咽部的解剖Anatomy of pharynx.doc

咽部的解剖Anatomy of pharynx 1. 分部parts: 鼻咽 nasopharynx:咽鼓管咽口 eustachial orifice ,圆枕 torus tubalis, 咽隐窝pharyngeal recess,腺样体 adenoid口咽 oropharynx: 咽峡 fauces,咽侧索 lateral chorda,舌扁桃体 lingual tonsil喉咽 hypopharynx: 会厌谷 vallecular epiglottica,梨状窝 piriform fossa,环后隙retrocricoid space 2. 淋巴组织 lymphatic tissue内环 inner loop外环 outer loop 腭扁桃体 palatine tonsilla腺样体 adenoid咽的生理physiology of pharynx 1.呼吸功能 repiratory function 2.吞咽功能 swallowing function 3.语言形成 formation of speech 4.保护功能 protection 5.调节中耳压力 modulation of air pressure of middle ear 6.扁桃体的免功能 immune function of tonsilla喉的解剖Anatomy of larynx 1.喉软骨laryngeal cartilage单个one: 会厌软骨 epiglottic cartilage,甲状软骨 thyroid cartilage,环状软骨cricoid cartilage成对 double:杓状软骨 arytenoid cartilage,小角软骨 cornicular cartilage,楔状软骨 cuniform cartilage喉肌muscle of the larynx 杓会厌肌 aryepiglottic muscle杓肌 arytenoid muscle环杓后肌 posterior cricoarytenoid muscle环杓侧肌 lateral cricoarytenoid muscle环甲肌 cricothyroid muscle甲杓肌 thyroarytenoid muscle甲状会厌肌 thyroepiglottic muscle 2.喉腔 laryngeal cavity:3 portions声门上区 supraglottic portion:会厌epiglottis,勺会厌襞 aritenoepiglottic fold,勺区 arytenoid area,假声带 false vocal cord声门区 glottic portion:声带vocal cord 声门裂fissure of glottis前联合anterior commisure声门下区 infraglottic portion:声门旁区 glottic portion: 3.喉的血管blood vessel of larynx喉上动脉superior laryngeal artery环甲动脉cricothyroid artery喉下动脉inferior laryngeal artery 4.淋巴 lymphatics of larynx 声门上区supraglottic portion:淋巴管丰富lymphatic ducts are abundant,引流至颈深淋巴结上群drainage to upper group of deep cervical lymph nodes 声门下区infraglottic portion:淋巴管不丰富lymphatic ducts are not abundant,引流至颈深淋巴结下群drainage to lower group of deep cervical lymph nodes 声门区glottic portion:基本无淋巴管few lymphatic ducts 5.神经nerves:迷走神经vagus nerve喉上神经 superior laryngeal nerve 内支inner beanches 外支outer branches支配环甲肌 cricothyroid muscle喉返神经recurrent laryngeal nerve 除环甲肌以外喉肌laryngeal muscles except for cricothyroid muscle喉的生理physiology of larynx 1.呼吸 respiration 2.发音 phonation 3.保护 protection 4.屏气 holding breath急性化脓性扁桃体炎Acute suppurative tonsillitis 1.病因etiology 外部因素external factors:溶血性链球菌hemolytic streptococcus,其它细菌others bacteria,腺病毒adenoid virus 内因internal factors:抵抗力下降resistence decreasing 2.流行病epidemiology:传染性infectivity 3.临床表现clinical manifestationa.急性卡他性扁桃体炎acute catarral tonsillitisb.急性化脓性扁桃体炎acute suppurative tonsillitis 4.诊断和鉴别诊断Diagnosis and differencial diagnsis a.诊断diagnosis:症状和体症symptoms and signs b.鉴别诊断differencial diagnsis:咽白喉diphteria fauci,奋森氏咽峡炎Vicent angina(ulceromembranous angina),粒细胞减少性咽峡炎hypoleukocytic angina,猩红热scarlet fever 5.并发症Complication:a.局部并发症local complication:扁桃体周围脓肿peritonsillar abscessb.