Regional anatomy of neck - 山东大学精品课程建设工作.ppt

regionalanatomyofneck 山东大学医学院解剖教研室李振华 partsandregionsoftheneck boundariessuperior alinejoininginferiorborderofmandible angleofmandible tipofmastoidprocess superiornuchallineandexternaloccipitalprotuberanceinferior alinejoiningjugularnotch sternoclavicularjoint superiorborderofclavicle acromionandspinousprocessesofc7 landmarksoftheneck hyoidbone舌骨thyroidcartilage甲状软骨cricoidcartilage环状软骨catotidtubercle颈动脉结节 landmarksoftheneck hyoidbone舌骨thyroidcartilage甲状软骨cricoidcartilage环状软骨catotidtubercle颈动脉结节 landmarksoftheneck sternocleidomastoidsuprasternalfossagreatersupraclaviclarfossa regionsofneck neck颈anteriorregionofneck颈前区sternocleidomastoidregion胸锁乳突肌区lateralregionofneck颈外侧区nape项部 trianglesofanteriorregionofneck suprahyoidregion舌骨上区submentaltriangle颏下三角submandibulartriangle下颌下三角infrahyoidregion舌骨下区carotidtriangle颈动脉三角musculartriangle肌三角 trianglesoflateralregionofneck occipitaltriangle枕三角supraclaviculartriangle锁骨上三角 greatersupraclavicularfossa 锁骨上大窝 skinoftheneck thenaturallineofcleavageoftheskinareconstantandrunalmosthorizontallyaroundtheneck superficialfascia contentsplatysma颈阔肌superficialveinsanteriorjugularv 颈前静脉externaljugularv 颈外静脉cutaneousnerveslesseroccipitaln 枕小神经greetauricularn 耳大神经transversenerveofneck颈横神经supraclavicularn 锁骨上神经cervicalbranchoffacialn 面神经颈支 cervicalfascia颈筋膜 superficiallayerofcervicalfascia颈筋膜浅层 investingfascia封套筋膜 enclosestrapezius sternocleidomastoid posteriorbellyofdigastricandparotidandsubmandibularglandsattachedtobonylandmarksofupperandlowerboundariesofneckandzygomaticarchofface cervicalfascia颈筋膜 pretracheallayer气管前层liesdeeptotheinfrahyoidmuscleenclosesvisceraofneck pharynx larynx trachea esophagus thyroidglandandparathyroidglandscompletelysurroundsthyroidgland formingasheathforit andbindtheglandtolarynxtoformsuspensoryligamentofthyroidgland甲状腺悬韧带extendsfromarchofcricoidcartilage thyroidcartilageandhyoidbonetofibrouspericardiumofsuperiormediastinum cervicalfascia颈筋膜 prevertebrallayer椎前层liesanteriortobodiesofcervicalvertebraeandprevertebralmuscles extendsfrombaseofskulldownwardintothesuperiormediastinum continuouswithanteriorlongitudinallig andendothoracicfasciacoverssubclavianvesselsandrootsofbrachialplexusextendsintoupperlimbasaxillarysheath cervicalfascia颈筋膜 carotidsheath颈动脉鞘formedbycomponentsofallthreelayersofdeepcervicalfasciacontainscommonandinternalcarotidarteries internaljugularvein andvagusnerve fasciaspaces筋膜间隙 suprasternalspace胸骨上间隙3 cmabovemanubriumofsternitheinvestingfasciasplitsintotwolayers whichareattachedtotheanteriorandposteriormarginsoftheupperborderofthemanubrium betweenthesetwolayersisaslit likespace calledthesuprasternalspacecontainsconnectivetissue andsometimesalymphnode fasciaspaces筋膜间隙 pretrachealspace气管前间隙liesbetweenpretracheallayerandcervicalpartoftracheacontainsarteriathyroideaima inferiorthyroidv unpairedthyroidvenousplexus brachiocephalictrunkandleftbrachiocephalicv fasciaspaces筋膜间隙 retropharyngealspace咽后间隙liesbetweenprevertebrallayerandbuccopharyngealfasciaprevertebralspace椎前间隙liesbetweenprevertebralmuscles cervicalpartofvertebralcolumnandprevertebrallayer anteriorregionofneck颈前区 suprahyoidregion submentaltriangle颏下三角liesbelowthechinboundarieslaterallybyanteriorbelliesofdigastricinferiorlybythebodyofhyoidbonecoveredbyskin superficialfasciaandinvestingfasciafloor mylohyoidmusclescontents submentallymphnodes suprahyoidregion submandibulartriangle下颌下三角boundariesanteriorandposteriorbelliesofdigastriclowerborderofthebodyofthemandiblecoveredbyskin