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1、sdu. sdu. sdu. lizhenhualizhenhualizhenhuaregional anatomy of neck 山东大学医学院山东大学医学院 解剖教研室解剖教研室李振华李振华sdu. sdu. sdu. lizhenhualizhenhualizhenhuaparts and regions of the neckboundaries nsuperior a line joining inferior border of mandible, angle of mandible, tip of mastoid process, superior nuchal line an
2、d external occipital protuberanceninferior a line joining jugular notch, sternoclavicular joint, superior border of clavicle, acromion and spinous processes of c7sdu. sdu. sdu. lizhenhualizhenhualizhenhualandmarks of the neck nhyoid bone 舌骨nthyroid cartilage 甲状软骨ncricoid cartilage 环状软骨ncatotid tuber
3、cle 颈动脉结节sdu. sdu. sdu. lizhenhualizhenhualizhenhualandmarks of the necknhyoid bone 舌骨nthyroid cartilage 甲状软骨ncricoid cartilage 环状软骨ncatotid tubercle 颈动脉结节sdu. sdu. sdu. lizhenhualizhenhualizhenhualandmarks of the neck nsternocleidomastoid nsuprasternal fossangreater supraclaviclar fossasdu. sdu. sd
4、u. lizhenhualizhenhualizhenhuaregions of necknneck 颈颈qanterior region of neck 颈前区颈前区qsternocleidomastoid region 胸锁乳突肌区胸锁乳突肌区qlateral region of neck 颈外侧区颈外侧区 nnape 项部项部sdu. sdu. sdu. lizhenhualizhenhualizhenhuatriangles of anterior region of necknsuprahyoid region 舌骨上区舌骨上区qsubmental triangle 颏下三角颏下三角
5、qsubmandibular triangle下颌下三角下颌下三角ninfrahyoid region 舌骨下区舌骨下区qcarotid triangle 颈动脉三角颈动脉三角qmuscular triangle 肌三角肌三角 sdu. sdu. sdu. lizhenhualizhenhualizhenhuatriangles of lateral region of neck noccipital triangle 枕三角枕三角nsupraclavicular triangle 锁骨上三角锁骨上三角 (greater supraclavicular fossa) 锁骨上大窝锁骨上大窝sdu
6、. sdu. sdu. lizhenhualizhenhualizhenhuaskin of the necknthe natural line of cleavage of the skin are constant and run almost horizontally around the necksdu. sdu. sdu. lizhenhualizhenhualizhenhuasuperficial fasciacontents nplatysma 颈阔肌 nsuperficial veinsqanterior jugular v. 颈前静脉qexternal jugular v.
7、颈外静脉ncutaneous nervesqlesser occipital n. 枕小神经qgreet auricular n. 耳大神经qtransverse nerve of neck 颈横神经qsupraclavicular n. 锁骨上神经ncervical branch of facial n. 面神经颈支sdu. sdu. sdu. lizhenhualizhenhualizhenhuacervical fascia 颈筋膜颈筋膜superficial layer of cervical fascia 颈筋膜浅层颈筋膜浅层 (investing fascia 封套筋膜封套筋膜)n
8、encloses trapezius, sternocleidomastoid, posterior belly of digastric and parotid and submandibular glandsnattached to bony landmarks of upper and lower boundaries of neck and zygomatic arch of facesdu. sdu. sdu. lizhenhualizhenhualizhenhua cervical fascia 颈筋膜颈筋膜pretracheal layer 气管前层气管前层nlies deep
9、to the infrahyoid muscle nencloses viscera of neck: pharynx, larynx, trachea, esophagus, thyroid gland and parathyroid glandsncompletely surrounds thyroid gland, forming a sheath for it, and bind the gland to larynx to form suspensory ligament of thyroid gland 甲状腺悬韧带甲状腺悬韧带nextends from arch of crico
10、id cartilage, thyroid cartilage and hyoid bone to fibrous pericardium of superior mediastinum sdu. sdu. sdu. lizhenhualizhenhualizhenhua cervical fascia 颈筋膜颈筋膜prevertebral layer 椎前层椎前层nlies anterior to bodies of cervical vertebrae and prevertebral muscles; extends from base of skull downward into th
11、e superior mediastinum, continuous with anterior longitudinal lig. and endothoracic fasciancovers subclavian vessels and roots of brachial plexus nextends into upper limb as axillary sheath sdu. sdu. sdu. lizhenhualizhenhualizhenhua cervical fascia 颈筋膜颈筋膜carotid sheath 颈动脉鞘颈动脉鞘nformed by components
12、of all three layers of deep cervical fasciancontains common and internal carotid arteries, internal jugular vein, and vagus nervesdu. sdu. sdu. lizhenhualizhenhualizhenhuafascia spaces筋膜间隙筋膜间隙suprasternal space 胸骨上间隙胸骨上间隙n3cm above manubrium of sterni the investing fascia splits into two layers, whi
