Henry Gray (18251861). Anatomy of the Human Body. 1918.
prevertebral fascia is fixed above to the base of the skull, and below is continued into the thorax in front of the Longus colli muscles. Parallel to the carotid sheath and along its medial aspect the prevertebral fascia gives off a thin lamina, the buccopharyngeal fascia, which closely invests the Constrictor muscles of the pharynx, and is continued forward from the Constrictor pharyngis superior on to the Buccinator. It is attached to the prevertebral layer by loose connective tissue only, and thus an easily distended space, the retropharyngeal space, is found between them. This space is limited above by the base of the skull, while below it extends behind the esophagus into the posterior mediastinal cavity of the thorax. The prevertebral fascia is prolonged downward and lateralward behind the carotid vessels and in front of the Scaleni, and forms a sheath for the brachial nerves and subclavian vessels in the posterior triangle of the neck; it is continued under the clavicle as the axillary sheath and is attached to the deep surface of the coracoclavicular fascia. Immediately above and behind the clavicle an areolar space exists between the investing layer and the sheath of the subclavian vessels, and in this space are found the lower part of the external jugular vein, the descending clavicular nerves, the transverse scapular and transverse cervical vessels, and the inferior belly of the Omohyoideus muscle. This space is limited below by the fusion of the coracoclavicular fascia with the anterior wall of the axillary sheath. (4) The pretrachial fascia extends medially in front of the carotid vessels, and assists in forming the carotid sheath. It is continued behind the depressor muscles of the hyoid bone, and, after enveloping the thyroid gland, is prolonged in front of the trachea to meet the corresponding layer of the opposite side. Above, it is fixed to the hyoid bone, while below it is carried downward in front of the trachea and large vessels at the root of the neck, and ultimately blends with the fibrous pericardium. This layer is fused on either side with the prevertebral fascia, and with it completes the compartment containing the larynx and trachea, the thyroid gland, and the pharynx and esophagus. 1
The Sternocleidomastoideus (Sternomastoid muscle) (Fig. 385) passes obliquely across the side of the neck. It is thick and narrow at its central part, but broader and thinner at either end. It arises from the sternum and clavicle by two heads. The medial or sternal head is a rounded fasciculus, tendinous in front, fleshy behind, which arises from the upper part of the anterior surface of the manubrium sterni, and is directed upward, lateralward, and backward. The lateral or clavicular head, composed of fleshy and aponeurotic fibers, arises from the superior border and anterior surface of the medial third of the clavicle; it is directed almost vertically upward. The two heads are separated from one another at their origins by a triangular interval, but gradually blend, below the middle of the neck, into a thick, rounded muscle which is inserted, by a strong tendon, into the lateral surface of the mastoid process, from its apex to its superior border, and by a thin aponeurosis into the lateral half of the superior nuchal line of the occipital bone.
Variations.The Sternocleidomastoideus varies much in the extent of its origin from the clavicle: in some cases the clavicular head may be as narrow as the sternal; in others it may be as much as 7.5 cm. in breadth. When the clavicular origin is broad, it is occasionally subdivided into several slips, separated by narrow intervals. More rarely, the adjoining margins of the Sternocleidomastoideus and Trapezius have been found in contact. The Supraclavicularis muscle arises from the manubrium behind the Sternocleidomastoideus and passes behind the Sternocleidomastoideus to the upper surface of the clavicle.
Triangles of the Neck.This muscle divides the quadrilateral area of the side of the neck into two triangles, an anterior and a posterior. The boundaries of the anterior triangle are, in front, the median line of the neck; above, the lower border of the body of the mandible, and an imaginary line drawn from the angle of the mandible to the Sternocleidomastoideus; behind, the anterior border of the Sternocleidomastoideus. The apex of the triangle is at the upper
Note 1. F.G. Parsons (Journal of Anatomy and Physiology, vol. xliv) regards the carotid sheath and the fascial planes in the neck as structures which are artificially produced by dissection. [back]