颈前区舌骨上区.ppt

1.额顶枕区层次结构如何?皮下、腱膜下、骨膜下血肿的扩展范围有何不同?,课前复习题,2.颅顶部的血管、神经及其来源如何？,颈部浅层结构、舌骨上区SuperficialStructuresoftheNeckandSuprahyoidRegion,DepartemntofHumanAnatomy，theSecondMilitaryMedicalUniversity,上界：下颌骨下缘、下颌角、乳突、上项线与枕外隆突的连线,下界：胸骨上缘、锁骨和肩峰至第7颈椎棘突的连线,颈部的境界Boundaryoftheneck,颈部(胸锁乳突肌)：颈前区anteriorregion胸锁乳突肌区sternocleidomastoidregion颈外侧区lateralregion,颈部(斜方肌前缘)：固有颈部properneck项部nape,颈部分区Districtionoftheneck,颈部三角Trianglesoftheneck,颈外侧区(肩胛舌骨肌下腹)：枕三角和锁骨上三角,颈前区(舌骨),舌骨上区,舌骨下区,下颌下三角,颏下三角,颈动脉三角,肌三角,触摸颈部表面标志Surfacelandmarkoftheneck,舌骨hyhoid(H)甲状软骨thyroidcartilage(T)喉结节laryngealprominence(P)环状软骨cricoidcartilage(C)第1气管环1sttrachealringe(1)甲状腺峡isthmus(S),浅筋膜sup.fascia,颈筋膜浅层superficiallayerofcervicalfascia,皮肤skin,颈阔肌platysma,颈丛皮支superficialbr.ofcervicalplexus,浅静脉sup.veinsoftheneck,颈浅淋巴结sup.cervicallymphnodes,颈部浅层结构Superficialstructuresoftheneck,皮肤切口Incisionoftheskin,1.颈阔肌2.颈深筋膜浅层3.颈前V,解剖颈阔肌Platysma,解剖颈部浅静脉Superficialveinsoftheneck,观察颈浅淋巴结Superficialcervicallymphnodes,颈丛皮支：耳大N，颈横N，锁骨上N，肩胛上N,解剖颈丛皮支Superficialbr.ofcervicalplexus,颈筋膜及筋膜间隙Cervicalfasciaandfascialspaces,浅层-封套筋膜,中层-气管前筋膜甲状腺鞘颈动脉鞘,深层-椎前筋膜,斜方肌,胸锁乳突肌,斜角肌,颈筋膜及筋膜间隙Cervicalfasciaandfascialspaces,胸骨上间隙、气管前间隙、咽后间隙、椎前间隙,解剖舌骨上区Suprahyoidregion,二腹肌digastric；下颌舌骨肌mylohyoid；茎突舌骨肌stylohyoid；颏舌骨肌geniohyoid,二腹肌后腹,二腹肌前腹,下颌舌骨肌,颏舌骨肌,mylohyoid,digastric,舌骨上肌suprahyoidmuscles：,下颌下腺submandibulargland的位置：,解剖下颌下三角Submandibulartriangle,舌神经,舌咽神经,舌下神经,下颌下腺,舌动脉,下颌下腺导管,舌骨舌肌,茎突咽肌,茎突舌肌,舌下腺,下颌下腺submandibulargland的毗邻：,解剖下颌下三角Submandibulartriangle,下颌下腺submandibulargland的毗邻：,周围：下颌下淋巴结submandibularlymphnodes上方：舌Nglossaln.下方：舌下Nhypoglossaln.外侧：面A、Vfaciala.&v.内侧：下颌下腺导管submandibularduct舌骨舌肌hyoglossus,解剖下颌下三角Submandibulartriangle,1.颈部的境界与分区及重要体表标志。2.颈丛皮支的浅出点及其临床意义，各皮支的分布。3.下颌下淋巴结的位置。4.下颌下腺的位置和毗邻。,重点内容,1.颈部阻滞麻醉的应用解剖2.二腹肌后腹的毗邻关系3.下颌下腺的位置和毗邻,小结,颈浅丛阻滞麻醉在胸锁乳突肌后缘中点进针，向上、向下注射。,颈丛阻滞麻醉的应用解剖Appliedanatomyofblockanesthesiaofthecervicalplexus,颈深丛阻滞麻醉：体位和方向：仰卧位，头转向头侧；垂直并稍向尾侧倾斜，注向24颈椎横突。层次：皮肤浅筋膜颈阔肌深筋膜椎前筋膜椎前肌注意事项：蛛网膜下隙、膈神经、喉返神经、颈交感干、椎动脉,颈丛阻滞麻醉的应用解剖Appliedanatomyofblockanesthesiaofthecervicalplexus,二腹肌后腹的毗邻关系Adjacentstructuresoftheposteriorbellyofdigastric,浅面：耳大神经、下颌后静脉、面神经颈支深面：颈内动、静脉、颈外动脉、迷走神经、副神经、舌下神经、颈交感干上缘：耳后动脉、面神经、舌咽神经下缘：枕动脉、舌下神经,下颌下腺的位置和毗邻AdjacentsandLocationoftheSubmandibularGland,周围：下颌下淋巴结submandibularlymphnodes上方：舌Nglossaln.下方：舌下Nhypoglossaln.外侧：面A、V