《局部解剖学》课件：The neck (Part 2)

1、The Neck (Part 2),Department of human anatomy September 16, 2020,Objectives:,Describe muscles and the vessels of the neck. Describe the boundaries and contents of carotid and muscular triangle. Describe the boundaries and contents of occipital and supraclavicular triangle. Describe the relationship

2、of thyroid gland and the cervical part of trachea. Describe the root of the neck and the scalene fissure and its contents.,Section 3Anterior region of neck,Divisions,Suprahyoid region Submental triangle颏下三角 Submandibular triangle下颌下三角 Infrahyoid region Carotid triangle 颈动脉三角 Muscular triangle肌三角,1.

3、Carotid triangle,Bounded by Anterior border of sternocleidomastoid胸锁乳突肌 Superior belly of omohyoid 肩胛舌骨肌 Posterior belly of digastic muscles二腹肌.,1. Carotid triangle,Contents: Common carotid a. and its branches颈总动脉 Internal jugular v. and its tributaries颈内静脉 Hypoglossal n. 舌下神经 The accessory and vagu

4、s nerves副、迷走神经 Part of the chain of deep cervical lymph nodes颈外侧深淋巴结,The left one arises from aortic arch. The right one arises from brachiocephalic trunk. It ascends in neck to upper border of thyroid cartilage and bifurcates into internal and external carotid arteries,Common carotid artery,Superio

5、r thyroid artery Lingual artery Facial artery Occipital artery Posterior auricular artery Maxillary artery Superficial temporal artery,External carotid artery,Carotid sinus,A baroreceptor Located at a localizes dilation of terminal part of common carotid artery or beginning of internal carotid arter

6、y Sensitive to blood pressure changes.,Carotid glomus,A chemoreceptor Lies posterior to the point of bifurcation of common carotid artery Sensitive to the changes of blood carbon dioxide (oxygen) level.,2. Muscular triangle,Bounded by Midline of the neck Superior belly of the omohyoid肩胛舌骨肌 Anterior

7、border of the sternocleidomastoid胸锁乳突肌.,2. Muscular triangle,Contents Sternohyoid胸骨舌骨肌 Superior belly of omohyoid肩胛舌骨肌上腹 Sternothyroid胸骨甲状肌 Thyrohyoid甲状舌骨肌 Thyroid gland甲状腺 Parathyroid gland甲状旁腺 Cervical part of trachea 气管 Cervical part of esophagus食管,(1) Thyroid gland,External features H-shape Left

8、 and right lobes Isthmus甲状腺峡: Overlies 2nd to 4th tracheal cartilage Pyramidal lobe锥状叶: Some times arises from isthmus,(1) Thyroid gland,Location : Lie on either side of inferior part of larynx 喉and superior part of trachea气管, extend from middle of thyroid cartilage to level of sixth trachea cartila

9、ge.,(1) Thyroid gland,Fibrous capsule: A sheath of pretracheal fascia which is attached to arch of cricoid and thyroid cartilages, hence, the thyroid gland moves with larynx during swallowing吞咽 and oscillates during speaking讲话.,1) Relations of thyroid gland,Anteriorly Skin皮肤 Superficial fascia浅筋膜 In

10、vesting fascia封套筋膜 Infrahyoid muscles Pretracheal layer气管前筋膜 Fibrous capsule纤维囊,1) Relations of thyroid gland,Posteromedialy Larynx 喉 Pharynx咽 Trachea气管 Esophagus食管 Recurrent laryngeal nerve,1) Relations of thyroid gland,Posterolateraly Carotid sheath颈动脉鞘 Cervical part of sympathetic trunk颈交感干,Branc

11、h of external carotid artery. Runs superficial and parallel to the external branch of superior laryngeal nerve to reach the upper pole of thyroid gland. Gives off superior laryngeal artery in company with external branch of superior laryngeal nerve.,2) Superior thyroid artery,Internal branch内支 Pierc

12、es thyrohyoid membrane to innervates mucous membrane of larynx above fissure of glottis External branch外支 Descends in company with the superior thyroid artery and supplies cricothyroid.,3) Superior laryngeal nerve,Branch of thyrocervical trunk which arises from subclavian artery. Turns medially and

13、downward, reaches the posterior border of the thyroid gland and is closely related to the recurrent laryngeal nerve. Supplies inferior pole of thyroid gland.,4) Inferior thyroid artery,5) Recurrent laryngeal nerves,Ascend in tracheo-esophageal groove. Pass deep to the lobe of the thyroid gland and c

14、ome into close relationship with the inferior thyroid artery. Cross either in front of or behind the inferior thyroid artery may pass between its branches.,Innervate: Laryngeal mucosa below fissure of glottis All laryngeal muscles except cricothyroid.,5) Recurrent laryngeal nerves,Venous drainage Su

15、perior and middle thyroid veins into internal jugular vein Inferior thyroid veins to left brachiocephalic vein,(2) Parathyroid gland甲状旁腺,Yellowish-brown, ovoid bodies Function: Regulate calcium and phosphate balance 调节钙磷代谢平衡and is therefore essential for life.,Position of parathyroid gland,Two super