全身并发症general complication:风湿热rheumatic fever,急性关节炎acute arthritis,心肌炎cardiomyosis,急性肾炎acute nephritis 6.预防prevention 7.治疗treatment 慢性扁桃体炎Chronic tonsillitis 1.病因etiology 2.病理pathology 3.症状symptoms 4.检查examination 5.并发症complication:the same as acute tonsillitis 6.诊断diagnosis 7.治疗treatment腺样体肥大adenoid vegetation 1.临床表现clinical manifestation a.局部症状local symptoms:1.耳ear 2.鼻nose 3.咽喉和下呼吸道pharynx larynx and lower respiratory tract 4.腺样体面容Adenoid expression b.全身症状general symptoms 2.检查examination:1. 腺样体面容adenoid expression 2.口咽检查oropharygeal examination 3.前鼻镜检查anterior nasoscope 4.纤维鼻咽镜Nasopharygo-fibroscope 5.触诊palpation 6.X-ray 3.治疗treatment鼻咽癌Nasopharyngeal carcinoma 1.病因etiology:a:遗传因素genetic factors b.病毒因素virus factors c.环境因素environmental factors 2.临床表现clinical manifestation 早期症状early symptoms: 1.出血bleeding 2.鼻堵塞nose:obstruction 3.耳部症状ear symptoms 4.颈淋巴结肿大enlargement of cervical lymph nodes 晚期症状 late symptoms: (1).头痛headache (2).颅神经症状Symptoms of cranial nerve 3.检查Examination(1)鼻咽镜nasopharyngeal-scope(2)CT (3)X-ray 4.诊断diagnosisa.活检biopsyb.细胞涂片sliding of cellsc.EB病毒抗体antibody of EB virusd.误诊率高missed diagnosis is highe.鉴别诊断 5.治疗treatment(1)放疗radiation:important method(2)化疗chemotherapy(3)手术surgery喉癌Laryngeal carcinoma 1.病因etiologya.吸烟smokingb.饮酒drinking c.空气污染air pollutiond.病毒感染virus infectione.癌前病变precancerous lesionsf.激素hormone 2.病理pathology(1)鳞癌占90%squamous cell carcinoma:90%(2)分型types:3型3 types声门上癌supraglottic carcinoma声门癌glottic carcinoma声门下癌infraglottic carcinoma(3)原位癌carcinoma in situ(4)继发癌secondary carcinoma 3.临床表现clinical manifestation (1)音哑hoarseness (2)喉痛sore throat (3)异物感sensation of foreign body (4)呼吸困难dyspnea (5)吞咽困难dysphagia (6)血痰blood spitting 声门上癌supraglottic carcinoma:early :异物感sensation of foreign body ,喉痛sore throat,吞咽困难dysphagia,血痰blood spitting 声门癌glottic carcinoma:音哑hoarseness,呼吸困难dyspnea 声门下癌infraglottic carcinoma:早期无症状,咳嗽,血痰early no symptoms,cough,blood spitting晚期呼吸困难,侵犯环甲膜,甲状腺late:dyspnea,invasion of cricothyroid membrane,thyroid gland 4.扩散和转移spread and metastasis:3 types(1)直接扩散direct spreading(2)淋巴转移lymphatic metastasis(3)血行转移blood metastasis 5.检查examination(1)体格检查physical examination:喉体膨大,会厌前间隙饱满enlargement of larynx,fullness of pre-epiglottic space(2)间接喉镜,纤维喉镜,喉动态镜indirect laryngoscope,fibro-laryngoscope,laryngostroboscopy 6.诊断diagnosis(1)病史:40岁以上,音哑4周以上history:above 40 years old,hoarseness,above 4 weeks(2)活检biopsy(3)X-ray,CT 鉴别诊断differential diagnosis(1)喉结核laryngeal tuberculosis(2)喉梅毒laryngeal syphilis(3)喉乳头状瘤laryngeal papilloma 7.治疗treatment(1)放疗radiation:a.1期病变stage 1 lesion b.不适合手术not suitable to operation(2)手术surgury:全喉切除术total laryngectomy,喉部分切除术partial laryngectomy,颈廓清neck resection(3)激光laser:KTP 喉阻塞Laryngeal obstruction 1.