耳鼻喉课件：颈部neck

1、颈部neck,颈部Neck,境界Boundaries 上界Superior下颌底、下颌角、乳突、上项线、枕外隆突inferior border of mandible, angle of mandible, tip of mastoid process, superior nuchal line, external occipital protuberance 下界Inferior颈静脉切迹、胸锁关节、锁骨上缘、肩峰、第七颈椎棘突jugular notch, sternoclavicular joint, superior border of clavicle, acromion, spino

2、us processes of C7,体表标志Landmarks,舌骨Hyoid bone 甲状软骨Thyroid cartilage 环状软骨Cricoid cartilage 颈动脉结节Carotid tubercle 胸锁乳突肌Sternocleidomastoid 胸骨上窝Suprasternal fossa 锁骨上大窝Greater supraclaviclar fossa,颈部分区Division of neck,固有颈部Proper neck 颈前区Anterior region 舌骨上区Suprahyoid region： 颏下三角Submental triangle 下颌下三

3、角Submandibular triangle 舌骨下区Infrahyoid region： 颈动脉三角Carotid triangle 肌三角Muscular triangle 胸锁乳突肌区Sternocleidomastoid region 颈外侧区Lateral region 枕三角Occipital triangle 锁骨上三角supraclavicular triangle Greater supraclavicular fossa 项部posterior portion（nape）,皮肤Skin 浅筋膜Superficial fascia 深筋膜Deep fascia 肌Muscl

4、es 血管Blood vessels, 淋巴管Lymphatic ducts 神经Nerves 咽、喉、食管、气管、甲状腺、甲状旁腺Pharynx,larynx and esophagua and trachea Thyroid gland, parathyroid gland,皮肤Skin,皮肤薄、移动性大、皮纹呈横向分布。The natural line of cleavage of the skin are constant and run almost horizontally around the neck,浅筋膜Superficial fascia,Contents 颈阔肌Plat

5、ysma 浅静脉Superficial veins 颈前静脉Anterior jugular v. 颈外静脉External jugular v. 皮神经Cutaneous nerves 枕小神经Lesser occipital n. 耳大神经Greet auricular n. 颈横神经Transverse nerve of neck 锁骨上神经Supraclavicular n. 面神经颈支Cervical branch of facial n.,颈筋膜Cervical fascia,浅层Superficial layer (investing fascia 封套筋膜) 气管前筋膜Pret

6、rachial layer 椎前筋膜Prevertebral layer,prevertebral fascia,investing fascia,pretracheal fascia,颈动脉鞘Carotid sheath,Formed by components of all three layers of deep cervical fascia 内容Contains 颈总动脉common carotid arteries 颈内动脉internal carotid arteries 颈内静脉internal jugular vein 迷走神经vagus nerve Ansa cervica

7、lis located on its anterior surface,筋膜间隙Spaces among fascia,胸骨上间隙Suprasternal space 气管前间隙Pretracheal space 咽后间隙Retropharyngeal space 椎前间隙Prevertebral space,颈前区anterior regions of the neck,下颌下三角Submandibular triangle,境界：二腹肌前、后腹和下颌骨体下缘围成。 浅面Roof: 皮肤、浅筋膜、颈阔肌、封套筋膜。 底Floor: 下颌舌骨肌、舌骨舌肌和咽中缩肌mylohyoid, hyog

8、lossus and middle constrictor of pharynx 内容Contents 下颌下腺submandibular gland 面血管facial a.and v. 舌血管lingual a. and v. 舌神经lingual n. 舌下神经hypoglossal n. 下颌下神经节submandibular ganglion 下颌下淋巴结submandibular lymph nodes,One gland Two blood vessles Two nerves,facial a.and v.: deep to the gland lingual a. and v

9、.: medially to the lower part of the gland hypoglossal n.：medially to the lower part of the gland lingual n.：medially to the upper part of the gland submandibular ganglion： medially to the upper part of the gland submandibular lymph nodes：around the gland,颏下三角Submental triangle 境界：两侧二腹肌前腹和舌骨围成。 顶：皮肤

