Cervical Fascia Anatomy

ok today we're going to talk about cervical fashion answer the what questions what is fashion what are the superficial and deep facial plains in the neck what's contained in each of these planes and what are retro pharyngeal and danger spaces hello everyone my name is dr. Morton and I'm the noted anatomist so first of all fashio is Latin for a band or bandage because fashion if it forms strands or sheets of fibrous or collagenous connective tissue that wrap around the anatomy of the body to form compartments oh and today we're going to talk about sheets of connective tissue that form compartments in the neck okay so the cervical fascia picture we're going to use is going to be this following orientation where you take cross section around the c6 level separate out look from foot to head and there's the section we're going to look at like this where the top of the picture is anterior the bottom is posterior okay anatomically cervical fash is important because it forms concentric layers of cervical fascia that compartmentalized the neck anatomy like muscular vascular and visceral compartments clinically it's important because of the surgical orientation it provides in the understanding a spread of diseases like cancer and infection and especially relevant in ear nose and throat surgery and radiology and so here's the picture and Shing there are the fascial planes within that we're going to talk with it compartmentalized concentric Li and there are the different facial planes and the anatomy contained therein we're going to talk about superficial fascia then deep fascia and the subdivisions so first superficial fascia is this blinking part there which is the subcutaneous tissue all around the circumference of the neck and continuous all throughout the body it's basically your hypodermis and it contains in the neck a muscle called the platysma muscle which arises from the corner of the mouth and goes all the way down in the neck and then fuses and into the fashion around the clavicle and pectoralis major muscle okay that's the platysma the only muscle in the superficial fascia it also has cutaneous veins arteries and nerves branches from the cervical plexus the deep fascia is this everything in that blinking area where there are compartments from muscles and vessels and viscera and it's easier for these structures and compartments slide over each other so the different subdivisions of the deep fascia are as follows we're gonna start with the deep investing fascia first the deep investing fashio is that blinking structure there and it's deep to the superficial fashion and it arises and circles around the entire neck it arises from the new click event and then it's going to envelop the trapezius muscle and the sternocleidomastoid and then wrap around to the other side of the neck so the deep investing fashion envelops the sternal cluedo masters and traps on both sides and it looks like the four corners of the neck the deep investing fascia forms the roof of the posterior triangle what's the posterior triangle well it's the space between the sternocleidomastoid in traps it's best seen in the lateral view there's a sternocleidomastoid and there's the trapezius Shing and it's the space in between and there's the posterior triangle that looks like a triangle and the space in between is the deep investing fashion the roof of the posterior triangle the the deep investing facist pierced by cutaneous branches off the cervical plexus an external jugular vein look at that cross-section there you see coming out that cervical plexus and then it pierces through the fashio right behind the student Oakley no mastoid into the superficial fascia so there it's called the herbs point to the neck right on the back of the sternocleidomastoid all of those cutaneous branches from the cervical plexus go out to the neck and then they're at the very bottom is the external jugular vein the bottom of that posterior triangle and that external jugular vein pierces that deep Investing fashio the boundaries well the boundaries of the deep investing fascia are the mandible and hyoid and sternum on the front the clavicle and scapula on the side and the occipital bone nuchal ligament trapezius along the back the next is the pre tracheal fascia which is that blinking one there and the pre tracheal fascia forms the visceral compartment what are the viscera well the thyroid gland in the trachea and the recurrent laryngeal nerves on either side and the esophagus in this section but the pharynx up higher and then there are the parathyroid glands as well that are not shown but are in that area the pre free aphasia has specific name to the back the posterior border is called the buccal pharyngeal fashio which is all along there in that tan color because that fashion envelops the Buxa nadir and the fringe you'll constrict your muscles the boundaries for the pre tracheal fascia are as follows it's going to see there is our pre tracheal fashion along the front it's the hyoid and thyroid laryngeal cartilages and it envelops the thyroid gland and fuses into the pericardial sac posteriorly there's the buccal fringe ile fashio it courses from the skull all the way down into the mediastinum between the pre trachea unbuckle friend jill fashio is the trachea and then the pharynx up high and the esophagus down