superficialfascia platysmaandinvestingfasciafloor mylohyoid hyoglossusandmiddleconstrictorofpharynxcontents submandibulargland faciala v hypoglossaln linguala v andn submandibularganglionandsubmandibularlymphnodes infrahyoidregion carotidtriangle颈动脉三角boundariesanteriorborderofsternocleidomastoidsuperiorbellyofomohyoidposteriorbellyofdigasticcoveredbyskin superficialfascia platysmaandinvestingfasciadeep prevertebralfasciamedial lateralwallofpharynx infrahyoidregion carotidtriangle颈动脉三角contentscommoncarotida anditsbranchesinternaljugularv anditstributarieshypoglossaln withitsdescendingbranchesvagusnerveaccessorynervedeepcervicallymphnodes infrahyoidregion ralationsofposteriorbellyofdigasticsuperficialgreatauricularn retromandibularv cervicalbranchoffacialn deepinternalandexternalcarotida internaljugularv cranialn cervicalpartofsympathetictrunksuperiorlyposteriorauriculara faciala glossopharyngealn infeiorlyoccipitala hypoglossaln infrahyoidregion musculartriangle肌三角boundedbymidlineoftheneck superiorbellyoftheomohyoidandanteriorborderofthesternocleidomastoid coveredbyskin superficialfascia platysma anteriorjugularv coutaneousn andinvestingfasciadeep prevertebralfascia infrahyoidregion musculartriangle肌三角contentssuperiorbellyofomohyoidsternohyoidsternothyroidthyrohyoidthyroidglandparathyroidglandcervicalpartoftracheaandesophagus thyroidgland甲状腺 shapeandpositionh shapeleftandrightlobes lieoneithersideofinferiorpartoflarynxandsuperiorpartoftrachea extendfrommiddleofthyroidcartilagetolevelofsixthtracheacartilageisthmus overlies2ndto4thtrachealcartilagepyramidallobe sometimesarisesfromisthmus thyroidgland甲状腺 coveringsofthethyroidglandfalsecapsule asheathofpretrachealfasciawhichisattachedtoarchofcricoidandthyroidcartilagestoformthesuspensoryligamentofthyroidgland hence thethyroidglandmoveswithlarynxduringswallowingandoscillatesduringspeakingtruecapsule fibrouscapsulespacebetweensheathandcapsuleofthyroidgland therearelooseconnectivetissue vessels nervesandparathyroidglands thyroidgland甲状腺 relationsofthethyroidglandanteriorly skinsuperficialfasciainvestingfasciainfrahyoidmusclesandpretrachealfasciaposteromedially larynxandtracheapharynxandesophagusrecurrentlaryngealnerveposterolaterally carotidsheathwithcommoncarotida internaljugularv andvagusn cervicalsympathetictrunk arteriesofthethyroidgland superiorthyroida 甲状腺上动脉branchofexternalcarotida runssuperficialandparalleltotheexternalbranchofsuperiorlaryngealn toreachtheupperpoleofthyroidglandgivesoffsuperiorlaryngeala incompanywithinternalbranchofsuperiorlaryngealn arteriesofthethyroidgland inferiorthyroidartery甲状腺下动脉branchofthyrocervicaltrunkofsubclaviana turnsmediallyanddownward reachestheposteriorborderofthethyroidgland whereitiscloselyrelatedtotherecurrentlaryngealn suppliesinferiorpoleofthyroidgland arteriesofthethyroidgland arteriathyroideaima甲状腺最下动脉mayarise 4 fromthebrachiocephalica oraorticarch nervesofthelarynx superiorlaryngealn 喉上神经internalbranch内支 whichpiercesthyrohyoidmembranetoinnervatesmucousmembraneoflarynxabovefissureofglottisexternalbranch外支 isfinen whichdescendsincompanywiththesuperiorthyroida andsuppliescricothyroid nervesofthelarynx recurrentlaryngealnerves喉返神经ascendintracheo esophagealgroovepassdeeptothelobeofthethyroidglandandcomeintocloserelationshipwiththeinferiorthyroida crosseitherinfrontoforbehindthearteryofmaypassbetweenitsbranchesnervesenterlarynxposteriortocricothyroidjoint