Advertisement

Surgical and Radiologic Anatomy

, Volume 40, Issue 8, pp 917–922 | Cite as

Anatomical and histological study of the deep neck fasciae: does the alar fascia exist?

  • M. GavidEmail author
  • J. M. Dumollard
  • C. Habougit
  • Y. Lelonge
  • F. Bergandi
  • M. Peoc’h
  • J. M. Prades
Original Article

Abstract

Purpose

The aim of this study was to determine whether the alar fascia is a distinct layer of the deep cervical neck fasciae. The present study also aimed to elucidate the anatomical limits of this fascia.

Methods

Neck dissections of ten adult cadavers were performed, layer by layer, in the retropharyngeal region, under a powered operating microscope. Detailed dissections revealed the anatomical limits of the deep neck fasciae. Histological descriptions were also performed on large tissue samples collected from three cervical dissections.

Results

In the ten dissections, three layers of fascia were identified and dissected in the retropharyngeal region: a visceral fascia, a prevertebral fascia and an alar fascia. The alar fascia appeared like a connecting band derivative of the visceral fascia, between both vascular sheaths. It fused completely with the visceral fascia anteriorly at the level of T2 and with the prevertebral fascia posteriorly at the level of C1. No sagittal connection between the visceral fascia and the prevertebral fascia was identified. The stained histological sections confirmed the presence of the visceral and prevertebral fasciae at the oropharyngeal level, with a third intermediate layer closely connected with the visceral fascia.

Conclusion

The alar fascia is a layer of the cervical neck fascia connected with the visceral fascia from C1 to T2 levels. The anatomical limits of this alar fascia and its relationships with the internal carotid artery are important in the surgical management and the prognosis of deep neck infections and retropharyngeal lymph node metastases.

Keywords

Alar fascia Visceral fascia Prevertebral fascia Layer of the cervical fascia Retropharyngeal node 