13、ch are attached to the anterior and posterior margins of the upper border of the manubrium, between these two layers is a slit-like space, called the suprasternal spacencontains connective tissue, and sometimes a lymph nodesdu. sdu. sdu. lizhenhualizhenhualizhenhuafascia spaces筋膜间隙筋膜间隙pretracheal sp
14、ace 气管前间隙气管前间隙nlies between pretracheal layer and cervical part of tracheancontains arteria thyroidea ima, inferior thyroid v., unpaired thyroid venous plexus, brachiocephalic trunk and left brachiocephalic v.sdu. sdu. sdu. lizhenhualizhenhualizhenhuafascia spaces筋膜间隙筋膜间隙retropharyngeal space 咽后间隙咽后
15、间隙nlies between prevertebral layer and buccopharyngeal fascia prevertebral space 椎前间隙椎前间隙nlies between prevertebral muscles, cervical part of vertebral column and prevertebral layersdu. sdu. sdu. lizhenhualizhenhualizhenhuaanterior region of neck 颈前区颈前区sdu. sdu. sdu. lizhenhualizhenhualizhenhuasupra
16、hyoid regionsubmental triangle 颏下三角颏下三角nlies below the chin nboundaries qlaterally by anterior bellies of digastricqinferiorly by the body of hyoid bonencovered by skin, superficial fascia and investing fascia nfloormylohyoid musclesncontentssubmental lymph nodessdu. sdu. sdu. lizhenhualizhenhualizh
17、enhuasuprahyoid regionsubmandibular triangle 下颌下三角下颌下三角nboundaries qanterior and posterior bellies of digastricqlower border of the body of the mandiblencovered by skin, superficial fascia, platysma and investing fascianfloor mylohyoid, hyoglossus and middle constrictor of pharynxncontentssubmandibu
18、lar gland, facial a., v., hypoglossal n. lingual a. v. and n., submandibular ganglion and submandibular lymph nodes sdu. sdu. sdu. lizhenhualizhenhualizhenhuainfrahyoid region carotid triangle 颈动脉三角颈动脉三角 nboundariesqanterior border of sternocleidomastoidqsuperior belly of omohyoid qposterior belly o
19、f digasticncovered by skin, superficial fascia, platysma and investing fasciandeepprevertebral fascia nmedial lateral wall of pharynxsdu. sdu. sdu. lizhenhualizhenhualizhenhuainfrahyoid region carotid triangle 颈动脉三角颈动脉三角 ncontentsqcommon carotid a. and its branchesqinternal jugular v. and its tribut
20、aries qhypoglossal n. with its descending branchesqvagus nerve qaccessory nerve qdeep cervical lymph nodessdu. sdu. sdu. lizhenhualizhenhualizhenhuainfrahyoid regionralations of posterior belly of digastic nsuperficialqgreat auricular n.qretromandibular v.qcervical branch of facial n.ndeepqinternal
21、and external carotid a. qinternal jugular v.q cranial n. qcervical part of sympathetic trunknsuperiorlyqposterior auricular a.qfacial a. qglossopharyngeal n.ninfeiorlyqoccipital a.qhypoglossal n.sdu. sdu. sdu. lizhenhualizhenhualizhenhuainfrahyoid region muscular triangle 肌三角肌三角nbounded by midline o
22、f the neck, superior belly of the omohyoid and anterior border of the sternocleidomastoid.ncovered by skin, superficial fascia, platysma, anterior jugular v., coutaneous n. and investing fasciandeepprevertebral fascia sdu. sdu. sdu. lizhenhualizhenhualizhenhuainfrahyoid regionmuscular triangle 肌三角肌三
23、角ncontentsqsuperior belly of omohyoid qsternohyoidqsternothyroid qthyrohyoidqthyroid glandqparathyroid glandqcervical part of trachea and esophagus sdu. sdu. sdu. lizhenhualizhenhualizhenhua thyroid gland 甲状腺甲状腺shape and positionnh-shapenleft and right lobes: lie on either side of inferior part of l
24、arynx and superior part of trachea, extend from middle of thyroid cartilage to level of sixth trachea cartilagenisthmus: overlies 2nd to 4th tracheal cartilagenpyramidal lobe: some times arises from isthmussdu. sdu. sdu. lizhenhualizhenhualizhenhua thyroid gland 甲状腺甲状腺coverings of the thyroid glandn