below okay now the pre vertebral fascia is next and it's that blinking fashion and it forms the muscular compartment which includes the vertebral column and there it is there includes the longest coli here longest capitis up higher and tier middle and posterior scalene muscles levator scapulae and the Paris finals now the sympathetic trunk an anatomist usually don't include it in there but often radiologists so included part of the pre vertebral fashio I've clone it outside because I'm an anatomist the phrenic nerve is in front of the scalene and the cervical and brachial plexus ease both course from between the anter middle scalings all this within the pre vertebral fashio the preferred bull fascia forms the axillary sheath and so what happens when we take a look at that brachial plexus is that as it exits it pulls that the fascia from the pre verbal fashio with it and it makes a sleeve along with it that we call the axillary sheath which is enveloping the brachial plexus as well as the subclavian and axillary artery it also forms the pre vertical fashion forms the floor of the posterior triangle there's the posterior triangle and there's a lateral view of the posterior triangle and it forms the floor because watch when you cut through Shing right on the floor the posterior triangle is pre vertebral fashio there's the cut edge and we go down there's that pre vertebral fashio sorry you can hear like our kids using a set down here calling to each other from around the house mm-hmm and so the pre vertebral fascia also has something called the ail are facets and anterior subdivision of the pre vertebral fashion let's watch as the pre vertical fashion approaches that transverse process Xin it separates and forms this ant your laminate called the ail our fascia basically the pre riddle of fashio along the front has two layers so in sagittal section and the cross section we can see pre vertebral ale our fashion preview Lalor fashion in that section okay and the LR fascia fuses with the buckle fringe you'll fascist somewhere around the t1 to t4 vertebral level pre vertebral fascia LR fascia buckle fringe eel fashion now follow the al-ahram buckle fringe eel fasciae they fuse around the t1 vertebra in my illustration here now the carotid sheath is that blinking structure and it is formed by the adjacent facial sleeves like the deep investing fashio by the sternocleidomastoid the pre vertebral fashion show by the entire scalene the pre tracheal fashion the edge of the thyroid all of those segments all then condense around and form this vascular compartment called the carotid sheath and this vascular compartment contains the internal jugular vein the carotid arteries and the vagus nerve like that now what's not seen here are the deep cervical nodes and the carotid sinus nerves now let's do that carotid sheath again except from this anterior view where there's the internal jugular vein there's a carotid arteries and you see that vagus nerve coming up but it hugs deep inside and to the two vessels there and so we blow that up and come over here and so there's our internal jugular vein lateral and then the carotid arteries medial and the vagus nervous snug as a bug is a rug in between them okay now the carotid sheath also has what's called the answer server callus within the wall we blow that up and we see something called the cervical plexus and there's C 1 to C 5 ntral Ram I and then coming from C 1 to C 2 and 3 is this loop called the answer server callus and if we take a cross-section right through there that inferior limb is formed as shown there in the cross-section and the superior limb is shown there in the cross-sections when you dissect in a cadaver this answer server callus is found within the sheath of the carotid sheath in the neck now the infrahyoid muscles are shown here and the fascia around the infrahyoid muscles it's kind of interesting in anatomy because where does it belong in the deep cervical fascia well it depends on the reference that you use and so the Grey's Anatomy never referenced and most clinicians will say that the fashion around the infrahyoid muscles is around is a subset of the pre tracheal fashion so there's a pre tracheal fashion and the fashioner on the infrahyoid x' is just a subdivision of that and that's the one that i subscribe to but some anatomist and surgeons will say well actually the fashio and the infrahyoid muscles is a subset of the deep investing fascist so we're gonna take the infrahyoid muscles and put it with the deep investing fashion and then some clinicians will say well it's only I don't it's it's own fascial compartment we'll call it the middle layer of deep cervical fashion now let's talk about anatomical spaces in the deep cervical fashion okay so anatomical spaces where the fascial layers in the detect defines some potential spaces and so in healthy patients these spaces are actually closed but infections can widen these spaces and then serve as conduits for that spread bacteria like streptococci produce proteolytic enzymes which digest this connective tissue furthering enable this infections to spread so the retro pharyngeal and the danger spaces are the two primary ones we're going to talk about let's start with the retro frangie labeouf renewal fascia and they al are fascia right there next is the danger space which is between