Head & Neck Surgery Course

Dr Pierfrancesco PELLICCIA

Pr Benjamin LALLEMANT

Service ORL et CMF

CHU de Nîmes

CH de Arles

Surgical anatomy of the neck:

cervical fascia

Summary (cross section of the neck)

• Superficial Layer

• Deep Layer

– Subdivisions not

histologically

separated

– Superficial

– Middle

– Deep

Superficial Layer

• Superior attachment – zygomatic process

• Inferior attachment – thorax, axilla.

• Ensheathes platysma and muscles of facial expression

Superficial Layer

Superficial Layer of the Deep Cervical Fascia

• Arises from spinous processes.

• Superior border – nuchal line, skull base, zygoma, mandible.

• Inferior border – sternum, clavicle and scapula

• Splits at mandible and covers the masseter laterally and the medial surface of the medial pterygoid.

Superficial Layer of the Deep Cervical Fascia

• Envelopes

– SCM

– Trapezius

– Submandibular

– Parotid

Middle Layer of the Deep Cervical Fascia

Muscular Division – Superior border – hyoid and thyroid

cartilage – Inferior border – sternum, clavicle

and scapula

Visceral Division – Superior border

• Anterior – hyoid and thyroid cartilage • Posterior – skull base

– Inferior border – continuous with fibrous pericardium in the upper mediastinum.

– Buccopharyngeal fascia • Name for portion that covers the

pharyngeal constrictors (peripharyngeal fascia) and buccinator.

Middle Layer of the Deep Cervical Fascia

Muscular Division Envelopes infrahyoid strap muscles

Visceral Division Envelopes

• Thyroid • Trachea • Esophagus • Pharynx • Larynx

Deep Layer of Deep Cervical Fascia

• Arises from spinous processes and ligamentum nuchae.

• Splits into two layers at the transverse processes: – Alar layer

• Superior border – skull base • Inferior border – upper

mediastinum at T1-T2 – Prevertebral layer

• Superior border – skull base • Inferior border – coccyx • Envelopes vertebral bodies

and deep muscles of the neck.

Carotid Sheath

• Formed by all three layers of deep fascia

• Anatomically separate from all layers.

• Contains carotid artery, internal jugular vein, and vagus nerve

• Extends from skull base to thorax.