thenerveisnowcalledinferiorlaryngealnerveinnervations laryngealmucosabelowfissureofglottis alllaryngeallaryngealmusclesexceptcricothyroid venousdrainageofthethyroidgland superiorthyroidveinsdrainintointernaljugularveinmiddlethyroidveinsdrainintointernaljugularveininferiorthyroidveinsoftwosidesanastomosewithoneanotherastheydescendinfrontofthetracheatoformunpairedthyroidvenousplexus甲状腺奇静脉丛 theydrainintobrachiocephalicveins parathyroidgland甲状旁腺 yellowish brown ovoidbodiespositiontwosuperiorparathyroidglands lieatjunctionofsuperiorandmiddlethirdofposteriorborderofthyroidglandtwoinferiorparathyroidglands lieneartheinferiorthyroidartery closetotheinferiorpolesofthyroidglandfunction regulatecalciumandphosphatebalanceandisthereforeessentialforlife cervicalpartoftrachea气管颈部 beginsatlowerendoflarynx levelofc6vertebraconsistsofaseriesofincompletecartilageringsextendsintothorax relationsofcervicalpartoftrachea气管颈部 anteriorlyskinsuperficialfasciainvestingfasciasuprasternalspaceandjugulararchinfrahyoidmusclesandpretrachealfasciaisthmusofthyroidgland infrontofthe2ndto4thtrachealcartilage inferiorthyroidv andunpairedthyroidvenousplexusarteriathyroidima ifpresent thymus leftbrachiocephalicv andaorticarchinchild relationsofcervicalpartoftrachea气管颈部 superolaterallylobesofthethyroidgland downasfarasthesixthring posteriorlyesophagusr l recurrentlaryngealnervesposterlaterallycervicalsympathetictrunkcarotidsheath cervicalpartofesophagus食管颈部 extendingfrompharynxatlevelofc6vertebradescendsthroughtheneck itinclinestotheleftsiderelationsofthecervicalpartofesophagusanteriorlytrachearecurrentlaryngealnervesposteriorlyprevertebrallayerofcerviclfascialonguscollivertebralcolumnlaterallylobeofthethyroidglandcarotidsheathwithcommoncarotida internaljugularv andvagusn sternocleidomastoidregion胸锁乳突肌区 coveredbysternocleidomastoidcontentsansacervicaliscarotidsheathcervicalplexuscervicalpartofsympathetictrunk rootofneck颈根部 atthoracicinletformedbyanteriorly manubriumsterniposteriorly bodyoffirstthoracicvertebralaterally firstribandcostalcartilagecentralmarkers scalenusanterior rootofneck颈根部 contentscupulaofpleura extendsupintotheneck overtheapexoflung 2 3cmabovethemedialthirdofclaviclesubclavianv thoracicductandrightlymphaticductsubclaviana vagusn phrenicn triangleofthevertebrala 椎动脉三角 boundariesmedially longuscollilaterally scalenusanteriorinferiorly firstpartofsubclaviana apex transverseprocessofc6posteriorly cupulaofpleura transverseprocessofc7 anteriorramiofc8spinalnerves costalneckof1stribanteriorly carotidsheath phrenicn andarchofthoracicduct left contentsvertebrala andv inferiorthyroida cervicalpartofsympathetictrunkcevicothoracicganglion lateralregionofneck颈外侧区 boundedbyposteriorborderofsternocleidomastoid anteriorborderoftrapeziusandmiddlethirdofclavicledividedbyinferiorbellyofomohyoidintooccipitaltriangleandsupraclaviculartriangle occipitaltriangle枕三角 boundedbyposteriorborderofsternocleidomastoid anteriorborderoftrapeziusandsuperiorborderofinferiorbellyofomohyoidcoveredbyskin superficialfascia andinvestingfasciadeep prevertebralfasciaandscalenusanterior scalenusmedius scalenusposterior spleniuscapitisandlevatorscapulaeconentsaccessoryn emergesabovethemiddleoftheposteriorborderofsternocleidomastoidandcrossestheoccipitaltriangletotrapeziuscervicalandbrachialplexuses supraclaviculartriangle锁骨上三角 boundedbyposteriorborderofsternocleidomastoid inferiorbellyofomohyoidandmiddlethirdofclaviclecoveredbyskin superficialfascia andinvestingfasciadeep