10、、浅筋膜、封套筋膜Covered by skin, superficial fascia and investing fascia 底Floor下颌锁骨肌mylohyoid muscles 内容Contents颏淋巴结submental lymph nodes,颈动脉三角Carotid triangle,境界Bounded胸锁乳突肌前缘、二腹肌后腹、肩胛舌骨肌上腹 by anterior border of sternocleidomastoid, superior belly of omohyoid and posterior belly of digastic muscles 顶Cover

11、ed皮肤、浅筋膜、颈阔肌、封套筋膜 by skin, superficial fascia, platysma and investing fascia 底Floor椎前筋膜、咽侧壁prevertebral fascia and lateral wall of pharynx Contents,内容Contents 颈总动脉及其分支common carotid a. and its branches 颈外动脉及其分支external carotid a. and its branches 颈内静脉及其属支internal jugular v. and its tributaries, 舌下神经

12、hypoglossal n. with its descending branches, 副神经accessory nerve 迷走神经vagus nerve 颈外侧深淋巴结part of the chain of deep cervical lymph nodes,The common carotid a., external carotid a., internal jugular v., and vagus nerve are enclosed in Carotid Sheath,二腹肌后腹Posterior belly of digastic muscle,浅面Superficial:

13、耳大神经 great auricular n., 下颌后静脉retromandibular v.,面神经颈支 cervical branch of facial n. 深Deep:颈内动脉、颈外动脉、颈内静脉、迷走神经、副神经、舌下神经、颈交感干 internal and external carotid a., internal jugular v., vagus n. accessory n. hypoglossal n. and cervical part of sympathetic trunk 上Superior:耳后动脉 posterior auricular a., 面动脉fac

14、ial a. and舌咽神经 glossopharyngeal n. 下Infeior: 枕动脉occipital a. and舌下神经 hypoglossal n.,肌三角Muscular triangle,境界：颈部前正中线、肩胛舌骨肌上腹、胸锁乳突肌前缘。. 顶：皮肤、浅筋膜、颈阔肌、颈前静脉、皮神经、封套筋膜Covered by skin, superficial fascia, platysma, anterior jugular v., coutaneous n. and investing fascia 底Floor椎前筋膜prevertebral fascia 内容Conten

15、ts,内容Contents 胸骨舌骨肌Sternohyoid 肩胛舌骨肌上腹superior belly of omohyoid 胸骨甲状肌Sternothyroid 甲状舌骨肌Thyrohyoid 甲状腺thyroid gland 甲状旁腺parathyroid gland 咽Pharynx 喉Larynx 气管颈段cervical part of trachea 食管颈段cervical part of esophagus 喉的神经、血管Blood vessels and nerves to larynx,Thyroid gland 甲状腺,甲状腺Thyroid gland,形态与位置Sh

16、ape and position H-shape 侧叶Left and right lobes: 位于喉的下部和气管上部两侧，上极平甲状软骨中部，下极平第六气管软骨环；高度约第5至7颈椎 峡Isthmus: 横过第2-4气管软骨环overlies 2nd to 4th tracheal cartilage ring 锥状叶Pyramidal lobe: 多与峡部相连some times arises from isthmus,Coverings 甲状腺鞘（假被囊） 由气管前筋膜形成，其后部增厚附着于甲状软骨和环状软骨弓，有固定甲状腺的作用。 the posterior part thicken

17、ed (suspensory lig. of throid gland) and attached to arch of cricoid and thyroid cartilages, hence, the thyroid gland moves with larynx during swallowing and oscillates during speaking 纤维囊（真被囊） 其与甲状腺鞘之间含有甲状旁腺和血管、神经。 Space between the sheath contains parathyroid gland, blood vessels and nerve,甲状腺动脉和喉

18、的神经 甲状腺上动脉Superior thyroid a. Branch of external carotid a. 与喉上神经伴行Runs superficial and parallel to the external branch of superior laryngeal n. and separate from each other near (0.51.0cm) the upper pole of thyroid gland and reach it Gives off superior laryngeal a. in company with internal branch o

