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Fascia
- fibrous, connective tissue
- superficial, deep, visceral
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Superficial Cervical Fascia
- internal surface of skin around neck
- less distinctive layer; stratum layer; stratum between dermis & deep cervical fascia
- outside layer
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Superficial layer of deep cervical Fascia
- deep to superficial fascia
- encircles whole cervical region
- invests SCM and trapezius
- attaches to cervical spines, EOP, mandible, mastoid process, hyoid bone, manubrium of sternum and scapula
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- outer red border
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Pretracheal layer of deep cervical fascia
- 2 layers
- -muscular layer
- -superficial layer
- - deep layer
- -visceral layer
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- visceral layer
- muscular layer
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Muscular layer (pretracheal layer)
- aka infrahyoid layer
- -superficial layer - invests sternohyoid & omohyoid mm
- -deep layer - invests
- purple layer at top just inside superficial layer of deep cervical Fascia
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Visceral Layer ( of pretrachial layer)
- - invests thyroid gland, larynx, pharynx, trachea, esophagus
- -continuous with buccopharyngeal fascia & carotid sheath
- Blue layer surrounds esophagus and trachea
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Buccopharyngeal fascia
- invests buccinator m & dorsal esophagus
- green between vertebrae and esophagus
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Carotid Sheath
- formed by communion of three fascial layers
- - investing, pretrachial, prevertebral
- internal & common carotid arteries, internal jugular viens, vagus n.
- - NO external jugular vein, external carotid artery
- Where pretracheal, pretervebral and investings meet
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Prevertebral Fascia
- -invests vertebral column & muscles
- -3 parts : Anterior, posterior , axillary sheath
- Large circle on bottom encircles vertebrae
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Anterior (alar)
(Prevertebral Fascia)
- -smaller of the 2 fascial planes
- -invests prevertebral mm
- -bifurcates to form alar fascia
- small area between esophagus and vertebrae
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posterior
(prevertebral fascia)
- -larger of the 2 planes
- -invests deep cervical mm
- larger bottom part of lower circle
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Retropharyngeal space
- -largest of cervical spaces
- -allow free movement when swallowing
- 2 parts
- - anterior
- - posterior
- space between buccopharyngeal & alar fascia
- as well alar and posterior prevertebral fascia
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Anterior Retropharyngeal space
between buccopharyngeal & alar fascia
-extends to C7
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Posterior Retropharyngeal
- alar and posterior prevertebral fascia
- NO midline raphe
- "danger space"
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pretracheal space
posterior to infrahyoid mm, surrounding trachea, anterior to esophagus, descends to superior mediatinum
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Prevertebral Space
potential space between prevertebral fascia & vertebral bodies
discs susceptible to infection
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superficial to Deep Fascia
- superficial cervical fascia (tela subcutanea)
- deep cervical fascia ( superficial layer)
- Pretracheal layer
- deep cervical fascia (Muscular/infrahyoid)
- Visceral fascia ( Visceral layer)
- Carotid Sheath -investing/ deep , pretracheal, prevertebral( visceral)
- Deep cervical fascia ( prevertebral layer)
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Platysma
- O: Fascia of pectoralis major & deltoid
- I: mandible
- A: depresses mandible & angle of mouth
- Inn: CN VII
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Trapezius
- O: EOP, ligamentum nuchae, & SP's of C7-T12
- I: lateral 1/3 clavicle, spine of scapula, acromion proscess
- A: elevates, retracts, depresses scapula
- INN: CNXI, C3/C4 from cervical plexus
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Sternocleidomastoid
- O: manubrium (sternal head)
- clavicle (clavicular head)
- I: mastoid process
- A: main flexor of head
- Inn: CNXI
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Infrahyoid muscle group
