系统解剖学之头部

头部The Head,头部位于人体躯干的最上部，其骨性支架包括脑颅骨和面颅骨；脑颅骨围成颅腔，容纳中枢神经系统的脑，面颅骨形成面部的骨性支架，参与构成眼眶、鼻腔和口腔 。,头部的境界和分区 Boundary & Division of the head,颅部Cranium头部 面部Face,颅骨的重要结构Important structures of the skull,茎乳孔 Stylomastoid foramen 面神经 Facial nerve 眶上孔 Supraorbital foramen 眶上神经Supraorbital nerve眶下孔 Infraorbital foramen 眶下神经Infraorbital nerve颏孔 Mental foramen 颏神经Mental nerve翼点Pterion : fracture 硬膜外血肿 epidural hemotoma 前囱 Bregma : (acalcerosis 缺钙症 ),颅顶 Calvaria颅底Cranial base 颅腔Cranial cavity,Bregma,Ant. Branch ofMid. Meningeal a.,皮肤Skin浅筋膜Superficial fascia帽 状 腱 膜Epicranial aponeurosis腱膜下疏松结缔组织Subaponeurotic loose connective tissue颅骨外膜Pericranium,颅部 Cranium,额顶枕区,层次 Layers,浅筋膜层中的血管和神经Vessels & Nerves in Superficial fascia,ScalpProper,前组Ant. group,滑车上神经、动脉Supratrochlear n. a.眶上神经、动脉Supraorbital n. a.,中组Med. group,耳颞神经Auriculotemporal n. 颞浅动脉Superficial temporal a. 枕小神经Less occipital n. 耳后动脉Posterior auricular a,后组Post. group,枕大神经Greater occipital n. 枕动脉Occipital a.,Occipitofrontalis,S kinC onective tissueA poneurosisL oose connective tissueP ericranium,Frontoparietooccipital region Scalp,颞区（颞窝） Temporal Region (Fossa),层次Layers,皮肤Skin浅筋膜Superficial fascia 耳颞神经Auriculotemporal n. 颞浅动脉Superficial temporal a. 面 神 经 颞 支Temporal branch of facial n. 颞 筋 膜Temporal fascia颞 肌Temporalis : A fan-shaped masticatory muscle,浅层Superficial layer深层Deep layer,境界Boundary,上 颞 线Upper temporal line颧 弓Zygomatic arch,颅骨外膜Pericranium,面部The face,浅层结构Superficial structures,皮肤 Skin: 皮纹 cleavage lines浅筋膜Superficial fascia: 富于血管,表情肌Facial Muscles,眼轮匝肌Orbicularis oculi口轮匝肌Orbicularis oris ,神经 Nerves,Facial nerve面神经,颞支Temporal branches颧支Zygomatic branches颊支Buccal branches下颌缘支Mandibular branch颈支Cervical branch,Stylomastoidforamen,眶下神经Infraorbital n.,Terminal branchesof trigeminal nerve三叉神经终末支,眶上神经Supraorbital n.滑车上神经Supratrochlear n.,上颌神经Maxillary n.,下颌神经Mandibular n.,眼神经Ophthalmic n.,耳颞神经Auriculotemporal n. 颏神经Mental n.,阻滞麻醉Block anaesthesia 三叉神经痛 Trigeminal neuralgia,茎乳孔,. 血管Vessels,Facial a.,下唇动脉Inferior labial a. 上唇动脉Superior labial a. 鼻外侧动脉Lateral nasal a.,内眦动脉Angular a.,Superficial temporal a.,Facial v. Angular v. 面静脉 内眦静脉,SuperiorOphthalmic v.眼上静脉,Deep facial v.面深静脉,Pterygoidv. Plexus翼静脉丛,InferiorOphthalmic v.眼下静脉,Cavernous Sinus海绵窦,No valves,头皮Scalp,面横动脉Transverse facial a.,危险三角Dangerous Triangle,颞浅动脉,面动脉,腮腺 Parotid gland,位置Position: 位于口腔的外侧壁；在耳廓auricle与 咬肌后1/3部分posterior 1/3 of surface of masseter交界处,分部Division,浅部Superficial part深部Deep part,峡部Isthmus,腮腺管Parotid duct,Surface of masseter,口腔Oral cavity,Second upper molar tooth,通过腮腺的重要结构Important structures through parotid gland,颈外动脉 External carotid artery颞浅动脉 Superficial temporal a耳颞神经 Auriculotemporal n.下颌后静脉 Retromandibular vein,Trans. Facial a.