Download MBBS Skin Superficial Fascia and Deep Fascia Lecture PPT

SKIN, SUPERFICIAL FASCIA,

AND

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DEEP FASCIA OF THE NECK
SKIN

? The skin in the region of neck is thin and normally

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under tension.

? The direction of tension lines (cleavage lines or

Langer's lines) often correspond with the wrinkle

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lines.

? The cleavage (Langer's) lines are disposed

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transversely around the neck. Therefore, surgical

incisions made along these lines, i.e., transverse

incisions, in neck heal with invisible scars.

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CUTANEOUS INNERVATION

? The cutaneous innervation of

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the neck is derived from C2,

C3, and C4 spinal segments.

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? The skin on the anterolateral

aspect of the neck is supplied

by cutaneous nerves derived

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from ventral rami of C2, C3,

and C4 spinal nerves.

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? The skin on the posterior

aspect of the neck is supplied

by dorsal rami of C2, C3, and

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C4 spinal nerves.
SUPERFICIAL FASCIA

? The superficial fascia of the neck consists of a thin

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layer of loose areolar tissue and contains a thin

sheet of muscle called platysma.

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? It also contains cutaneous nerves, superficial veins,

superficial lymph nodes, and lymph vessels.

? The cutaneous nerves and veins lie deep to the

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platysma.

? Amount of subcutaneous fat is more in children and

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women.
PLATYSMA

? It is a thin quadrilateral broad sheet of muscle in the

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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

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triangle and superior part of the anteriortriangle of

the neck.

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? Origin
? Arises from skin and deep fascia covering the upper

parts of the pectoralis major and anterior part of the

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deltoid muscle.

? Insertion
? After origin, the fibres sweep upwards and forwards

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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

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lower border of the mandible, where anterior fibres

decussate with the corresponding fibres of the

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opposite side across the midline for about 2.5 cm

below and behind the symphysis menti.

? Intermediate and posterior fibres are inserted into

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the lower border of the body of the mandible.

? Some posterior fibres pass superficial to the angle

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of the mandible and masseter muscle and then

turn medially to insert into the skin of angle of the

mouth through risorius.

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? Nerve Supply
? The platysma is supplied by the cervical branch of

the facial nerve.

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? Actions
1. Acting from above, the platysma produces

vertical ridges in the skin of the neck releasing the

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pressure of skin over the underlying veins and thus

helps in the venous return. It, therefore, serves to

ease the pressure of tight collar.

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2. Acting from below, it helps to depress the

mandible and draws the angle of the mouth

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downwards and laterally as in expression of

terror/horror.
SUPERFICIAL VEINS OF THE NECK

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? 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

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the mandible by the union of

? posterior division of retromandibular vein and posterior

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auricular vein.

? Runs vertically downward across the

sternocleidomastoid under the cover of platysma

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? Pierce the deep cervical fascia about 2.5 cm above and

terminates in the subclavian vein.

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? Its tributaries

are

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1. Posterior auricular

vein

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2. Retromandibular v.
3. Posterior external

jugular v.

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4. Oblique jugular v.
5. Transverse

cervical v.

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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

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unnamed veins from the chin.

? It pierces investing layer of deep cervical fascia and

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enter suprasternal space(of Burns), then it turns lat.

& passes deep to sternocleidomastoid and

terminates in the external jugular vein.

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? In this space, anterior jugular vein is united in the

midline to its fellow of opposite side by a transverse

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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

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deep structures of the head.

? Most of the efferent lymph vessels from these

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lymph nodes pass to deep cervical lymph nodes

arranged along the internal jugular vein.

? A few scattered superficial nodes are found along

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the external and anterior jugular veins. They also

drain into deep cervical lymph nodes.

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? Situated around the

junction of head and

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neck to form

pericervical/cervical

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collar.

? They are arranged into

groups

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1. Submental nodes.
2. Submandibular nodes.
3. Superficial parotid

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(preauricular) nodes.

4. Retroauricular nodes.
5. Occipital nodes.
1.Submental nodes

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? Number--Three or four
? Lie on mylohyoid muscle
? Below the symphysis menti (chin) and
? Receive the lymph from
Tip of the tongue,

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Lower lip, and
Chin.
2.Submandibular nodes
? Number-- Half a dozen
? Lie on the surface of the submandibular gland and

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? Receive the lymph from
Face,
Cheek
Nose,
Upper lip,

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Gums, and
Tongue.
3.Parotid (preauricular) nodes
? Lie superficial to parotid fascia
? Drain the lymph from

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Scalp,
Auricle,
Eyelids, and
Cheeks.
4.Mastoid (postauricular) nodes

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? Number--One or two
? Lie on the mastoid process and
? Drain the lymph from
Scalp and
Auricle.

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5.Occipital nodes
? Number-- One or two
? Lie on trapezius about 2.5 cm inferolateral to the

inion and

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? Drain the lymph from
scalp.
? They are palpable in German measles.

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? 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

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DEEP CERVICAL FASCIA (FASCIA COLLI)

? Clinically very important as it forms various fascial

spaces in the neck.

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? It also provides capsules to the glands and invests

the muscles in the region.

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? It also forms protective sheaths around

neurovascular structures.

