CERVICOTHORACIC CONTINUUM

An understanding of the normal anatomic pathways that connect the cervical region with the mediastinum aids in the differential diagnosis of abnormalities and indicates how pathologic processes interrelate within the cervicothoracic spaces. A fascial envelope, the deep cervical fascia, surrounds the deep structures of the neck. The deep cervical fascia subdivides into 3 layers which define distinct compartments. In these lie the muscles of the neck, the pharynx and trachea, the esophagus, lymph nodes and large blood vessels and nerves as they course from the cervical to the thoracic area. Pathologic processes arising from these structures can spread through the cervicothoracic area via these fascial planes and extend from the facial and pharyngeal structures above to the mediastinum and diaphragm below. Human cadavers, after hanging upright, were frozen in dry ice for 24 h. Horizontal and sagittal sections were made of the cervical and thoracic areas. Regional dissection of the cadavers was also performed, and a correlation with the sectional anatomy obtained. Clinical cases were selected to illustrate the cervicothoracic spread of pathologic processes.