19、f superior laryngeal n. 喉上神经分为喉内支与喉外支,甲状腺下动脉Inferior thyroid artery 起自锁骨下动脉的甲状颈干Branch of thyrocervical trunk of subclavian a. 在甲状腺下及与喉返神经关系密切。Turns medially and downward, reaches the posterior border of the thyroid gland and is closely related to the recurrent laryngeal n. Supplies inferior pole of

20、 thyroid gland,甲状腺最下动脉lowest thyroid artery (arteria thyroidea ima ) 起自头臂干或主动脉弓。may arise (613% ) from the brachiocephalic a. or aortic arch,静脉回流Venous drainage 甲状腺上静脉superior thyroid veins 回流至颈内静脉drains into internal jugular vein 甲状腺中静脉middle thyroid veins 回流支颈内静脉drains into internal jugular vein 甲

21、状腺下静脉inferior thyroid veins 回流至头臂静脉drains into left brachiocephalic vein,喉上神经 Superior laryngeal nerve 内支Internal branch which pierces thyrohyoid membrane to innervates mucous membrane of larynx above fissure of glottis 外支External branch is fine n., which descends in company with the superior thyroi

22、d a. and supplies cricothyroid,喉返神经Recurrent laryngeal nerves Ascend in tracheo-esophageal groove, pass deep to the lobe of the thyroid gland and come into close relationship with the inferior thyroid a. Cross either in front of or behind the artery or may pass between its branches Nerves enter lary

23、nx posterior to cricothyroid joint, then is called 喉下神经inferior laryngeal nerve Innervations: laryngeal mucosa below fissure of glottis , all laryngeal muscles except cricothyroid,R N A,甲状腺的毗邻Neighborhood 前（浅面）Anteriorlly 皮肤Skin 浅筋膜superficial fascia 封套筋膜investing fascia 舌骨下肌群infrahyoid muscles 气管前筋

24、膜pretracheal layer of cervical fascia 后内侧Posteromedialy 喉和气管；咽和食管；喉返神经larynx and trachea, pharynx and esophagus, recurrent laryngeal n. （Difficulty in Breathing, Swallowing and phonation ） 后外侧Posterolateraly颈动脉鞘和颈交感干carotid sheath and cervical part of sympathetic trunk（Horners syndrom）,甲状旁腺Parathyro

25、id gland,黄褐色、卵圆形小体Yellowish-brown, ovoid bodies 位置Position Two superior parathyroid glands: lie at junction of superior and middle third of posterior border of thyroid gland Two inferior parathyroid glands: lie near the inferior thyroid artery, close to the inferior poles of thyroid gland 功能Function

26、: 调节钙磷平衡regulate calcium and phosphate balance and is therefore essential for life,气管颈部Cervical part of trachea,Begins at lower end of larynx at the level of C6 vertebra to the jugular notch Consists of a series of incomplete cartilage rings Extends into thorax,毗邻Relations in the neck 前Anteriorly -皮

27、肤skin -浅筋膜superficial fascia -封套筋膜investing fascia -胸骨上间隙和颈静脉弓suprasternal space and jugular arch -舌骨下肌群infrahyoid muscles -气管前筋膜pretracheal fascia -甲状腺峡isthmus of thyroid gland ( in front of the 2nd to 4th tracheal cartilage) -甲状腺下静脉和奇静脉丛inferior thyroid v. and unpaired thyroid venous plexus -甲状腺最下

28、动脉arteria thyroid ima ( if present) -左头臂静脉left brachiocephalic v. in child,外侧Laterally 甲状腺侧叶、甲状旁腺、颈动脉鞘The lobes of the thyroid gland ( down as far as the sixth ring)，parathyroid gland and the carotid sheath 后Posteriorly 食管、喉返神经the esophagus，the recurrent laryngeal nerves,食管颈部Cervical part of esophag

29、us,Connecting the pharynx at level of C6 vertebra 毗邻Relations in the nack 前Anteriorly 气管、喉返神经Trachea, recurrent laryngeal n. 后Posteriorly 椎前筋膜、脊柱、颈长肌Prevertebral layer of cervical fascia, vertebral column, and longus colli 外侧Laterally 甲状腺侧叶、颈动脉鞘Lobe of the thyroid gland and carotid sheath 后外侧Postero