病因etiologya.感染Infection b.外伤injury c.异物foreign bodyd.水肿edemae.肿瘤tumors f.畸形deformityg.声带麻痹vocal cord paralysis临床表现Clinical manifestation a.吸气期呼吸困难 inspiratory dyspnea b.吸气期喉鸣 inspirarory laryngeal stridor c.吸气期软组织凹陷 inspiratory recess of soft tissue d.音哑 hoarseness f.紫绀 cyanosis检查examination:4度 1度.平静时无症状,运动和哭闹时轻度症状rest:no symptoms,motion and crying:mild symptoms 2度. 平静时轻度症状, 运动和哭闹时加重rest: mild symptoms,motion:agggravating 3度.严重吸气期呼吸困难severe inspirarory dyspnea 4度.极度吸气期呼吸困难more severe inspiratory dyspnea诊断和鉴别诊断diagnosis and differential diagnosis (1)病史,症状,体征history ,symptoms,signs (2)根据程度决定是否取材去除病因according to the degree,reasons should be detected or not 鉴别诊断differential diagnosis治疗treatment 10.保守治疗conservative treatment 40.立即气管切开或环甲膜切开immediate tracheostomy or intercricothyrotomy 20-30.根据条件和病因according to the conditions and etiologya.炎症inflammation:先保守,不好转气管切开conservation,tracheostomyb.异物,手术foreign body:operation咽后脓肿:切开,引流retropharyngeal abscess:incision and drainagec.肿瘤,双侧喉返神经麻痹,喉外伤不能立即去除病因,应气管切开tumor,bilateral recurrent nerve paralysis,injury of larynx,can not be resolved immediately tracheotomy气管切开术Tracheotomy anatomy解剖1.气管trachea2.软组织soft tissue3.血管blood vessel4.甲状腺峡部isthmus of thyroid gland适应症indication 1.喉阻塞laryngeal obstruction 2.下呼吸道阻塞和肺水肿Obstruction of lower respiratory tract and ischeotomy 3.预防性气管切开preventive tracheotomy步骤 procedures 1.体位posture 2.消毒disinfection 3.麻醉anesthesia 4.切口incision 5.分离软组织separation of soft tissue 6.暴露气管exposing of trachea 7.气管切开tracheotomy 8.插入套管insertion of cannula 9.缝合和固定suture and fixation术后护理postoperative nursing 1.保持内套管通畅keep inner cannula unobstructed 2.保持下呼吸道通畅keep lower respiratory tract unobstructed 3.切口消毒antiseption of incision 4.预防脱管prevent seperation of cannula 5.拔管decannulation:堵管 48小时后48 hours later after obstruction并发症Complication 1.皮下气肿subcutaneous emphysema 2.纵隔气肿mediastinal emphysema 3.气胸pneumatothorax 4.出血bleeding 5.拔管困难Difficulty in decannulation环甲膜切开Intercricothyrotomy耳部EAR 解剖anatomy 外耳the external ear(1) 耳廓auricle(2) 外耳道external acoustic meatus外耳道软骨部 external cartilaginous meatus外耳道骨部 external bony meatus 外耳的血液和神经 blood and nerve supply of the external ear中耳middle ear 鼓室tympanic cavity上,中,下鼓室epitympanum mesotypanum hypotympanum 6个壁6 walls外壁 outer wall 由鼓膜和上鼓室骨部外侧形成formed chiefly by the tympanic membrane and the outer bony wall of the epitympanum 鼓膜分为紧张部和松弛部tympanic membrane:pars tensa and pars flaccida 鼓膜由三层组织构成tympanic membrane consists of three layers外层为上皮层an outer epithelium中间为弹力组织 a middle elastic tissue内层为粘膜层 an inner mucous membrane 标志 marks of the drum of the