系统解剖学-颅脑

1、Head 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Region and partsnCranium 颅部颅部nFace 面部面部Landmaeks nSuperciliary nSupraorbital notch nInfraorbital foramennMental foramennPterionnZygomatic arch nMastoid process nExternal occipital protuberanceEpidural hemorrhagePterionMuscles of head Facial muscles 面肌面肌nEpicranius

2、 颅顶肌颅顶肌 (oddipitofrontalis) 枕额枕额肌肌qFrontal belly 额腹额腹qOccipital belly 枕腹枕腹qGalea aponeurotica 帽帽状腱膜状腱膜nOrbicularis oculi 眼眼轮匝肌轮匝肌nBuccinator 颊肌颊肌nOrbicularis oris 口口轮匝肌轮匝肌nNasalis 鼻肌鼻肌Platysma 颈阔肌颈阔肌nThe skin of face is very thin and connected to the facial bones by loose connective tissue. There is

3、 no deep fascia. The facial muscles lie in this connective tissue.Masticatory musclesnMasseter 咬肌咬肌qOrigininferior border and medial surface of zygomatic archqInsertionlateral surface of ramus of mandible and angle of mandibleqActionelevates mandiblenTemporalis 颞肌颞肌qOrigintemporal fossaqInsertioncor

4、onoid process of mandibleqActionelevates and retracts mandiblenlateral pterygoid 翼外肌翼外肌nMedial pterygoid 翼内肌翼内肌Arteries of headFacial a. 面动脉面动脉nBranch of external caroteid a. nRuns forward over digastric and submandibular glandnLoops around mandible (where it is palpable), at anterior border of mass

5、eter, to enter the facenFollows a tortuous course to medial angle of eye nLies deep to most facial musclesnBranchesqInferior labial a. 下唇动脉下唇动脉qSuperior labial a. 上唇动脉上唇动脉 qAngular a. 内眦动脉内眦动脉Superficial temporal a.颞浅动脉颞浅动脉nTerminal branch of external carotid a.nAscends in front of ear (where it is

6、palpable) to supply temporal and anterior portion of scalpnTransverse facial a. 面面横动脉横动脉runs above parotid duct to supply the cheek regionMaxillary artery 上颌动脉上颌动脉nBranch of external carotid a.nEntrance to infratemporal fossa medial to neck of mandiblenBranchesqInferior alveolar a. 下牙槽动脉下牙槽动脉qMiddle

7、 meningeal a. 脑膜中动脉脑膜中动脉 nenters the skull through foremen spinosumnSupplies cranium and dura materqPosterior superior alveolar a.上牙槽后动脉上牙槽后动脉Veins of head Facial vein 面静脉面静脉nBegins at medial angle of eye (angular vein)nRuns downward and backward through the face, posterior to the facial arterynBelo

8、w angle of mandible, joins anterior branch of retromandibular vein to form common facial vein, which drains into internal jugular veinnConnections with cavernous sinus 海绵窦海绵窦through the ophthalmic vein眼静脉眼静脉, and also through pteygoid plexus 翼静脉丛翼静脉丛 via the deep facial vein 面深静脉面深静脉 n“Danger area”

9、危险三角危险三角lies between root of nose and two angles of mouth; in this area the facial vein has no valvesRetromandibular vein 下颌后静脉下颌后静脉nFormed by union of superficial temporal and maxillary veinsnDivides into an anterior branch that unites with facial vein and a posterior branch that joins posterior au

10、ricular vein to become external jugular veinPteygoid plexus 翼静脉丛翼静脉丛nLocated between and around muscles of masticationnReceives blood from all regions supplied by maxillary a. nCommunicates with qFace by deep facial veinsqCavernous sinus by veins draining base of skullnProvides possible pathway for

11、spread of infection to cranial cavityThe lymphatic drainage of head Lymph nodes of headnLocated at junction of head and necknConsist of occipital, mastoid, parotid, submandibular, submental lymph nodesnDrain into deep cervical lymph nodes nSubmandibular lymph node 下颌下淋巴结下颌下淋巴结 lies near the submandi

12、bular gland, receive lymphatic vessels from the face, nose and mouthNerves of head Facial nerve () 面神面神经经nLeaves skull through internal acoustic meatus, facial canal and stylomastoid foramennDivided three parts qFirst partbetween stylomastoid foramen and parotid gland qSecond partwithin parotid glan

