Topography of the fascia and cell spaces of the neck
Last reviewed: 19.10.2021
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The description of the anatomy of the cervical fascia presents certain difficulties, since the muscles and internal organs are in complex anatomical and topographic relationships in different areas of the neck, both with each other and with separate plates of the cervical fascia.
Accordingly, three plates of the cervical fascia (three cervical fascia) secrete the three groups of neck muscles (superficial, over- and sub-sublingual and deep), having a different origin and anatomical position. The subcutaneous muscle of the neck, like all other facial muscles, lies subcutaneously and has only its own fascia.
The fascia cervicitis is located mainly in the anterior sections of the neck and consists of three plates (leaflets): superficial, pre-tracheal (medium) and deep (pre-invertebrate). The superficial fascia of the cervical fascia (lamina superficialis), or superficial fascia (fascia superficialis), encompasses the neck from all sides and forms the fascial vagina for the sternocleidomastoid and trapezius muscles. At the bottom this plate is attached to the anterior edge of the clavicle and the sternum handle and passes into the fascia of the breast. Above, the surface plate is attached to the hyoid bone and extends upwards in front of the sub-sublingual muscles, where it fuses with the connective tissue capsule of the sublingual salivary gland. Leaping over the base of the lower jaw, the surface plate continues into the chewing fascia.
The pre-tracheal plate (ldmma pretrachealis), or the middle fascia of the neck (fascia media), is distinctly expressed in the lower part of the neck. It extends from the back surface of the handle of the sternum and clavicle below to the hyoid bone at the top, and laterally - to the scapular-hyoid muscle. This plate forms fascial vaginas for the scapula-sublingual, sterno-sublingual, sternum-thyroid and thyroid-secretory muscles. The pre-tracheal plate is stretched between the shoulder-hyoid muscles of both sides in the form of a sail (Richet sail). With the contraction of the scapular-hyoid muscles, the pre-tracheal plate is stretched, facilitating the outflow of blood through the cervical veins.
The prefetal plate, or the invertebrate (deep) fascia (lamina prevertebralis, s.fascia prevertebralis, s.profunda), is located behind the pharynx, covers the pre-vertebral and stair muscles, forming for them fascial vaginas. This plate connects with the sleepy vagina (vagina carotica), enveloping the neurovascular bundle of the neck (common carotid artery, internal jugular vein and vagus nerve).
Above, the prevertebral plate is attached to the outer base of the skull behind the pharyngeal tubercle. On the sides it is attached to the transverse processes of the cervical vertebrae. Below the prevertebral plate along with the muscles is attached to the I and II ribs and passes into the hilar fascia.
It should be noted that in some textbooks of normal and topographic anatomy, five sheets of the cervical fascia (according to VN Shevkunenko) are described. However, with this classification of the fascia of the neck can not be accepted. The fact is that the subcutaneous muscle of the neck, which is a mimic muscle and closely related to the skin, like all other mimic muscles, has only its own fascia and lies above the surface plate of the cervical fascia. Superficial, pre-tracheal and pre-invertebral plates of the cervical fascia are formed in the process of development and development of the function of the corresponding groups of cervical muscles. The thoracic-clavicular-mastoid and trapezius muscles have branchial origin, are located on the neck superficially, the fascial vagina for them is the superficial plate of the cervical fascia. Nad- and sub-sublingual muscles develop from the anterior parts of myotomes, lie in front of the trachea and other organs of the neck, and they own the pre-tracheal plate. Deep (pre-invertebrate) muscles of the neck, also formed from myotomes, have their common fascia - a pre-inferior plate. In the neck organs (salivary glands, larynx, trachea, thyroid gland, pharynx and esophagus), the outer membrane is an adventitia, or connective tissue capsule (in the salivary glands), which can not be fascia due to its structure and origin.
Between the plates of the cervical fascia, and also between them and the organs of the neck, there are spaces filled with a small amount of loose connective tissue. Knowledge of these spaces is of great practical importance for understanding the ways of spreading inflammatory processes that can form in the neck and spread downwards into the chest cavity.
There are supragastinal interfascial, pre-visceral and ultrastructural spaces.
The supra-intestinal interfascial cell space is above the jugular notch of the sternum, between the superficial and pre-tracheal plates of the cervical fascia. It contains an important venous anastomosis (jugular venous arch) that connects the anterior jugular veins. The supraordinate interfascial space, continuing to the right and to the left, forms lateral indentations behind the beginning of the sternocleidomastoid muscle (Hruber's supraclavicular-clavicular-mastoid blind globule).
The previsual cell space is located between the pre-tracheal plate of the cervical fascia in front and the internal organs of the neck (thyroid, larynx and trachea) from behind. This cell space along the anterior surface of the internal organs communicates with the fiber of the anterior mediastinum.
Postovisticular cellular space is located between the posterior wall of the pharynx in front and the pre-vertebral plate of the cervical fascia from behind. This space is filled with a loose connective tissue, continues along the esophagus downwards, into the posterior mediastinum.
The space between the prevertebral plate in front and the backbone, in which the pre-mandibular muscles are located, has received the name of the pre-invertebrate cellular space.