颈部的局部解剖与操作

局部解剖学（九）颈部的局部解剖与操作（1）当前第1页\共有57页\编于星期五\13点颈部Neck概述introduction浅层结构superificalstructures下颌下三角submandibulartriangle颏下三角submentaltriangle当前第2页\共有57页\编于星期五\13点一、概述Introduction境界和分区boundaryandregions表面解剖surfaceanatomy表面标志surfacelandmark体表投影surfaceprojection当前第3页\共有57页\编于星期五\13点上界：为下颌骨下缘、下颌角、乳突、上项线与枕外隆突的连线。Superiorly：anlinelinkingwiththelowerborderofmandible,theangleofmandible,themastoidprocess,thesuperiornuchallineandtheexternaloccipitalprotuberance;

下界：由胸骨上缘、锁骨和肩峰至第7颈椎棘突的连线。Inferiorly：bytheupperborderofsternum,theclavicleandalineextendingfromtheacromiontothespineof7thcervicalvertebra.1.颈部的境界boundaryoftheneck当前第4页\共有57页\编于星期五\13点2.颈部分区颈部:分为固有颈部（properneck）和项部（nape）。固有颈部:又可分为颈前区anteriorregion、胸锁乳突肌区sternocleidomastoidregion和颈外侧区lateralregion。当前第5页\共有57页\编于星期五\13点颈前区：被舌骨hyoid分为舌骨上区suprahyoidregion（包括2个下颌下三角和1个颏下三角）和舌骨下区infrahyoidregion（包括成对的颈动脉三角和肌三角）。颈外侧区：被肩胛舌骨肌下腹分为枕三角和锁骨上三角。当前第6页\共有57页\编于星期五\13点3.表面标志surfacelandmarkLessersupraclavicularfossa(Greater)supraclavicularfossaSuprasternalfossa当前第7页\共有57页\编于星期五\13点表面标志

SurfaceLandmark舌骨Hyhoid(H)甲状软骨Thyroidcartilage(T)喉结节Laryngealprominence(P)环状软骨Cricoidcartilage(C)第1气管环Thefirsttrachealringe(1)甲状腺峡Isthmus(S)当前第8页\共有57页\编于星期五\13点环状软骨(弓)的意义第6颈椎水平Thelevelofthe6thcervicalvertebra.喉与气管交界Thejunctionofthelarynxwiththetrachea.咽与食管交界Thejunctionofthepharynxwiththeesophagus.当前第9页\共有57页\编于星期五\13点Thelevelatwhichthevertebralarteryentersthetransverseforamenofthe6thcervicalvertebra.Thesiteatwhichthecarotidarterycanbepressedagainstthecarotidtubercleofthe6thcervicalvertebra.当前第10页\共有57页\编于星期五\13点Thelevelatwhichtheinferiorthyroidarteryandthemiddlethyroidveinenterorleavethethyroidgland.当前第11页\共有57页\编于星期五\13点Thelevelatwhichthesuperiorbellyoftheomohyoidmusclecrossesthecarotidsheath.当前第12页\共有57页\编于星期五\13点Thelevelofthemiddlesympatheticganglion.当前第13页\共有57页\编于星期五\13点二、颈部浅层结构

Thesuperficialstructuresoftheneck皮肤Theskin(thinandpliable)浅筋膜及其内容Thesuperficialfasciaanditscontentsathinlayeroffatasheetofplatysmatheanteriorjugularveinthelateraljugularveinthesuperficial(lateralandanerior)cervicallymphnodesthecutaneousbranchesofthecervicalplexusthecervicalbranchofthefacialnerve当前第14页\共有57页\编于星期五\13点1.颈阔肌

TheplatysmaIsabroad,thinsheetofmuscleinthesubcutaneoustissue.Coverstheanterolateralaspectoftheneck.Aariseinfasciacoveringsuperiorpartsofthedeltoidandpectoralismajormusclesandsweepsuperomediallyovertheclavicletotheinferiorborderofthemandible,skin,andsubcutaneoustissueoflowerface.Isoneofthemusclesoffacialexpression.Isinnervatedbythecervicalbranchofthefacialnerve.当前第15页\共有57页\编于星期五\13点Thesuperficialcervicalveinsandnervesarelocateddeeptotheplatysma.当前第16页\共有57页\编于星期五\13点Themainactionoftheplatysma:①drawscornersofmouthinferiorlyandwidensitasinexpressionsofsadnessandfright;②drawstheskinofnecksuperiorlywhenteethare“clenched”.当前第17页\共有57页\编于星期五\13点2.颈前静脉或颈前正中静脉、颈外静脉当前第18页\共有57页\编于星期五\13点颈静脉弓Jugularvenousarch当前第19页\共有57页\编于星期五\13点3.颈浅淋巴结Superficialcervicallymphnodes当前第20页\共有57页\编于星期五\13点4.SuperficialcervicalnervesCutaneousbranchesofthecervicalplexusNervepointofneckCervicalbranchofthefacialnerve当前第21页\共有57页\编于星期五\13点面神经的颈支Cervicalbranchoffacialnerve当前第22页\共有57页\编于星期五\13点三、颈筋膜及筋膜间隙

CervicalFasciaandFascialSpace

当前第23页\共有57页\编于星期五\13点1.

