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Quick Review #241 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental
1. Skin: The incision is made just inferior to the mandible in a natural skin crease.
2. Subcutaneous tissue: After the skin incision, the subcutaneous layer is dissected, containing fat and superficial nerves, such as branches of the marginal mandibular nerve of the facial nerve, which should be carefully protected.
3. Platysma muscle: Once the subcutaneous tissue is cleared, the platysma muscle is encountered. This thin muscle layer is divided in line with the skin incision.
4. Deep cervical fascia: After the platysma, the deep cervical fascia is dissected. The deep fascia covers the superficial surface of the masseter muscle and the underlying structures.
4a. Investing Layer (Superficial Layer of Deep Cervical Fascia):
• This is the most superficial layer of the deep cervical fascia.
• It surrounds the entire neck, enclosing both the sternocleidomastoid and trapezius muscles.
• It also surrounds the parotid and submandibular glands.
• Anteriorly, it attaches to the hyoid bone and forms the roof of the anterior and posterior triangles of the neck.
• Posteriorly, it attaches to the nuchal ligament and spinous processes of the cervical vertebrae.
4b. Pretracheal Layer (Middle Layer of Deep Cervical Fascia):
• This layer is limited to the anterior part of the neck.
• It extends from the hyoid bone down to the thorax, where it blends with the pericardium.
• It surrounds the visceral compartment, which includes the trachea, esophagus, thyroid gland, and parathyroid glands.
• This fascia has a muscular portion, which encloses the infrahyoid muscles, and a visceral portion, which encloses the thyroid gland, trachea, and esophagus.
• Posteriorly, it is referred to as the buccopharyngeal fascia, which separates the esophagus and the pharynx from the prevertebral fascia.
4c. Prevertebral Layer (Deep Layer of Deep Cervical Fascia):
• This layer covers the vertebral column and the muscles associated with it, including the scalene muscles, the longus colli, and the erector spinae.
• It extends from the base of the skull to the T3 vertebra, where it blends with the anterior longitudinal ligament.
• The prevertebral fascia is important in defining potential spaces for the spread of infection, such as the danger space and the retropharyngeal space.
5. Masseter muscle fascia: In some cases, the masseter muscle may be partially elevated off the mandible to allow for access to the bone.
References:
1. Anatomy QA. (n.d.). Deep cervical fascia. Anatomy Made Simple.
2. Miloro, M., Ghali, G. E., Larsen, P. E., & Waite, P. (Eds.). (2022). Peterson’s principles of oral and maxillofacial surgery (4th ed.). Springer.
3. Hupp, J. R., Ellis, E., & Tucker, M. R. (2018). Contemporary oral and maxillofacial surgery (7th ed.). Elsevier.
4. ChatGPT. 2024.
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