QS Study

The deep cervical fascia (Fascia collie) acts to compartmentalize most structures of the neck and prevents the spread of infections. It is located under the skin, the superficial fascia, and the platysma muscle. This fascia is organized into several layers. These layers act like a shirt collar, supporting the structures and vessels of the neck. To steer the spread of infection or pus in the neck, the layers of deep cervical fascia create fascial planes.

The deep cervical fascia is condensed to form the following layers:

  • Investing layer.
  • Prevertebral layer.
  • Pretracheal layer.
  • Carotid sheath.

Deep Cervical Fascia 1

Fig: Deep Cervical Fascia

(1) Investing layer: It surrounds all the structures in the neck. It can be thought of like a tube; with superior, inferior, anterior and posterior attachments.

  1. It surrounds the neck like a collar.
  2. It splits to enclose muscles, glands & omohyoid tendons.

(2) Pretracheal layer: It spans between the hyoid bone superiorly and the thorax inferiorly (where it fuses with the pericardium).

  1. It encloses & suspends the thyroid gland.
  2. On either side, it forms a suspensory ligament for the thyroid gland.
  3. It provides a slippery surface for free movements of the trachea during swallowing.

(3) Prevertebral layer: The prevertebral fascia surrounds the vertebral column and its associated muscles; scalene muscles, prevertebral muscles, and the deep muscles of the back.

  1. It lies infront of the prevertebral muscles.
  2. It provides a fixed base for the movements of the pharynx, the oesophagus & the carotid sheaths during neck movement & swallowing.

(4) Carotid sheath: It is a condensation of the fibroareolar tissue around the main vessels of the neck and the vagus nerve. It is a fibrous connective tissue that encircles four key structures within the neck.

Clinical importance of cervical fascia

The fascial layers allow surgical cleavage planes and are vitally important in limiting the spread of disease (mainly infection and malignancy).

(A) Fascial spaces:

Visceral, retropharyngeal, submandibular & masticatory spaces are important because organisms can spread among the fascial planes & spaces from mouth, teeth, pharynx, oesophagus.

(B) Acute infections of the fascial spaces:

Dental infections: Spreads from the mandible into submandibular & masticatory spaces.

Ludwig’s angina: An acute infection of submandibular fascial space; secondary to dental infection.

(C) Chronic infection of the fascial spaces:

TB in deep cervical lymph nodes: A collar stud abscess formed in superficial fascia.

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