颈部局部解剖课件

局部解剖学 九 颈部的局部解剖与操作 1 颈部Neck 概述introduction浅层结构superificalstructures下颌下三角submandibulartriangle颏下三角submentaltriangle 一 概述Introduction 境界和分区boundaryandregions表面解剖surfaceanatomy表面标志surfacelandmark体表投影surfaceprojection 上界 为下颌骨下缘 下颌角 乳突 上项线与枕外隆突的连线 Superiorly anlinelinkingwiththelowerborderofmandible theangleofmandible themastoidprocess thesuperiornuchallineandtheexternaloccipitalprotuberance 下界 由胸骨上缘 锁骨和肩峰至第7颈椎棘突的连线 Inferiorly bytheupperborderofsternum theclavicleandalineextendingfromtheacromiontothespineof7thcervicalvertebra 1 颈部的境界boundaryoftheneck 2 颈部分区 颈部 分为固有颈部 properneck 和项部 nape 固有颈部 又可分为颈前区anteriorregion 胸锁乳突肌区sternocleidomastoidregion和颈外侧区lateralregion 颈前区 被舌骨hyoid分为舌骨上区suprahyoidregion 包括2个下颌下三角和1个颏下三角 和舌骨下区infrahyoidregion 包括成对的颈动脉三角和肌三角 颈外侧区 被肩胛舌骨肌下腹分为枕三角和锁骨上三角 3 表面标志surfacelandmark Lessersupraclavicularfossa Greater supraclavicularfossa Suprasternalfossa 表面标志SurfaceLandmark 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Thefirsttrachealringe 1 甲状腺峡Isthmus S 环状软骨 弓 的意义第6颈椎水平Thelevelofthe6thcervicalvertebra 喉与气管交界Thejunctionofthelarynxwiththetrachea 咽与食管交界Thejunctionofthepharynxwiththeesophagus Thelevelatwhichthevertebralarteryentersthetransverseforamenofthe6thcervicalvertebra Thesiteatwhichthecarotidarterycanbepressedagainstthecarotidtubercleofthe6thcervicalvertebra Thelevelatwhichtheinferiorthyroidarteryandthemiddlethyroidveinenterorleavethethyroidgland Thelevelatwhichthesuperiorbellyoftheomohyoidmusclecrossesthecarotidsheath Thelevelofthemiddlesympatheticganglion 二 颈部浅层结构Thesuperficialstructuresoftheneck 皮肤Theskin thinandpliable 浅筋膜及其内容Thesuperficialfasciaanditscontentsathinlayeroffatasheetofplatysmatheanteriorjugularveinthelateraljugularveinthesuperficial lateralandanerior cervicallymphnodesthecutaneousbranchesofthecervicalplexusthecervicalbranchofthefacialnerve 1 颈阔肌Theplatysma Isabroad thinsheetofmuscleinthesubcutaneoustissue Coverstheanterolateralaspectoftheneck Aariseinfasciacoveringsuperiorpartsofthedeltoidandpectoralismajormusclesandsweepsuperomediallyovertheclavicletotheinferiorborderofthemandible skin andsubcutaneoustissueoflowerface Isoneofthemusclesoffacialexpression Isinnervatedbythecervicalbranchofthefacialnerve Thesuperficialcervicalveinsandnervesarelocateddeeptotheplatysma Themainactionoftheplatysma drawscornersofmouthinferiorlyandwidensitasinexpressionsofsadnessandfright drawstheskinofnecksuperiorlywhenteethare clenched 2 颈前静脉或颈前正中静脉 颈外静脉 颈静脉弓 Jugularvenousarch 3 颈浅淋巴结Superficialcervicallymphnodes 4 Superficialcervicalnerves CutaneousbranchesofthecervicalplexusNervepointofneckCervicalbranchofthefacialnerve 面神经的颈支Cervicalbranchoffacialnerve 三 颈筋膜及筋膜间隙CervicalFasciaandFascialSpace 1 颈筋膜CervicalFascia 颈深筋膜分为三层Deepcervicalfasciaconsistsofthreefasciallayers 