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The cervical fascia is a system of connective tissue layers in the neck that compartmentalizes structures, defines deep neck spaces, and determines pathways of infection spread.

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![(A–D) The layers of cervical fascia. (A) Subcutaneous tissue. (B) Masticator fascia, submandibular fascia, and sternocleidomastoid-trapezius fascia. The fascia covering the lateral surface of the parotid gland is controversial and therefore not shown. (C) Strap muscle fascia (green) and perivertebral fascia (purple). (D) Visceral fascia (orange) and carotid sheath.

Guidera AK, Dawes PJD, Fong A, Stringer MD. Head and neck fascia and compartments: No space for spaces. Head & Neck. 2013;36(7):1058-1068. doi:10.1002/hed.23442](attachment:6cb48521-68bc-40e6-abc2-352d803a09dd:image.png)

(A–D) The layers of cervical fascia. (A) Subcutaneous tissue. (B) Masticator fascia, submandibular fascia, and sternocleidomastoid-trapezius fascia. The fascia covering the lateral surface of the parotid gland is controversial and therefore not shown. (C) Strap muscle fascia (green) and perivertebral fascia (purple). (D) Visceral fascia (orange) and carotid sheath.

Guidera AK, Dawes PJD, Fong A, Stringer MD. Head and neck fascia and compartments: No space for spaces. Head & Neck. 2013;36(7):1058-1068. doi:10.1002/hed.23442

Anatomical divisions

It is divided into superficial fascia and deep cervical fascia (with three main layers). Deep fascia is again organized into three layers: investing, pretracheal, prevertebral (plus the carotid sheath).

Layer Structures Enclosed Clinical Relevance
Superficial fascia Platysma, superficial veins, lymphatics Source of superficial infections/abscesses
Investing fascia SCM, trapezius, submandibular & parotid glands Parotid/submandibular infections, fascial plane limit
Pretracheal fascia Thyroid, trachea, esophagus Mediastinal spread of thyroid goiter or infection
Prevertebral fascia Vertebral column, paraspinal & scalene muscles Defines retropharyngeal & danger spaces, posterior mediastinal spread
Carotid sheath Carotid artery, IJV, CN X, lymph nodes Pathway for infection/tumor spread

![Illustration demonstrating the three-layer organization of the fasciae in the retropharyngeal region. CCA, common carotid artery; DS, danger space; IJV, internal jugular vein; RPS, retropharyngeal space

Illustrated by J. Holland and D. Nahabedian Snosek M, Macchi V, Stecco C, Tubbs RS, De Caro R, Loukas M. Anatomical and histological study of the alar fascia. Clinical Anatomy. 2020;34(4):609-616. doi:10.1002/ca.23644](attachment:4bb6d954-961b-4ba7-aad0-a55727ab8392:ca23644-fig-0012-m.jpg)

Illustration demonstrating the three-layer organization of the fasciae in the retropharyngeal region. CCA, common carotid artery; DS, danger space; IJV, internal jugular vein; RPS, retropharyngeal space

Illustrated by J. Holland and D. Nahabedian Snosek M, Macchi V, Stecco C, Tubbs RS, De Caro R, Loukas M. Anatomical and histological study of the alar fascia. Clinical Anatomy. 2020;34(4):609-616. doi:10.1002/ca.23644

Deep Neck Spaces Formed by Fascia

Parapharyngeal space Between pharynx and masticator/parotid space.
Retropharyngeal space Between buccopharyngeal and alar fascia (can extend into mediastinum).
Danger space Between alar fascia and prevertebral fascia (direct spread into posterior mediastinum).
Prevertebral space Behind prevertebral fascia.
Carotid space Along carotid sheath.

Clinical Significance of Cervical Fascia

Summary Table

![The deep ‘spaces’ in the neck (infrahyoid transverse section adapted from McMinn RMH, Last's Anatomy)

RMH McMinn (ed.). Last's Anatomy. Regional and Applied, 9th edn. Edinburgh: Churchill Livingstone, 1994. Guidera AK, Dawes PJD, Stringer MD. Cervical fascia: a terminological pain in the neck. ANZ Journal of Surgery. 2012;82(11):786-791. doi:10.1111/j.1445-2197.2012.06231.x](attachment:347ec346-3422-48fe-adeb-8b689b4e9c44:image.png)

The deep ‘spaces’ in the neck (infrahyoid transverse section adapted from McMinn RMH, Last's Anatomy)

RMH McMinn (ed.). Last's Anatomy. Regional and Applied, 9th edn. Edinburgh: Churchill Livingstone, 1994. Guidera AK, Dawes PJD, Stringer MD. Cervical fascia: a terminological pain in the neck. ANZ Journal of Surgery. 2012;82(11):786-791. doi:10.1111/j.1445-2197.2012.06231.x