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Anatomy of Neck and Blood Supply of Brain
Published in Sudhir K. Gupta, Forensic Pathology of Asphyxial Deaths, 2022
Lines of greatest tension in the neck are termed ‘relaxed skin tension lines’. The next layer is superficial cervical fascia, which consists of the adipose tissue and platysma. The deep cervical fascia surrounds the muscles and other structures of the neck to varying extent. The carotid sheath is a condensed part of deep fascia that encloses the structures like carotid arteries, vagus nerve and internal jugular vein. In health, the tissues within these spaces are either closely applied to each other or are filled with relatively loose connective tissue. However, they offer potential routes by which unchecked infection may spread within head and neck and between the face and the mediastinum.
Paediatric deep neck space infections
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
The two major fascial layers in the neck are the superficial cervical and deep cervical fascia. The superficial cervical fascia encloses platysma and surrounds the neck. The deep cervical fascia is divided into three layers – the superficial layer or investing fascia, the middle (pretracheal) layer and the deep (prevertebral) layer. The carotid sheath consists of fascia from all three deep layers and surrounds the common carotid artery, internal jugular vein and vagus nerve.
Surgical Anatomy of the Neck
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Laura Warner, Christopher Jennings, John C. Watkinson
This middle layer of the deep cervical fascia, known as the pretracheal or visceral layer of cervical fascia, is again derived from the investing layer. It attaches to the hyoid bone superiorly and can be considered as having two parts: the muscular compartment encasing the infrahyoid muscles and the visceral compartment containing the trachea, the thyroid gland, the pharynx and upper oesophagus. Inferiorly it fuses with the fascia of the superior mediastinum around the great vessels and the fibrous pericardium. Laterally it connects to the carotid sheath by loose areolar tissue.
Comparison of ultrasound-guided percutaneous microwave ablation and parathyroidectomy for primary hyperparathyroidism
Published in International Journal of Hyperthermia, 2019
Fangyi Liu, Xiaoling Yu, Zhoulu Liu, Zhi Qiao, Jianping Dou, Zhigang Cheng, Zhiyu Han, Jie Yu, Ping Liang
Parathyroidectomy was performed under general anesthesia. After successful general anesthesia, the patient took a supine position, shoulder pillow, head back, routine disinfection and sterile sheet, and cloth was placed on both sides of the neck to fix. The upper two transverse fingers of sternal notch were taken and the collar transverse incision along the dermatoglyphic direction was about 5–8 cm. The skin, subcutaneous, latissimus cervicalis and superficial layer of deep cervical fascia were incised, and the incision was pulled up. The skin flaps were free between the loose connective tissue plane of latissimus cervicalis and deep cervical fascia, from the upper margin of thyroid cartilage to the sternal notch to fully expose the outer layer of deep cervical fascia. Lift the fascia on both sides of the median line, cut the white line of the neck and separate the gap between the subhyoid muscle group and the thyroid capsule with the finger to the front of the sternocleidomastoid muscle. The bilateral sternohyoid and thyroidal muscles were pulled apart to explore parathyroid tumors and to perform parathyroidectomy. The ipsilateral recurrent laryngeal nerve (RLN) was explored by nerve monitor to protect it intraoperatively. Hemostasis was fully achieved and the incision was sutured layer by layer.
Microvascular reconstruction after extensive cervical necrotizing fasciitis: A case series
Published in Acta Oto-Laryngologica Case Reports, 2019
Rajan P. Dang, Joseph P. Bradley, Joseph Zenga, Patrik Pipkorn
The superficial cervical fascia and the superficial layer of the deep cervical fascia provide barriers against deep penetration of infection. Spread of necrotizing fasciitis through these layers may lead to loss of platysma and overlying skin, but frequently spares deeper critical structures. Through spread within the deep cervical fascia, those deeper critical structures may be lost and infection may gain access to the mediastinum, which is associated with high mortality [8, 11]. With early recognition of the serious nature of the disease and aggressive surgical debridement, patients may survive. In surviving patients, the resulting soft tissue defect can usually be managed with primary closure or skin grafting [9,12].
Safety enhancement of improved hydrodissection for microwave ablation in secondary hyperparathyroidism
Published in International Journal of Hyperthermia, 2023
Ying Wei, Zhen-long Zhao, Yun Niu, Jie Wu, Shi-liang Cao, Li-li Peng, Yan Li, Ming-an Yu
The location and ultrasonic characteristics of the six periparathyroid fascial spaces after hydrodissection were as follows: (1) The PTS, located between the thyroid and trachea, formed a stable semicircular arc or triangular anechoic isolating band on US after hydrodissection, pushing the trachea and esophagus away from the SHPT lesion and thyroid. The RLN and superior laryngeal nerves are located inside the PTS. (2) The RS, located posterior to the thyroid and carotid sheath, formed a stable anechoic isolating band on US after hydrodissection, and pushed the SHPT lesion and thyroid away from the longus colli, carotid sheath, and cervical sympathetic ganglion. (3) The ACS, located between the infrahyoid muscles and thyroid, formed an irregularly anechoic isolating band on US after hydrodissection and pushed the SHPT lesion and thyroid away from the infrahyoid muscles and the carotid sheath. (4) The CS, delimited by the three layers of the deep cervical fascia, formed a circular anechoic region on US after hydrodissection and pushed the SHPT lesion away from the common carotid artery, internal jugular vein, sympathetic plexus, supra- and infrahyoid cervical lymph nodes, and the vagus nerve. (5) The TGS enclosing the trachea and esophagus formed a mixed-echoic semicircular multilayer structure on US after hydrodissection and pushed the SHPT lesion away from the RLN, trachea, and esophagus. (6) The CPS, the space around the parathyroid gland, consists of multilayered continuous collagenous fibers and forms an onion-skin-like structure with an obvious border and tension on US after hydrodissection and pushes the SHPT lesion away from the surrounding critical structures. A schematic of the periparathyroidal space is shown in Figure 4.