耳的解剖学PPT课件.ppt

耳科学Otology耳的解剖、生理、症状学,1,PartOne:Anatomyoftheear,颞骨毗邻：上方-顶骨前方-蝶骨、颧骨后方-枕骨颞骨分部:squamous(鳞部）mastoidpart(乳突)petrouspart(岩部)tympanicpart(鼓部)styloidprocess(茎突)构建颅中窝和颅后窝,颞骨解剖AnatomyofTemporalbone,2,PartOne:Anatomyoftheear,耳的解剖,Anatomy：outerearmiddleearinnerear,耳的解剖划分Anatomyoftheear,3,PartOne:Anatomyoftheear,外耳的解剖,outerear-auricle（耳廓）Externalauditorymeatus（外耳道）,Anatomyoftheouterear,耳轮,对耳轮,三角窝,耳轮脚,耳屏,对耳屏,舟状窝,耳甲腔,耳屏间切迹,耳垂,4,PartOne:Anatomyoftheear,耳廓除耳垂为脂肪与结缔组织构成而无软骨外，其余均以弹性软骨为支架，外覆软骨膜和皮肤前面的皮肤与软骨粘连甚紧，皮下组织少，在炎症发生肿胀时，感觉神经受压迫而引起剧痛耳廓的血肿及渗出物极难吸收耳部外伤手术可引起软骨膜炎，甚至引起耳廓变形耳廓血管表浅，皮肤菲薄，很易受冻,外耳的解剖,耳廓的解剖特点,5,PartOne:Anatomyoftheear,外耳的解剖,outerear-auricle（耳廓）Externalauditorymeatus（外耳道）,Externalauditorymeatus,长约2.5-3.5cm，外1/3为软骨部，内2/3为骨部外耳道呈“”形弯曲外耳道有二个生理狭窄外耳道皮下组织甚少外耳道皮肤是耳廓皮肤的延续软骨部皮肤富有毛囊，皮脂腺及耵聍腺-厚骨部皮肤缺乏毛囊结构-菲薄,6,PartOne:Anatomyoftheear,中耳的解剖,鼓室tympaniccavity咽鼓管eustachiantube鼓窦tympanicantrum乳突mastoidprocess,Anatomyofmiddleear,7,PartOne:Anatomyoftheear,鼓室容积容积约1-2ml鼓室的划分上鼓室epitympanum中鼓室mesotympanum下鼓室hypotympanum鼓室间距上下径-15mm前后径-13mm内外径-上鼓室约6mm中鼓室约2mm下鼓室约4mm,图5-1-9,中耳的解剖,Tympaniccavity(鼓室),8,PartOne:Anatomyoftheear,中耳的解剖,Tympaniccavity(鼓室),前壁：颈内动脉、鼓膜张肌半管和咽鼓管鼓室开口后壁：面神经垂直段，鼓窦入口上壁：鼓室天盖、岩鳞裂fissurapetrosquamosa下壁：颈静脉球、颈内动脉,9,PartOne:Anatomyoftheear,中耳的解剖,Tympaniccavity(鼓室),内壁鼓岬promontory卵圆窗ovalwindow圆窗roundwindow面神经水平段facialnervecanal外侧半规管lateralsemicircularcanal外壁鼓膜、上鼓室外侧壁,10,PartOne:Anatomyoftheear,中耳的解剖,Tympanicmembrane,鼓膜：大小：9mm8mm厚度：0.1mm结构：上皮层纤维层黏膜层鼓膜表面的主要标志象限划分：四个象限-意义：定位、穿刺,11,PartOne:Anatomyoftheear,中耳的解剖,Tympaniccavity鼓室内容：听小骨ossicles：锤骨(malleus)砧骨(incus)镫骨(stapes)听骨韧带：锤、砧、镫鼓室肌肉：鼓膜张肌tensortympanimuscle镫骨肌stapediusmuscle,锤骨,镫骨,Ossicularchain,12,PartOne:Anatomyoftheear,中耳的解剖,鼓室tympaniccavity咽鼓管eustachiantube鼓窦tympanicantrum乳突mastoidprocess,Anatomyofmiddleear,13,PartOne:Anatomyoftheear,中耳的解剖,咽鼓管是沟通鼓室与鼻咽部的管道起-止，长约35mm外1/3是骨部，内2/3是软骨部（近咽部侧）静止时咽鼓管呈闭合状态,其主要功能是调节中耳内外之压力，引流中耳之分泌物小儿的咽鼓管特点？