? The layers of deep cervical fascia form fascial planes

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to direct the spread of infection or pus in the neck.
? The deep cervical fascia of the neck consists of

three layers.

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? From outside inwards these are as follows:
1. Investing layer of deep cervical fascia.
2. Pretracheal fascia.
3. Prevertebral fascia.

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? Investing fascia
? This layer encircles the neck like a collar.
? Lies deep to platysma and superficial fascia.

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? It encloses the sternocleidomastoid and trapezius.
? Attachments
1. Superiorly attached to external occipital

protuberance, superior nuchal line, mastoid

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process, and lower border of mandible from

behind forwards.

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2. Inferiorlyattached to the spine of scapula,

acromion process, upper aspect of clavicle, and

jugular notch of manubrium sterni from behind

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forwards.
3. Anteriorly across the midline, it becomes

continuous with its counter part of the other side.

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In the anterior midline it is attached to symphysis

menti, hyoid bone jugular notch from above

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downwards.

4. Posteriorlyattached to ligamentum nuchae and

spine of 7th cervical vertebra.

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? Tracing of the investing layer
? Vertical tracing: When traced upwards above the

hyoid bone

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? It splits to enclose the submandibular salivary gland
? The superficial layer is attached to the lower border

of the body of the mandible.

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? The deep layer attached to the mylohyoid line of

the mandible.

? At the lower pole of the parotid gland, it splits to

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enclose parotid gland

? The superficial layer is strong and covers parotid gland

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as parotidomasseteric fascia to get attached to the

lower border of the zygomatic arch.

? The deeper layer get attached to the lower border of

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the tympanic plate and styloid process of the temporal

bone.

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? Between the styloid process and the angle of mandible

condenses to form the stylomandibular ligament

which separates the parotid gland from submandibular

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gland.
? When traced downwards, the fascia splits twice to

enclose two spaces:

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? Above the suprasternal notch, it splits into two layers

to enclose suprasternal space (of Burns) before being

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attached to the anterior and posterior borders of the

suprasternal notch.

? The suprasternal space contains:

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(a) sternal heads of sternocleidomastoid muscles,
(b) jugular venous arch,
(c) interclavicular ligament, and
(d) lymph node.

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? Above the middle third of clavicle:
? it splits into two layers to enclose the supraclavicular

space .

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? The anterior and posterior layers get attached to the

anterior and posterior borders of the upper surface of

the clavicle.

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? The posterior layer encloses the inferior belly of

omohyoid and it becomes continuous with the

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posterior layer of clavipectoral fascia.

? The supraclavicular space contains:

(a) terminal part of the external jugular vein, and

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? (b) supraclavicular nerves before they become

cutaneous.

? The investing layer also forms fascial pulleys to anchor

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the tendons of the digastric and omohyoid muscles.
? Horizontal tracing:
? When traced forwards from its attachment to

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ligament nuchae--

? It first splits to enclose the trapezius, then forms

the roof of the posterior triangle.

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? Again splits to enclose the sternocleidomastoid,

and finally forms the roof of the anterior triangle.
`Rule of 2'

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? Encloses 2 muscles trapezius and

sternocleidomastoid.

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? Forms roofs of 2 triangles anterior and posterior

triangles.

? Splits to enclose 2 glands submandibular and

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parotid.

? Splits to enclose 2 spaces suprasternal and

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supraclavicular.

? Forms 2 fascial slings (pulleys) inferior belly of

omohyoid and tendon of digastric muscle.

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? Pretracheal fascia
? This layer of deep cervical fascia covers the front

and sides of trachea, hence its name--pretracheal

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fascia.

? It splits to enclose the thyroid gland forming its

capsule and is attached to the oblique line of

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thyroid cartilageand to the arch of cricoid cartilage

anteriorly.

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? Ligament of Berry is derived from this fascia and

connects the capsule of the lateral lobe of the

thyroid gland to the cricoid cartilage

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? Tracing of the pretracheal fascia
? Horizontal tracing:
? It merges with the investing layer of deep cervical

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fascia enclosing the sternocleidomastoid and the

anterior wall of the carotid sheath.

? Vertical tracing:

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? 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

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pericardium.
? Prevertebral fascia
? It is extremely strong and lies in front of the

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prevertebral muscles

? Tracing of the prevertebral fascia
? Horizontal tracing:
? It forms the fascial carpet of the posterior triangle.

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? It also forms axillary sheath, which may extend up

to the elbow.

? Subclavian and axillary veins lie outside the sheath

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? Vertical tracing:
? Traced aboveextends up to the base of the skull

to which it is attached.

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? Traced below continues downwards and blends

with the anterior longitudinal ligament of the upper

thoracic vertebrae (T1 to T3).

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Retropharyngeal space

? Anteriorly, the prevertebral layer of deep cervical

fascia is separated from posterior aspect of the

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pharynx and its covering, buccopharyngeal fascia,

by a potential space called retropharyngeal space.

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? The retropharyngeal space is continuous with the

parapharyngeal spaces at the sides of the pharynx.

? The retropharyngeal space is divided into two

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lateral compartments (spaces of Gillette) by a

midline fibrous raphe.

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? The space behind the prevertebral fascia and in

front of the vertebral bodies is called prevertebral

space.

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