The cervical fasciae

Five fascial layers are distinguished.

I. The superficial cervical fascia (fascia colli superficialis/поверхностная фасция шеи)

It is the part of the common superficial fascia of the body. It contains the platysma.

II. The superficial layer of cervical fascia proper (lamina superficialis fasciae colli propriae/поверхностная пластинка собственной фасции шеи)

• This fascia covers the suprahyoid and infrahyoid muscles, the salivary glands, the vessels and nerves.

• It is attached to the mandible and the mastoid process above, to the anterior border of the manubrium of the sternum and the clavicles, to the transverse processes laterally and to the spinous processes posteriorly.

• In front, on the midline it fuses with the deep layer of the cervical fascia proper to from the linea alba cervicalis.

• The fascia forms the fascial sheaths for the sternocleidomastoid and the trapezius.

III. The deep layer of cervical fascia proper

(lamina profunda fasciae colli propriae/глубокая пластинка собственной фасции шеи)

• This fascia is present only in the middle part of the neck and passes from the hyoid bone to the posterior border of the sternum and the clavicles.

• It forms the fascial sheaths for the infrahyoid muscles.

• The fascia fuses with the superficial layer of the cervical fascia proper along the omohyoid muscles and linea alba cervicalis.

• Between two layers of the cervical fascia proper there is the suprasternal space (spatium suprasternale/надгрудинное пространство), containing the superficial veins of the neck. Laterally this space communicates with the recessus lateralis – a blind space behind the inferior end of the sternocleidomastoid into which pus may penetrate.

IV. The endocervical fascia (fascia endocervicalis/внутришейная фасция)

• It encloses the organs located in the neck (larynx, trachea, thyroid gland, pharynx, oesophagus and the large vessels).

• This fascia consists of two layers:

• A visceral layer encloses each of these organs and forms a capsule for them.

• A parietal layer encloses all these organs and forms a sheath for the common carotid artery and the internal jugular vein.

• The space between the parietal and visceral layers of this fascia lies in front of the viscera and is therefore called the previsceral space (spatium previscerale/предорганное пространство), that in front of trachea, in particular, is called the pretracheal space (spatium pretracheale/предтрахеальное пространство). The later contains the isthmus of the thyroid gland and blood vessels.

• The pretracheal space extends into the anterior mediastinum.

V. The prevertebral fascia (fascia prevertebralis/предпозвоночная фасция)

• It covers anteriorly the deep muscles of the neck.

• The retrovisceral space (spatium retroviscerale/позадиорганное пространство) is between the endocervical and prevertebral fasciae. It continuous with the posterior mediastinum.

Topography of the neck

The neck is divided into four regions: posterior, lateral, the region of the sternocleidomastoid and anterior region.

• The posterior cervical region is behind the lateral border of the trapezius and is the nape, or nucha.

• The lateral cervical region is bounded in front by the sternocleidomastoid, below by the clavicle, behind by the trapezius. There are two triangles within lateral region:

• The omoclavicular triangle (trigonum omoclaviculare/лопаточно-ключичный треугольник) is bounded by the sternocleidomastoid in front, the inferior belly of the omohyoid above, the clavicle below.

• The omotrapezoid triangle (trigonum omotrapezoideum/лопаточно-трапециевидный треугольник) is bounded by the sternocleidomastoid in front, the inferior belly of the omohyoid below, the trapezius behind.

• The sternocleidomastoid region corresponds to the projection of this muscle.

• The anterior cervical region is bounded posteriorly by the sternocleidomastoid, in front by the midline of the neck, above by the lower border of the mandible. There are three triangles within anterior region:

• The carotis triangle (trigonum caroticum/сонный треугольник) (transmitting the carotid artery) is bounded by the sternocleidomastoid posteriorly, the posterior belly of the digastric in front and above, the superior belly of the omohyoid in front and below.

• The submandibular triangle (trigonum submandibulare/поднижнечелюстной треугольник) (lodging the submaxillary gland) is bounded by the inferior border of the mandible above and two bellies of the digastric. There is Pirogov’s triangle (transmitting the lingual artery) within the submandibular triangle. It is bounded by the posterior border of the mylohyoid, intermediate tendon of the digastricus and the hypoglossal nerve.

• The omotracheale triangle (trigonum omotracheale/лопаточно-трахеальный треугольник) is bounded by the middle line of the neck medially, the sternocleidomastoideus behind and below, the superior belly of the omohyoid behind and above.

• A small area behind the mandibular angle and in front of the mastoid process is called the retromandibular fossa lodging the parotid gland.

• Between the anterior and middle scalene muscles is the interscalene space, bounded by the first rib below. It transmits the subclavian artery and the brachial plexus.

• In front of the anterior scalene muscle there is the antescalene space, transmitting the subclavian vein.

THE MUSCLES OF THORAX (musculi thoracis/мышцы груди)