平、短、宽,Pharyngotympanictube,为什么小儿容易患急性中耳炎？,14,PartOne:Anatomyoftheear,中耳的解剖,鼓室tympaniccavity咽鼓管eustachiantube鼓窦tympanicantrum乳突mastoidprocess,Anatomyofmiddleear,15,PartOne:Anatomyoftheear,中耳的解剖,乳突Mastoidprocess2岁发育，6岁基本成熟分成三型气化型(pneumatictype)硬化型（坚实型）(sclerotictype)板障型(diploetictype),Mastoidprocess,16,PartOne:Anatomyoftheear,内耳的解剖Anatomyoftheinnerear,内耳又称为迷路(labyrinth)位于颞骨岩部，有听觉和位觉功能迷路骨迷路osseouslabrinth膜迷路membranouslabyrinth膜迷路位于骨迷路之内膜迷路内充满内淋巴液endolymph膜迷路与骨迷路之间充满外淋巴液perilymph,17,PartOne:Anatomyoftheear,内耳的解剖theinnerear,骨迷路由致密的骨质构成,前庭vestibule骨半规管semicirculecanal耳蜗cochlear,18,PartOne:Anatomyoftheear,内耳的解剖vestibule前庭,后部有五个开口外壁有前庭窗、圆窗前庭嵴（vestibulecrest）球囊隐窝、椭圆囊隐窝,19,PartOne:Anatomyoftheear,内耳的解剖semicirculecanal,外半规管(水平)lateralsemicircularcanal前半规管(垂直)anteriorsemicircularcanal后半规管(垂直)posteriorsemicircularcanal,20,PartOne:Anatomyoftheear,内耳的解剖cochlear,耳蜗由中央的蜗轴和周围的骨蜗管组成，骨蜗管围绕蜗轴21/223/4周，底周相当于鼓岬蜗轴伸出骨螺旋板将骨蜗管分成上下二腔，上腔又由前庭膜分成2腔，故蜗管内共有前庭阶、中阶、鼓阶,21,PartOne:Anatomyoftheear,内耳的解剖membranouslabyrinth,膜迷路-由膜管和膜囊组成椭圆囊球囊膜半规管膜蜗管,图,22,PartOne:Anatomyoftheear,内耳的解剖Cortiorgan,23,PartOne:Anatomyoftheear,内耳的解剖Cortiorgan,24,PartOne:Anatomyoftheear,内耳的解剖membranouslabyrinth,25,PartOne:Anatomyoftheear,内耳的血管基底动脉(或小脑前下动脉)迷路动脉(Labyrinthineartery)前庭动脉前庭蜗总动脉蜗固有动脉耳蜗前庭蜗动脉半规管,内耳的血液供应,为什么迷路动脉功能受限会引起耳聋，眩晕,?,26,PartOne:Anatomyoftheear,第2、3级神经元有交叉和不交叉神经纤维，一侧外侧丘系或皮层受损，导致双侧听力减退，对侧为重,蜗神经及其传导通路,螺旋神经节(spinalganglion)周围突-分布于螺旋器的毛细胞中枢突-形成蜗神经(cochlearnerve)蜗神经背核和腹核上橄榄核外侧丘系核下丘内侧膝状体听中枢（上颞横回）,27,PartOne:Anatomyoftheear,前庭神经及其传导通路,前庭神经节前庭神经纤维前庭神经核（上、外、内、下）前庭脊髓纤维与脊髓前角细胞相连，引起颈部、躯干和四肢肌肉的发射性反应上升纤维经内侧纵束到达同侧和对侧的动眼神经、滑车神经和外展神经核前庭神经内核发出纤维通过脑干的网状结构与植物神经细胞群连接，引起植物神经系统反应，恶心呕吐、面色苍白出