耳鼻咽喉应用解剖肖雪培训课件

1、The NoseExternal nose 外鼻Nasal cavity 鼻腔Paranasal sinuses 副鼻窦1耳鼻咽喉应用解剖肖雪10/3/2022The NoseExternal nose 外鼻1耳鼻咽喉应The External NoseNasal root 鼻根Nasal back 鼻背Nasal apex 鼻尖Alae nasi 鼻翼Nostrils 鼻孔Lateral nasal cartilage鼻外侧软骨2耳鼻咽喉应用解剖肖雪10/3/2022The External NoseNasal root 鼻外鼻静脉特点主要经面静脉和内眦静脉回流到颈内静脉。内眦静脉经眼上、眼

2、下静脉与颅内海绵窦相通，该区静脉无瓣膜内眦静脉 面静脉 颈内静脉 眼上/ 下静脉 海绵窦3耳鼻咽喉应用解剖肖雪10/3/2022外鼻静脉特点主要经面静脉和内眦静脉回流到颈内静脉。内眦静脉经Nasal cavity 鼻腔Nasal vestibule 鼻前庭Nasal vestibule is the anterior and inferior part of nasal cavity. It is lined by skin and contains sebaceous glands, hair follicles and hair.Nasal cavity proper 固有鼻腔4耳鼻咽喉应

3、用解剖肖雪10/3/2022Nasal cavity 鼻腔Nasal vestibuleNasal cavity properThe roof. Anterior sloping part of the roof is formed by nasal bones; Posterior sloping part by the body of sphenoid bone; The middle horizontal part, by the cribriform plate (筛板).5耳鼻咽喉应用解剖肖雪10/3/2022Nasal cavity properThe roof. Nasal ca

4、vity properThe floor . formed by the palatal process of the maxilla（上颌骨腭突）and the horizontal process of the palate bones（腭骨水平部）.3/41/46耳鼻咽喉应用解剖肖雪10/3/2022Nasal cavity properThe floor .Nasal cavity properNasal septum. 鼻中隔鼻中隔软骨犁骨筛骨正中板上颌骨腭突7耳鼻咽喉应用解剖肖雪10/3/2022Nasal cavity properNasal septuLittles area

5、（plexus）利特尔区 (动脉丛)Littles area （plexus）利特尔区 (动脉丛)Confluence of :Anterior Ethmoidal a. 筛前动脉 Greater Palatine a. 腭大动脉Sphenopalatine a. 蝶腭动脉Sup. Labial a. 上唇动脉8耳鼻咽喉应用解剖肖雪10/3/2022Littles area （plexus）利特尔区 (动Nasal cavity properLateral wall.three scroll-like bone projections called turbinate or conchae（鼻

6、甲）. Below and lateral to each turbinate is the corresponding meatus（鼻道）.9耳鼻咽喉应用解剖肖雪10/3/2022Nasal cavity properLateral walNasal cavity proper Lateral wall.Nasolacrimal duct (鼻泪管) opens in the anterior part of inferior meatus.鼻泪管开口于下鼻道的前方The anterior group of sinuses (frontal, marxillary and anterior

7、 ethmoidal sinuses) open to the infundibulum （筛漏斗）in middle meatus.前组鼻窦（额窦，前组筛窦，上颌窦）开口于中鼻道的筛漏斗。Posterior ethmoidal sinuses open into superior meatus.后组筛窦开口于上鼻道。The openning of sphenoid sinus situate is phenoethmoidal recess （蝶筛隐窝）lies above the superior turbinate.蝶窦开口位于上鼻甲上方的蝶筛隐窝10耳鼻咽喉应用解剖肖雪10/3/202

8、2Nasal cavity proper LateraPosterior naris (choanae) 后鼻孔Nasal septum鼻中隔 Inferior turbinate下鼻甲 Nasal cavity proper11耳鼻咽喉应用解剖肖雪10/3/2022Posterior naris (choanae) 后鼻Paranasal sinuses 副鼻窦The sinuses are air-filled bony cavities located in the face and skull adjacent to the nose. 12耳鼻咽喉应用解剖肖雪10/3/2022Par

