Providing a support network to the structures of the neck, the deep cervical fascia has 4 components – a superficial (investing) layer, a middle (pretracheal) layer, a deep (prevertebral) layer and the carotid sheath which is continuous at various points with the aforementioned fascial layers.
Investing layer; forms a collar encompassing whole neck
Superiorly attaches along the inferior edge of the mandible, mastoid process, superior nuchal line & external occipital protuberance
Inferiorly spine & acromion of scapula, clavicle and manubrium
Posteriorly blends with the nuchal ligament
Anteriorly attaches to the hyoid bone
Splits around (and thus contains) sternocleidomastoid and trapezius muscles
Encompasses submandibular and parotid glands
Forms a fibrous sling to anchor the intermediate tendon of omohyoid close to clavicle
Pretracheal layer; runs in the anterior neck from hyoid bone into the thorax where it fuses with the fibrous pericardium.
Divided into two parts
Visceral layer encompasses thyroid gland, parathyroid gland, trachea & oesophagus
(N.B. - posteriorly, it is contributed to by the buccopharyngeal fascia)
Muscular layer encompasses the infrahyoid muscles
Prevertebral layer; fixed superiorly to the base of the skull, it descends into the posterior mediastinum and continues as the endothoracic fascia.
Surrounds paraspinal muscles & cervical vertebrae
Carotid sheath; extends from the root of the neck to the base of the skull. Antero-laterally it blends with the investing layer, antero-medially with the pretracheal layer and posteriorly with the prevertebral layer.
Contains the common carotid artery, internal jugular vein, deep cervical lymph modes and vagus nerve.
Anterior to the prevertebral fascia and posterior to the alar fascia, lies a potential space that runs unimpeded from the base of the skull to the diaphragm that is known as the Danger Area. This is because it forms a direct passage for the potential of infection into the thorax.
Not to be confused with the retropharyngeal space which lies anterior to the alar fascia, posterior to the pretracheal fascia. An abscess here can bulge into the pharynx, causing dysphagia or dysarthria
Quick-look box – Deep Cervical Fascia
· Sternocleidomastoid and trapezius
· Submandibular and parotid glands
· Cervical viscera
· Infrahyoid muscles
· Cervical vertebrae
· Paraspinal muscles
The layers of the deep cervical fascia act to support the cervical viscera, vessels and muscles, as well as limit the spread of infection through the neck. They also allow for structures to slide & move over one another (e.g. – swallowing, turning of the head).
· Ellis H & Mahadevan V. 2010. Clinical Anatomy 12th ed. Oxford: Wiley-Blackwell
· Whitaker RH & Borley NR. 2010. Instant Anatomy 4th ed. Oxford: Wiley-Blackwell
· Sinnatamby CS. 2006. Last’s Anatomy 11th ed. China: Churchill Livingstone
· Moore KL & Dalley AF. 2006. Clinically Oriented Anatomy 5th ed. Baltimore: Lippincott Williams & Wilkins