Notes

Author contributions

MG: protocol/project development, data collection, manuscript writing. JMD: data analysis, manuscript writing. CH: data analysis, histological figure management. YL: data analysis. FB: data collection, dissection. MP: data analysis. JMP: protocol/project development, manuscript correction.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Baldassari CM, Howell R, Amorn M, Budacki R, Choi S, Pena M (2011) Complications in pediatric deep neck space abscesses. Otolaryngol Head Neck Surg 144(4):592–595CrossRefPubMedGoogle Scholar
  2. 2.
    Berkovitz BKB, Moxham BJ (2002) The neck. In: Head and neck anatomy: a clinical reference. Martin Lunitz, Londres, pp 332–339Google Scholar
  3. 3.
    Brito TP, Hazboun IM, Fernandes FL, Bento LR, Zappelini CEM, Chone CT, Crespo AN (2017) Deep neck abscesses: study of 101 cases. Braz J Otorhinolaryngol 83(3):341–348CrossRefPubMedGoogle Scholar
  4. 4.
    Broeckaert J (1908) Les phlegmons du cou d’origine buccopharyngée. J.-B. Baillière et fils, ParisGoogle Scholar
  5. 5.
    Chevrel JP, Fontaine C (1996) Anatomie Clinique. Tome, 3rd Edn. Springer, Paris, pp 318–319Google Scholar
  6. 6.
    Chong VF, Fan YF (2000) Radiology of the retropharyngeal space. Clin Radiol 55(10):740–748CrossRefPubMedGoogle Scholar
  7. 7.
    Chow AW (1992) Life-threatening infections of the head and neck. Clin Infect Dis 14(5):991–1002CrossRefPubMedGoogle Scholar
  8. 8.
    Coskun HH, Ferlito A, Medina JE, Robbins KT, Rodrigo JP, Strojan P, Suárez C, Takes RP, Woolgar JA, Shaha AR, de Bree R, Rinaldo A, Silver CE (2011) Retropharyngeal lymph node metastases in head and neck malignancies. Head Neck 33(10):1520–1529CrossRefPubMedGoogle Scholar
  9. 9.
    Grodinsky M, Holyoke EA (1938) The fasciae and fascial spaces of the head, neck and adjacent regions. Am J Anat 63:367–408CrossRefGoogle Scholar
  10. 10.
    Hoffmann C, Pierrot S, Contencin P, Morisseau-Durand MP, Manach Y, Couloigner V (2011) Retropharyngeal infections in children. Treatment strategies and outcomes. Int J Pediatr Otorhinolaryngol 75(9):1099–1103CrossRefPubMedGoogle Scholar
  11. 11.
    Hollinshead WH (1982) Anatomy for surgeons: the head and neck. Tome 1. 3ème éd. JB Lippincott company, Philadelphie, pp 269–288Google Scholar
  12. 12.
    Kamina P (2006) Anatomie Clinique. Tome 2. 3ème éd, Maloine, Paris, pp 199–207Google Scholar
  13. 13.
    Langdon JD (2005) Cervical fascia. In Standring S, Berkovitz BKB at al. Gray’s anatomy: The anatomical basis of clinical practice. 39ème éd. Churchill Livingstone, Philadelphia, pp 541–542Google Scholar
  14. 14.
    Malgaigne JF (1838) Traité d'anatomie chirurgicale et de chirurgie expérimentale. JB. Baillière, ParisGoogle Scholar
  15. 15.
    Miyake N, Takeuchi H, Cho BH, Murakami G, Fujimiya M, Kitano H (2011) Fetal anatomy of the lower cervical and upper thoracic fasciae with special reference to the prevertebral fascial structures including the suprapleural membrane. Clin Anat 24(5):607–618CrossRefPubMedGoogle Scholar
  16. 16.
    Mukherji SK, Castillo M (1998) A simplified approach to the spaces of the suprahyoid neck. Radiol Clin North Am 36(5):761–780CrossRefPubMedGoogle Scholar
  17. 17.
    Norton NS, Netter FH (2009) Précis d’anatomie clinique de la tête et du cou. Netter, Masson, Paris, pp 462–463Google Scholar
  18. 18.
    Ogura I, Kaneda T, Kato M, Mori S, Motohashi J, Lee K (2004) MR study of lateral retropharyngeal lymph nodes at different ages. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98(3):355–358CrossRefPubMedGoogle Scholar
  19. 19.
    Ozlugedik S, Ibrahim Acar H, Apaydin N, Firat Esmer A, Tekdemir I, Elhan A, Ozcan M (2005) Retropharyngeal space and lymph nodes: an anatomical guide for surgical dissection. Acta Otolaryngol 125(10):1111–1115CrossRefPubMedGoogle Scholar
  20. 20.
    Poirier P, Charpy A (1901) Traité d’anatomie humaine. Tome deuxième. Premier fascicule. 2ème éd. Masson, Paris, pp 409–428Google Scholar
  21. 21.
    Richet MA (1873) Traité pratique d’anatomie chirurgicale. Tome deuxième. 4ème éd. Lauwereyns, Paris, pp 300–310Google Scholar
  22. 22.
    Rouvière H (1927) Anatomie humaine descriptive et topographique, Tome 1, 2ème éd. Masson, Paris, pp 535–540Google Scholar
  23. 23.
    Scali F, Nash LG, Pontell ME (2015) Defining the morphology and distribution of the alar fascia: a sheet plastination investigation. Ann Otol Rhinol Laryngol 124(10):814–819CrossRefPubMedGoogle Scholar
  24. 24.
    Testut L (1902) Traité d’anatomie Humaine, Tome 3, 1rst edn. Gaston Doin, Paris, pp 1016–1019Google Scholar
  25. 25.
    Tillaux PJ (1890) Traité d’ anatomie topographique, avec applications à la chirurgie, 2nd edn. Asselin et Houzeau, Paris, pp 441–448Google Scholar
  26. 26.
    Vasan NR, Medina JE (2004) Retropharyngeal node dissection. Op Techn Otolaryngol 15:180–183CrossRefGoogle Scholar
  27. 27.
    Vieira F, Allen SM, Stocks RM, Thompson JW (2008) Deep neck infection. Otolaryngol Clin N Am 41(3):459–483CrossRefGoogle Scholar
  28. 28.
    Wong YK, Novotny GM (1978) Retropharyngeal space—a review of anatomy, pathology, and clinical presentation. J Otolaryngol 7(6):528–536PubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of AnatomyJean Monnet UniversitySaint-EtienneFrance
  2. 2.Department of Otorhinolaryngology Head Neck SurgeryCHU Saint-EtienneSaint-EtienneFrance
  3. 3.Department of AnatomopathologyCHU Saint-EtienneSaint-EtienneFrance

Personalised recommendations