Fascias and interfascial spaces are very important elements of human anatomy. During surgery on the neck or in the face, it is precisely the intercellular connective tissue that is removed, which is more susceptible to suppuration than other tissues.
What are cell spaces?
Cellular spaces are located between the muscle fascia. This space is nothing but connective tissue, loose in nature. A characteristic feature of this tissue is that all inflammations and suppurations quickly develop in it and then spread to nearby muscles and tendons.
We will consider the anatomy of these tissues in this article in order to understand why abscesses, phlegmon and other purulent diseases in these areas are very dangerous. And when you need to resort to surgery.
Functions and features of connective tissue
The loose connective tissue of which the cellular spaces of the head and neck are composed has many features. We list some of them:
- it has fat cells, mast, plasma and histiocytes;
- characterized by not too high (compared with other types of connective tissue) fiber content in the intercellular substance;
- has an amorphous substance, which is the main component of the tissue here;
- the main function of loose connective tissue is to interact with other types of living tissues.
Cellulose tissue fills the empty space between functional tissues and also contributes to the constant maintenance of homeostasis. Loose fiber is present in all parts of the body. She participates in all biological processes: in tissue healing, regeneration, and sclerotic changes.
Cell Space Anatomy
Let us take a closer look at the cellular spaces of the neck. The anatomy of this environment is also complex. Connective tissue has fibroblast cells . These cells produce an amorphous substance. Other cells - phagocytes, which are part of the tissue, are involved in the process of the immune response. During phagocytosis, bacteria and dead tissue are swallowed. This is the main immune power that maintains the health of the body.
Loose connective tissue is therefore the area where any slightest inflammation grows into an abscess, boil or phlegmon.
Myofibroblasts, mast cells (or basophils) and fat cells are also present in such connective tissue. Myofibroblasts synthesize collagen and essential contractile proteins. Mast cells lower blood coagulation and are involved in maintaining local homeostasis.
The formation of intercellular substance in fetal development occurs at 1-2 months of gestation. In total, connective tissue occupies almost 50% of the total body weight of a person.
Neck anatomy. Fascias. Their functions
The official anatomy distinguishes 3 plates of the cervical fascia and the carotid vagina. What is fascia in general in anatomy? This is a kind of framework for muscle fibers. Such a framework is an important element in our body. Fascias help to keep a tone, to distribute all power load.
There are several functions of the cervical fascia:
- Fascias on the neck contribute to the biomechanics of all muscles.
- Support the vessels of the neck and glands near the larynx.
- With tension, the fascia veins expand to increase blood flow from the brain. This is because the lining of the veins is fused with the adjacent fascia.
There are also several muscle fascia in the neck. They have their own structure and basic anatomical features.
According to Shevkunenko, the following fascia are distinguished:
- Superficial - a case for muscles under the skin.
- Own (surface).
- Own (deep plate).
- Intracervical Visceral and parietal leaflets are considered here. Parietal is located near the vascular bundle, and visceral - covers organs. In this case, the trachea and cervical glands.
- The prevertebral fascia covers the group of the posterior cervical muscles.
Fascias and cellular spaces of the neck form a single functional whole. Connective tissue is needed to nourish the muscles, to be the support of all systems - circulatory, nervous, muscle.
Topographic anatomy of the cellular spaces of the neck
The intercellular fissures filled with connective tissue are conditionally divided into closed and open (or communicating). First, consider the interfascial cellular spaces of the neck closed:
- Fascial bag of the submandibular gland. Between the leaves of the 2nd fascia and the lower jaw.
- Fascial bag of sternocleidomastoid muscle. It is located between the deep and superficial leaves of the 2nd fascia.
- Blind bags of a gruber. The suprasternal space, continuing beyond the sternocleidomastoid muscle.
- The suprasternal interaponeurotic space. It is located between the 2nd and 3rd fascia (above the sternum).
- The space of the thyroid gland. Between the visceral leaf of the 4th fascia and the capsule.
- Prevertebral space. Located between the 5th fascia and directly the vertebrae.
Unclosed include the following:
- Previsceral (preorganized) space. It is located between the parietal and visceral sheets of the 4th muscle fascia of the neck.
- Retrovisceral (posterior) fiber space of the neck. Between the parietal leaf of the 4th fascia and the 5th.
- The space of the side triangle. Located between the 2nd and 5th fascia.
- Neurovascular bundle. Near the parietal leaf of the 4th fascia.
This is the basis of the anatomy of the interfascial cellular spaces of the neck. This arrangement of the connective tissue of the muscles and vertebrae indicates the norm. Any irregularities in the topographic anatomy of this zone indicate an anomaly.
The location of the cellular spaces of the neck. Projection on organs and tissues
Consider what anatomical structures affect the cervical tissue. So, in order:
- The interaponeurotic suprasternal space covers the neck vein (superficial) and the jugular arch.
- Gruber bags are the final section of the jugular vein.
- The fascial bag of the stigmatus muscle is actually next to this muscle.
- The space of the submandibular gland - contains lymph nodes, salivary gland, blood arteries and veins.
- The thyroid gland is the blood vessels of this gland.
- The prevertebral space is the sympathetic brain stem.
- The space of the vascular bundle and preorganized - both cover the anterior mediastinum.
