Pretracheal fascia

The pretracheal fascia is the middle layer of the deep cervical fascia, situated in the anterior part of the neck, where it encloses both the infrahyoid muscles and the visceral structures of the neck. It is typically divided into two portions: a muscular (infrahyoid) part and a visceral part.

Muscular part of pretracheal fascia

The muscular part invests the strap muscles—the sternohyoid, sternothyroid, omohyoid, and thyrohyoid—and extends from the hyoid bone and thyroid cartilage superiorly to the posterior surface of the manubrium and clavicles inferiorly, where it becomes continuous with the clavipectoral fascia of the thorax.

Visceral part of pretracheal fascia

• The visceral part encloses the thyroid and parathyroid glands, trachea, and esophagus, forming a fascial compartment that supports these structures and allows smooth gliding during swallowing and neck movement.

• Superiorly, it attaches to the thyroid cartilage and cricoid cartilage, while inferiorly, it descends into the thorax, blending with the fibrous pericardium.

• Posteriorly, the visceral part continues as the buccopharyngeal fascia, which covers the posterior surface of the pharynx and separates it from the retropharyngeal space.

• Laterally, the pretracheal fascia blends with the carotid sheath.

Functions

Functionally, the pretracheal fascia anchors the visceral compartment of the neck, permits mobility of the trachea, esophagus, and larynx during swallowing, and acts as a barrier to the spread of infection. However, infections deep to this fascia (such as in the retropharyngeal space) may track inferiorly into the superior or anterior mediastinum due to its continuity with the thoracic fascia.