prevertebralfasciaandinferiorpartsofscalenusconentssubclavianv andvenousanglesubclaviana brachialplexus skinincisions maketheskinincisionsshowninfigurereflecttheskinposteriorlytowellbehindtheear dissectionofsuperficialstructures notetheunderlyingplatysmamuscle amuscleoffacialexpression whichhasmigratedontotheneck beneaththeplatysmaliethesupraclavicularcutaneousnerves c3 4 medial intermediateandlateral slightlysuperiortothemiddleoftheposteriorborderofthesternocleidomastoidmuscle locatethespinalaccessorynervecoursingdownwardtowardthetrapeziusmuscle platysma dissectionofsuperficialstructures usingyourscissorsinciseandspreadthetoughfascialcoveringoftheposteriortriangleandlocatethelesseroccipitalnerve c2 3 emergingclosetocn notethedirectionthateachnervetakesasittraversestheposteriortriangle nextlocatethegreatauricularnerve c2 3 whichascendsposteriorandparallelwiththeexternaljugularveinonthesternoclidomastoid trytoidentifythesmalltransversecervicalnerve c2 3 supplyingskinovertheanteriorneck lookforthefacialvein retromandibularveinand ifpresent thesmallanteriorjugularvein andreviewtheexternaljugularsystem cutaneousnervesandsuperficialveins musculartriangle thistriangleincludesthe strap musclesthatlieanteriortothetrachea thesuperficiallayerofstrapmusclesconsistsofthesuperiorbellyoftheomohyoidandsternohyoid deeptothesearethesternothyroidandshortthyrohyoidmuscles spreadtheinfrahyoidmusclesapartandidentifythecricothyroidmembranestretchingbetweenthethyroidandcricoidcartilages carotidtriangle thistriangleisboundbythesuperiorbellyoftheomohyoid posteriorbellyofthedigastric andanteriorborderofthesternocleidomastoid dividethesternocleidomastoidmuscleabout5cmaboveitsinferiorattachmentandreflectthemuscletowardthemastoidprocesswhilepreservingthespinalaccessorynerve cutthefacialveinwhereitemptiesintotheinternaljugularvein carotidtriangle palpateandlocatethetipofthegreaterhornofthehyoidbone justsuperiortothetip findthehypoglossalnervewhereitcrossesthecarotidsheathanteriorlyandlataerally nowtrytofindthesuperiorrootoftheansacervicaliswhichiscomposedmainlyoffibersfromc1thatrunwiththecn theinferiorroot c2 3 descendsfromthemoreposteriorsuperiorneckregiontojointhesuperiorroot togetherformingaloopoverlyingthecarotidsheath theansainnervatestheinfrahyoidmusclesandoftenisenmeshedinthecarotidsheath carotidtriangle findthevagusnervebycarefullyopeningthecarotidsheath itlieswithinthecarotidsheathbetweenthecommoncarotidarteryandinternaljugularvein relaxtheneck andthensevertheomohyoid sternohyoid andthyrohyoidmusclesclosetothehyoidbone thisexposesthethyrohyoidmembraneandtheinternallaryngealnervecanbeseenpiercingthismembrane theotherportionofthesuperiorlaryngealnerveisitsverysmallexternallaryngealnerve carotidtriangle identifythecommoncarotidartery internalcarotidarteryandthecloselyappliedinternaljugularvein identifytheexternalcarotidarteryanditsfirstfivebranches superiorthyroida suppliestheupperpartofthethyroidglandandgivesoffthesuperiorlaryngealartery whichpiercesthethyrohyoidmembranewiththeinternallaryngealnerve linguala faciala occipitala ascendingpharyngeala carotidtriangle cleanthecarotidbifurcationandnotethedilatedproximalportionoftheinternalcarotidartery thisisthecarotidsinusregion inthebifurcation closelyadherenttotheinternalcarotidarteryisthecarotidbody anotherspecializedreceptor chemoreceptor whichmonitorsbloodo2andco2levels andph innervatedbyasmallbranchofcn thyroidgland exposethethyroidglandandverifythatitconsistsofrightandleftlobesandani