANGLE PREVERTEBRAL FASCIA FORMS THE POSTERIOR WALL OF RETROPHARYNGEAL SPACE RETROPHARYNGEAL ABSESS CAUSES DYSPHAGIA
- 21. CAROTID SHEATH IT IS A FASCIAL SHEATH SITUATED DEEP TO STERNOCLEIDOMASTOID MUSCLE ON EACH OF THE FRONT OF THE NECK FORMATION ANTERIOR WALL- BY PRETRACHEAL LAYER OF DEEP CERVICAL FASCIA POSTERIOR WALL- BY PREVERTEBRAL LAYER OF DEEP CERVICAL FASCIA CONTENTS INTERNAL JUGULAR VEIN LATERALLY, COMMON CAROTID ARTERY ( IN THE LOWER PART) & INTERNAL CAROTID ARTERY ( IN THE UPPER PART) MEDIALLY, VAGUS NERVE IN B/W THEM IN A POSTERIOR PLANE RELATIONS ANTERIORLY- ANSA CERVICALIS POSTERIORLY – SYMPATHETIC TRUNK
- 23. THE PHARINGEAL FASCIA IS SEPARATED INTO TWO LAYERS WHICH SANDWHICH THE PHAREANGEAL MUSCLES B/W THEM-A THIN LAYER ( buccopharyngeal fascia ) COATS THE OUTSIDE OF THE MUSCULAR PART OF THE WALL; A MUCH THICKER LAYER (pharyngobasilar fascia ) LINES THE INNER SURFACE. TMPORAL FASCIA- THICK FIBROUS SHEET WHICH COVERS TEMPORALIS MUSCLE & FORMS THE ROOF OF TEMPORAL FOSSA
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