9、anasal sinuses 副鼻窦The sinusMaxillary sinus 上颌窦 The maxillary sinus is the largest one, present in the maxilla bone. Drains into the nasal cavity through its ostium that is situated in the middle meatus. 13耳鼻咽喉应用解剖肖雪10/3/2022Maxillary sinus Ethmoid sinus 筛窦 Comprises a group of air cells, which form

10、one of the most complex structures in the body. Drains through the middle meatus and above the superior turbinate.14耳鼻咽喉应用解剖肖雪10/3/2022Ethmoid sinus 筛窦 ComprFrontal sinus 额窦 The frontal sinuses are situated beneath the bone of the forehead and just in front of the bone overlying the brain. And drain

11、s through the frontal recess（额隐窝）to the middle meatus.15耳鼻咽喉应用解剖肖雪10/3/2022Frontal sinus 额窦 The fSphenoid sinus 蝶窦 The sphenoid sinuses open in the upper part of anterior wall and drains into the sphenoethmoidal recess （蝶筛隐窝）. 16耳鼻咽喉应用解剖肖雪10/3/2022Sphenoid sinus 蝶窦 The spOstiomeatal complex 窦口鼻道复合体

12、The ostiomeatal complex is the sinus hot spot, one of the most important anatomical regions with regard to sinus health and disease. That comprises maxillary sinus ostia,anterior ethmoid cells and their ostia,ethmoid infundibulum, hiatus semilunaris, and middle meatus.筛漏斗及其周围的中鼻甲、钩突、筛泡、半月裂以及额窦、前组筛窦和

13、上颌窦的自然开口等结构形成的区域，称为鼻道窦口复合体(ostiomeatal complex)，是内窥镜鼻窦手术以后提出的新概念，对指导手术有重要意义。17耳鼻咽喉应用解剖肖雪10/3/2022Ostiomeatal complex 窦口鼻道复合体 鼻瓣膜区nasal valve area生理性鼻甲周期 physiological turbinal cycle/鼻周期nasal cycle鼻肺反射 nasopulmonary reflex喷嚏反射sneeze reflex18耳鼻咽喉应用解剖肖雪10/3/2022鼻瓣膜区nasal valve area18耳鼻咽喉应用解剖The Ear19耳鼻

14、咽喉应用解剖肖雪10/3/2022The Ear19耳鼻咽喉应用解剖肖雪10/3/2022External, Middle, and Inner ear.Each serves different aspects of the auditory sensation.集音传音感音 20耳鼻咽喉应用解剖肖雪10/3/2022External, Middle, and Inner eThe External Ear 外耳The auricle 耳廓The external acoustic meatus 外耳道 略呈S状弯曲，长约2.53.5cm。外13为软骨部，内23为骨部，外耳道有两处较狭窄，一

15、为骨部与软骨部交界处，另一处为骨部距鼓膜0.5cm处较狭窄处，称为外耳道狭部。软骨部是耳疖的好发部位。The external Ear 外耳21耳鼻咽喉应用解剖肖雪10/3/2022The External Ear 外耳The auricleThe Middle Ear 中耳Tympanic cavityMastoid Process 乳突Auditory tube咽鼓管Consists of the tympanic cavity(鼓室), auditory tube(咽鼓管), tympanic antrum(鼓窦) and mastoid process(乳突).22耳鼻咽喉应用解剖肖雪

16、10/3/2022The Middle Ear 中耳Tympanic caviThe tympanic Cavity 鼓室The epitympanumThe mesotympanumThe hypotympana23耳鼻咽喉应用解剖肖雪10/3/2022The tympanic Cavity 鼓室The epi鼓室六壁 上壁 为鼓室盖，与中颅窝大脑颞叶相隔。下壁 以薄骨板与颈静脉球相隔。内壁 即内耳外壁。有“一岬两窗两凸”，鼓岬、前庭窗、圆窗、面神经管隆凸、外半规管隆凸24耳鼻咽喉应用解剖肖雪10/3/2022鼓室六壁上壁 为鼓室盖，与中颅窝大脑颞叶相隔。24耳鼻咽喉外壁 大部分为鼓膜所封闭

