By John E. Skandalakis M.D., Ph.D., Lee John Skandalakis M.D., Panajiotis N. Skandalakis M.D. (auth.)
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Extra resources for Surgical Anatomy and Technique: A Pocket Manual
I. 24. Lateral view of the structures in the left carotid sheath at the base of the skull. The posterior belly of the digastric is shown in dotted outline. The hypoglossal nerve (not shown) hooks around the vagus and appears between the artery and the vein below the lower border of the digastric. (By permission of RJ Last, Anatomy: Regional and Applied. ) dible. The lower tip of the mastoid process is palpated and a fingertip is placed on the lateral surface pointing forward. The trunk of the facial nerve will be found deep and anterior to the center of the fingertip.
FASCIAE OF THE NECK The following classification of the rather complicated fascial planes of the neck follows the work of several investigators: 1. Superficial fascia 2. Deep fascia a. Investing layer (anterior or superficial layer) b. Middle, or pretracheal, layer (in front and below hyoid bone only) c. Prevertebral layer (posterior or deep layer) Superficial Fascia The superficial fascia lies beneath the skin and is composed of loose connective tissue, fat, the platysma muscle, and small unnamed nerves and blood vessels (Fig.
Also, it is important to remember that the lymph nodes lie within the envelope of the submandibular fascia in close relationship with the gland. Differentiation between gland and lymph node may be difficult. The anterior and posterior facial veins cross the triangle in front of the submandibular gland and unite close to the angle of the mandible to form the common facial vein, which empties into the internal jugular vein near the greater cornu of the hyoid bone. It is wise to identify, isolate, clamp, and ligate both these veins.