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

Gavid, M.; Dumollard, Jean Marc; Habougit, Cyril; Lelonge, Yann; Bergandi, Florian; Péoc’h, Michel; Prades, Jean-Michel

doi:10.1007/s00276-018-1977-5

Cited by 25 publications

(40 citation statements)

References 14 publications

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“…Feigl (2015) called the alar fascia 'fascia intercarotica' because it crosses the median plane from the left carotid sheath to the right one. Recently, Gavid et al (2018) confirmed these results, as shown in fig. 4 of their article.…”

Section: Discussionsupporting

confidence: 58%

“…Scali et al (2015) asserted that the alar fascia could not be identified above the level of C1; the superior limit of the alar fascia was the horizontal plane passing through the superior limit of the posterior tubercle of the atlas. Gavid et al (2018) found that the alar fascia extended from C1 to T2. For Standring (2016), the alar fascia extends inferiorly from the cranial base to about the level of C7 (varying between C6 and T4).…”

Section: Discussionmentioning

confidence: 96%

“…Subsequently, other authors have confirmed the existence of the alar fascia (Lindner, 1986;Ozlugedik et al 2005;Vieira et al 2008;Guidera et al 2012;Standring, 2016). Recently, it has been identified through plastination (Scali et al 2015) and anatomical dissection (Gavid et al 2018).…”

Section: Fetal Periodmentioning

confidence: 99%

“…The visceral layer has also been described under different names, such as the pretracheal or buccopharyngeal fascia. The deep layer of deep cervical fascia is formed by the prevertebral and alar fasciae (Vieira et al 2008;Standring, 2016;Gavid et al 2018).…”

Section: Introductionmentioning

confidence: 99%

“…In adults, the alar fascia extends, according the authors, from the cranial base to C7 (Grodinsky & Holyoke, 1938) or T2 (Lindner, 1986;Vieira et al 2008;Gavid et al 2018); however, according to Standring (2016), it varies between C6 and T4, its caudal limit being the level of fusion between the alar fascia and visceral fascia. The alar fascia has been shown to be an important landmark in the surgical approach of the retropharyngeal space (Ozlugedik et al 2005).…”

Section: Introductionmentioning

confidence: 99%

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Early stages of development of the alar fascia (human specimens at 6–12 weeks of development)

et al. 2019

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In recent years, there has been much discussion concerning the cervical fasciae. The aim of this study is to confirm and to describe the development of the alar fascia as well as its relationship with nearby structures. Histological preparations of 25 human embryos (6-8 weeks of development) and 25 human fetuses (9-12 weeks of development) were studied bilaterally using a conventional optical microscope. Our study confirms the existence of the alar fascia and permits three stages to be established during its development. The initial stage (1st), corresponding to the 6th week of development (Carnegie stages 18-19), is characterized by the beginning of the alar fascia primordium in the retroesophageal space at the level of C7-T1. In the formation stage (2nd), corresponding to the 7th and 8th weeks of development (Carnegie stages 20-23), the alar fascia primordium grows upwards and reaches the level of C2-C3. In the maturation stage (3rd), beginning in the 9th week of development, the visceral, alar and prevertebral fasciae can be identified. The alar fascia divides the retrovisceral space (retropharyngeal and retroesophageal) into two spaces: one anterior (between the alar fascia and the visceral fascia and extending from C1 to T1, named retropharyngeal or retroesophageal space according to the level) and the other posterior (between the alar fascia and the prevertebral fascia, named danger space). We suggest that this latter space be named the retroalar space. This study suggests that alar fascia development is related to mechanical factors and that the alar fascia permits the sliding of the pharynx and the oesophagus during swallowing.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 96%

Section: Fetal Periodmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early stages of development of the alar fascia (human specimens at 6–12 weeks of development)

et al. 2019

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Air dissection of the spaces of the head and neck: A new teaching and dissection method

Iwanaga

Watanabe

Anand³

et al. 2019

Clinical Anatomy

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Our goal was to evaluate a new air dissection technique for the spaces of the head and neck using fresh-frozen cadavers. Eight sides from four fresh-frozen Caucasian cadavers were used in this study. Compressed air was initially placed into the pterygomandibular space while simultaneously observing the spaces of the head and neck. Subsequently, the pterygomandibular space on the contralateral side of the specimen was insufflated and observations made. For these methods, simultaneous observation of mediastina and lungs was made using intrathoracic endoscopy. On all sides, the buccal, submental, sublingual, parotid, parapharyngeal, and retropharyngeal spaces were insufflated on both ipsilateral and contralateral sides. Deviation of the larynx and trachea was observed externally and deviation of the mediastinum and lungs via intrathoracic endoscopy. We introduced air dissection into spaces of the head and neck. This new technique might help students, teachers, dentists, medical doctors, and other healthcare providers to better understand the three-dimensional anatomy of the spaces of the head and neck and their communicating pathways. Clin. Anat. 33:207-213, 2020.

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Anatomical and histological study of the alar fascia

et al. 2020

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Introduction The alar fascia remains one of the most variably described fascial structure in the human body. Much disagreement persists in the literature and mainstream anatomical texts about its anatomy, function, and clinical significance. It is generally described as a coronally oriented fascial sheet separating the retropharyngeal space anteriorly from the danger space posteriorly. The current study aimed to confirm the presence of the alar fascia and delineate its anatomical characteristics, connections, and potential function through gross dissection and microscopic analysis. Possible clinical and surgical implications are considered. Methods Twelve (12) cadaveric necks were dissected and examined histologically. Smooth muscle (αSMA), nerve (S100 protein), and myosin proteins were identified immunohistologically to characterize the composition and possible functions of the alar fascia. Results The alar fascia was found in all specimens spanning between the carotid sheaths. Morphologically, it was not a delamination or derivative of the prevertebral fascia. It extended from the base of the skull to the upper thoracic level (T2) where it fused with the visceral fascia. No midsagittal connection was found between the alar and visceral fasciae. Immunohistochemically, the alar fascia was positive in focal areas for αSMA and S100 proteins but negative for fast and slow myosin. Conclusion The alar fascia is an independent and constant coronal fascial layer between the carotid sheaths. It contains neurovasculature and may limit the spread of retropharyngeal infections into the thorax as well as facilitate normal physiological functions of the cervical viscera.

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

Cited by 25 publications

References 14 publications

Early stages of development of the alar fascia (human specimens at 6–12 weeks of development)

Early stages of development of the alar fascia (human specimens at 6–12 weeks of development)

Air dissection of the spaces of the head and neck: A new teaching and dissection method

Anatomical and histological study of the alar fascia

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