浅层Superficiallayer封套筋膜Investingfascia中层Middlelayer气管前筋膜Prechachealfascia内脏筋膜Visceralfascia深层Deeplayer椎前筋膜Prevertebralfascia 封套筋膜 气管前筋膜 椎前筋膜 颈动脉鞘 气管前筋膜 甲状腺鞘 甲状腺悬韧带 2 颈筋膜间隙CervicalFascialSpaces 胸骨上间隙Suprasternalspace咽后间隙Retropharyngealspace气管前间隙Prechachealspace椎前间隙Prevertebralspace 胸骨上间隙 咽后间隙 气管前间隙 椎前间隙 胸骨上间隙的内容ContentsoftheSuprasternalspace Includethe 颈前筋膜下端Inferiorendsoftheanteriorjugularveins颈静脉弓Jugularvenousarch疏松结缔组织Looseconnectivetissue1 2个淋巴结Oneortwodeeplymphnodes 胸锁乳突胸骨头Sternalheadsoftheternocleidomastoid锁骨间韧带Interclavicularligament 锁骨上间隙的内容Contentsofthesupraclavicularspace Includethe 颈外静脉Apartoftheexternaljugularvein锁骨上神经Supraclavicularnerves 颈横静脉Transversecervicalvein肩胛上静脉Suprascapularvein淋巴管Afewlymphvessels 四 颏下三角SubmentalTriangle 境界Boundary内容Contents 颏下三角Boundarisofsubmentaltriangle Bodyofhyoidbone 颏下三角的内容Contentsofthesubmentaltriangle Includethe 几个小的颏下淋巴结Severalsmallsubmentallymphnodes 几条小静脉 汇合成颈前静脉Smallveinsthatunitetoformtheanteriorjugularvein 五 下颌下三角SubmandibularTriangle 境界Boundary内容Contents 1 下颌下三角Boundarisofthesubmandibulartriangle Aroofofthesubmandibulartriangleisformedbytheskin superficialfascia platysmaandinvestingfascia Afloorofthesubmandibulartriangleisformedbythemylohyoid hyoglossusandmiddlepharyngealconstrictor Middlepharyngealconstrictor Mylohyoid Hyoglossus 下颌下三角的底 下颌下三角的顶与底 2 下颌下三角的主要结构Maincontentsofthesubmandibulartriangle 下颌腺及其导管Submandibularglandanditsduct 面静脉Facialvein面神经的颈支Cervicalbranchoffacialnerve下颌下淋巴结Submandibularlymphnodes 面动脉Facialartery颏下动 静脉Submentalarteryandvein下颌舌骨肌神经Mylohyoidnerve舌下神经Hypoglossalnerve舌动 静脉Lingualarteryandvein舌神经LingualNerve 下颌下神经节Submandibularganglion 1 在下颌下腺的浅面有 面静脉 面神经的颈支 下颌下淋巴结 Cervicalbranchesoffacialnerve Mylohyoid 2 Thesubmandibularglandisdividedintothesuperficialanddeeppartsbytheposteriorborderofmylohyoid itsductemergesfromthedeepoftheglandandthenopensonthesublingualpapilla 3 在下颌下腺的深面 在下颌舌骨肌浅面的结构有颏下动脉和静脉 下颌舌骨肌神经 在舌骨舌肌浅面的结构有舌静脉 面动脉 舌下神经 下颌下神经节和舌神经 在舌骨舌肌深面的结构有舌动脉 4 下颌下腺深部及其导管的毗邻 自上而下为舌神经 下颌下神经节 下颌下腺及其导管 舌下神经 舌动脉和静脉 六 解剖与观察DissectionandObservation 1 Makeamedianskinincision2 Reflecttheskinflaps3 Reflecttheplatysma4 Dissectthesuperficialstructures5 Dissectthesubmentaltriangle6 Dissectthesubmandibulartriangle 1 Makeamedianskinincisionfromthementalsymphysistothesuprasternalnotch 2 Reflecttheskinflapslaterallytotheanteriorborderofthetrapeziustoexposetheplatysmadirectly 3 Dividetheplatysmaalongtheupperborderoftheclavicleandreflectitupwardstothemandible Donotdamagetheunderlyingstructures 4 Lookforandexposethesuperficialstructuresoftheneck 5 Cleanboundarisofthesubmentaltriangle 6 Cutthroughtheinvestingfasciatoexopsethesubmandibulargland thefacialvein thecervicalbranchesofthefacialnerveandsubmandibularlymphnodes Identifythefacialarteryandfollowittoitsorigin Dividetheoriginoftheanteriorbellyofthedigastricandrefl