耳鼻咽喉应用解剖课件 耳鼻咽喉头颈外科学课件

1、耳鼻咽喉应用解剖课件耳鼻咽喉应用解剖课件 耳鼻咽耳鼻咽喉头颈外科学课件喉头颈外科学课件The NoseExternal nose 外鼻Nasal cavity 鼻腔Paranasal sinuses 副鼻窦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Nasal cavity

2、 鼻腔鼻腔 Nasal vestibule 鼻前庭鼻前庭 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 固有鼻腔固有鼻腔Nasal cavity proper The roof. Anterior sloping part of the roof is formed by nasal bones; Posterior

3、sloping part by the body of sphenoid bone; The middle horizontal part, by the cribriform plate (筛板).Nasal cavity proper The floor . formed by the palatal process of the maxilla上颌骨腭突上颌骨腭突and the horizontal process of the palate bones腭骨水平腭骨水平部部.3/41/4Nasal cavity proper Nasal septum. 鼻中隔鼻中隔软骨犁骨筛骨正中板上颌

4、骨腭突Littles area plexus利特尔区利特尔区 (动脉丛动脉丛)Littles area plexus利特尔区利特尔区 (动脉丛动脉丛)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Nasal cavity proper Lateral wall. three scroll-like bone projections called turbinate or conchae鼻甲. Below and later

5、al to each turbinate is the corresponding meatus鼻道.Nasal 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 ethmoidal sinuses) open to the infundibulum 筛漏斗in middle meatus.前组鼻窦额窦

6、，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Posterior naris (choanae) 后鼻孔Nasal septum鼻中隔 Inferior turbinate下鼻甲 Nasal cavity properParanasal s

7、inuses 副鼻窦副鼻窦The sinuses are air-filled bony cavities located in the face and skull adjacent to the nose. Maxillary sinus 上颌窦上颌窦 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. Ethmoid sinus 筛

8、窦筛窦 Comprises a group of air cells, which form one of the most complex structures in the body. Drains through the middle meatus and above the superior turbinate.Frontal sinus 额窦额窦 The frontal sinuses are situated beneath the bone of the forehead and just in front of the bone overlying the brain. And

9、 drains through the frontal recess额隐窝to the middle meatus.Sphenoid sinus 蝶窦蝶窦 The sphenoid sinuses open in the upper part of anterior wall and drains into the sphenoethmoidal recess 蝶筛隐窝蝶筛隐窝. Ostiomeatal complex 窦窦口鼻道复合体口鼻道复合体 The ostiomeatal complex is the sinus hot spot, one of the most important

10、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、前组筛窦和上颌窦的自然开口等结构形成的额窦、前组筛窦和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区域

11、，称为鼻道窦口复合体(ostiomeatal (ostiomeatal complex)complex)，是内窥镜鼻窦手术以后提出的新概念，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。对指导手术有重要意义。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 reflexThe Ear External, Middle, and Inner ear. Each serves different aspects of the

12、auditory sensation. 集音 传音 感音 The External Ear 外耳外耳 The auricle 耳廓 The external acoustic meatus 外耳道 略呈略呈S状弯曲，长约状弯曲，长约2.53.5cm。外外13为软骨部，内为软骨部，内23为骨部，外耳道有两处较狭窄，一为骨部与软骨部交界为骨部，外耳道有两处较狭窄，一为骨部与软骨部交界处，另一处为骨部距鼓膜处，另一处为骨部距鼓膜0.5cm处较狭窄处，称为外耳道狭部。处较狭窄处，称为外耳道狭部。软骨部是耳疖的好发部位软骨部是耳疖的好发部位。The external Ear 外耳The Middle E

13、ar 中耳Tympanic cavityMastoid Process 乳突乳突Auditory tube咽鼓管咽鼓管Consists of the tympanic cavity(鼓室), auditory tube(咽鼓管), tympanic antrum(鼓窦) and mastoid process(乳突).The tympanic Cavity 鼓室鼓室The epitympanumThe mesotympanumThe hypotympana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