the LR fashion and the pre vertical fashion right there so there are two different potential spaces that was fun let's do it again so the retro pharyngeal space in this cross-section is between the buccal fringy fascia and the LR fashion right there and this is what permits movements of the pharynx larynx and esophagus during swallowing so the retro pharyngeal space is like bedsheets so when we take a look at this bed oh that's a nice bit that's not my bed looks like so there's the mattress sheet and then there's another bed sheet in the cosy space oh the cosy space is right they're right between the bedsheet the mattress sheet so the space is there but the only way to get in there is you push your feet into that cool comfortable space and that's what separates the two sheets because the space is not really there it's potential but it you have to form it by pushing something in there well the retro pharyngeal space is like bed sheets so here we have the buckle fringe elf Asha one bed sheet the ALR fashio the other bed sheet and then the cozy retro pharyngeal space is right in there but the only way to do it is you have to force your way into that and then do this Shing and then force it open like that which is how we see it in these pictures all the time but those pictures are actually misleading because that's the way it looks all the time now what causes the retro very chill space to extend expand well that is where the abscesses and infections come into play okay and so abscesses infections may bulge anteriorly and then they can restrict swallowing and breathing and the reason why is that the esophagus is directly in front of the retro very real space that would restrict swallowing because the pharynx is just above it and then really bad would push on the trachea and the airways and restrict breathing then and so the retro pharyngeal space can also have infections that spread into the mediastinum so there's our pre vertebral and ALR fascism there's the buccal fringe efficient now watch alarm buccal fringe elf ashes fuse around the t1 to t4 vertebral levels and so when the retro vert and Jill space if there's an infection can spread down and right there it's like short sheeting in a bed where they to fuse and the infection cannot spread pass that now the danger pre workable space is between the pre vertebral and ALR fascists and so right there's where the fascia is or in cross-section right in that area and so infection can spread from the skull base all the way down into the poster mediastinum so let's now do a review of both of these spaces there's buccal fringe ill and ALR Fascism what's between them retro pharyngeal space there's the ALR fashion verbal fashio what's between them the danger spaces so therefore the LR fascist separates the retro pharyngeal from the danger spaces cool so anatomically there are two distinct spaces but in healthy patients LR fash is not visible why because it's also like a bedsheet the ALR fascia really is like this it's collapsed and so anatomist and clinicians will say that whole yellow space in there that's the retro pharyngeal space so often when we define the retro for your jill space an animus will say well the book of renewal fascia is between and the pre vertebral flashes where the retro pharyngeal space is or they'll say retro free and gel space is between buccal fringe Jill and LR fascism buccal fringe' and pre vertebral flashes that's what makes it confusing in many references or professors that might be lecturing on this topic and so what happens is they see that dark line that's an infection spreading that goes and it pushes the LR fascia away from the pre verbal fashio and you form the danger space and then the rest of the opening in front of it that's the retro pharyngeal space and so you can say retro varial space looks like that or like that either one thank you anatomist thank you for making that so clear so let's do a little review shall we so most clinicians are going to use the following categorization of the superficial and deep Fascism the neck now radiologists on the other hand will say well that's superficial fashion that's the jargon I'm going to use and the deep fashion I'm gonna use my own jargon instead of calling this the deep investing fashio I'm gonna say that's the superficial layer of the deep and deep fascia and instead of calling this a pre tracheal fascia I'm gonna say that's the middle layer of the deep cervical fascia and then I'll just call that the carotid sheath and instead of calling this the pre vertebral fashion I'm gonna call the deep layer of the deep cervical fascia and so what we see is there's discrepancy and there's problems in the cervical facet terminology and description and so there's this early surgeon named Josef Francois Malaga Nia who said the cervical fascia appear in a new form under the pen of each author who attempts to just oh so frustrating I totally good it and back in 1800 1800 s and right to today is the same thing so radiologists use this jargon mostly everyone else uses this jargon and that my friends is the cervical fascia in a nutshell [Music]

