Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Latest Skin Superficial Fascia and Deep Fascia Lecture PPT
SKIN, SUPERFICIAL FASCIA,
AND
DEEP FASCIA OF THE NECK
SKIN
? The skin in the region of neck is thin and normally
under tension.
? The direction of tension lines (cleavage lines or
Langer's lines) often correspond with the wrinkle
lines.
? The cleavage (Langer's) lines are disposed
transversely around the neck. Therefore, surgical
incisions made along these lines, i.e., transverse
incisions, in neck heal with invisible scars.
CUTANEOUS INNERVATION
? The cutaneous innervation of
the neck is derived from C2,
C3, and C4 spinal segments.
? The skin on the anterolateral
aspect of the neck is supplied
by cutaneous nerves derived
from ventral rami of C2, C3,
and C4 spinal nerves.
? The skin on the posterior
aspect of the neck is supplied
by dorsal rami of C2, C3, and
C4 spinal nerves.
SUPERFICIAL FASCIA
? The superficial fascia of the neck consists of a thin
layer of loose areolar tissue and contains a thin
sheet of muscle called platysma.
? It also contains cutaneous nerves, superficial veins,
superficial lymph nodes, and lymph vessels.
? The cutaneous nerves and veins lie deep to the
platysma.
? Amount of subcutaneous fat is more in children and
women.
PLATYSMA
? It is a thin quadrilateral broad sheet of muscle in the
superficial fascia of the side of the neck.
? It ascends onto the face from the front of the neck.
? It develops from the 2nd pharyngeal arch.
? It covers the anteroinferior part of the posterior
triangle and superior part of the anteriortriangle of
the neck.
? Origin
? Arises from skin and deep fascia covering the upper
parts of the pectoralis major and anterior part of the
deltoid muscle.
? Insertion
? After origin, the fibres sweep upwards and forwards
superficial to the clavicle and sternocleidomastoid.
? It crosses over the lower part of the posterior triangle
and upper part of the anterior triangle to reach the
lower border of the mandible, where anterior fibres
decussate with the corresponding fibres of the
opposite side across the midline for about 2.5 cm
below and behind the symphysis menti.
? Intermediate and posterior fibres are inserted into
the lower border of the body of the mandible.
? Some posterior fibres pass superficial to the angle
of the mandible and masseter muscle and then
turn medially to insert into the skin of angle of the
mouth through risorius.
? Nerve Supply
? The platysma is supplied by the cervical branch of
the facial nerve.
? Actions
1. Acting from above, the platysma produces
vertical ridges in the skin of the neck releasing the
pressure of skin over the underlying veins and thus
helps in the venous return. It, therefore, serves to
ease the pressure of tight collar.
2. Acting from below, it helps to depress the
mandible and draws the angle of the mouth
downwards and laterally as in expression of
terror/horror.
SUPERFICIAL VEINS OF THE NECK
? There are two superficial veins of the neck.
1. External jugular vein.
2. Anterior jugular vein
1.External jugular vein It begins just below the angle of
the mandible by the union of
? posterior division of retromandibular vein and posterior
auricular vein.
? Runs vertically downward across the
sternocleidomastoid under the cover of platysma
? Pierce the deep cervical fascia about 2.5 cm above and
terminates in the subclavian vein.
? Its tributaries
are
1. Posterior auricular
vein
2. Retromandibular v.
3. Posterior external
jugular v.
4. Oblique jugular v.
5. Transverse
cervical v.
6. Suprascapular v.
7. Anterior jugular v.
2.Anterior jugular vein It begins below the chin in
the submental region by the union of small
unnamed veins from the chin.
? It pierces investing layer of deep cervical fascia and
enter suprasternal space(of Burns), then it turns lat.
& passes deep to sternocleidomastoid and
terminates in the external jugular vein.
? In this space, anterior jugular vein is united in the
midline to its fellow of opposite side by a transverse
venous channel called jugular venous arch.
SUPERFICIAL LYMPH NODES AND LYMPH VESSELS
? Situated around the junction of head with the neck.
? They drain all the superficial structures and some
deep structures of the head.
? Most of the efferent lymph vessels from these
lymph nodes pass to deep cervical lymph nodes
arranged along the internal jugular vein.
? A few scattered superficial nodes are found along
the external and anterior jugular veins. They also
drain into deep cervical lymph nodes.
? Situated around the
junction of head and
neck to form
pericervical/cervical
collar.
? They are arranged into
groups
1. Submental nodes.
2. Submandibular nodes.
3. Superficial parotid
(preauricular) nodes.
4. Retroauricular nodes.
5. Occipital nodes.
1.Submental nodes
? Number--Three or four
? Lie on mylohyoid muscle
? Below the symphysis menti (chin) and
? Receive the lymph from
Tip of the tongue,
Lower lip, and
Chin.
