Objective       To learn the anatomic features of the middle layer of the cervical fascia and its relations with adjacent structures to make the anterior cervical approach more reasonable and safer.      Methods         Twenty-two embalmed cadavers were dissected. At the midline the excise was made in the neck to expose the carotid sheath and the infrahyoid muscles so as to observe the morphous

texture of the middle layer of the cervical fascia and its relationships to the carotid sheath. The carotid sheath and visceral sheath were dissected and pulled bilaterally

meanwhile the texture and amount of the connective tissue between the visceral sheath a

nd carotid sheath were observed and assessed

and the difficulty during the blunt dissection between the visceral sheath and carotid sheath in the anterior cervical surgery was evaluated. The anatomic relationships between the middle layer of cervical fascia and the inferior thyroid artery and the right recurrent laryngeal nerve was observed

and the anatomic relationships between the carotid sheath and the inferior thyroid artery and the right recurrent laryngeal nerve was observed.      Results       The middle layer of the cervical fascia merged into the carotid sheath anterolaterally

and its layer and boundary was distinct. There was just a little loose connective tissue between the carotid sheath and visceral sheath deep to the middle layer of cervical fascia

which could be dissected readily. In the right neck

the recurrent laryngeal nerve exited from the prevertebral fascia at approximately the level of T

1

vertebrae at the medial posterior margin of the carotid sheath

but did not get touch with the middle layer of cervical fascia. The inferior thyroid artery exited from the prevertebral fascia at approximately the level of C

6

vertebrae at the medial posterior margin of the carotid sheath

but did not get touch with the middle layer of cervical fascia.      Conclusion       The anatomic features of the middle layer of cervical fascia and its relationships to the surrounding tissues can be utilized to make the anterior cervical approach more reasonable and safer.