16、ior parathyroid glands: Lie at junction of superior and middle one-third of posterior border of thyroid gland.,Position of parathyroid gland,Two inferior parathyroid glands: Lie near the inferior thyroid artery, close to the inferior poles of thyroid gland.,(3) Cervical part of trachea,Begins at low

17、er end of larynxlevel of C6 vertebra. Consists of a series of incomplete cartilage rings. Extends into thorax.,Relations of trachea,Anteriorly: The skin Superficial fascia Investing fascia封套筋膜 Suprasternal space and jugular arch Infrahyoid muscles Pretracheal fascia and space,Relations of trachea :,

18、Anteriorly: (Additional structures in child幼儿以下结构常会高出胸骨颈静脉切迹达气管颈部前面.) Left brachiocephalic vein左头臂静脉 Aortic arch主动脉弓 Thymus gland 胸腺,Relations of trachea,Laterally The lobes of the thyroid gland 甲状腺侧叶 the carotid sheath颈动脉鞘.,Relations of trachea,Posteriorly The right and left recurrent laryngeal ner

19、ves喉返神经 the esophagus食管.,(4) Cervical part of esophagus,Connecting the pharynx at level of C6 vertebra. Anteriorly Trachea气管 Recurrent laryngeal nerves喉返神经 (ascending on each side, in the groove between the trachea and esophagus),(4) Cervical part of esophagus,Posteriorly Prevertebral layer of cervi

20、cal fascia椎前筋膜 vertebral column脊柱. Laterally Lobe of the thyroid gland甲状腺侧叶 carotid sheath颈动脉鞘.,Section 5Lateral region of neck,Introduction,Bounded by posterior border of sternocleidomastoid胸锁乳突肌, anterior border of trapezius 斜方肌and middle third of clavicle. Divided by inferior belly of omohyoid mu

21、scle into occipital 枕三角and supraclavicular triangles锁骨上三角.,1. Occipital triangle枕三角,Bounded by Posterior border of sternocleidomastoid Anterior border of trapezius斜方肌. Superior border of inferior belly of omohyoid肩胛舌骨肌.,1. Occipital triangle枕三角,Conents: Accessory nerve 副神经 Cervical plexuses 颈丛 Brach

22、ial plexuses 臂丛,Bounded by posterior border of sternocleidomastoid inferior belly of omohyoid Middle one-third of clavicle,2. Supraclavicular triangle,Conents: Subclavian vein Venous angle 静脉角 Subclavian artery Brachial plexus,2. Supraclavicular triangle,Section 4Root of neck,At thoracic inlet. Form

23、ed by: Anteriorly：Manubrium sterni胸骨柄 Posteriorly：Body of first thoracic vertebra第一胸椎体 Laterally：First rib and costal cartilage第一肋,Introduction,Contents: Cupula of pleura Subclavian vessels Thoracic duct 胸导管 Right lymphatic duct右淋巴导管 Vagus nerve Phrenic nerve Sympathetic trunk in the neck Brachial p

24、lexus,Surface projection： Over the medial one third of clavicle 23cm（14cm/2.5cm） Relation： Anteriorly ：scalenus anterior, subclavian vessels, phrenic nerve, vagus nerve, thoracic duct (at the left), right lymphatic duct (on the right).,1. Cupula of pleura胸膜顶,Posteriorly ：scalenus posterior, the firs

25、t and second rib, sympathetic trunk, anterior branch of the first thoracic nerve Laterally ：scalenus medius, brachial plexus. Medially ：trachea, esophagus, thoracic duct and recurrent laryngeal nerve,2. Scalene fissure斜角肌间隙,A triangular space above the first rib. Bounded by the scalenus anterior前斜角肌

26、, the scalenus medius中斜角肌 and the first rib. The brachial plexus 臂丛and the subclavian artery 锁骨下动脉emerge from this space.,3. Subclavian artery,Origin (arises from/springs from) Brachiocephalic trunk on right Aortic arch on left The scalenus anterior divides the subclavian artery into three part: the

27、 first part is medial to it, the second part is behind to it, and the third part is lateral to it.,3. Subclavian artery,Branches: The first part: Vertebral a. Internal thoracic a. Thyrocervical trunk Inferior thyroid artery Costocervical trunk The second part The third part,Summary of Dissection Pro

28、cedure:,Review the bony landmarks. Dissect the thyroid gland and its vascular supply, the recurrent laryngeal nerves and the parathyroid glands. Identify the accessory nerve and the roots of the cervical plexus. Follow the internal jugular vein to its termination noting its tributaries. Look for deep cervical lymph nodes and find the thoracic duct on the left.,Summary of Dissection Procedure:,Dissect the root of the neck to expose the subclavian arteries and their branches, the cervical sympathetic trunk and its ganglia, and the recurrent laryngeal nerve. Cut the