The investing layer of the deep cervical fascia does not exist between the sternocleidomastoid and trapezius muscles.
OBJECTIVE
We sought to describe the 3-dimensional organization of connective tissues in the suboccipital region.


METHODS
We conducted a sectional anatomic investigation with the use of E12 sheet plastination.


METHODS
Six human adult cadavers (2 male and 4 female; age range, 54 to 86 years) were used in this study. Five of them were sectioned as 2.5-mm-thick coronal (1 cadaver), transverse (2 cadavers), or sagittal (2 cadavers) sections.


RESULTS
No aggregation of fibrous connective tissue was seen between the sternocleidomastoid and trapezius muscles. The intervening space was fully occupied by fatty tissue that was indistinguishable from the subcutaneous tissue.


CONCLUSIONS
The investing layer of the deep cervical fascia is incomplete so that the carotid sheath is directly exposed to the subcutaneous tissue via a gap between the sternocleidomastoid and trapezius muscle.


CONCLUSIONS
This anatomic feature should be considered when designing a minimally invasive endoscopic approach to the carotid sheath and the surrounding deep cervical structures.
Zhang
Ming
M
Department of Anatomy and Structural Biology, University of Otago, Dunedin, New Zealand. zhang.ming@stonebow.otago.ac.nz
Lee
Antonio S J
AS
D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000473:pathology*; D003238:Connective Tissue / Q000473:pathology; D005205:Fascia / Q000473:pathology*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008416:Mastoid / Q000473:pathology*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology*; D009778:Occipital Lobe / Q000473:pathology; D013249:Sternum / Q000473:pathology*