25、false capsule: a sheath of pretracheal fascia which is attached to arch of cricoid and thyroid cartilages to form the suspensory ligament of thyroid gland, hence, the thyroid gland moves with larynx during swallowing and oscillates during speakingntrue capsule: fibrous capsulenspace between sheath a
26、nd capsule of thyroid gland: there are loose connective tissue, vessels, nerves and parathyroid glandssdu. sdu. sdu. lizhenhualizhenhualizhenhua thyroid gland 甲状腺甲状腺relations of the thyroid gland nanteriorly: qskinqsuperficial fascia qinvesting fasciaqinfrahyoid muscles and pretracheal fascia nposte
27、romedially:qlarynx and tracheaqpharynx and esophagusqrecurrent laryngeal nervenposterolaterally:qcarotid sheath with common carotid a., internal jugular v., and vagus n.qcervical sympathetic trunksdu. sdu. sdu. lizhenhualizhenhualizhenhua arteries of the thyroid glandsuperior thyroid a. 甲状腺上动脉甲状腺上动脉
28、nbranch of external carotid a.nruns superficial and parallel to the external branch of superior laryngeal n. to reach the upper pole of thyroid glandngives off superior laryngeal a. in company with internal branch of superior laryngeal n.sdu. sdu. sdu. lizhenhualizhenhualizhenhua arteries of the thy
29、roid glandinferior thyroid artery 甲状腺下动脉甲状腺下动脉nbranch of thyrocervical trunk of subclavian a.nturns medially and downward, reaches the posterior border of the thyroid gland, where it is closely related to the recurrent laryngeal n. nsupplies inferior pole of thyroid glandsdu. sdu. sdu. lizhenhualizh
30、enhualizhenhua arteries of the thyroid glandarteria thyroidea ima 甲状腺最下动脉甲状腺最下动脉 may arise (4%) from the brachiocephalic a. or aortic archsdu. sdu. sdu. lizhenhualizhenhualizhenhua nerves of the larynx superior laryngeal n. 喉上神经喉上神经ninternal branch 内支内支:which pierces thyrohyoid membrane to innervate
31、s mucous membrane of larynx above fissure of glottisnexternal branch 外支外支:is fine n., which descends in company with the superior thyroid a. and supplies cricothyroid sdu. sdu. sdu. lizhenhualizhenhualizhenhua nerves of the larynx recurrent laryngeal nerves 喉返神经喉返神经nascend in tracheo-esophageal groo
32、venpass deep to the lobe of the thyroid gland and come into close relationship with the inferior thyroid a.ncross either in front of or behind the artery of may pass between its branchesnnerves enter larynx posterior to cricothyroid joint, the nerve is now called inferior laryngeal nerveninnervation
33、s: laryngeal mucosa below fissure of glottis , all laryngeal laryngeal muscles except cricothyroid sdu. sdu. sdu. lizhenhualizhenhualizhenhuavenous drainage of the thyroid glandnsuperior thyroid veins drain into internal jugular vein nmiddle thyroid veins drain into internal jugular veinninferior th
34、yroid veins of two sides anastomose with one another as they descend in front of the trachea to form unpaired thyroid venous plexus 甲状腺甲状腺奇静脉丛奇静脉丛. they drain into brachiocephalic veins.sdu. sdu. sdu. lizhenhualizhenhualizhenhua parathyroid gland 甲状旁腺甲状旁腺nyellowish-brown, ovoid bodiesnpositionqtwo s
35、uperior parathyroid glands: lie at junction of superior and middle third of posterior border of thyroid glandqtwo inferior parathyroid glands: lie near the inferior thyroid artery, close to the inferior poles of thyroid glandnfunction: regulate calcium and phosphate balance and is therefore essentia
36、l for lifesdu. sdu. sdu. lizhenhualizhenhualizhenhuacervical part of trachea 气管颈部气管颈部nbegins at lower end of larynxlevel of c6 vertebranconsists of a series of incomplete cartilage ringsnextends into thoraxsdu. sdu. sdu. lizhenhualizhenhualizhenhuarelations of cervical part of trachea 气管颈部气管颈部 anter