ok today we&#39;re going to talk about cervical fashion answer the what questions what is fashion what are the superficial and deep facial plains in the neck what&#39;s contained in each of these planes and what are retro pharyngeal and danger spaces hello everyone my name is dr. Morton and I&#39;m the noted anatomist so first of all fashio is Latin for a band or bandage because fashion if it forms strands or sheets of fibrous or collagenous connective tissue that wrap around the anatomy of the body to form compartments oh and today we&#39;re going to talk about sheets of connective tissue that form compartments in the neck okay so the cervical fascia picture we&#39;re going to use is going to be this following orientation where you take cross section around the c6 level separate out look from foot to head and there&#39;s the section we&#39;re going to look at like this where the top of the picture is anterior the bottom is posterior okay anatomically cervical fash is important because it forms concentric layers of cervical fascia that compartmentalized the neck anatomy like muscular vascular and visceral compartments clinically it&#39;s important because of the surgical orientation it provides in the understanding a spread of diseases like cancer and infection and especially relevant in ear nose and throat surgery and radiology and so here&#39;s the picture and Shing there are the fascial planes within that we&#39;re going to talk with it compartmentalized concentric Li and there are the different facial planes and the anatomy contained therein we&#39;re going to talk about superficial fascia then deep fascia and the subdivisions so first superficial fascia is this blinking part there which is the subcutaneous tissue all around the circumference of the neck and continuous all throughout the body it&#39;s basically your hypodermis and it contains in the neck a muscle called the platysma muscle which arises from the corner of the mouth and goes all the way down in the neck and then fuses and into the fashion around the clavicle and pectoralis major muscle okay that&#39;s the platysma the only muscle in the superficial fascia it also has cutaneous veins arteries and nerves branches from the cervical plexus the deep fascia is this everything in that blinking area where there are compartments from muscles and vessels and viscera and it&#39;s easier for these structures and compartments slide over each other so the different subdivisions of the deep fascia are as follows we&#39;re gonna start with the deep investing fascia first the deep investing fashio is that blinking structure there and it&#39;s deep to the superficial fashion and it arises and circles around the entire neck it arises from the new click event and then it&#39;s going to envelop the trapezius muscle and the sternocleidomastoid and then wrap around to the other side of the neck so the deep investing fashion envelops the sternal cluedo masters and traps on both sides and it looks like the four corners of the neck the deep investing fascia forms the roof of the posterior triangle what&#39;s the posterior triangle well it&#39;s the space between the sternocleidomastoid in traps it&#39;s best seen in the lateral view there&#39;s a sternocleidomastoid and there&#39;s the trapezius Shing and it&#39;s the space in between and there&#39;s the posterior triangle that looks like a triangle and the space in between is the deep investing fashion the roof of the posterior triangle the the deep investing facist pierced by cutaneous branches off the cervical plexus an external jugular vein look at that cross-section there you see coming out that cervical plexus and then it pierces through the fashio right behind the student Oakley no mastoid into the superficial fascia so there it&#39;s called the herbs point to the neck right on the back of the sternocleidomastoid all of those cutaneous branches from the cervical plexus go out to the neck and then they&#39;re at the very bottom is the external jugular vein the bottom of that posterior triangle and that external jugular vein pierces that deep Investing fashio the boundaries well the boundaries of the deep investing fascia are the mandible and hyoid and sternum on the front the clavicle and scapula on the side and the occipital bone nuchal ligament trapezius along the back the next is the pre tracheal fascia which is that blinking one there and the pre tracheal fascia forms the visceral compartment what are the viscera well the thyroid gland in the trachea and the recurrent laryngeal nerves on either side and the esophagus in this section but the pharynx up higher and then there are the parathyroid glands as well that are not shown but are in that area the pre free aphasia has specific name to the back the posterior border is called the buccal pharyngeal fashio which is all along there in that tan color because that fashion envelops the Buxa nadir and the fringe you&#39;ll constrict your muscles the boundaries for the pre tracheal fascia are as follows it&#39;s going to see there is our pre tracheal fashion along the front it&#39;s the hyoid and thyroid laryngeal cartilages and it envelops the thyroid gland and fuses into the pericardial sac posteriorly there&#39;s the buccal fringe ile fashio it courses from the skull all the way down into the mediastinum between the pre trachea unbuckle friend jill fashio is the trachea and then the pharynx up high and the esophagus down below okay now the pre vertebral fascia is next and it&#39;s that blinking fashion and it forms the muscular compartment which includes