局部解剖头部

局部解剖学,头部的局部解剖与操作,头部 head,颅部颅顶额顶枕区 frontoparietooccipital region颞区 temporal region颅底与颅腔及其内容物面部面浅部 superficial part of the face腮腺咬肌区 Parotid and masseteric region 面深部 deep part of the face,一、概 述,境界与分区 Boundary and region of head表面解剖体表标志 surface landmark体表投影 surface projection,境 界 与 分 区,表面解剖,Mental foramen,Frontal tuber,Supraorbital foramen,Infraorbital foramen,Supraorbital notch,Frontal tuber,Pterion,Zygomatic arch,Angle of mandible,Mastoid process,External occipital protuberance,Temporal line superior,Eyebrow,体 表 投 影 Surface projection,1.Middle meningeal a.,2.Central sulcus,3.Lateral sulcus,二、颅顶,额顶枕区软组织的层次及其特点颞区软组织的层次及其特点,（一）Layers of Scalp (Frontal Section),Skin 皮肤Connective tissue 结缔组织Aponeurosis 帽状腱膜Loose connective tissue 疏松结缔组织Pericarnium 骨膜,浅筋膜内的血管神经,分组行径与分布特点及其临床意义,Layers of Scalp (lateral aspect ),（二）Layers of Temporal Region,1. 皮肤 skin2. 浅筋膜 Superficial fascia3. 颞筋膜 Temporal fascia4. 颞肌 Temporalis 5. 骨膜 Pericranium,咬 肌Masseter,颞 肌Temporalis,颞区各层次的结构特点,皮肤浅筋膜内的血管和神经颞筋膜的浅、深层颞肌颞肌深部的血管和神经,颞间隙,颞浅间隙：位于颞筋膜与颞肌之间。颞筋膜间隙：位于颞筋膜下部两层之间。颞深间隙：位于颞肌(筋膜)与骨膜之间。,三、面部,面部浅层结构the superficial structures of the face面侧区the lateral region of the face腮腺咬肌区 the Parotid and masseteric region 面侧深部 the deep part of the face,面部浅层结构 Superficial structures of face,皮肤 skin 浅筋膜 superficial fascia面表情肌 muscles of expression腮腺管 parotid duct 面动、静脉 facial artery and vein淋巴结 lymph nodes三叉神经 Trigeminal nerve面神经 facial nerve,面动脉 Facial Artery 三叉神经Trigeminal Nerve面神经 Facial Nerve,头 部 淋 巴 回 流Lymphatic drainage of the head,（二）腮腺咬肌区Parotid and Masseteric Region,腮 腺 parotid gland 位置和形态 morphology and location腮腺管 parotid duct 腮腺咬肌筋膜 Parotid-masseteric fascia腮腺淋巴结 Parotid lymph node腮腺内主要血管、神经的排列 Arrangement of main vessels and nerves in the parotid gland腮腺的毗邻 Relation of the parotid gland咬肌 Masseter,1.腮腺咬肌筋膜：咬肌筋膜和腮腺鞘,2. 腮腺parotid gland （1） 位置,（2）形态：呈不规则的楔形，底向外，尖向内突至咽旁；被面神经丛或下颌支后缘分为浅部和深部。,（3）腮腺管parotid duct：行程、体表投影、开口部位,Opening of the parotid duct,3. 腮腺的淋巴结：分为浅淋巴结（位于腮腺表面，引流耳廓、颅顶前部和面上部的淋巴）和深淋巴结（位于腮腺实质内，引流外耳道、中耳、鼻、腭和颊部深部的淋巴），其输出淋巴管注入颈外侧深淋巴结。,4.穿经腮腺的结构,纵行穿行腮腺的结构：Auriculotemporal n.Superficial temporal a .&.v. External carotid a. Retromandibular v. 横行穿行腮腺的结构：Transverse facial v.Facial n.Maxillary a.,面神经的颅外行程及分段,下颌后静脉,颈外动脉、耳颞神经,“parotid bed”,Glossopharyngeal n.,Vagus n.,Accessory n.,Hypoglossal n.,styloid process and its attached m.,Internal jugular v.,Internal carotid a.,Stylopharyngeus m.,Styloglossus m.,Stylohyoid m.,5. 