What are Langer's lines and why are they important in neck surgery?

Langer's lines are cleavage lines in the skin of the neck that run transversely. Surgical incisions made along these lines heal with minimal scarring, which is crucial for cosmetic outcomes in neck procedures.

What structures are found in the superficial fascia of the neck?

The superficial fascia contains loose areolar tissue with the platysma muscle, cutaneous nerves and veins (deep to platysma), and superficial lymph nodes and vessels. It has more subcutaneous fat in children and women than in men.

What is the platysma muscle and what does it do?

The platysma is a thin, broad muscle in the superficial fascia of the neck. Its actions include relieving venous pressure by forming vertical ridges on neck skin and depressing the mandible and drawing the angle of the mouth down/laterally (contributing to a horror expression). It is innervated by the cervical branch of the facial nerve.

What are the main cutaneous nerves of the neck and where do they come from?

The main cutaneous nerves are derived from the cervical plexus (ventral rami of C2–C4) and include the lesser occipital nerve (C2), great auricular nerve (C2, C3), transverse cervical nerve (C2, C3), and supraclavicular nerves (C3, C4). The posterior skin is supplied by dorsal rami of C2–C4.

What is the external jugular vein and why is it clinically significant?

The external jugular vein is a superficial vein formed by the union of the posterior auricular vein and posterior division of the retromandibular vein. It drains into the subclavian vein and is clinically important because cutting it at its entry into deep fascia can cause air embolism, it is used for central venous access (right side preferred), and distension at 45° can indicate increased right atrial pressure, such as in congestive heart failure.

What are the superficial lymph nodes of the neck and what do they drain?

Superficial lymph nodes form a pericervical collar around the head-neck junction. Key groups include submental (drains tip of tongue, chin, lower lip), submandibular (drains cheek, face, upper lip, gums, anterior tongue), preauricular (drains scalp, auricle, eyelids, cheeks), retroauricular (drains scalp, auricle), and occipital (drains scalp, palpable in rubella).

Why is the platysma muscle important in neck surgery?

In surgery, the platysma must be sutured separately to prevent adhesion and ugly scarring. Additionally, if retracted, it can keep cut veins open, leading to continued bleeding unless the deep fascia is also divided.

Superficial Neck – Platysma, Veins & Nerves

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