13、d qThird partoutside of parotid gland nEnters parotid gland and divides into its five terminal branches for muscles of facial expressionqTemporal 颞支颞支 qZygomatic 颧支颧支 qBuccal 颊支颊支qMarginal mandibular 下颌缘支下颌缘支 q Cervical 颈支颈支Trigeminal nerve () 三叉神经三叉神经nOphthalmic nerve 眼神经眼神经 (1) supraorbital n. 眶上神

14、经眶上神经nMaxillary nerve 上颌神经上颌神经 (2) infraorbital n. 眶下神经眶下神经nMandibular nerve 下下颌神经颌神经 (3) mental n. 颏神经颏神经Parotid gland 腮腺腮腺nPosition: situated below the external auditory meatus and lies in a deep hollow behind the ramus of mandibular and in front of the sternocleidomastoidnSuperficial part: triang

15、ular in shape, lies below and in front of the external acoustic meatus, and partially covers the masseter.n Deep part: lies deep to medial pterygoid .Parotid duct 腮腺管腮腺管 nArises front anterior border of gland nLies 1.5 cm below and parallel to zygomatic arch nPasses forward over masseter, pierces th

16、e buccinator and oral mucosa to open opposite second upper molar toothCapsule of the parotid glandnThe parotid gland is enclosed within a well-defined capsule which extension of the investing fascia of the neck. nThe superficial capsule is thick and unyielding and tightly affixed to the underlying g

17、landular tissue by numerous fibrous septa.nThe deep capsule id quite thin and easily disrupted.Structures passing through the parotid glandnVertical qExternal carotid a.qRetromandibular veinqSuperficial temporal a. & v.qAuriculotemporal n.nTransversal qMaxillary a. & v.qTranverse facial a. & v.qBran

18、ches of facial n. Relationships of parotid glandnSuperiorexternal acostic meatus, poterior margin of temporomandibular jointnAnteromedialymasseter, ramus of mandible, posterior part of medial pterygoidnPoateromedialmastoid process, sternocleidomastoid, posterior belly of digastric, styloid process,

19、internal carotid a., internal jugular v., cranial nervesn“Parotid bed”internal carotid a., internal jugular v., cranial nervesMasseter space 咬肌间隙咬肌间隙nLies between the masseter, and ramus of mandiblePterygomandibual space 翼下颌间隙翼下颌间隙 nLies between ramus of mandible and medial pterygoidSublingual space

20、 舌下间隙舌下间隙nBetween mucous membrane of floor of mouth and mylohyoid and hyoglossus Dissection Skin incisionsThe cranial partFrontal parietal occipital region额顶枕区额顶枕区BoundariesnAnteriorsupraorbital marginnPosteriorexternal occipital protuberance and superior nuchal linenLateralsuperior temporal lineLay

21、ers nconsists of five layers: qSkin 皮肤皮肤qSuperficial fascia 浅筋膜浅筋膜 qGalea aponeurotica and occipitofrontalis 帽状腱膜和枕额肌帽状腱膜和枕额肌qSubaponeurotic space (loose connective tissue) 腱膜下隙腱膜下隙qPericranium 颅骨外膜颅骨外膜nThe superficial 3 layer are closely knit together, called scalp头皮nThe skin has the greatest conce

22、ntration of hair and sebaceous glands 皮厚、腺多、血运丰富皮厚、腺多、血运丰富nThe superficial fascia is dense connective tissue that binds the skin strongly to the underlying galea aponeurotica qThe vasculature of the scalp runs primarily in the. lt is richand widely anastornotic-qWounds of the scalp bleed profusely b

23、ut heal well. Arteries, veins and nervesnAnterior groupqSupratrochlear a. v. n.qSupraorbital a. v. n.nPosterior groupqOccipital a. v. qGreater occipital n.n炎症不易扩散，肿胀疼痛剧烈，血管吻合多，止血应呈环状，局麻范围要广，切口呈放射状，皮瓣蒂在下方nGalea aponeuroticaqIt is interposed between the frontalis and occipitalis portions of the occipi

24、tofrontalis muscle.qThese muscles place the aponeurosis under tension so that deep transverse lacerations of the scalp gape widely . n坚韧致密，前连额腹，后连枕腹，1、2、3层，合称头皮nSubaponeurotic space (loose connective tissue)qExtracranial hematoma, the result of bleeding in the subaponeurotic space, can extend over t

25、he cranium. lt can extend posteriorly, to the superior nuchal line; anteriorly, into the eyelids to produce the “black eye”; and lateraliy, to the temporal line.qThe loose connective tissue layer provides the plane of separation inany injury that tears the scalp from the calvaria or for the surgeon elevating thescalp from the periosteum.qContains a rich network of deep arteries and veins. Therefore, this layer has been called the “dangero