腮腺的毗邻 relation of parotid gland,腮腺的毗邻,咬肌及其浅面的结构,咬肌、咬肌筋膜、咬肌神经面神经面横血管腮腺管腮腺浅部,二、面侧深区结构The deep structures of the lateral face,位置与境界 location and boundary翼内、外肌medial and lateral pterygoid musceles翼静脉丛 pterygoid venous plexus 上颌动脉 maxillary artery and its branches下颌神经 mandibular nerve,颞下窝 boundaris of infratemporal fossa,上界：蝶骨大翼的颞下面。superiorly - the infratemporal surface of the greater wing of the sphenoid bone and a portion of the squamous part of the temporal bone.,内侧界：蝶骨的翼突外侧板。Medially- the outer plate of the pterygoid process of the sphenoid bone,外侧界：下颌支的上部和颧弓。laterally- the upper portion of the ramus of mandible and the zygomatic arch,前界：颧骨的下部和上颌骨的颞下面。Anteriorly-the lower portion of the zygomatic bone and the infratemporal surface of the maxillary bone.,翼内、外肌,翼静脉丛 Pterygoid venous plexus上颌静脉Maxillary vein,上颌动脉Maxillary artery：行径、分段及其分支,下颌段下牙槽动脉脑膜中动脉翼肌段咀嚼肌动脉颊动脉翼腭窝段上牙槽动脉眶下动脉,下颌神经 mandibular nerve,颊神经 buccal nerve耳颞神经auriculotemporal nerve舌神经Lingual nerve下牙槽神经Inferior alveolar nerve,三、面部的间隙Spaces of face,咬肌间隙Masseteric space翼下颌间隙Pterygomandibular space 舌下间隙sublingual space,颞深间隙,颧弓深面,颞下间隙,翼下颌间隙,翼内肌后缘,咽旁间隙,咽后间隙,向后,下颌切迹,咬肌间隙,咽旁间隙,咽后间隙,颞浅间隙,颧弓深面,解剖步骤和注意事项Dissection notes and procedure,切口Incision,皮肤 Skin incision 翻皮瓣 Reflect the skin flaps,The scalp: identify the layers of the scalp,颞区浅层结构 The superficial part of temporal region 在耳屏前方解剖颞浅动、静脉和耳颞神经。In front of the tragus dissect the superficial temporal artery and vein and auriculotemporal n.,面浅层结构 The superficial part of the face,1. 暴露重要的面表情肌Expose the major facial muscles.,2.解剖面神经的分支清理腮腺的表面，寻找腮腺管和面神经的颏支，或在面神经浅面的下颌缘支。循着面神经分支逆行追踪至腮腺内面神经主干，然后循着面神经主干找到其分支，并追踪至所支配的面表情肌。,2. Dissect the branches of the facial nerve Clean the surface of the parotid gland, find out the parotid duct and the buccal branches of the facial nerve, or the marginal mandibular branches of the facial nerve superficial to the facial artery. Follow one of the branches of the facial nerve back through the parotid gland to the trunk of the nerve, and then trace the other branches of the facial nerve following the trunk of the nerve to the muscles of expression.,3. 解剖面动、静脉在下颌骨下缘与咬肌前缘交界处找到面动脉，并追踪至眼的内眦。注意保护跨过面动脉浅面的下颌缘支。找出并清理位于面动脉后方的面静脉。,3.dissect the facial artery and vein Find the artery at the junction of the lower border of the mandible of the anterior border of the masseter and then trace it to the medial angle of the eye. Preserve the marginal mandibular branches superfical to the facial artery. Find and clean the facial vein posterior to the facial artery.,4.解剖三叉神经的终末支在额肌和眼轮匝肌之间切开，寻找眶上神经和血管。在眼轮匝肌与提上唇肌之间切开，寻找眶下神经和血管。在下颌骨下缘切开降口角肌和降下唇，寻找颏神经和神经。,4. Dissect three terminal branches of the trigeminal nerveCut between the frontalis and the orbicularis oculi to find out the supraobital nerve and v