37、iorlyqskinqsuperficial fasciaqinvesting fasciaqsuprasternal space and jugular archqinfrahyoid muscles and pretracheal fasciaqisthmus of thyroid gland ( in front of the 2nd to 4th tracheal cartilage)qinferior thyroid v. and unpaired thyroid venous plexusqarteria thyroid ima ( if present)qthymus, left
38、 brachiocephalic v. and aortic arch in childsdu. sdu. sdu. lizhenhualizhenhualizhenhuarelations of cervical part of trachea 气管颈部气管颈部nsuperolaterally qlobes of the thyroid gland ( down as far as the sixth ring) nposteriorlyqesophagusqr. & l. recurrent laryngeal nervesnposterlaterallyqcervical sym
39、pathetic trunkqcarotid sheathsdu. sdu. sdu. lizhenhualizhenhualizhenhuacervical part of esophagus 食管颈部食管颈部nextending from pharynx at level of c6 vertebrandescends through the neck, it inclines to the left side nrelations of the cervical part of esophagusqanteriorly ntracheanrecurrent laryngeal nerve
40、s qposteriorly nprevertebral layer of cervicl fascianlongus collinvertebral columnqlaterally nlobe of the thyroid glandncarotid sheath with common carotid a., internal jugular v., and vagus n. sdu. sdu. sdu. lizhenhualizhenhualizhenhuasternocleidomastoid region 胸锁乳突肌区胸锁乳突肌区ncovered by sternocleidoma
41、stoid ncontents qansa cervicalis qcarotid sheath qcervical plexusqcervical part of sympathetic trunksdu. sdu. sdu. lizhenhualizhenhualizhenhuaroot of neck 颈根部颈根部nat thoracic inlet nformed byqanteriorlymanubrium sterniqposteriorlybody of first thoracic vertebraqlaterallyfirst rib and costal cartilage
42、qcentral markersscalenus anteriorsdu. sdu. sdu. lizhenhualizhenhualizhenhuaroot of neck 颈根部颈根部contents ncupula of pleuraextends up into the neck, over the apex of lung, 23cm above the medial third of claviclensubclavian v.nthoracic duct and right lymphatic ductnsubclavian a.nvagus n.nphrenic n.sdu.
43、sdu. sdu. lizhenhualizhenhualizhenhuatriangle of the vertebral a. 椎动脉三角椎动脉三角nboundaries qmediallylongus colliqlaterallyscalenus anterior qinferiorlyfirst part of subclavian a.qapextransverse process of c6qposteriorlycupula of pleura, transverse process of c7, anterior rami of c8 spinal nerves, costa
44、l neck of 1st ribqanteriorlycarotid sheath, phrenic n. and arch of thoracic duct (left)ncontents qvertebral a. and v.qinferior thyroid a.qcervical part of sympathetic trunkqcevicothoracic ganglionsdu. sdu. sdu. lizhenhualizhenhualizhenhualateral region of neck 颈外侧区颈外侧区nbounded by posterior border of
45、 sternocleidomastoid, anterior border of trapezius and middle third of claviclendivided by inferior belly of omohyoid into occipital triangle and supraclavicular triangle sdu. sdu. sdu. lizhenhualizhenhualizhenhuaoccipital triangle 枕三角枕三角nbounded by posterior border of sternocleidomastoid, anterior
46、border of trapezius and superior border of inferior belly of omohyoid ncovered by skin, superficial fascia, and investing fasciandeepprevertebral fascia and scalenus anterior, scalenus medius, scalenus posterior, splenius capitis and levator scapulaenconentsqaccessory n.emerges above the middle of t
47、he posterior border of sternocleidomastoid and crosses the occipital triangle to trapeziusqcervical and brachial plexusessdu. sdu. sdu. lizhenhualizhenhualizhenhuasupraclavicular triangle 锁骨上三角锁骨上三角nbounded by posterior border of sternocleidomastoid, inferior belly of omohyoid and middle third of cl
48、aviclencovered by skin, superficial fascia, and investing fasciandeepprevertebral fascia and inferior parts of scalenusnconentsqsubclavian v. and venous angle qsubclavian a.qbrachial plexussdu. sdu. sdu. lizhenhualizhenhualizhenhuaskin incisionsnmake the skin incisions shown in figure nreflect the s