17、。前壁 上有鼓膜张肌半管，下有咽鼓管鼓室口。前壁下部借一薄骨板与颈内动脉管相隔。后壁 即乳突前壁，乃骨部外听道的延续，上部有鼓窦入口通鼓窦，后壁有面神经的垂直段通过25耳鼻咽喉应用解剖肖雪10/3/2022外壁 大部分为鼓膜所封闭。25耳鼻咽喉应用解剖肖雪10/3Tympanic Membrane 鼓膜光锥Cone of light紧张部Pars tense松弛部Pars flaccid锤纹 Malleolar stria锤骨短突Short process of malleus外耳道皮肤26耳鼻咽喉应用解剖肖雪10/3/2022Tympanic Membrane 鼓膜光锥紧张部松弛部锤Late

18、ral & Anterior WallsAnterior wall面神经颈内动脉咽鼓管鼓膜张肌鼓索神经27耳鼻咽喉应用解剖肖雪10/3/2022Lateral & Anterior WallsAnterMedial Wall鼓岬圆窗鼓窦28耳鼻咽喉应用解剖肖雪10/3/2022Medial Wall鼓岬圆窗鼓窦28耳鼻咽喉应用解剖肖雪1malleus incusstapes Tympanic vestibular Membrane windowMalleus 锤骨Incus砧骨 Stapes 镫骨Auditory ossicles and Ossicular chain听骨 &听骨链29耳鼻咽

19、喉应用解剖肖雪10/3/2022malleus incusstapesMalleus The Auditory Tube (Eustachian tube)咽鼓管 Two parts: bony & cartiliginous parts （外1/3为骨部，内2/3为软骨部）Two openings: the pharyngeal & the tympanic orificesVariety with anatomy between infant and adult30耳鼻咽喉应用解剖肖雪10/3/2022The Auditory Tube (Eustachian The Inner Ear

20、内耳 / Labyrinth 迷路The inner earosseous labyrinth（骨迷路） contains the vestibule（前庭）, semicircular canals（半规管） and cochlea（耳蜗）membranous labyrinth（膜迷路）. utricle(椭圆囊), saccule(球囊), membranous semicircular canals(膜半规管), membranous cochlea duct(膜蜗管), 内淋巴管囊(endolymphatic duct)Vestibule前庭Cochlea耳蜗Semicircular

21、 canals半规管31耳鼻咽喉应用解剖肖雪10/3/2022The Inner Ear 内耳 / Labyrinth Osseous labyrinth 骨迷路Lateral semicircular canal水平半规管Posterior semicircular canal后半规管Superior semicircular Canal上半规管Vestibule window前庭窗Cochlea window蜗 窗Cochlea耳蜗Osseous labyrinth（骨迷路）vestibule（前庭） semicircular canals（半规管） cochlea（耳蜗）32耳鼻咽喉应用

22、解剖肖雪10/3/2022Osseous labyrinth 骨迷路Lateral ssemicircular canals半规管Lateral semicircular canal外（水平）半规管Posterior semicircular canal后半规管Superior semicircular Canal上半规管位于前庭后方，为上、后、外三个弓形互相垂直的骨管，5孔开口于前庭，膨大端为壶腹，另一端为单脚。上半规管与后半规管单脚合并为总角。33耳鼻咽喉应用解剖肖雪10/3/2022semicircular canals半规管LateralVestibule 前庭lateral wall

23、the vestibular window，the cochlear window 为鼓室内壁的一部分，有前庭窗及蜗窗，分别为镫骨底板及圆窗膜所封闭；posterior wall- 5 orifices of semicircular canals Anterior wall - an opening communicates with scala vestibuli（前庭阶）Vestibular window前庭窗Cochlear window蜗窗34耳鼻咽喉应用解剖肖雪10/3/2022Vestibule 前庭Vestibular windowCbony canals of cochlea

24、 winding for 2.2-2.75 around central modiolus.The Cochlea Scala tympani 鼓阶Scala vestibuli 前庭阶Cochlear duct 蜗管 前庭膜于前庭的前下方，为螺旋形骨管，绕蜗轴旋转两圈半，形似蜗牛。骨蜗管由骨螺旋板、基底膜和前庭膜将蜗管分为前庭阶、中阶和鼓阶三个管腔。中阶(膜蜗管)内储内淋巴，系膜迷路，为一封闭的盲管。 35耳鼻咽喉应用解剖肖雪10/3/2022bony canals of cochlea windingSemicircularcanalsCochlearDuct蜗管Utricle椭圆囊Sac