30、lateraly 颈交感干Sympathetic trunk,胸锁乳突肌区Sternocleidomastoid region,position Covered by sternocleidomastoid Contents 颈袢Ansa cervicalis 颈动脉鞘Carotid sheath 颈丛Cervical plexus 颈交感干Cervical part of sympathetic trunk,颈动脉鞘carotid sheath Formed by components of all three layers of deep cervical fascia 内容Content

31、s 颈总动脉common carotid arteries -posteromedially 颈内动脉internal carotid arteries -posteromedially 颈内静脉internal jugular vein -anterolaterally 迷走神经vagus nerve -behind and between the a. and v.,颈袢Ansa cervicalis 位于颈动脉鞘前面located on the anterior surface of carotid sheath 上根来自舌下神经Formed by superior root from

32、hypoglossal n. and 下根来自第2、3颈神经前支inferior root from C2,3 cervical n.,颈丛cervical plexus 位置position：胸锁乳突肌上部和中斜角肌之间located between the sternoclavicomastoid and Salenus anterior surface 分支branches： 皮神经cutaneous nerves 肌支Muscular branches 膈神经Phrenic nerve,颈交感干cervical part of symphathetic trunk 位于脊柱两侧、椎前筋

33、膜深面Located beside the vertebral column and deep to the vertebra layer of cervical fascia. 有三个神经节Composed of three(superior, middle and lower) ganglia。 Send off cervical cardiac branches from each ganglion,颈根部Root of neck,指颈部与胸部接壤的区域，由进出胸廓上口的诸结构占据。Formed at thoracic inlet by 前Anteriorly胸骨柄manubrium s

34、terni 后Posteriorly第一胸椎体body of first thoracic vertebra 外侧Laterally第1肋first rib and costal cartilage,内容Contents 胸膜顶Cupula of pleuraextends up into the neck, over the apex of lung, 23cm above the medial third of clavicle. Suprapleural membrane: fascia connect the cupula to transverse process of 7th ve

35、rtebra, body of 1st thoracic vertebra and neck of 1st rib, serves as suspenssory lig. 锁骨下静脉Subclavian v. 锁骨下动脉Subclavian a. 胸导管Thoracic duct 右淋巴导管Right lymphatic duct 迷走神经Vagus n. 膈神经Phrenic n.,前斜角肌Scalenus anterior,毗邻Relationship of the scalenus anterior 前内侧Anterior Transverse: 颈横动脉、锁骨下静脉transverse

36、 cervical a., subclavian v. thoracic duct(left) 纵行的Vertical:颈总动脉、颈内静脉、迷走神经、膈神经、胸膜顶 、颈交感干jugular v. phrenic n. 后Posterior 锁骨下动脉第2段2nd part of subclavian A. 臂丛Roots and trunks of brachial plexues,Salenus anterior: the main structure in this region,锁骨下动脉subclavian A 左起自主动脉弓、右起头臂干，于第1肋外侧续于腋动脉。pathway：ru

37、ns laterally anterior to the Cupula of pleura, then behind the scalenus anterior and pass through scalene fissure to continue with axillary at the lateral border of 1st rib.,1st segment 位于胸膜顶的前上方、前斜角肌的内侧，左侧前方有膈神经及胸导管颈部，右侧前方有迷走神经。分支有：椎动脉、胸廓内动脉，甲状颈干（常分为甲状腺下动脉、肩胛上动脉和颈横动脉）、肋颈干（颈深动脉颈深肌，肋间最上动脉第1、2肋间隙）,2nd

38、 Segment ： 位于前斜角肌的后方，上方紧邻臂丛各干，下方跨越胸膜顶。 3rd segment ： 位于前斜角肌外侧，第1肋上方，前下方有锁骨下静脉，外上方为臂丛。此段有时发出颈横动脉或肩胛上动脉。,锁骨下静脉subclavian V.： 前方有锁骨下肌和锁骨，下方邻第1肋；后方与前斜角肌、膈神经和胸膜顶相邻；后上方为锁骨下动脉和臂丛。,胸导管thoracic duct： 胸导管弓（平C7高度，向左跨越胸膜顶形成）经颈动脉鞘后方，椎动、静脉的前方，注入左静脉角。 右淋巴导管right lymphatic duct： 接受3个淋巴干，注入右静脉角。,vagus N.： 右迷走神经在锁骨动脉

