DEEP CERVICAL FASCIA AND PLATYSMA DEEP CERVICAL FASCIA Surrounding the whole neck is a collar of fascia.

Investing layer of deep cervical fascia,encloses the trapezius and sternocleidomastoid muscles. The fascia and the muscles are attached above to the base of the skull and below to the clavicle at the root of the neck. It consists of four parts. The investing layer Pretrachial fascia Prevertebral fascia The carotid sheath

1. THE INVESTING LAYER This fascia which is comparable in every way to the deep fascia present elsewhere in the body surrounds the neck like a collar. It splits around sternocleidomastoid and trapezius . Posteriorly it blends with the ligamentum nuchae, which is attached to the spines of the cervical vertebrae. Anteriorly it is attached to the hyoid bone; and above to the lower border of the mandible and to the mastoid process, superior nuchal line and external occipital protuberance at the base of the skull. Between the angle of the mandible and the tip of the mastoid process the investing layer is strong and splits to enclose the parotid gland. Below, the investing layer is attached to the spine and acromion of the scapula and the clavicle with the trapezius, and to the

clavicle and the manubrium of the sternum with the sternocleidomastoid. In the intervals between these muscles, it is attached to both clavicles and to the juglar notch by two layers. The layers are attached to the anterior and posterior borders of the juglar notch, enclosing between them the suprasternal space which contains the lower parts of the anterior juglar veins. An anastomotic arch between them, the sternal heads of the sternocleidomastoids and sometimes a lymph node. The two layers are pierced by the external juglar vein. 2. PREVERTEBRAL FASCIA This is a firm, tough membrane that lies in front of the prevertebral muscles. It extends from the base of the skull, in front of the longus capitis, rectus capitis lateralis and longus colli muscles, downwards to blend with the anterior longitudinal ligament on the body of T4 vertebra. It covers the muscles that form the floor of the posterior triangle of the neck and all the cervical nerve roots. The cervical plexus and trunks of the brachial plexus lie deep to it. The lymph nodes of the posterior triangle and the accessory nerve lie superficial to it. The third part of the subclavian artery lies deep to the fascia. This fascia does not invest the subclavian or axillary vein; these lie in loose areolar tissue anterior to it, free to dilate during times of increased venous return from the upper limb.

 The fascia is pierced by the four cutaneous branches of the cervical plexus ( great auricular, lesser occipital, transverse cervical and supraclavicular). This thin fascia lies deep to the infrahyoid strap muscles (sternothyroid, sternohyoid and omohyoid). Its upward attachment is limited by the body of the bone and the oblique line of the thyroid cartilage. It splits to enclose the thyroid gland, to which it is not adherent except between the isthmus and second. Third and fourth rings of the trachea. Laterally, it fuses with the front of the carotid sheath on the deep surface of the SCM muscle. Inferiorly it passes behind the brachiocephalic veins to blend with the adventitia of the arch of the aorta and the fibrous pericardium. 4. CAROTID SHEATH This is not a fascia in sense of a demonstrable membranous layer, but consists of a feltwork of areolar tissue that surrounds the common and internal carotid arteries, internal juglar vein, vague nerve and some deep cervical lymph nodes. It is thin where it overlies the IJV(internal jugular vein), allowing the vein to dilate during increased blood flow. The sheath is attached to the base of the skull at the margins of the carotid canal and jugular fossa, and is continued downwards along the vessels to blend with adventitia of the aortic arch. In front the lower part of the sheath fuses with fascia on the deep surface of the SCM muscle.

 Where they lie alongside, the sheath blends with the pretrachial fascia. Behind the carotid sheath there is minimum of loose areolar tissue between it and the prevertebral fascia. The cervical sympathetic trunk lies here in front of the prevertebral fascia. Contents of carotid sheath Four major structures contained in the carotid sheath are: The common carotid artery as well as the internal carotid artery Internal jugular vein The vagus nerve(Cranial nerve 10) The deep cervical lymph nodes. 5.PLATYSMA MUSCLE It is a broad flat sheet of muscle that lies superficial to the investing layer of deep cervical fascia. it extends from the fascia over the upper parts of the pectoralis major and deltoid to the lower border of the mandible. some fibres continue on to the face, blending with the muscles of facial expression. The muscle covers the external and anterior jugular veins. The two muscles are separated below. Converge above towards the midline just beneath the chin. It is supplied by cervical branch of the Facial nerve. It plays a part in facial expression and may assist in opening the mouth.