25、cule球囊The Membranous Labyrinth 膜迷路亦分前庭、半规管及耳蜗三部（内有听觉和位觉感受器）36耳鼻咽喉应用解剖肖雪10/3/2022SemicircularCochlearUtricleSacOuter Hair CellsInner Hair CellsSupporting cells.stereociliaThe organ of Corti （Corti器）位于耳蜗基底膜上，为耳蜗神经的末梢感受器37耳鼻咽喉应用解剖肖雪10/3/2022Outer Hair CellsInner Hair CelUtricle & Saccule 椭圆囊和球囊-位于前庭，感受

26、直线加速度运动的刺激38耳鼻咽喉应用解剖肖雪10/3/2022Utricle & Saccule 椭圆囊和球囊-位于前Ampulla 壶腹Cupula 壶腹嵴Membranous semicircular canals 膜半规管Cupula 壶腹嵴（位于半规管壶腹端 ，主要感受正负角加速度的刺激）39耳鼻咽喉应用解剖肖雪10/3/2022Ampulla Cupula Membranous semi蜗神经的传导径路耳蜗神经核上橄榄核外侧丘系核下丘听觉皮层耳蜗40耳鼻咽喉应用解剖肖雪10/3/2022蜗神经的传导径路耳蜗神经核上橄榄核外侧丘系核下丘听觉皮层耳蜗The Pharynx41耳鼻咽喉应用

27、解剖肖雪10/3/2022The Pharynx41耳鼻咽喉应用解剖肖雪10/3/2042耳鼻咽喉应用解剖肖雪10/3/202242耳鼻咽喉应用解剖肖雪10/3/2022Nasopharynx 鼻咽43耳鼻咽喉应用解剖肖雪10/3/2022Nasopharynx 鼻咽43耳鼻咽喉应用解剖肖雪10/后鼻孔下鼻甲中鼻甲上鼻甲咽隐窝咽鼓管圆枕腺样体（Adenoid）：顶部与后壁交界处的丰富淋巴组织团块，过分肥大可引起耳鼻咽喉等处的症状，10岁以后逐渐萎缩。咽鼓管咽口（The orifice of Eustachian tube）：下鼻甲后端后方约1-1.5cm处咽鼓管圆枕（Torus tubalis

28、）：咽口上方隆起的部分咽隐窝（Pharyngeal recess）：咽鼓管圆枕后上方的凹陷区，为鼻咽癌的好发部位。该处接近颅底破裂孔，鼻咽癌可循此自然孔道侵入颅内。鼻咽 （nasopharynx）Posterior naris (choanae) 44耳鼻咽喉应用解剖肖雪10/3/2022后鼻孔下鼻甲中鼻甲上鼻甲咽隐窝咽鼓管圆枕腺样体（AdenoiThe Oropharynx 口咽Palatopharyngeal arch 腭咽弓Palatoglossal arch 腭舌弓45耳鼻咽喉应用解剖肖雪10/3/2022The Oropharynx 口咽Palatopharyn口咽 (orophar

29、ynx)咽峡：上-悬雍垂(uvula)、软腭游离缘(soft palate)，侧-舌腭弓(palatoglossal arch)、扁桃体(tonsil)、咽腭弓(palatopharyngeal arch)，下-舌背。腭扁桃体：咽侧索：每侧咽腭弓的后方的纵行条索状淋巴组织46耳鼻咽喉应用解剖肖雪10/3/2022口咽 (oropharynx)咽峡：46耳鼻咽喉应用解剖肖雪Laryngopharynx 喉咽Post-cricoid region 环后区Pyriform sinuses 梨状窝47耳鼻咽喉应用解剖肖雪10/3/2022Laryngopharynx 喉咽Post-cricoidWal

30、deyers Ring 咽淋巴环Adenoid 腺样体Tubal Tonsils. 咽鼓管扁桃体Palatine Tonsils. 腭扁桃体Lingual Tonsils. 舌扁桃体Lat. Pharyngeal bands. 咽侧索Definition: Ring of Lymphoid tissue guarding entrance to the digestive & respiratory tracts.48耳鼻咽喉应用解剖肖雪10/3/2022Waldeyers Ring 咽淋巴环Adenoid 咽旁间隙咽后间隙Parapharyngeal and retroparyngeal s

