Understanding the Fascial planes of head and Neck

Understanding the Fascial planes
of head and Neck
Fascia
• A sheet of connective tissue covering or
binding together body structures
• Types
– Superficial Fascia
– Deep Fascia
Superficial Fascia
• Muscles of facial expression
• Continuous with superficial Cervical fascia
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Deep Fascia• Geography of Deep Fasica
• Deep fascia of head and Neck
Deep Fascia of Jaws
• Muscles of Mastication
– Temporal Fascia
– Masseteric fascia
– Parotidomasseteric fascia
– Pterygoid fascia
Continuous with Deep
Fascia of Neck
Fascia of Neck
•
Cervical Fascia- 2 components
– Superficial Cervical Fascia
• Envelops Platysma muscle
• Continuous with superficial
fascia of face
– Deep Cervical Fascia
• Superiorly-attached to inferior border of
Mandible
• Lower in the neck has 3 divisions
– Anterior Layer
– Middle Layer
– Posterior Layer
Deep Cervical Fascia
• Anterior layer
– Investing fascia
• Parotideomasseteric
• Temporal
• Middle layer
– Sternohyoid-omohyoid
– Sternothyroid-thyrohyoid
– Visceral Division
• Buccopharyngeal
• Pretracheal
• Retropharyngeal
• Posterior layer
– Alar Division
– Prevertebral Division
Anterior Layer
(superficial or investing layer)
• Encircles the neck,
splits around SCM and
Trapezius-attaches
posteriorly to the
spinous processes of
the cervical vertebrae
Anterior Layer
(superficial or investing layer)
• Forms superficial border of the submandibular space and
splits to form the capsule of the gland
• Attaches to the inferior border of mandible
– Anteriorly-blends with the periosteum of facial bones and
is under the muscles of facial expressions
• Covers the anterior/posterior belly of digastricus muscle,
submandibular salivary gland
• Stylomandibular ligament – dense band of the investing fascia
– (extends from styloid process to angle of the mandible)
Anterior Layer
(superficial or investing layer)
• Superficially it splits at the inferior border of the mandible to become
continous with
– Parotidomasseteric fascia –
• Covers superficial part of the masseter and splits around the parotid
gland
– Pterygoid fascia
• Encloses the
– hyoid bone
– Suprahyoid muscles
Superficial or Investing layer(contd…)
• Inferiorly-Attaches to
the shoulder girdle and
sternum
• At the superior edge of
the sternum it splits to
form the Suprasternal
space (Space of Burns.)
Middle Layer
• Surrounds infrahyoid (strap)
muscles: Sternohyoid,
Sternothyroid, Omohyoid,
Thyrohyoid
• Runs between hyoid bone and
clavicle
• Thickens to form a pulley
through which the intermediate
tendon of the digastric muscle
passes, suspending the hyoid
bone
Middle Layer-Visceral Division
– Below hyoid-surrounds trachea, esophagus
and thyroid gland
– Above the hyoid it wraps around the lateral
and posterior sides of the pharynx lying on
the superficial side of the pharyngeal
constrictor muscles.(Called
Buccopharyngeal fascia in this region)
– Deep spaces of the neck (lateral pharyngeal,
retropharyngeal and pretracheal spaces) all
lie on the superficial side of the visceral
division.
Carotid Sheath• Base of the skull to the root of the neck
– Common and Internal Carotid artery
– Internal Jugular vein
– Vagus nerve
Posterior Layer
• From skull
base(occipital bone) to
diaphragm
• 2 divisions
– Alar
– Prevertebral
• Envelops
– Thyroid and cricoid cartilages
– Pharyngeal tubercle of
occipital bone
– Attaches to the
pterygomandibular raphe,
pharyngeal aponeurosis
• Inferiorly
– Continues into thorax blends
with pericardium
Posterior Division
• 2 layers
– Alar
– Prevertebral
• Extends from base of skull to diaphragm
Posterior Layer-Alar Fascia
• Alar fascia
– –Ribbon of fascia and it
attaches to the carotid sheath
and visceral fascia(middle
layer)
– Extends from skull to seventh
cervical vertebra
Posterior Division- Prevertebral Fascia
• Prevertebral Fascia surrounds the vertebrae
and postural muscles of neck and back
• Lies just anterior to the periosteum of the
vertebrae and is susceptible to infections of it
(tuberculosis osteomyelitis)
• Usually not invaded by oral and maxillofacial
infections.