颈筋膜CervicalFascia颈深筋膜分为三层

Deepcervicalfasciaconsistsofthreefasciallayers:浅层Superficiallayer封套筋膜Investingfascia中层Middlelayer气管前筋膜Prechachealfascia内脏筋膜Visceralfascia深层Deeplayer椎前筋膜Prevertebralfascia当前第24页\共有57页\编于星期五\13点当前第25页\共有57页\编于星期五\13点封套筋膜、气管前筋膜、椎前筋膜当前第26页\共有57页\编于星期五\13点颈动脉鞘、气管前筋膜、甲状腺鞘、甲状腺悬韧带当前第27页\共有57页\编于星期五\13点2.颈筋膜间隙

CervicalFascialSpaces胸骨上间隙Suprasternalspace咽后间隙Retropharyngealspace气管前间隙Prechachealspace椎前间隙Prevertebralspace当前第28页\共有57页\编于星期五\13点胸骨上间隙、咽后间隙、气管前间隙、椎前间隙当前第29页\共有57页\编于星期五\13点当前第30页\共有57页\编于星期五\13点胸骨上间隙的内容

ContentsoftheSuprasternalspaceIncludethe:颈前筋膜下端Inferiorendsoftheanteriorjugularveins颈静脉弓Jugularvenousarch疏松结缔组织Looseconnectivetissue1~2个淋巴结Oneortwodeeplymphnodes

胸锁乳突胸骨头Sternalheadsoftheternocleidomastoid锁骨间韧带Interclavicularligament当前第31页\共有57页\编于星期五\13点锁骨上间隙的内容

ContentsofthesupraclavicularspaceIncludethe:颈外静脉Apartoftheexternaljugularvein锁骨上神经Supraclavicularnerves

颈横静脉Transversecervicalvein肩胛上静脉Suprascapularvein淋巴管Afewlymphvessels当前第32页\共有57页\编于星期五\13点四、颏下三角

SubmentalTriangle

境界Boundary内容Contents当前第33页\共有57页\编于星期五\13点颏下三角BoundarisofsubmentaltriangleBodyofhyoidbone当前第34页\共有57页\编于星期五\13点颏下三角的内容

ContentsofthesubmentaltriangleIncludethe:几个小的颏下淋巴结Severalsmallsubmentallymphnodes.几条小静脉，汇合成颈前静脉Smallveinsthatunitetoformtheanteriorjugularvein.当前第35页\共有57页\编于星期五\13点五、下颌下三角

SubmandibularTriangle境界Boundary内容Contents当前第36页\共有57页\编于星期五\13点1.下颌下三角

Boundarisofthesubmandibulartriangle当前第37页\共有57页\编于星期五\13点Aroofofthesubmandibulartriangleisformedbytheskin,superficialfascia,platysmaandinvestingfascia.当前第38页\共有57页\编于星期五\13点Afloorofthesubmandibulartriangleisformedbythemylohyoid,hyoglossusandmiddlepharyngealconstrictor.MiddlepharyngealconstrictorMylohyoidHyoglossus当前第39页\共有57页\编于星期五\13点下颌下三角的底当前第40页\共有57页\编于星期五\13点下颌下三角的顶与底当前第41页\共有57页\编于星期五\13点2.下颌下三角的主要结构

Maincontentsofthesubmandibulartriangle下颌腺及其导管Submandibularglandanditsduct

面静脉Facialvein面神经的颈支Cervicalbranchoffacialnerve下颌下淋巴结Submandibularlymphnodes

面动脉Facialartery颏下动、静脉Submentalarteryandvein下颌舌骨肌神经Mylohyoidnerve舌下神经Hypoglossalnerve舌动、静脉Lingualarteryandvein舌神经LingualNerve,下颌下神经节Submandibularganglion当前第42页\共有57页\编于星期五\13点1.在下颌下腺的浅面有：

面静脉、面神经的颈支、下颌下淋巴结Cervicalbranchesoffacialnerve当前第43页\共有57页\编于星期五\13点Mylohyoid2.

Thesubmandibularglandisdividedintothesuperficialanddeeppartsbytheposteriorborderofmylohyoid,itsductemergesfromthedeepoftheglandandthenopensonthesublingualpapilla.当前第44页\共有57页\编于星期五\13点3.在下颌下腺的深面：①在下颌舌骨肌浅面的结构有颏下动脉和静脉、下颌舌骨肌神经；②在舌骨舌肌浅面的结构有舌静脉、面动脉、舌下神经、下颌下神经节和舌神经；③在舌骨舌肌深面的结构有舌动脉。当前第45页\共有57页\编于星期五\13点当前第46页\共有57页\编于星期五\13点4.下颌下腺深部及其导管的毗邻：自上而下为舌神经、下颌下神经节、下颌下腺及其导管、舌下神经、舌动脉和静脉。当前第47页\共有57页\编于星期五\13点六、解剖与观察

DissectionandObservation

1.Makeamedianskinincision2.Reflecttheskinflaps3.Reflecttheplatysma4.Dissectthesuperficialstructures5.Dissectthesubmentaltriangle6.Dissectthesubmandibulartriangle当前第48页\共有57页\编于星期五\13点1.Makeamedianskinincisionfromthementalsymphysistothesuprasternalnotch.当前第49页\共有57页\编于星期五\13点2.Reflecttheskinflapslaterallytotheanteriorborderofthetrapeziustoexposetheplatysmadirectly.

3.Dividetheplatysmaalongtheupperborderoftheclavicleandreflectitupwardstothemandible.Donotdamagetheunderlyingstructures.当前第50页\共有57页\编于星期五\13点4.Lookforandexposethesuperficialstructuresoftheneck.当前第51页\共有57页\编于星期五\13点5.Cleanboundarisofthesubmentaltriangle当前第52页\共有57页\编于星期五\13点6.Cutthroughtheinvestingfasciatoexopsethesubmandibulargland,thefacialvein,thecervicalbranchesofthefacialnerveandsubmandibularlymphnodes.当前第53页\共有57页\编于星期五\13点Identifythefacialarteryandfollowittoitsorigin.