ear脐部umbo,锤骨短突 short process of malleus,锤前皱襞anterior melleolar fold,锤后皱襞 posterior malleolar fold,光锥 cone of light, 锤骨柄 handle of malleus 内壁 inner wall鼓岬 promontory,前庭窗 vestibular window(oval windows), 蜗窗 cochlear window(round window), 水平半规管horizontal semicircular canal 前壁anterior wall咽鼓管开口opening of the Eustachian Tube鼓膜张肌 canal of the tensor tympani muscle 后壁posterior wall 上壁upper wall鼓室盖tegmen tympani 下壁lower wall 中耳含3块听小骨middle ear contains three ossicles锤骨malleus,砧骨 incus,镫骨 stapes 中耳肌肉包括鼓膜张肌和镫骨肌muscle of the middle ear:the tensor tympanic muscle,stapedius muscles 中耳的血液和神经支配blood and nerve supply of the middle earblood supply鼓室丛 tympanic plexus, 鼓索神经 chorda tympanic nerve 咽鼓管pharyngotympanic tube 鼓窦typanic antrum 乳突mastoid process:气化型pneumatic type板障型diploetic type硬化型sclerotic type混合型mixed type内耳the inner ear 迷路inner ear(labyrinth)骨迷路osseous labyrinth膜迷路membranous labyrinth:内淋巴endolymph外淋巴perilymph 骨迷路osseous labyrinth:前庭vestibule,骨半规管 osseous semicircular canals,蜗管cochlea 膜迷路membranous labyrinth:椭圆囊 utricle,球囊 saccule，膜半规管membranous semicircular canals,膜蜗管membraneous cochlear duct 内耳血液blood supply of inner ear耳生理 physiology of the ear 中耳生理the middle ear mechanism 耳蜗生理cochlear mechanism 听觉生理physiology of hearing气导 air conduction骨导 bone conduction外耳疾病diseases of external ear分泌性中耳炎secretory otitis media 定义definition 病因etiology 1.咽鼓管功能不良insufficiency of Eustachian tube(1)机械性堵塞mechanical obsruction(2)功能障碍dysfunction 2.感染infection 3.免疫反应immune responce 病理pathology 表现manifestation 1.听力减退Hearing loss,deafness 2.缺乏疼痛absence of pain 3.耳鸣tinnitus 检查examination 1.鼓膜the tympanic membrane 2.听力检查hearing examination 诊断diagnosis 鉴别诊断differential diagnosis 1.鼻咽部nasopharyngeal tumors 2.脑脊液耳漏cerebrospinal fistula 3.其它 others治疗treatment 1.鼓膜穿刺puncture of tympanic membrane 2.鼓膜切开 myrigotomy 3.鼓膜置管术 the tube in situ in the tympanic membrane 4.保持鼻腔通畅 keep nasal cavity unobstructed 5.咽鼓管吹张 eustachian tube inflation 6.病因治疗 etiology treatment 7.治疗鼻咽部疾病treatment of nasopharyngeal disease 8.抗生素antibiotics 9.激素hormone急性化脓性中耳炎acute suppurative otitis media 定义difinition 感染源sources of infection 1.咽鼓管Eustachian tube is the chief route(1)上呼吸道急性感染acute infetion of upper respiratory system(2)传染病infectious disease(3)游泳swimming(4)婴幼儿infantile 2.外耳道和鼓膜 external meatus and tympanic membrane 3.血行感染 blood infetion 病理 pathology 症状 symptoms 1.全身症状 general symptoms 2.疼痛 pain 3.耳聋和耳鸣 deafness and tinnitus 4.分泌物 discharge 预防 prevention 治疗 treatment 1.全身治疗general treatment (1)抗生素 antibiotics (2)滴鼻剂 drop nose(3)休息 rest 2.