14、管隆凸、外半规管隆凸外壁 大局部为鼓膜所封闭。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Tympanic Membrane 鼓膜鼓膜光锥光锥Cone of lightCone of light紧张部紧张部Pars tensePars tense松弛部松弛部Pars flaccidPars flaccid锤纹锤纹 Malleolar striaMalleolar stria锤骨短突锤骨短突Short process Short process of malleusof mall

15、eus外耳道皮肤外耳道皮肤Lateral & Anterior WallsAnterior wall面神经面神经颈内动脉颈内动脉咽鼓管咽鼓管鼓膜张肌鼓膜张肌鼓索神经鼓索神经Medial WallMedial Wall鼓岬鼓岬圆窗圆窗鼓窦鼓窦malleus incusstapes Tympanic vestibular Membrane windowMalleus 锤骨锤骨Incus砧骨砧骨 Stapes 镫骨镫骨Auditory ossicles and Ossicular chain听骨 &听骨链The Auditory Tube (Eustachian tube)咽鼓管 Two parts

16、: bony & cartiliginous parts 外1/3为骨部，内2/3为软骨部 Two openings: the pharyngeal & the tympanic orifices Variety with anatomy between infant and adultThe Inner Ear 内耳内耳 / Labyrinth 迷路迷路 The inner ear osseous labyrinth骨迷路骨迷路 contains the vestibule前庭前庭, semicircular canals半规管半规管 and cochlea耳蜗耳蜗 membranous l

17、abyrinth膜迷路膜迷路. utricle(椭圆囊椭圆囊), saccule(球囊球囊), membranous semicircular canals(膜膜半规管半规管), membranous cochlea duct(膜蜗管膜蜗管), 内淋巴管囊内淋巴管囊(endolymphatic duct)Vestibule前庭前庭Cochlea耳蜗耳蜗Semicircular canals半规管半规管Osseous labyrinth 骨迷路Lateral semicircular canal水平半规管水平半规管Posterior semicircular canal后半规管后半规管Super

18、ior semicircular Canal上半规管上半规管Vestibule window前庭窗前庭窗Cochlea window蜗蜗 窗窗Cochlea耳蜗耳蜗Osseous labyrinth骨迷路vestibule前庭 semicircular canals半规管 cochlea耳蜗semicircular canals半规管Lateral semicircular canal外水平半规管外水平半规管Posterior semicircular canal后半规管后半规管Superior semicircular Canal上半规管上半规管位于前庭前方，为上、后、外三个弓形互相垂直的骨

19、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。Vestibule 前庭前庭 lateral wallthe vestibular window，the cochlear window 为鼓室内壁的一局部，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bony c

20、anals of cochlea 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。 2021-10-15SemicircularcanalsCochlearDuct蜗管蜗管Utricle椭圆囊椭圆囊Saccule球囊球囊The Membrano

21、us Labyrinth 膜迷路膜迷路亦分前庭、半规管及耳蜗三部内有听觉和位觉感受器Outer 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Utricle & Saccule 椭圆囊和球囊椭圆囊和球囊-位于前庭，感受直线加速度运动的刺激Ampulla 壶腹Cupula 壶腹嵴Membranous semicircular canals 膜半规管膜半规管Cupula 壶腹嵴位于半规壶腹嵴位于半规管壶腹端管壶腹端 ，主要感受正负，主要感受正负角加

22、速度的刺激角加速度的刺激耳蜗神经核上橄榄核外侧丘系核下丘听觉皮层耳蜗The PharynxNasopharynx 鼻咽后鼻孔后鼻孔下鼻甲下鼻甲中鼻甲中鼻甲上鼻甲上鼻甲咽隐窝咽隐窝咽鼓管圆枕咽鼓管圆枕l 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病症，10岁以后逐渐萎缩。l 咽鼓管咽口The orifice of Eustachian tube：下鼻甲后端前方约1-1.5cm处l 咽鼓管圆枕Torus tubalis：咽口上方隆起的局部l 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

