Viva Tutorials for Surgeons in Training: Applied Surgical Anatomy

HEAD AND NECK Fascial Compartments of the Neck What is the significance of the fascial compartments of the neck? They compartmentalise structures in the neck and form natural planes of cleavage through which tissues can be separated in surgery. They also form planes along which infections can spread. What are the different fascial layers? They are made up of superficial and deep cervical fascia. Superficial fascia lies between the skin and investing layer of deep fascia. As well as containing nerves, blood vessels and lymphatics, it encloses the platysma muscle anteriorly. The deep cervical fascia consists of four parts: investing; pretracheal; prevertebral; and the carotid sheath. Can you tell me the margins of the investing layer? The investing layer of fascia surrounds the neck deep to the superficial fascial layer. It splits to enclose the trapezius and sternocleidomastoid muscles on either side. The superior attachment of the investing layer extends from the superior nuchal line to the tip of the mastoid process. It extends to the zygomatic arch and the lower border of the mandible. Anteriorly, it attaches to the hyoid bone and posteriorly, it attaches to the ligamentum nuchae. Between the angle of the mandible and mastoid process, it splits to enclose the parotid and submandibular glands. Inferiorly, it attaches to the manubrium, clavicles and the spines and acromion of the scapulae. In attaching to the manubrium, the investing layer attaches to the anterior and posterior border forming a suprasternal space.