the vertebral column and there it is there includes the longest coli here longest capitis up higher and tier middle and posterior scalene muscles levator scapulae and the Paris finals now the sympathetic trunk an anatomist usually don&#39;t include it in there but often radiologists so included part of the pre vertebral fashio I&#39;ve clone it outside because I&#39;m an anatomist the phrenic nerve is in front of the scalene and the cervical and brachial plexus ease both course from between the anter middle scalings all this within the pre vertebral fashio the preferred bull fascia forms the axillary sheath and so what happens when we take a look at that brachial plexus is that as it exits it pulls that the fascia from the pre verbal fashio with it and it makes a sleeve along with it that we call the axillary sheath which is enveloping the brachial plexus as well as the subclavian and axillary artery it also forms the pre vertical fashion forms the floor of the posterior triangle there&#39;s the posterior triangle and there&#39;s a lateral view of the posterior triangle and it forms the floor because watch when you cut through Shing right on the floor the posterior triangle is pre vertebral fashio there&#39;s the cut edge and we go down there&#39;s that pre vertebral fashio sorry you can hear like our kids using a set down here calling to each other from around the house mm-hmm and so the pre vertebral fascia also has something called the ail are facets and anterior subdivision of the pre vertebral fashion let&#39;s watch as the pre vertical fashion approaches that transverse process Xin it separates and forms this ant your laminate called the ail our fascia basically the pre riddle of fashio along the front has two layers so in sagittal section and the cross section we can see pre vertebral ale our fashion preview Lalor fashion in that section okay and the LR fascia fuses with the buckle fringe you&#39;ll fascist somewhere around the t1 to t4 vertebral level pre vertebral fascia LR fascia buckle fringe eel fashion now follow the al-ahram buckle fringe eel fasciae they fuse around the t1 vertebra in my illustration here now the carotid sheath is that blinking structure and it is formed by the adjacent facial sleeves like the deep investing fashio by the sternocleidomastoid the pre vertebral fashion show by the entire scalene the pre tracheal fashion the edge of the thyroid all of those segments all then condense around and form this vascular compartment called the carotid sheath and this vascular compartment contains the internal jugular vein the carotid arteries and the vagus nerve like that now what&#39;s not seen here are the deep cervical nodes and the carotid sinus nerves now let&#39;s do that carotid sheath again except from this anterior view where there&#39;s the internal jugular vein there&#39;s a carotid arteries and you see that vagus nerve coming up but it hugs deep inside and to the two vessels there and so we blow that up and come over here and so there&#39;s our internal jugular vein lateral and then the carotid arteries medial and the vagus nervous snug as a bug is a rug in between them okay now the carotid sheath also has what&#39;s called the answer server callus within the wall we blow that up and we see something called the cervical plexus and there&#39;s C 1 to C 5 ntral Ram I and then coming from C 1 to C 2 and 3 is this loop called the answer server callus and if we take a cross-section right through there that inferior limb is formed as shown there in the cross-section and the superior limb is shown there in the cross-sections when you dissect in a cadaver this answer server callus is found within the sheath of the carotid sheath in the neck now the infrahyoid muscles are shown here and the fascia around the infrahyoid muscles it&#39;s kind of interesting in anatomy because where does it belong in the deep cervical fascia well it depends on the reference that you use and so the Grey&#39;s Anatomy never referenced and most clinicians will say that the fashion around the infrahyoid muscles is around is a subset of the pre tracheal fashion so there&#39;s a pre tracheal fashion and the fashioner on the infrahyoid x&#39; is just a subdivision of that and that&#39;s the one that i subscribe to but some anatomist and surgeons will say well actually the fashio and the infrahyoid muscles is a subset of the deep investing fascist so we&#39;re gonna take the infrahyoid muscles and put it with the deep investing fashion and then some clinicians will say well it&#39;s only I don&#39;t it&#39;s it&#39;s own fascial compartment we&#39;ll call it the middle layer of deep cervical fashion now let&#39;s talk about anatomical spaces in the deep cervical fashion okay so anatomical spaces where the fascial layers in the detect defines some potential spaces and so in healthy patients these spaces are actually closed but infections can widen these spaces and then serve as conduits for that spread bacteria like streptococci produce proteolytic enzymes which digest this connective tissue furthering enable this infections to spread so the retro pharyngeal and the danger spaces are the two primary ones we&#39;re going to talk about let&#39;s start with the retro frangie labeouf renewal fascia and they al are fascia right there next is the danger space which is between the LR fashion