23、可循此自然孔道侵入颅内。Posterior naris (choanae) The Oropharynx 口咽口咽Palatopharyngeal arch 腭咽弓腭咽弓Palatoglossal arch 腭舌弓腭舌弓口咽口咽 (oropharynx)l 咽峡：l 上-悬雍垂(uvula)、软腭游离缘(soft palate)，l 侧-舌腭弓(palatoglossal arch)、扁桃体(tonsil)、咽腭弓(palatopharyngeal arch)，l 下-舌背。l 腭扁桃体：l 咽侧索：每侧咽腭弓的前方的纵行条索状淋巴组织Laryngopharynx 喉咽喉咽Post-crico

24、id region 环后区Pyriform sinuses 梨状窝梨状窝Waldeyers Ring 咽淋巴环咽淋巴环 Adenoid 腺样体腺样体 Tubal Tonsils. 咽鼓管扁桃体咽鼓管扁桃体 Palatine Tonsils. 腭扁桃体腭扁桃体 Lingual Tonsils. 舌扁桃体舌扁桃体 Lat. Pharyngeal bands. 咽侧索咽侧索Definition: Ring of Lymphoid tissue guarding entrance to the digestive & respiratory tracts.咽旁间隙咽后间隙Parapharyngeal

25、and retroparyngeal space 咽旁隙和咽后隙Parapharyngeal space 咽旁隙咽旁隙internal carotid a. 颈内动脉颈内动脉jugular v. 颈内静脉颈内静脉cranial nerves sympathetic chain 交感干交感干cervical lymphnodes 颈淋巴结颈淋巴结咽后隙 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局部。内容：疏松结缔组织和淋巴结，易形成咽后壁脓肿，小儿多见。

26、 The Larynxl 喉部位于颈前正中，舌骨之下；l 上接喉咽部，下连气管；l 是呼吸的重要通道，下呼吸道的门户；l 由软骨组成支架，附以肌肉、韧带、粘膜等；为呼吸和发音器官。Epiglottic cartilage 会厌软骨 Thyroid cartilage 甲状软骨 The largest cartilage of larynxCricoid cartilage 环状软骨The only complete cartilaginous ringArytenoid cartilage 杓状软骨杓状软骨paired, pyramidal shapedl声带突：声带附着处l肌突：环杓后肌及环

27、杓侧肌附着喉的韧带与膜 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Muscles of larynx extrinsic laryngeal muscles喉外肌 intrinsic laryngeal muscles喉内肌 Intrinsic laryngeal muscles 喉内肌喉内肌 Abductor 外展外展 Posterior cricoarytenoid 环杓后肌环杓后肌 Adductors 内收内收 Lateral cricoarytenoid 环杓侧肌环杓

28、侧肌 Transverse arytenoid 杓横肌杓横肌 Adjust tension of the vocal cord: Cricothyroid 环甲肌环甲肌 Thyroarytenoid 甲杓肌甲杓肌 Move the epiglottic: Thyreo-epiglotticus 甲状会厌肌甲状会厌肌Extrinsic laryngeal muscles 喉外肌喉外肌Suprahyoid Muscles 舌骨上肌群舌骨上肌群 Mylohyoid 下颌舌骨肌下颌舌骨肌 Digastric 二腹肌二腹肌 Geniohyoid 颏舌骨肌颏舌骨肌 Stylohyoid 茎突舌骨茎突舌骨 Genioglossus 颏舌肌颏舌肌 Styloglossus 茎突舌肌茎突舌肌Infrahyoid Muscles 舌骨下肌群舌骨下肌群 Thyrohyoid 甲状舌骨肌甲状舌骨肌 Omohyoid 肩胛舌骨肌肩胛舌骨肌 Sternohyoid 胸骨舌骨肌胸骨舌骨肌 Sternothyroid 胸骨甲状肌胸骨甲状肌Intrinsic laryngeal muscles 喉内肌喉内肌 环甲肌Cricothyroid环杓侧肌Lateral crico-arytenoid 环杓后肌Posterior crico-arytenoid