Classification of cervical fasciae
In domestic topographical anatomy, the classification by V.N. Shevkunenko is traditionally used. It distinguishes five leaves, which can be correlated with the Terminologia Anatomica (PNA).
| According to Shevkunenko | According to PNA | What they form |
|---|---|---|
| 1st fascia | Superficial fascia | Sheath for the platysma muscle (m. platysma) |
| 2nd fascia | Superficial lamina | Sheaths for m. sternocleidomastoideus and m. trapezius |
| 3rd fascia | Pretracheal lamina | Sheaths for the infrahyoid muscles |
| 4th fascia | Carotid sheath | Sheaths for the cervical organs and neurovascular bundle |
| 5th fascia | Prevertebral lamina | Sheaths for the deep neck muscles |
Superficial fasciae (1st, 2nd, and 3rd leaves)
First fascia (superficial) lies immediately beneath the skin and is firmly fused to it by connective tissue bands, thus moving together with the skin. It forms a sheath for the platysma muscle (m. platysma) and is extremely mobile relative to deeper structures, extending to the face and chest.
Second fascia (deep cervical fascia, superficial layer) surrounds the neck from all sides like a continuous "collar". Attaching to the transverse processes of the vertebrae, it divides the neck into anterior and posterior compartments. Superiorly, it splits to create a bed for the submandibular salivary gland. Inferiorly, its laminae diverge, forming the suprasternal interaponeurotic space (spatium interaponeuroticum suprasternale), which contains the jugular venous arch (arcus venosus juguli).
Third fascia (omoclavicular fascia, or Richer's aponeurosis) has a trapezoidal shape. It is stretched between the hyoid bone superiorly and the sternum and clavicles inferiorly. Laterally, its boundaries are defined by the omohyoid muscles (mm. omohyoidei). Its main function is the formation of a bed for the group of infrahyoid muscles.
Deep fasciae (4th and 5th leaves)
Fourth fascia (endocervical fascia, fascia endocervicalis) plays a key role in the topography of the internal organs of the neck. It consists of two laminae:
- Visceral layer closely envelops each organ (trachea, esophagus, thyroid gland).
- Parietal layer forms the common sheath for the main neurovascular bundle of the neck.
Fifth fascia (prevertebral fascia, fascia prevertebralis) is best developed in the middle section of the neck. Originating from the base of the skull, it descends to the III–IV thoracic vertebrae. This fascia forms osteofascial sheaths for the longus colli, longus capitis, and scalene muscles. Extensions of the fifth fascia create sheaths for the brachial plexus and subclavian artery.
Cervical fascial spaces
Between the fascial leaves are spaces filled with loose connective tissue. They serve as pathways for the spread of infections:
- Previsceral space (spatium previscerale) — located between the parietal and visceral laminae of the 4th fascia, anterior to the cervical organs. Its lower part is called the pretracheal space.
- Retrovisceral space (spatium retroviscerale) — localized between the 4th and 5th fasciae.
- Retropharyngeal space (spatium retropharyngeum) — bounded anteriorly by the posterior wall of the pharynx (covered by the visceral lamina of the 4th fascia) and posteriorly by the 5th fascia. In the middle, it is divided by a connective tissue septum.
- Parapharyngeal space (spatium parapharyngeum) — located at the lateral wall of the pharynx. A complex of muscles extending from the styloid process ("styloid diaphragm") divides it into anterior and posterior compartments. The posterior compartment contains vital structures: the internal carotid artery, internal jugular vein, and four pairs of cranial nerves.
Briefly: answers to topical questions
Which cervical organs are covered by the visceral lamina of the fourth fascia?
The visceral lamina of the fourth fascia (lamina visceralis fasciae endocervicalis) forms the fascial covering of the cervical organs, including:
- larynx (larynx);
- trachea (trachea);
- thyroid gland (glandula thyroidea).
Which muscles make up the "styloid diaphragm"?
The "styloid diaphragm" (also known as Riolan's bouquet) includes muscles originating from the styloid process and their fascial sheaths. These include:
- Stylopharyngeus muscle (m. stylopharyngeus) — directed toward the pharynx;
- Styloglossus muscle (m. styloglossus) — runs to the tongue;
- Stylohyoid muscle (m. stylohyoideus) — attaches to the hyoid bone.
These structures anatomically divide the parapharyngeal space into anterior and posterior compartments.
What is the content of the anterior compartment of the parapharyngeal space?
The anterior compartment of the parapharyngeal space contains:
- adipose tissue;
- ascending pharyngeal vessels;
- pharyngeal process of the parotid salivary gland, separated by a poorly developed fascia.
To which anatomical regions can purulent collections spread from the retropharyngeal space?
Purulent collections from the retropharyngeal space can spread:
- into the superior mediastinum;
- into the posterior mediastinum via the retrovisceral space, which communicates with the posterior mediastinum; spreading behind the esophagus can lead to posterior mediastinitis.
To remember the muscles forming the stylopharyngeal diaphragm (which divides the parapharyngeal space), use the three "stylo-" rule: the stylopharyngeus, styloglossus, and stylohyoid muscles.
Class and exam questions
What structures are contained within the neurovascular bundle of the neck?
The bundle includes the common carotid artery (a. carotis communis), internal jugular vein (v. jugularis interna), and vagus nerve (n. vagus). They are surrounded by the parietal layer of the 4th fascia.
Where is Gruber's pouch located?
Gruber's pouch (saccus caecus retrosternocleidomastoideus) is located behind the lower part of the sternocleidomastoid muscle and communicates with the suprasternal interaponeurotic space.
Which nerves pass through the posterior parapharyngeal space?
Four cranial nerves lie in the posterior compartment of the parapharyngeal space: glossopharyngeal (IX), vagus (X), accessory (XI), and hypoglossal (XII).
What else to study on this topic
- Topography and boundaries of the scalene gaps (prescalene and interscalene spaces)
- Detailed structure of the submandibular salivary gland bed and cellular tissue drainage pathways
- Features of the fusion of the parietal layer of the 4th fascia with the 3rd fascia at the thyroid gland level
- Formation of the linea alba of the neck (linea alba cervicalis) and its significance in operative surgery
- Relationship of the sympathetic trunk with the prevertebral (5th) fascia
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