局部治疗 local treatment 穿孔前 before perforation(1) 滴鼻剂drop nose (2) 鼓膜切开术 myringotomy 穿孔后 after perforation(1)洗耳 washing ear(2)滴耳,水溶性 drop ear:water-soluble(3)当分泌物减少时,用酒精或甘油滴耳剂 when discharge decrease,glycerine or alcohol-soluble otic drop can be used(4)控制感染后,穿孔可愈合.如果不愈合,可行鼓膜修补术 after controlling of infection,perforation can heal.If perforation did not heal,myringoplsty should be undertaken 3.病因治疗Etiology treatment 慢性化脓性中耳炎chronic suppurative otitis media 定义 definition 病因 etiology 病理和临床表现 pathology and manifestation 1.单纯性 simple 2.骨疡性 caries 3.胆脂瘤 cholesteatoma 先天性胆脂瘤 congenital cholesteatoma 后天性胆脂瘤 acquired cholesteatoma 鉴别诊断 differential diagnosis (1)中耳癌 cancer of middle ear (2)中耳结核 tuberculosis otitis media 治疗 treatment 1.病因治疗 etiology treatment 2.局部治疗 local treatment耳源性并发症otogenic complication 病因etiology 1.中耳炎类型 Type of otitis media 2.细菌 bacteriology 3.病人机体抵抗力 resistence of patients 4.局部因素 local factors 传播途径speading way 1.血液循环circulation of blood 2.循破坏的骨壁 destruction of bone wall 3.正常的解剖途径 normal anatomical route分类classification 1.颅外并发症 extra cranial complications (1)耳后骨膜下脓肿 postauricular subperiosteal abscess(2)贝佐氏脓肿 Bezolds abscess(3)迷路炎 labyrinthitis(4)面瘫 facial nerve paralysis(5)岩尖炎 petrositis 颅内并发症 intracranial complication （1）硬膜外脓肿 extradural/perisinus abscess （2）乙状窦 lateral sinus thrombosis （3）脑膜炎 otitic meningitis （4）脑脓肿 cerebral abscess（ 5）硬膜下脓肿 subdural abscess （6）脑积水 otitic hydrocephalus （7）脑疝 brain herniation 诊断 diagnosis 1.病史 history of diseases 2.局部检查 local examination 3. 颅外和颅内并发症 extra cranial and intra cranial complications 4.X-ray and CT or MRI 5.类型 type of complication 治疗 treatment 1.手术 operation 2.抗生素 antibiotics迷路炎 labyrinthitis 1.限局性迷路炎circumscribed labyrinthitis or fistula of labyrinthitis 病理 pathology 表现 manifestation1.眩晕 vertigo 2.眼震 nystagmus3.听力损失 hearing loss4.漏孔试验 fistula test5.ENG治疗 treatment （1）抗生素 antibiotics （2）手术 operation2.浆液性迷路炎 serous labyrinthitis病理 pathology表现 manifestation1.眩晕 vertigo2.眼震 nystugmus 3.听力损失hearing loss 4.疼痛pain 鉴别诊断differential diagnosis 治疗treatment 3.化脓性迷路炎 suppurative labyrinthitis 病理 pathology 表现 manifestation1.眩晕 vertigo 2.平衡失调 dysfunction of equilibrium3.耳鸣耳聋 tinnitus and deafness 4.眼震 nystagmus5.体温 temperature6. 漏孔试验 fistula test 治疗treatment 1.抗生素 antibiotics 2.手术 operation 3.补液 supplyment of fluid脑脓肿brain abscess 1.感染途径 infection way 2.病理 pathology 3.表现 manifestation 4.诊断 diagnosis 5.鉴别诊断 differential diagnosis 6.治疗 treatment鼻科学第一章 鼻应用解剖学及生理学 外鼻、鼻腔、鼻窦呼吸功能保护功能嗅觉功能声音共鸣功能第一节鼻应用解剖学Anatomy of nose鼻（nose)由外鼻、鼻腔、鼻窦组成 一、外鼻 （external nose ） 外鼻的一些解剖名称 ：鼻根nasal root、鼻尖nasal apex、鼻梁nasal bridge、鼻背nasal dorsum、鼻翼alae nasi、鼻底basis nasi 、前鼻孔anterior nares、鼻小柱columella nasi、鼻唇沟nasolabial fold 一）支架Skeleton 由骨和软骨构成骨支架梨状孔pyriform aperture1、鼻骨 nasal bones上窄厚upper part narrow aand thick，下宽薄lower part wide and thin，容易骨折easy to fracture.2、软骨（1）隔背软骨：鼻外侧软骨、 鼻中隔软骨（2）大翼软骨（3）鼻副软骨二）皮肤 鼻尖和鼻翼为痤疮、鼻疖的好发部位。