39、下第1段前面发出喉返神经 phrenic N.： 起自颈丛，经前斜角肌上份外侧缘向内下沿前斜角肌表面下降， 再经锁骨下动、静脉之间入胸腔。,椎动脉三角Triangle of the vertebral a.,Boundaries 内侧Medially颈长肌longus colli 外侧Laterally前斜角肌scalenus anterior 下Inferiorly锁骨下动脉第1段first part of subclavian a. 尖Apex第6颈椎横突transvese process of C6 后Posteriorly第7颈椎横突transvese process of C7, 第

40、8颈神经前支 前Anteriorly颈动脉鞘、膈神经、胸导管弓carotid sheath, phrenic n. and arch of thoracic duct (left) 内容Contents 胸膜顶cupula of pleura, 椎动脉Vertebral a. 甲状腺下动脉Inferior thyroid a. 颈交感干Cervical part of sympathetic trunk 颈胸神经节Cevicothoracic ganglion,颈外侧区Lateral region of neck,Bounded by posterior border of sternocle

41、idomastoid, anterior border of trapezius and middle third of clavicle Divided by inferior belly of omohyoid into occipital and supraclavicular triangles,枕三角Occipital triangle Bounded by posterior border of sternocleidomastoid, anterior border of trapezius and superior border of inferior belly of omo

42、hyoid Covered by skin, superficial fascia, and investing fascia Floorprevertebral fascia and scalenus anterior, scalenus medius, scalenus posterior, splenius capitis and levator scapulae Conents Accessory n.emerges above the middle of the posterior border of sternocleidomastoid and crosses the occip

43、ital triangle to trapezius Cervical and brachial plexuses-肩胛上N、胸长N等。走出部位在胸锁乳突肌后缘中点附近,锁骨上三角Supraclavicular triangle Bounded by posterior border of sternocleidomastoid, inferior belly of omohyoid and middle third of clavicle Covered by skin, superficial fascia, and investing fascia Floorprevertebral f

44、ascia and inferior parts of scalenus Conents Subclavian v. and venous angle Subclavian a.-肩胛上动脉、颈横动脉、肩胛背动脉 Brachial plexus,lymph nodes of the head,Lymph nodes of neck,颈前淋巴结Anterior cervical lymph nodes Superficial anterior cervical lymph nodes Deep anterior cervical lymph nodes 颈外侧淋巴结 Lateral cervic

45、al lymph node Superficial lateral cervical lymph nodeslie along the external jugular vein Deep lateral cervical lymph nodes,颈外侧深淋巴结Deep lateral cervical lymph nodes extend along the internal jugular vein from the base of skull to the root of neck divide into superior deep lateral cervical lymph node

46、s and inferior deep lateral cervical lymph nodes receive lymphatic vessels from head, neck, tongue, larynx, cervical parts of esophagus and trachea, thyroid gland, upper parts of the thoracic wall and breast efferent vessels form the jugular trunkthe left jugular trunk joins the thoracic duct and ri

47、ght may joint the right lymphatic duct,Superior deep lateral cervical lymph nodes 颈外侧上深淋巴结 Jugulodigastric lymph node 颈内静脉二腹肌淋巴结: lies at the junction of posterior belly of digastric and internal jugular vein Inferior deep lateral cervical lymph nodes 颈外侧下深淋巴结 Juguloomohyoid lymph node 颈内静脉肩胛舌骨肌淋巴结: lies at the junction of the intermediate tendon of omohyoid and internal jugular vein Supraclavicular lymph nodes 锁骨上淋巴结: lie along the subclavian artery,Thanks,Superficial layer (investing fascia 封套筋膜) Encloses trapezius, sternocleidomastoid, posterior belly of digastric and parotid and s