and the pre vertical fashion right there so there are two different potential spaces that was fun let&#39;s do it again so the retro pharyngeal space in this cross-section is between the buccal fringy fascia and the LR fashion right there and this is what permits movements of the pharynx larynx and esophagus during swallowing so the retro pharyngeal space is like bedsheets so when we take a look at this bed oh that&#39;s a nice bit that&#39;s not my bed looks like so there&#39;s the mattress sheet and then there&#39;s another bed sheet in the cosy space oh the cosy space is right they&#39;re right between the bedsheet the mattress sheet so the space is there but the only way to get in there is you push your feet into that cool comfortable space and that&#39;s what separates the two sheets because the space is not really there it&#39;s potential but it you have to form it by pushing something in there well the retro pharyngeal space is like bed sheets so here we have the buckle fringe elf Asha one bed sheet the ALR fashio the other bed sheet and then the cozy retro pharyngeal space is right in there but the only way to do it is you have to force your way into that and then do this Shing and then force it open like that which is how we see it in these pictures all the time but those pictures are actually misleading because that&#39;s the way it looks all the time now what causes the retro very chill space to extend expand well that is where the abscesses and infections come into play okay and so abscesses infections may bulge anteriorly and then they can restrict swallowing and breathing and the reason why is that the esophagus is directly in front of the retro very real space that would restrict swallowing because the pharynx is just above it and then really bad would push on the trachea and the airways and restrict breathing then and so the retro pharyngeal space can also have infections that spread into the mediastinum so there&#39;s our pre vertebral and ALR fascism there&#39;s the buccal fringe efficient now watch alarm buccal fringe elf ashes fuse around the t1 to t4 vertebral levels and so when the retro vert and Jill space if there&#39;s an infection can spread down and right there it&#39;s like short sheeting in a bed where they to fuse and the infection cannot spread pass that now the danger pre workable space is between the pre vertebral and ALR fascists and so right there&#39;s where the fascia is or in cross-section right in that area and so infection can spread from the skull base all the way down into the poster mediastinum so let&#39;s now do a review of both of these spaces there&#39;s buccal fringe ill and ALR Fascism what&#39;s between them retro pharyngeal space there&#39;s the ALR fashion verbal fashio what&#39;s between them the danger spaces so therefore the LR fascist separates the retro pharyngeal from the danger spaces cool so anatomically there are two distinct spaces but in healthy patients LR fash is not visible why because it&#39;s also like a bedsheet the ALR fascia really is like this it&#39;s collapsed and so anatomist and clinicians will say that whole yellow space in there that&#39;s the retro pharyngeal space so often when we define the retro for your jill space an animus will say well the book of renewal fascia is between and the pre vertebral flashes where the retro pharyngeal space is or they&#39;ll say retro free and gel space is between buccal fringe Jill and LR fascism buccal fringe&#39; and pre vertebral flashes that&#39;s what makes it confusing in many references or professors that might be lecturing on this topic and so what happens is they see that dark line that&#39;s an infection spreading that goes and it pushes the LR fascia away from the pre verbal fashio and you form the danger space and then the rest of the opening in front of it that&#39;s the retro pharyngeal space and so you can say retro varial space looks like that or like that either one thank you anatomist thank you for making that so clear so let&#39;s do a little review shall we so most clinicians are going to use the following categorization of the superficial and deep Fascism the neck now radiologists on the other hand will say well that&#39;s superficial fashion that&#39;s the jargon I&#39;m going to use and the deep fashion I&#39;m gonna use my own jargon instead of calling this the deep investing fashio I&#39;m gonna say that&#39;s the superficial layer of the deep and deep fascia and instead of calling this a pre tracheal fascia I&#39;m gonna say that&#39;s the middle layer of the deep cervical fascia and then I&#39;ll just call that the carotid sheath and instead of calling this the pre vertebral fashion I&#39;m gonna call the deep layer of the deep cervical fascia and so what we see is there&#39;s discrepancy and there&#39;s problems in the cervical facet terminology and description and so there&#39;s this early surgeon named Josef Francois Malaga Nia who said the cervical fascia appear in a new form under the pen of each author who attempts to just oh so frustrating I totally good it and back in 1800 1800 s and right to today is the same thing so radiologists use this jargon mostly everyone else uses this jargon and that my friends is the cervical fascia in a nutshell [Music]

Transcript for:Cervical Fascia Anatomy

Transcript for:
Cervical Fascia Anatomy