局部解剖学（双语） 精品课程 课件pptneck

May 18, 2008,The Neck (L. collum, cervix; Ch. 颈部),The neck joins the head to the trunk and limbs and serves as a major conduit for structures passing between them. In addition, several important organs with unique functions are located here: the larynx and the thyroid and parathyroid glands, for example.,Neck: Cervical Regions,A. SCM region- Lesser supraclavicular fossa (1),B. Posterior cervical region,C. Lateral cervical regionOccipital triangle (2) Omoclavicular triangle (3),D. Anterior cervical regionSubmandibular triangle (4) Submental triangle (5) Carotid triangle (6) Muscular triangle (7),Landmark muscles: Sternocleidomastoid (SCM), Trapezius , Omohyoid, Digastric,Neck: Surface Anatomy,Mandibular angleExternal jugular V.Laryngeal prominence (Adams apple) TrapeziusMSC - clavicular head - sternal head,Jugular notchLesser supraclavicular fossaGreater supraclavicular fossa,Bones and cartilages of neck,The skeleton of the neck is formed by the seven cervical vertebrae, hyoid bone manubrium of the sternumclaviclesLarynx cartilagesthyroid cartilageCricoid cartilageTrachea,Fascia of Neck,superficial cervical fascia deep cervical fasciainvesting layerpretracheal layer carotid sheath The common & internal carotid arteries.The internal jugular vein (IJV).The vagus nerve (CN X) prevertebral layer retropharyngeal space,superficial cervical fascia(muscle),It contains cutaneous nerves, blood and lymphatic vessels, superficial lymph nodes, and variable amounts of fat; anterolaterally, it contains the platysma. The platysma, a muscle of facial expression, arises in fascia covering the superior parts of the deltoid and pectoralis major muscles and sweeps superomedially over the clavicle to the inferior border of the mandible.,The subcutaneous tissue is usually a thin layer of connective tissue that lies between the dermis of the skin and the investing layer of deep cervical fascia,Superficial veins, nerves, and lymph nodes,external jugular vein (EJV) subclavian vein cutaneous branches of the cervical plexus emerge around the middle of the posterior border of the SCM, often called the nerve point of the neck, and supply the skin of the neck superficial cervical lymph nodes inferior deep cervical lymph nodes supraclavicular lymph nodes,Submandibular triangle (5)Submandibular glandSubmandibular lymph nodesHypoglossal n.,Carotid triangle (6),Hypoglossal n.carotid sheath The common carotid artery (CCA)Internal carotid a. (ICA): carotid sinus & carotid bodyExternal carotid a. (ECA): lingual a., & sup. thyroid a.The internal jugular vein (IJV).The vagus nerve (CN X),The roots of brachial plexus (Five rami unite to form the three trunks of the brachial plexus), which descend inferolaterally through the lateral cervical region. The plexus then passes between the 1st rib, clavicle, and superior border of the scapula (the cervicoaxillary canal) to enter the axilla, Thyrocervical trunk- transverse cervical a.,Cervical sympathetic trunk,Cervical sympathetic trunkInferior cervical ganglionMiddle cervical ganglionSuperior cervical ganglionSympathetic periarterial plexus (CCA, ICA, ECA, VA)Vertebral a. (VA),The Root of Neck,Veins: subclavian v.Internal Jugular v.Brachiocephalic v.Arteries:CCASubclavian a.: vertebral aBrachiocephalic trunkMajor nerves: vagus nerve & recurrent laryngeal nphrenic nervesympathetic trunkLymphatic ducts & nodes:Right lymphatic ductThoracic duct,Thyroid and parathyroid glands,Thyroid and parathyroid glands in the endocrine layer The thyroid gland produces thyroid hormone, which controls the rate of metabolism, and calcitonin, a hormone controlling calcium metabolism. The parathyroid glands produce parathormone (PTH), which controls the metabolism of phosphorus and calcium in the blood The thyroid gland is located anteriorly in the neck. It lies deep to the sternothyroid and sternohyoid muscles from the level of the C5T1 vertebrae. It consists primarily of right and left lobes, anterolateral to the larynx and trachea. A relatively thin isthmus unites the lobes over the trachea, usually anterior to the 2nd and 3rd tracheal rings,The cervical viscera are organized in three layers, Superficial to deep, they are the endocrine layer (thyroid and parathyroid glands), the respiratory layer (larynx and trachea) the alimentary layer (pharynx and esophagus).,Viscera of Neck,Note: parathyroid glands located the back of the thyroid gland lobes,The rich blood supply of the thyroid gland,superior and inferior thyroid arteries & related nervesExternal laryngeal n.Recurrent laryngeal n. In approximately 10% of people, a thyroid ima artery Three pairs of thyroid veins usually drain the thyroid plexus of veins on the anterior surface of the thyroid gland and trachea The inferior thyroid arteries supply both the superior and the inferior parathyroid glands,Pyramidal Lobe of the Thyroid Gland,Approximately 50% of thyroid glands have a small prominence, the pyramidal lobe, on the superior surface of the isthmus of the thyroid gland, usually to the left of the median plane.,Review & Questions,Please think and give your answers during the experimental class,1. Tracheotomy and Tracheostomy,A transverse incision through the skin of the neck and anterior wall of the trachea establishes an airway in patients with upper airway obstruction or respiratory failure. The infrahyoid muscles are retracted laterally, and the isthmus of the thyroid gland is either divided or retracted superiorly. An opening is made in the trachea through the 2nd through 4th tracheal rings. A tracheostomy tube is then inserted into the trachea and secured.,1. Tracheotomy and TracheostomyQuestion,What layers were passed through to reach the trachea during the surgery?To avoid complications during a tracheostomy, what anatomical relationships are important?,2. Thyroid gland: A Goiter or Tumor,Nepalese poster shows a woman with goiter, urges victims to seek treatment,This scintigram shows a diffuse, enlarged thyroid gland,2. Thyroid gland: A Goiter or Tumor: Thyroidectomy,A,B,Thyroidectomy is done while you are under general anesthesia (unconscious and pain-free). Sometimes it is done with regional anesthesia (awake, but pain-free). The surgeon makes a cut in the neck and locates the gland. All or part of the thyroid gland, depending on the particular procedure, is removed.,2. Thyroidectomy: Questions,As the figure showed, the left lobe of the thyroid gland was removed. What layers and anatomical structures were passed through to reach the lobe during the surgery?To avoid bleeding, which vessels were ligated during the surgery?To avoid hoarseness or aphonia, which nerves should be carefully protected during surgery?A patient showed tetany, a severe neurologic syndrome characterized by muscle twitches and cramps, days after he received a thyroidectmy. His serum calcium level decreased. What organs were damaged during the surgery on him?,3. Carotid occlusion & endarterectomy,Atherosclerotic thickening of the intima (innermost coat) of the internal carotid artery may obstruct blood flow. A partial occlusion may cause a transient ischemic attack (TIA), a sudden focal loss of neurological function (e.g., dizziness and disorientation) that disappears within 24 hr. Arterial occlusion may also cause a stroke.Carotid occlusion, causing stenosis (narrowing), can be relieved by opening the artery at its origin and stripping off the atherosclerotic plaque with the intima. This procedure is called carotid endarterectomy.,3. Carotid occlusion & endarterectomyQuestions,Where do you make the incision in order to fully explore the right ICA?What layers and anatomical structures should be passed t