49、kin posteriorly to well behind the ear. sdu. sdu. sdu. lizhenhualizhenhualizhenhuadissection of superficial structures nnote the underlying platysma muscle, a muscle of facial expression, which has migrated onto the neck. beneath the platysma lie the supraclavicular cutaneous nerves (c3-4) (medial,i
50、ntermediate and lateral). slightly superior to the middle of the posterior border of the sternocleidomastoid muscle, locate the spinal accessory nerve coursing downward toward the trapezius muscle. platysmasdu. sdu. sdu. lizhenhualizhenhualizhenhuadissection of superficial structuresnusing your scis
51、sors incise and spread the tough fascial covering of the posterior triangle and locate the lesser occipital nerve (c2-3) emerging close to cn., note the direction that each nerve takes as it traverses the posterior triangle.nnext locate the great auricular nerve (c2-3) which ascends posterior and pa
52、rallel with the external jugular vein on the sternoclidomastoid. ntry to identify the small transverse cervical nerve (c2-3) supplying skin over the anterior neck.nlook for the facial vein, retromandibular vein and, if present, the small anterior jugular vein, and review the external jugular system.
53、 sdu. sdu. sdu. lizhenhualizhenhualizhenhuacutaneous nerves and superficial veinsexternal jugular veinanterior jugular veinlesser occipital n.greet auricular n.transverse nerve of necksupraclavicular n.sdu. sdu. sdu. lizhenhualizhenhualizhenhuamuscular trianglenthis triangle includes the “strap” mus
54、cles that lie anterior to the trachea. the superficial layer of strap muscles consists of the superior belly of the omohyoid and sternohyoid. ndeep to these are the sternothyroid and short thyrohyoid muscles. spread the infrahyoid muscles apart and identify the cricothyroid membrane stretching betwe
55、en the thyroid and cricoid cartilages. sdu. sdu. sdu. lizhenhualizhenhualizhenhuacarotid trianglenthis triangle is bound by the superior belly of the omohyoid, posterior belly of the digastric, and anterior border of the sternocleidomastoid. ndivide the sternocleidomastoid muscle about 5cm above its
56、 inferior attachment and reflect the muscle toward the mastoid process while preserving the spinal accessory nerve. ncut the facial vein where it empties into the internal jugular vein.sdu. sdu. sdu. lizhenhualizhenhualizhenhuacarotid trianglenpalpate and locate the tip of the greater horn of the hy
57、oid bone. just superior to the tip, find the hypoglossal nerve where it crosses the carotid sheath anteriorly and lataerally. nnow try to find the superior root of the ansa cervicalis which is composed mainly of fibers from c1 that run with the cn. . the inferior root (c2-3) descends from the more p
58、osterior superior neck region to join the superior root, together forming a loop overlying the carotid sheath. the ansa innervates the infrahyoid muscles and often is enmeshed in the carotid sheath.sdu. sdu. sdu. lizhenhualizhenhualizhenhuasubmendibular glandomohyoidsternohyoidsternothyroidsuperior
59、thyroid a.cervical plexusphrenic n.ansa cervicalisvagus n.hypoglossal n.accessory n.digastric sdu. sdu. sdu. lizhenhualizhenhualizhenhuacarotid trianglenfind the vagus nerve by carefully opening the carotid sheath. it lies within the carotid sheath between the common carotid artery and internal jugu
60、lar vein. nrelax the neck, and then sever the omohyoid, sternohyoid, and thyrohyoid muscles close to the hyoid bone. this exposes the thyrohyoid membrane and the internal laryngeal nerve can be seen piercing this membrane. the other portion of the superior laryngeal nerve is its very small external lary
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