三）静脉回流外鼻静脉特点: characteristics of vein of external nose 1.与颅内海绵窦相通 connect with cavernous sinus 2.面部静脉无瓣膜 no valves in facial vein四）神经 运动神经：面神经，感觉神经主要是三叉神经第一支（眼神经）和第二支（上颌神经）的一些分支。五）淋巴回流 汇入下颌下淋巴结和腮腺淋巴结。二、鼻腔nasal cavity 分为鼻前庭nasal vestibule 、固有鼻腔nasal fossa proper （一）鼻前庭（二）固有鼻腔:内,外,顶,底四壁internal ,external,superior ,inferior wall1、内侧壁（鼻中隔nasal septum）由骨和软骨组成Little area 2、外侧壁 上、中、下鼻甲superior ,middle inferior turbinate 上、中、下鼻道superior ,middle inferior meatus（1）下鼻甲inferior turbinate及下鼻道inferior meatus： 鼻泪管nasolacrimal duct的开口（2） 中鼻甲middle turbinate及中鼻道middle meatus: 中鼻甲基板basal lamella，ground lamella 鼻丘agger nasi 钩突uncinate process 筛泡ethmoid bulla半月裂 semilunar hiatus筛漏斗ethmoid infundibulum窦口鼻道复合体 ostiomeatal complex，OMC （3）上鼻甲supeerior turbinate及上鼻道superior meatus 蝶筛隐窝sphenoethmoidal recess嗅沟olfactorty sulcus或嗅裂 总鼻道 common meatu 3、顶壁:前段为鼻骨和额骨鼻突构成，中段为筛骨水平板（筛板cribriform plate）,有嗅丝通过,易骨折，后段即蝶窦前壁。 4、底壁:硬腭的鼻腔面，前3/4由上颌骨额突palatine process of maxilla、后1/4由腭骨水平部horizontal process of palate bone构成 5、前鼻孔 6、后鼻孔posterior nares，choanae（三）鼻腔的粘膜 mucosa 1、嗅区粘膜olfactory region 分布在上鼻甲内面、部分中鼻甲内面和相对应的鼻中隔部分。 2、呼吸区粘膜respiratory region 大部分上皮有纤毛，粘膜内的杯状细胞、粘液腺、浆液腺能产生大量分泌物，粘膜下富有毛细血管和海绵状血窦。三、鼻窦nasal sinuses 概念:围绕鼻腔、藏于某些面颅骨内的含气骨腔 依其所在骨命名，既上颌窦 maxillary sinus、额窦frontal sinus、筛窦ethmoid sinus、蝶窦sphenoid sinus 鼻窦的开口部位：上颌窦、前组筛窦、额窦中鼻道，后组筛窦上鼻道，蝶窦蝶筛隐窝 鼻窦分组：前组筛窦-上颌窦、前组筛窦和额窦；后组鼻窦-后组筛窦和蝶窦（一）上颌窦maxillary sinus:位于上颌骨内,共5壁 前壁（面壁）anterior wall:中央薄,尖牙窝canine fossa 后外壁posterolateral wall:与翼腭窝和颞下窝毗邻，近翼内肌intropterygoid muscle,可致张口困难 上壁superior wall:眶下壁 inferior wall of orbite 下壁inferior wall:牙槽突，牙根感染有时可引起牙源性上颌窦炎 内壁internal wall:鼻腔外侧壁下部，此壁之后上部（贴近上壁之下）有上颌窦窦口通中鼻道（二）筛窦ethmoid sinus:位于筛骨内,蜂窝状,共六壁 外壁: lateral wall 眶内壁inferior wall of orbite,绝大部分为纸样板 内壁:鼻腔外壁的上部,附有中鼻甲,上鼻甲 顶壁:颅前窝底bottom of anterior cranial fossa的一部分，内侧与筛骨水平板相连接，顶壁与筛板的连接有两种方式：水平式（倾斜式）二是高台式 下壁:中鼻道外侧壁的结构，如筛泡ethmoid bullus、钩突和筛漏斗等 前壁:上颌骨额突frontal process of maxillae和额窦相接。 后壁:蝶窦前壁（三）额窦frontal sinus: 位于额骨鳞部下部和眶部之上，大小,形状不一致,有时可一侧或双侧不发育 前（外）壁：额骨外骨板 后（内）壁：额骨内骨板，与颅前窝内结构毗邻。 底壁：为眼眶顶壁和前组筛窦之顶壁，有额窦开口经鼻额管nasofrontal duct或经前组筛窦引流到中鼻道前端 内侧壁 ：实为两侧额窦之中隔，多偏向一侧。额隐窝 （FR）外侧壁为纸样板，内侧壁是中鼻甲最前上部分与前颅窝的最前部分，前方为鼻丘气房，后壁通常由筛泡前壁构成。（四）蝶窦sphenoid sinus:位于蝶骨体内,5个壁外侧壁:与颅中窝、海绵窦、颈内动脉internal cervical artery、视神经optic nerve毗邻。视神经管隆突或压迹位于前上方，颈内动脉隆土或压迹位于其后下。 顶壁：parietal wall:蝶鞍底部，承托垂体前壁：内侧为蝶骨嵴，蝶窦开口位于蝶骨嵴之旁。后壁：其后为枕骨之斜坡，毗邻脑桥。下壁：后鼻孔上缘和鼻咽顶，内壁：蝶窦中隔第四节 鼻生理学一、鼻腔生理学 （一）呼吸功能 respiration （二）保护功能 protection （三）嗅觉功能olfactory function （四）声音共鸣功能 resonance二、鼻窦生理学 鼻窦参与呼吸生理，无嗅黏膜，故无嗅觉功能，但鼻窦在声音共鸣以及减轻头颅骨重量和维持