- Sternohyoid
- sternothyroid
- thyrohyoid
- omohyoid
- depress hyoid and/or larynx
- innervation by cervical plexus
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Sternohyoid
- O: manubrium, medial clavicle
- I: body of hyoid bone
- A: depresses hyoid bone & larynx
- INN: C1-C3 via ansa cervicalis
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Omohyoid
- O: inferior belly: scapula
- superior belly: intermediate tendon
- I: inferior belly: intermediate tendon
- superior belly: hyoid
- A: depresses hyoid bone & larynx
- Inn: C1-C3 via ansa cervicalis
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Thyrohyoid
- O: thyroid cartilage
- I: body of hyoid bone
- A: depresses hyoid bone
- Inn: C1 via hypoglossal nerve (C1 & C2)
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Suprahyoid Muscle group
- Digastric
- Stylohyoid
- Mylohyoid
- Geniohyoid
-elevate hyoid
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Digastric
- O: Posterior belly- mastoid process
- Anterior belly - digastric fossa of mandible
- I:intermediate tendon of the digastric
- A: elevate hyoid bone or depress mandible when hyoid is fixed
- Inn: Posterior belly - CNVII
- Anterior Belly - CNV
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Stylohyoid
- O: styloid process
- I: hyoid bone
- A: elevates hyoid bone & tongue
- Inn: CNVII
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Mylohyoid
- O: mylohyoid line of mandible
- I: body of hyoid bone & median raphe
- A: elevates hyoid & floor of mouth
- Inn: CN V ( n. to Mylohyoid)
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Cricothyroid
- O: anterolateral cricoid cartilage
- I: inferior thyroid cartilage
- A: tenses & elongates vocal cords
- INN: external laryngeal banch of vagus n.
Neither infrahyoid or suprahyoid
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Geniohyoid
- O: inferior genial tubercle
- I: body of hyoid bone
- A: elevate hyoid bone & tongue
- Inn: C1 via hypoglossal n.
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Triangles
- Anterior triangle
- Digastric triangle
- Submental triangle
- Carotid Triangle
- Muscular triange
- Posterior Triangle
- Occipital triangle
- Omoclavicular/ subclavian triangle
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Anterior Triangle
- Anterior- Midline; line from symphysis menti to sternal notch divides L&R
- Posterior- Posterior border of SCM
- Superior - inferior margin of mandible
divides into 4 triangles by digastric and omohyoid
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Digastric triangle (submandibular)
- Superior: inferior margin of mandible
- Anterior: anterior belly of digastric
- Posterior: posterior belly of digastric
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Submental triangle (suprahyoid)
- Lateral: 2 opposing anterior bellies of digastric muscles
- Caudal/ posterior: body of hyoid
- Medial: midline of neck
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Carotid triangle
- Superior: posterior belly of digastric & stylohyoid
- Ant: superior belly of omohyoid
- Post: SCM
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Muscular triangle
- Sup./Post: superior belly of omohyoid
- Inf/Post: SCM
- Ant: midline
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Posterior Triangle
- Ant: SCM
- Post: Trapezius
- Caudally: clavicle
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Occipital triangle
boundaries: Trapezius, SCM, & inferior belly of omohyoid
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Omoclavicular/subclavian triangle
Bounded by: SCM, inferior belly of omohyoid, & clavicle
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Longus Colli
(Superior obliques)
- O: TP of C3-5
- I: anterior arch of atlas
- Flexion of head and neck
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Longus Colli
(inferior Oblique)
- O: anterior vertebral bodies of T1-3
- I: TPs of C5&6
- Flexion of head and neck
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Longus Colli
(vertical)
- O: anterior vertebral bodies of C5-T3
- I: anterior vertebral bodies of C2-C4
- Flexion of head and neck
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Longus Capitus
- O: anterior TPs of C3-6
- I: basilar part of occipital bone
- A: flex the head & neck, ipsilateral rotation
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Scalene muscles
- Anterior, middle, & posterior
- O: TPs of C2-C7
- I: 1st and 2nd ribs
- A: elevation of ribs, flexion of head & neck
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