- The posterior - the posterior mediastinum.
- The area of the lateral triangle is the projection of the axillary and scapular region.
Cellular spaces of the head and neck, the anatomy of which, of course, are much more complicated than described, are important for the correct location of organs, form their stroma.
Cellular spaces of the face
Fiber of the face consists of the same type of connective tissue and the same fascial leaves. Let's start with the face.
There are 3 types of fascia. Namely superficial, intrinsic and visceral. The facial fascia of the face is divided, in turn, into: temporal, parotid, chewing, inter-wing-shaped and prevertebral.
In the face there are 9 main cellulite cracks:
- Chewing fiber space. It contains chewing muscle, pterygoid, and also some vessels and nerves. The deep part of this fiber communicates with the periopharyngeal space of the oral cavity.
- Temporal cellulose. The temporal portion attaches directly to the bone. Fascia encompasses deep temporal vessels and nerves, a muscle and 2 cell fissures, they are located just above the temporal muscle. These elements are paired.
- Buccal fatty lump. It is located a little deeper than the buccal muscle. It passes gradually into the cellular tissue of the canine fossa and infraorbital region.
- Fiber in the canine fossa region. Located between the periosteum of the jaw (upper) and facial facial muscles.
- Pharyngeal cellular space. It starts from the base of the skull at the top and goes down into the tissue of the esophagus.
- Anterior pharyngeal. Contains lymph nodes and ascending pharyngeal vessels. It communicates with the parotid gland and passes into the fiber of the bottom of the oral cavity.
- Zadiaphragmatic. This is a paired cellular space, which is located on the sides of the pharyngeal. Medially reaches the periopharyngeal fascia.
- The space of the parotid gland is limited by a special capsule created by the parotid chewing fascia. It contains important anatomical structures - the facial nerve, the branch of the carotid artery and part of the deep vein of the face. And here are the important lymph nodes.
- Cellular space of the bottom of the oral cavity. It is limited by the jaw-hyoid muscle and the shell of the bottom of the oral cavity. Here anatomists distinguish 5 separate intercellular clefts: the median, two medial and two lateral clefts.
The cellular spaces of the face and neck are studied in great detail on a course of surgical anatomy.
Fascia and fiber of the brain
As for the skull - the brain part of the head, there is only one department. Fronto-parieto-occipital region. Here is one fascia called the occipital helmet.
Fiber of the head is located under the periosteum, and therefore it is called the subperiostal fiber space. The periosteum itself fuses with the cranial bone along the suture line.
How is phlegmon of the neck or face formed and distributed?
If any infection enters the cellular region, infection may develop. The infectious and inflammatory process extends to the interconnected parts of the neck and face, and pus quickly encompasses the deep parts of the neck. Phlegmon - literally "heat" from the Latin - is purulent inflammation of the soft tissues.
The danger of phlegmon is that the focus of inflammation can develop into acute mediastinitis. Or the phlegmon will grow so much that it begins to squeeze the trachea.
The reasons for the accumulation of pus are acute diseases of the tonsils or the infection enters through the dental canals. The spread of infection is also likely due to inflammation of the cervical lymph nodes. These formations must be operated on if they have grown and interfere with breathing.
When a surgeon needs to make an incision in his neck, he should not engage a muscle or nerve. The incision is made in relatively safe places.
Face, neck surgery: indications
The cellular spaces of the head and neck contain important arteries, lymph nodes, and glands for life. And any, even small abscesses, should be observed by a doctor.
The indication for the operation is a very enlarged focus of inflammation, which is visible without appliances. Large abscesses and boils bring a lot of inconvenience and anxiety. Running abscesses can no longer be treated with drugs, lotions, and more. The doctor always requires pre-computed computed tomography, which will clearly show whether or not there are malignant tumors and serious neck anomalies. Then appoint the time of the operation.
How is the operation to remove phlegmon?
The interfascial cellular spaces of the face and neck, closed and communicating, are tissues on which the operation is relatively easy and quick. Phlegmon, which is not very deep in the tissues of the face or neck, is removed under local anesthesia. And the patient is in the day hospital at this time. And after a couple of days, if there are no complications, you may already forget about the operation.
Postoperative rehabilitation
After the focus of inflammation is removed, a person needs to rest from the operation for several hours. If the patient has lost blood, you need to make up for the loss. Any analgesics can be used only after 6-8 hours after surgery. If necessary, sometimes the neck is immobilized.
Doctors should tell how to eat a person in the postoperative period. If neither the trachea nor the muscles are damaged, a person can swallow food after a while. The surgical incision must be constantly monitored so that there is no suppuration, the dressing needs to be changed every day. But if a minimally invasive technique was used, then the patient is discharged after a day.
The entire postoperative period during which a person is observed is only 10-15 days.
findings
Cellulose tissue is located between the muscle fascia. The cellular spaces of the head and neck deserve attention. These spaces have their own anatomical structure, their functions are to maintain communication between different tissues and maintain a constant internal environment.
The topographic anatomy of the cellular spaces of the face and neck examines the location, interaction of connective tissues, their projection onto the skin and attitude to the skeleton.
In the case when the fiber has anomalies due to the development of inflammation, doctors prescribe an operation. Surgical removal of the affected tissue is then the only way out.