Investing Layer of the Cervical Fascia of the Neck May Not Exist

Pandit, J. J.; Dorje, Pema; Satya-Krishna, R.

doi:10.1097/00000542-200606000-00038

Cited by 12 publications

(10 citation statements)

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“…According to recent work by Guidera et al [ 35 ], the cervical fasciae can be classified as superficial and deep, although, instead of using the term “superficial cervical fascia,” the more specific term “subcutaneous tissue” has been suggested to reduce confusion with the superficial layer of the deep cervical fascia [ 36 ]. The deep cervical fascia can be divided into three layers [ 35 ]: (a) the superficial layer, which was also called the investing fascia but is now referred to as the masticator fascia, submandibular fascia, or sternocleidomastoid (SCM)-trapezius fascia, although it has been argued that the SCM-trapezius fascia is incomplete between the SCM and trapezius muscles [ 21 , 22 ]; (b) the middle layer, which is suggested as to be named as strap muscle fascia or visceral fascia; and (c) the deep layer, which is suggested to be named as the perivertebral fascia instead of the prevertebral fascia because the term “prevertebral fascia” should be used for the anterior part only. The carotid space, containing major vessels, the deep cervical lymph nodes, and nerves, is a very important structure that can be affected during a CPB, and this space is usually referred to as the “carotid sheath and its contents” [ 36 ].…”

Section: Anatomymentioning

confidence: 99%

Cervical plexus block

Kim

Bang

et al. 2018

Korean J Anesthesiol

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Cervical plexus blocks (CPBs) have been used in various head and neck surgeries to provide adequate anesthesia and/or analgesia; however, the block is performed in a narrow space in the region of the neck that contains many sensitive structures, multiple fascial layers, and complicated innervation. Since the intermediate CPB was introduced in addition to superficial and deep CPBs in 2004, there has been some confusion regarding the nomenclature and definition of CPBs, particularly the intermediate CPB. Additionally, as the role of ultrasound in the head and neck region has expanded, CPBs can be performed more safely and accurately under ultrasound guidance. In this review, the authors will describe the methods, including ultrasound-guided techniques, and clinical applications of conventional deep and superficial CPBs; in addition, the authors will discuss the controversial issues regarding intermediate CPBs, including nomenclature and associated potential adverse effects that may often be neglected, focusing on the anatomy of the cervical fascial layers and cervical plexus. Finally, the authors will attempt to refine the classification of CPB methods based on the target compartments, which can be easily identified under ultrasound guidance, with consideration of the effects of each method of CPB.

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Section: Anatomymentioning

confidence: 99%

Cervical plexus block

Kim

Bang

et al. 2018

Korean J Anesthesiol

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“…The peri-operative analgesic efficacy was nearly the same in the two groups US and LM. This may be explained by the assumption that the investing layer of fascia thought to be under the SCM may not exist at all [23,24], therefore drugs injected subcutaneously without the use of US can diffuse easily into the targeted intermuscular plane [24] and produce effective anesthesia of the SCP. Moreover, the superficial location of the branches of the SCP renders them easy to be anesthetized blindly by subcutaneous injection of local anesthetic mixture [23,24].…”

Section: Discussionmentioning

confidence: 99%

“…This may be explained by the assumption that the investing layer of fascia thought to be under the SCM may not exist at all [23,24], therefore drugs injected subcutaneously without the use of US can diffuse easily into the targeted intermuscular plane [24] and produce effective anesthesia of the SCP. Moreover, the superficial location of the branches of the SCP renders them easy to be anesthetized blindly by subcutaneous injection of local anesthetic mixture [23,24]. Our practice didn't report any adverse events with the landmark-based BSCPB because the volume of local anesthetic was not excessive and depth of injection was not >5 mm, while performing the block, to avoid spread of local anesthetics to phrenic nerve or recurrent laryngeal nerve.…”

Section: Discussionmentioning

confidence: 99%

Analgesic efficacy of ultrasound guided versus landmark-based bilateral superficial cervical plexus block for thyroid surgery

Hassan

Hashim

2017

Egyptian Journal of Anaesthesia

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a b s t r a c tBackground: The use of bilateral superficial cervical plexus block (BSCPB) to provide analgesia for thyroid operations remains debatable. This study was done to assess the analgesic efficacy and safety of ultrasound (US) guided or landmark-based BSCPB, performed under general anesthesia, compared to systemic narcotics in thyroid surgery. Patients and methods: A total of 69 patients ASA I and II scheduled for thyroid surgery were randomly assigned into three groups (23 patients each): Group (US) received US guided BSCPB. Group (LM) received landmark-based BSCPB. In both groups, the block was performed under general anesthesia and before surgery using 0.5% bupivacaine 12 ml on each side. Group (C) who didn't receive any block. We measured intra-operative hemodynamics and fentanyl requirements. We also measured postoperative analgesia within 24 h of surgery as regard: pethidine consumption, visual analogue scale (VAS) pain scores and time to first rescue analgesic demand. Postoperative nausea and vomiting (PONV) and other adverse events were noted as well.Results: There was a significant reduction in systolic blood pressure (SBP) and heart rate (HR) in groups US and LM compared with group C. Intra-operative fentanyl requirements were significantly increased in group C compared to groups US and LM. Time to first analgesic request was significantly longer in groups US and LM than in group C. Postoperative pethidine consumption and VAS scores, measured during the first postoperative day, were significantly higher in group C than groups US and LM. No significant difference was noted between the three groups regarding PONV. No other adverse events were recorded. No significant differences were noted between groups US and LM. Conclusion: BSCPB (US guided or landmark-based), performed under general anesthesia, effectively decreased peri-operative analgesic requirements in thyroid operations. However, there was no significant difference in analgesic efficacy or safety between US guided and landmark based BSCPB.

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“…Another explanation stems from the fact the socalled investing fascia, traditionally thought to be located underneath the sternocleidomastoid muscle, may not exist. 16,17 Thus, local anesthetics injected subcutaneously (LM group) can potentially diffuse freely into the sternocleidomastoid-scalene intermuscular plane (injection site of US group). 17 However, because of the small sample size, we cannot exclude the possibility that our study was underpowered to detect a small difference between the 2 techniques.…”

Section: Discussionmentioning

confidence: 99%