面横动 脉面神经Facial nerve,Parotidplexus,Facial Paralysis面神经瘫,咬肌浅面,解剖步骤 Dissection1.皮肤切口Skin incision,1) 正中矢状切口 A median sagittal incision 自枕外隆突external occipital protuberance到鼻根处root of nose,2) 冠状切口A coronal incision 自上一切口Midpoint of above incision的中点切至耳廓根部root of auricle,3) 另一条正中切口Another median sagittal incision 自上一正中切口的鼻根处 Root of nose下延至下颌尖chin,4)横行切口 A transverse incision 自正中切口的鼻根处从眼裂上下方绕过切至耳廓根部5) 另一条横行切口a transverse incision 从下颌尖处Chin延切至下颌角处angle of mandible,1.开腮腺咬肌筋膜，寻认腮腺管;2.腮腺上缘，前缘和下切缘分别找出面N分出的五组分支;,寻认面A（咬肌前缘与下颌体下缘相交处），可向内上方追踪至内眦A。,1.逐块除去腮腺组织，向后追踪面N各分支，在面N进入腮腺处切断面N，向前翻起，观察深面结构：下颌后V、颈外A等。2.腮腺上缘近耳根处，找出颞浅A/V及后方伴行的 耳颞N。,面侧深区Deep area of lateral face （颞下窝）,境界Boundary,顶：蝶骨大翼的颞下面底：平下颌骨下缘前壁：上颌骨体后面后壁：腮腺深部外侧壁：下颌支内侧壁：翼突外侧板,主要内容Main Contents 1、翼内肌、翼外肌external pterygoid m. and medial pterygoid m.2、翼静脉丛pterygoid venous plexus3、上颌动脉maxillary a. 4、下颌神经mandibular n,翼内肌、翼外肌External pterygoid m. and medial pterygoid m.,面侧区的间隙1、咬肌间隙（咬肌与下颌支之间，下颌支浅面）2、翼下颌间隙（翼内肌与下颌支之间，下颌支深面）,翼内肌：起自翼窝和上颌结节， 止于下颌支内侧面的翼肌粗隆。,翼外肌：有两头，上头起自 蝶骨大翼的颞下面，下头起自 翼突外侧板的外面。两头止于 翼肌凹及颞下颌关节囊。,上颌动脉的分段及分支,第1段主要分支：下牙槽A脑膜中A第2段主要分支：颊A颞深前、后A第3段主要分支：上牙槽后A眶下A,下颌神经,卵圆孔出颅，主干短，行于翼外肌深面运动支支配咀嚼肌感觉支包括1、颊N2、耳颞N3、舌N4、下牙槽N,解剖面侧深区,1、沿颧弓下缘切断咬肌起点；沿上缘切开颞筋膜，掀向颅顶。,2、在颧弓最前方和关节结节前方锯断颧弓。,3、自下颌切迹中点到下颌支前缘与体交界处凿断下颌骨冠突，连带向上翻起颞肌。修洁、显露颞下窝内的肌 肉、血管和神经： 1）观察翼V丛，然后除去； 2）寻认上颌A及其分支；3）下颌神经的分支。,5、除去颞下颌关节盘和下颌头及其连带的翼外肌向前翻起，寻认下颌N主干及其分支。,4、锯断下颌颈和下颌支，进一步显露上述结构。,硬脑膜及硬脑膜窦,硬脑膜分内外两层内层在颅腔内折叠形成大脑镰、小脑幕、鞍膈等在某些部分，内外两层间衬以内皮，形成硬脑膜窦。如上矢状窦、下矢状窦、横窦、海绵窦等,颅底（内面） Internal Surface of Cranial Base,颅前窝Ant. cranial fossa:额叶Frontal lobes 颅中窝Mid. cranial fossa: 颞叶Temporal lobes 颅后窝Post. cranial fossa: 脑干、小脑Brain stem & Cerebellum,蝶鞍区Region of Sella turcica,Hypophysial fossa 垂体窝,Dorsum sellae 鞍背,Sulcus chiasma 交叉沟,鞍结节Tubercle of sellae,Sphenoidal sinus 蝶窦,碟鞍区的重要结构Important structures inRegion of Sella turcica,1.垂体Hypophysis (Pituitary gland),位置position,位于垂体窝内，鞍 膈的下方,毗邻关系Relations,前Ant：鞍结节tubercle of sellae 后Post：鞍背dorsum sellae 外侧Later：海绵窦cavernous sinus 下面Infer：碟窦sphenoidal sinus上面Super: 视交叉optic chiasma,垂体瘤A pituitary tumor 压迫视交叉Optic chiasma 双颞半盲Bitemporal hemianopia Tunnel vision,Sphenoidal sinus 蝶窦,(III) Oculomotor nerve 动眼神经(IV)Trochlear nerve 滑车神经,2.海绵窦Cavernous Sinus, 为碟鞍两侧一对海绵样的硬脑膜静脉窦.,交通Communications,海绵窦Cavernous Sinus,Sphenoparietal Sinus 蝶顶窦Superficial middle cerebral v. 大脑中浅静脉Super & InferOphthalmic v眼上、下静脉,Sup. PetrosalSinus 岩上窦Inf. PetrosalSinus 岩下窦,Trans. Sinus 横窦Int. jugular v 颈内静脉,毗邻关系Relations,Internal carotid artery 颈内动脉(VI) Abducent nerve 展神经,穿过窦壁的结构Pass through lateral wall,Ophthalmic nerve 眼神经Maxillary nerve 上颌神经,(V),穿过窦内结构Pass through,开颅取脑,颅顶正中矢状和冠状皮肤切口，四瓣翻开头皮前平眶上缘上方1.5cm,后平枕外隆凸上方1.5cm，环形锯开颅骨。用骨凿沿锯缝撬开颅盖。注意分离硬脑膜和颅盖。,3、上矢状窦两侧由前向后剪开硬脑膜；由