31、pace 咽旁隙和咽后隙Parapharyngeal space 咽旁隙internal carotid a. 颈内动脉jugular v. 颈内静脉cranial nerves sympathetic chain 交感干cervical lymphnodes 颈淋巴结49耳鼻咽喉应用解剖肖雪10/3/2022咽旁间隙咽后间隙Parapharyngeal and ret咽后隙 retropharyngeal space 上界：起于颅底。下界：止于第一、二胸椎平面。前界：颊咽筋膜、咽后壁。后界：椎前筋膜。外界：以薄层筋膜与咽旁隙相隔。内界：为咽缝将其分为左右两部分。内容：疏松结缔组织和淋巴结，易

32、形成咽后壁脓肿，小儿多见。 50耳鼻咽喉应用解剖肖雪10/3/2022咽后隙 retropharyngeal space 上界：起The Larynx喉部位于颈前正中，舌骨之下；上接喉咽部，下连气管；是呼吸的重要通道，下呼吸道的门户；由软骨组成支架，附以肌肉、韧带、粘膜等；为呼吸和发音器官。51耳鼻咽喉应用解剖肖雪10/3/2022The Larynx喉部位于颈前正中，舌骨之下；51耳鼻咽喉Epiglottic cartilage 会厌软骨 52耳鼻咽喉应用解剖肖雪10/3/2022Epiglottic cartilage 会厌软骨 52耳Thyroid cartilage 甲状软骨 The

33、largest cartilage of larynx53耳鼻咽喉应用解剖肖雪10/3/2022Thyroid cartilage 甲状软骨 The lCricoid cartilage 环状软骨The only complete cartilaginous ring54耳鼻咽喉应用解剖肖雪10/3/2022Cricoid cartilage 环状软骨The oArytenoid cartilage 杓状软骨paired, pyramidal shaped声带突：声带附着处肌突：环杓后肌及环杓侧肌附着55耳鼻咽喉应用解剖肖雪10/3/2022Arytenoid cartilage 杓状软骨pa

34、ir喉的韧带与膜 喉软骨之间有纤维状韧带相连接，有甲状舌骨膜、舌骨会厌韧带、舌会厌韧带、甲状会厌韧带、喉弹性膜、环甲膜等，环甲膜正位于声门下，是紧急气管切开的部位环甲膜穿刺或切开术56耳鼻咽喉应用解剖肖雪10/3/2022喉的韧带与膜 喉软骨之间有纤维状韧带相连接，有甲状舌骨Muscles of larynx extrinsic laryngeal muscles喉外肌 intrinsic laryngeal muscles喉内肌 57耳鼻咽喉应用解剖肖雪10/3/2022Muscles of larynx Intrinsic laryngeal muscles 喉内肌Abductor 外展P

35、osterior cricoarytenoid 环杓后肌Adductors 内收Lateral cricoarytenoid 环杓侧肌Transverse arytenoid 杓横肌Adjust tension of the vocal cord: Cricothyroid 环甲肌Thyroarytenoid 甲杓肌Move the epiglottic: Thyreo-epiglotticus 甲状会厌肌58耳鼻咽喉应用解剖肖雪10/3/2022Intrinsic laryngeal muscles 喉内Extrinsic laryngeal muscles 喉外肌Suprahyoid Mu

36、scles 舌骨上肌群Mylohyoid 下颌舌骨肌Digastric 二腹肌Geniohyoid 颏舌骨肌Stylohyoid 茎突舌骨Genioglossus 颏舌肌Styloglossus 茎突舌肌Infrahyoid Muscles 舌骨下肌群Thyrohyoid 甲状舌骨肌Omohyoid 肩胛舌骨肌Sternohyoid 胸骨舌骨肌Sternothyroid 胸骨甲状肌59耳鼻咽喉应用解剖肖雪10/3/2022Extrinsic laryngeal muscles 喉Intrinsic laryngeal muscles 喉内肌 环甲肌Cricothyroid环杓侧肌Lateral crico-arytenoid 环杓后肌Posterior crico-arytenoid杓肌Arytenoid甲杓肌Thyroarytenoid60耳鼻咽喉应用解剖肖雪10/3/2022Intrinsic laryngeal muscles Laryngeal ne