DEEP CERVICAL FASCIA

1.

The deep cervical fascia consists of three fascial layers (sheaths):

Investing
Pretracheal
prevertebral (Fig. 8.4A & B).

2.

These layers support

the viscera (e.g., the thyroid gland)
muscles, vessels
deep lymph nodes.

3.

The deep cervical fascia also condenses around

common carotid arteries
internal jugular veins (IJVs)
vagus nerves to form the carotid sheath (Fig. 8.4B & C)

4. These three fascial layers form natural cleavage planes through which tissues may be
separated during surgery, and they limit the spread of abscesses (collections of pus)
resulting from infections.
5. The deep cervical fascial layers also afford the slipperiness that allows structures in
the neck to move and pass over one another without difficulty, such as when
swallowing and turning the head and neck.

A. INVESTING LAYER OF DEEP CERVICAL FASCIA

1. The investing layer of deep cervical fascia, the most superficial deep fascial layer,
surrounds the entire neck deep to the skin and subcutaneous tissue.
2. At the four corners of the neck, it splits into superficial and deep layers to enclose
(invest) the trapezius and sternocleidomastoid (SCM) muscles.
3. These muscles are derived from the same embryonic sheet of muscle and are
innervated by the same nerve (CN XI). They have essentially continuous attachments
to the cranial base superiorly and to the scapular spine and acromion and clavicle
inferiorly (Fig. 8.4B & C).
4. Superiorly, the investing layer of deep cervical fascia attaches to the:

Superior nuchal lines of the occipital bone.

Mastoid processes of the temporal bones.

Zygomatic arches.

Inferior border of the mandible.

Hyoid bone.

Spinous processes of the cervical vertebrae.

5. Just inferior to its attachment to the mandible, the investing layer of deep fascia splits
to enclose the submandibular gland; posterior to the mandible, it splits to form the
fibrous capsule of the parotid gland.
6. The stylomandibular ligament is a thickened modification of this fascial layer.
7. Inferiorly, the investing layer of deep cervical fascia attaches to the manubrium,
clavicles, and acromions and spines of the scapulae. The investing layer of deep
cervical fascia is continuous posteriorly with the periosteum covering the C7 spinous
process, and with the nuchal ligament (L. ligamentum nuchae), a triangular membrane
that forms a median fibrous septum between the muscles of the two sides of the neck
(Fig. 8.4B)
8. Inferiorly between the sternal heads of the SCMs and just superior to the manubrium,
the investing layer of deep cervical fascia remains divided into two layers to enclose
the SCM; one layer attaches to the anterior and the other to the posterior surface of the
manubrium
9. A suprasternal space lies between these layers (Fig. 8.4A).
10. It encloses the inferior ends of the anterior jugular veins, the jugular venous arch, fat,
and a few deep lymph nodes.
B. PRETRACHEAL LAYER OF DEEP CERVICAL FASCIA
1. The thin pretracheal layer of deep cervical fascia is limited to the anterior part of the
neck (Fig. 8.4).
2. It extends inferiorly from the hyoid into the thorax, where it blends with the fibrous
pericardium covering the heart.
3. The pretracheal layer of fascia includes a thin muscular part, which encloses the
infrahyoid muscles, and a visceral part, which encloses the thyroid gland, trachea, and
esophagus and is continuous posteriorly and superiorly with the buccopharyngeal
fascia of the pharynx.
4. The pretracheal layer of deep fascia blends laterally with the carotid sheaths.
5. Superior to the hyoid, a thickening of the pretracheal fascia forms a pulley or trochlea
through which the intermediate tendon of the digastric muscle passes, suspending the
hyoid.

6. By wrapping around the lateral border of the intermediate tendon of the omohyoid,
the pretracheal layer also tethers the two-bellied omohyoid muscle, redirecting the
course of the muscle between the bellies.

C. PREVERTEBRAL LAYER OF DEEP CERVICAL FASCIA

1. The prevertebral layer of deep cervical fascia forms a tubular sheath for the vertebral
column and the muscles associated with it, such as the longus colli and longus capitis
anteriorly, the scalenes laterally, and the deep cervical muscles posteriorly (Fig. 8.4).
2. The prevertebral layer of deep fascia is fixed to the cranial base superiorly.
3. Inferiorly, it blends with the endothoracic fascia peripherally and fuses with the
anterior longitudinal ligament centrally at approximately the T3 vertebra (see Chapter
4) (Fig. 8.4A).
4. The prevertebral fascia extends laterally as the axillary sheath (Chapter 6), which
surrounds the axillary vessels and brachial plexus.
5. The cervical parts of the sympathetic trunks are embedded in the prevertebral layer of
deep cervical fascia.

Carotid Sheath
1. The carotid sheath is a tubular fascial investment that extends from the cranial base to
the root of the neck.
2. This sheath blends anteriorly with the investing and pretracheal layers of fascia and
posteriorly with the prevertebral layer of fascia (Fig. 8.4B & C).
3. The carotid sheath contains the:

Common and internal carotid arteries.

Internal jugular vein.

Vagus nerve (CN X).

Some deep cervical lymph nodes.

Carotid sinus nerve.

Sympathetic nerve fibers (carotid periarterial plexuses).

4. The carotid sheath and pretracheal fascia communicate freely with the mediastinum of
the thorax inferiorly and the cranial cavity superiorly.
5. These communications represent potential pathways for the spread of infection and
extravasated blood.

Retropharyngeal Space
1. The retropharyngeal space is the largest and most important interfascial space in the
neck (Fig. 8.4A & B).
2. It is a potential space that consists of loose connective tissue between the visceral part
of the prevertebral layer of deep cervical fascia and the buccopharyngeal fascia
surrounding the pharynx superficially.
3. Inferiorly, the buccopharyngeal fascia is continuous with the pretracheal layer of deep
cervical fascia.
4. The alar fascia forms a further subdivision of the retropharyngeal space.
5. This thin layer is attached along the midline of the buccopharyngeal fascia from the
cranium to the level of the C7 vertebra.
6. From this attachment, it extends laterally and terminates in the carotid sheath.
7. The retropharyngeal space permits movement of the pharynx, esophagus, larynx, and
trachea relative to the vertebral column during swallowing.
8. This space is closed superiorly by the cranial base and on each side by the carotid
sheath.
9. It opens inferiorly into the superior mediastinum