Miesnie szyi

8/10/2019 Miesnie szyi

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The investing layer is the most superficial of the deep cervical fascial layers. It surrounds all the

structures in the neck. When it meets the trapezius and sternocleidomastoid muscles, it splits

into two to completely inves t the muscle. The fascia can be thought of as a tube, with superior,

lateral and inferior attachments.

Superior: to the external occipital protuberance and the superior nuchal line. Lateral: to the mastoid process and zygomatic arch. Inferior: to the spine of the scapula, the acromion, the clavicle, and the manubrium of

sternum.

Pretracheal Layer

The pretracheal layer of fascia is situated anteriorly . It envelops the trachea, oesophagus,

thyroid gland, and the infrahyoid muscles, running from the hyoid bone down to the superior

thorax, where it fuses with the pericardium . This layer of fascia can be functionally split into two

parts:

1. Visceral part encloses the thyroid gland, trachea and oesophagus.

2. Muscular part encloses the infrahyoid muscles.

The posterior section of the muscular fascial layer is formed by contributions fromthe buccopharyngeal fascia.

Fig 1.2 Transverse section of the neck, showing the pretracheal fascia in red.


19/23

Prevertebral Layer

The prevertebral fascial layer surrounds the vertebral column and its associated muscles

(scalence, pre-vertebral, and deep muscles of the back). The anterior portion of the fascia

attaches to the transverse processes and vertebral bodies of the vertebral column. Posteriorly,

it attaches along the ligamentum nuchae. In the inferior region of the neck, the fascia surrounds

the brachial plexus and subclavian artery , and here it is known as the axillary sheath.

Fig 1.3- Transverse section of the neck. The carotid sheaths and prevertebral sheaths are

highlighted.

Carotid sheaths

The carotid sheaths are paired structures, which encloses important vessels and nerves. The

fascial layer receives contributions from the pretracheal fascia anteriorly, and the prevertebral

fascia posteriorly. The contents of the carotid sheath are :

Common carotid artery (which bifurcates within the carotid sheath into the external and

internal carotid arteries)

Internal jugular vein Vagus nerve


20/23

Cervical lymph nodes

The carotid fascia is organised into a column , descending from the base of the skull to the

thorax. This represents a pathway for the spread of infection, and it clinically very important.

Clinical Relevance: Spread of Infections

The fascia of the neck is important in preventing the spread of infections, and when they do

occur, it explains their spread.

A superficial skin abscess is prevented from spreading further into the neck by the investing

layer of fascia.

There are locations deep to the investing layer of fascia where an infection can cause real

problems:

1. Posterior to the prevertebral fascia This can erode through the prevertebral fascia, and

drain into the retropharyngeal space (space between the pretracheal and prevertebral fascial

layers). The retropharyngeal space extends into the thorax, and the drainage of pus into the

thorax can lead to infection of the mediastinal contents.

2. Between the investing fascia and visceral part of the pretracheal fascia - This can spread

inferiorly into the chest, causing infection anterior to the pericardium.


21/23

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W skutek pierwotnych lub wtrnych zmian w obr bie mi ni szyi lub kr gosupa szyjnegopowoduj cych przymusowe przechylenie gowy i szyi w stron barku z ewentualnymskr ceniem w stron przeciwn .

Stanowi wynik r nych zmian chorobowych, takich jak:

urazowe uszkodzenie kr gosupa w wyniku ktrego dochodzi do wadliwego ustawienia gowy jednostronne zmiany bliznowate tkanek mi kkich zmiany zapalne, przykadowo w przebiegu gru licy choroby ukadowe , np. fibromialgia

jednostronny niedowad lub pora enie wiotkie (kr cz powstaje po stronie przeciwnej do pora onej) kompensacja wady wzroku ( torticollis ocularis ) - zaliczany te do kr czu uo eniowego kompensacja wady suchu - zaliczany te do kr czu uo eniowego

M .

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