2.Submandibular nodes
? Number-- Half a dozen
? Lie on the surface of the submandibular gland and
? Receive the lymph from
Face,
Cheek
Nose,
Upper lip,
Gums, and
Tongue.
3.Parotid (preauricular) nodes
? Lie superficial to parotid fascia
? Drain the lymph from
Scalp,
Auricle,
Eyelids, and
Cheeks.
4.Mastoid (postauricular) nodes
? Number--One or two
? Lie on the mastoid process and
? Drain the lymph from
Scalp and
Auricle.
5.Occipital nodes
? Number-- One or two
? Lie on trapezius about 2.5 cm inferolateral to the
inion and
? Drain the lymph from
scalp.
? They are palpable in German measles.
? These groups form a ring of lymph nodes at the
junction of the head and neck and called necklace
of lymph nodes at the craniocervical junction
DEEP CERVICAL FASCIA (FASCIA COLLI)
? 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.
? It also forms protective sheaths around
neurovascular structures.
? The layers of deep cervical fascia form fascial planes
to direct the spread of infection or pus in the neck.
? The deep cervical fascia of the neck consists of
three layers.
? From outside inwards these are as follows:
1. Investing layer of deep cervical fascia.
2. Pretracheal fascia.
3. Prevertebral fascia.
? Investing fascia
? This layer encircles the neck like a collar.
? Lies deep to platysma and superficial fascia.
? It encloses the sternocleidomastoid and trapezius.
? Attachments
1. Superiorly attached to external occipital
protuberance, superior nuchal line, mastoid
process, and lower border of mandible from
behind forwards.
2. Inferiorlyattached 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. Posteriorlyattached 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 is attached to the lower border
of the body of the mandible.
? The deep layer attached to the mylohyoid line of
the mandible.
? At the lower pole of the parotid gland, it splits to
enclose parotid gland
? The superficial layer is strong and covers parotid gland
as parotidomasseteric fascia to get attached to the
lower border of the zygomatic arch.
? The deeper layer get attached to the lower border of
the tympanic plate and styloid process of the temporal
bone.
? Between the styloid process and the angle of mandible
condenses to form the stylomandibular ligament
which separates the parotid gland from submandibular
gland.
? 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 the
suprasternal notch.
? The suprasternal space contains:
(a) sternal heads of sternocleidomastoid muscles,
(b) jugular venous arch,
(c) interclavicular ligament, and
(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 posterior layer encloses the inferior belly of
omohyoid and it becomes continuous with the
posterior layer of clavipectoral fascia.
? The supraclavicular space contains:
(a) terminal part of the external jugular vein, and
? (b) supraclavicular nerves before they become
cutaneous.
? The 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.
? Again splits to enclose the sternocleidomastoid,
and finally forms the roof of the anterior triangle.
`Rule of 2'
? 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) inferior belly of
omohyoid and tendon of digastric muscle.
? Pretracheal fascia
? This layer of deep cervical fascia covers the front
and sides of trachea, hence its name--pretracheal
fascia.
? It splits to enclose the thyroid gland forming its
capsule and is attached to the oblique line of
thyroid cartilageand to the arch of cricoid cartilage
anteriorly.
? Ligament of Berry is derived from this fascia and
connects the capsule of the lateral lobe of the
thyroid gland to the cricoid cartilage
? Tracing of the pretracheal fascia
? Horizontal tracing:
? It merges with the investing layer of deep cervical
fascia enclosing the sternocleidomastoid and the
anterior wall of the carotid sheath.
? Vertical tracing:
? It is attached to the hyoid bone and when traced
below, it enters the thorax in front of the trachea
and blends with the apex of the fibrous
pericardium.
? Prevertebral fascia
? It is extremely strong and lies in front of the
prevertebral muscles
? Tracing of the prevertebral fascia
? Horizontal tracing:
? It forms the fascial carpet of the posterior triangle.
? It also forms axillary sheath, which may extend up
to the elbow.
? Subclavian and axillary veins lie outside the sheath
? Vertical tracing:
? Traced aboveextends up to the base of the skull
to which it is attached.
? Traced below continues downwards and blends
with the anterior longitudinal ligament of the upper
thoracic vertebrae (T1 to T3).
Retropharyngeal space
? Anteriorly, the prevertebral layer of deep cervical
fascia is separated from posterior aspect of the
pharynx and its covering, buccopharyngeal fascia,
by a potential space called retropharyngeal space.
? The retropharyngeal space is continuous with the
parapharyngeal spaces at the sides of the pharynx.
? The retropharyngeal space is divided into two
lateral compartments (spaces of Gillette) by a
midline fibrous raphe.
? The space behind the prevertebral fascia and in
front of the vertebral bodies is called prevertebral
space.
This post was last modified on 30 November 2021