Transcript
Pro
f. S
aeed
Sh
afi
SM
C-U
HS
PM
DC
Ste
p-1
Revie
w
He
ad
& N
ec
k C
lin
ica
l A
na
tom
y
LEARNING OUTCOMES
a) Demonstrate integrity of cranial nerves.
b) Interpret role of Neck tissue spaces in health &
disease.
c) Compare & contrast light & accomodation reflex.
d) Correlate epistaxis to its anatomiocal basis.
e) Illustrate cutaneous innervation of face, pinna &neck.
f) Interpret role of PNS in health & disease.
g) Correlate role of arterial anastomosis in Head& neck
to rapid wound healing.
CERVICAL FASCIA
Superficial Cervical FasciaDeep Cervical Fascia
Investing layer
Pretracheal Fascia
Preverterbral Fascia
Carotid Sheath
CERVICAL FASCIA
&
TRANSVERSE SECTION OF NECK
Definitions:
Cervical = neck region
Fascia = a sheet or band of fibrous tissue that forms an investment for muscles & various
organs of the body
SUPERFICIAL CERVICAL FASCIA
• Thin
• Covers the platysma
• May contain considerable amounts of adipose tissue
• Layer of loose connective tissue between dermis & deep fascia
DEEP CERVICAL FASCIA
DEEP CERVICAL FASCIA… INVESTING LAYER
• Surrounds the neck like a collar
• Splits around trapezius & SCM
• Posteriorly : meets the ligamentum
nuchae
• Attached to hyoid bone anteriorly
• Superiorly – superior nuchal line;
mastoid process, EOP, base of mandible
• Inferiorly – spine of scapula; acromion
process, clavicle & manubrium
• Between angle of mandible & mastoid
process - splits to enclose parotid
gland
• Between angle of mandible & styloid
process – becomes thickened and forms
stylomandibular ligament
• Enclose submandibular gland
DEEP CERVICAL FASCIA… PRETRACHEAL FASCIA
• Lies deep to infrahyoid strap muscles
• Attached to midline of hyoid bone &
oblique line of thyroid cartilage laterally
• Splits to enclose & suspend thyroid gland
• Pierced by thyroid vessels
• Laterally – fuses with carotid sheath
• Inferiorly – passes behind brachiocephalic
veins to blend with fibrous pericardium
• Provides a slippery surface for the up &
down gliding of trachea during swallowing &
neck movements
DEEP CERVICAL FASCIA… PREVERTEBRAL FASCIA
• Lies in front of prevertebral muscles
• Extends from base of skull in front of longus capitus & rectus capitus lateralis to body of
T3 veterbrae
• Covers muscles in the floor of the posterior triangle of neck
• Cervical plexus & subclavian artery lies deep to it
• Accessory nerve lie superficial to it
• Over the subclavian artery it becomes the axillary sheath
• Does not invest subclavian & axillary veins
• Provides a fixed surface on which pharynx, oesophagus & carotid sheath can
glide during neck movements & swallowing
DEEP CERVICAL FASCIA… CAROTID SHEATH
• Surrounds the carotid arteries;
internal jugular vein & vagus nerve
• Thin over the IJV because the vein
needs to be free to dilate during
increased blood flow
• Ansa cervicalis is embedded in anterior
wall
• Cervical symphatetics lie behind it
• Attached to base of skull at margins
of carotid canal
DEEP CERVICAL FASCIA… CAROTID SHEATH
CERVICAL FASCIA
Superficial Cervical FasciaDeep Cervical Fascia
Investing layer
Pretracheal Fascia
Preverterbral Fascia
Carotid Sheath
Common Carotid Artery
Internal Jugular Vein
Vagus Nerve
In front of prevertebral muscles
Forms floor of posterior triangle
Encloses & suspends thyroid gland
Encloses 2 muscles:
SCM & Trapezius
Encloses 2 glands:
Parotid & Submandibular
TRANSVERSE SECTION OF NECK
TRANSVERSE SECTION OF NECK
Deep cervical fascia
It is organized into several distinct layers
• Investing layer, which surrounds all structures in the neck;
• Prevertebral layer, which surrounds the vertebral column and the deep muscles associated with the back;
• Pretracheal layer, which encloses the viscera of the neck;
• Carotid sheaths, which receive a contribution from the other three fascial layers and surround the two major neurovascular bundles on either side of the neck.
Fascia of neck (transverse
view)
Fascia of the neck, sagittal
view
SUBMANDIBULAR GANGLION
• Parasympathetic peripheral
ganglion
• Relay station for secretomotor
fibres to submandibular and
sublingual salivary glands
• Topographically related to
lingual nerve
• Functionally connected to
facial nerve (chorda tympani)
• Lies on hyoglossus muscle just
above deep part of
submandibular gland
• Suspended by lingual nerve by
two roots
NERVE SUPPLY
Secretomotor pathway
Superior
salivatory
nucleus
Preganglionic fibres
Sensory root facial nerve
Geniculate
ganglion
facial
nerve
Submandibular
gland
Chorda tympani
Lingual
nerve
submandibular
ganglion
Postganglionic fibres
BLOOD SUPPLY
Facial artery
Cleft Palate
VOMER
Cleft palate
Primary palate
Secondary palate
R L
Hard
Soft
Uvula
Incisor Foramen
Skull
Brain +
Meninges
Spinal cord
Sinuses
Nose
Mandible
Teeth
Tongue
Cervical
vertebrae
Hyoid bone
Thyroid gland
Take Home Message?
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