Deep Cervical Fascia - I (Investing Layer)/ Anatomy / Simplified/ Fascia colli
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Link of second part of Deep Cervical Fascia video:
Deep Cervical fascia - II (Pretracheal & Prevertebral Layer)
• Deep Cervical fascia - II (Pretracheal & P...
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DEEP CERVICAL FASCIA (FASCIA COLLI)
The deep cervical fascia (DCF) of the neck is clinically very important as it forms various fascial spaces in the neck. It also provides capsules to the glands and invests the muscles in the region. In addition, it forms protective sheaths around neurovascular structures. The layers of DCF form fascial planes to direct the spread of infection or pus in the neck.
DCF of the neck consists of three layers.
1. Investing layer of DCF.
2. Pretracheal fascia.
3. Prevertebral fascia.
Investing fascia
This layer encircles the neck like a collar, deep to platysma and superficial fascia.
Attachments
1. Superiorly it is attached to external occipital protuberance, superior nuchal line, mastoid process, and lower border of mandible from behind forwards.
2. Inferiorly it is attached to the spine of scapula, acromion process, upper aspect of clavicle, and jugular notch of manubrium sterni from behind forwards.
3. Anteriorly across the midline, it becomes continuous with its counter part of the other side. In the anterior midline it is attached to symphysis menti, hyoid bone jugular notch from above downwards.
4. Posteriorly it is attached to ligamentum nuchae and spine of 7th cervical vertebra.
Tracing of the investing layer
Vertical tracing: When traced upwards above the hyoid bone, it splits to enclose the submandibular salivary gland. The superficial layer covers the superficial surface
of the gland and it is attached to the lower border of the body of the mandible. The deep layer covers the medial surface of the gland and is attached to the mylohyoid line of the mandible. Posterior to the submandibular gland, at the lower pole of the parotid gland, it splits to enclose this gland also.
The superficial layer is strong and covers the superficial surface of the parotid gland as parotidomasseteric fascia. The deeper layer passes deep to the parotid gland to get attached to the lower border of the tympanic plate and styloid process of the temporal bone. The part of this layer stretching between the styloid process and the angle of mandible condenses to form the stylomandibular ligament.
When traced downwards, the fascia splits twice to enclose two spaces:
Above the suprasternal notch, it splits into two layers to enclose suprasternal space of Burns, before being attached to the anterior and posterior borders of suprasternal notch.
The suprasternal space contains:
(a) sternal heads of sternocleidomastoid muscles
(b) jugular venous arch
(c) interclavicular ligament
(d) lymph node
Above the middle third of clavicle, it splits into two layers to enclose the supraclavicular space. The anterior and posterior layers get attached to the anterior and posterior borders of the upper surface of the clavicle.
The supraclavicular space contains:
(a) terminal part of the external jugular vein, and
(b) supraclavicular nerves before they become cutaneous.
Investing layer also forms fascial pulleys to anchor the tendons of the digastric and omohyoid muscles.
Horizontal tracing: When traced forwards from its attachment to ligament nuchae, it first splits to enclose the trapezius, then forms the roof of the posterior triangle, then again splits to enclose the sternocleidomastoid, and finally forms the roof of the anterior triangle.
‘Rule of 2’. it is noted that investing layer of DCF presents everything in ‘2’,
for example it
• encloses 2 muscles, trapezius and sternocleidomastoid.
• forms roofs of 2 triangles, anterior and posterior triangles.
• splits to enclose 2 glands, submandibular and parotid.
• splits to enclose 2 spaces, suprasternal and supraclavicular.
• forms 2 fascial slings (pulleys) for inferior belly of omohyoid and intermediate tendon of digastric muscle.
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Thank you
Smart Med Learn
Dr. Ankit Jain
MBBS, MS