颈部的局部解剖与操作课件(PPT 57页)

1、局部解剖学（九） 颈部的局部解剖与操作（1）第1页，共57页。颈 部 Neck概述 introduction浅层结构 superifical structures下颌下三角 submandibular triangle颏下三角 submental triangle第2页，共57页。一、概述 Introduction境界和分区 boundary and regions表面解剖 surface anatomy表面标志 surface landmark体表投影 surface projection第3页，共57页。上界：为下颌骨下缘、下颌角、乳突、上项线与枕外隆突的连线。Superiorly：an

2、line linking with the lower border of mandible, the angle of mandible, the mastoid process, the superior nuchal line and the external occipital protuberance; 下界：由胸骨上缘、锁骨和肩峰至第7颈椎棘突的连线。Inferiorly：by the upper border of sternum, the clavicle and a line extending from the acromion to the spine of 7th ce

3、rvical vertebra.1. 颈部的境界 boundary of the neck第4页，共57页。2.颈部分区颈部:分为固有颈部（proper neck）和项部（nape）。固有颈部:又可分为颈前区anterior region、胸锁乳突肌区sternocleidomastoid region和颈外侧区lateral region。第5页，共57页。颈前区：被舌骨hyoid分为舌骨上区suprahyoid region（包括2个下颌下三角和1个颏下三角）和舌骨下区infrahyoid region（包括成对的颈动脉三角和肌三角）。颈外侧区：被肩胛舌骨肌下腹分为枕三角和锁骨上三角。第6

4、页，共57页。3.表面标志 surface landmarkLesser supraclavicular fossa(Greater) supraclavicular fossaSuprasternal fossa第7页，共57页。表面标志Surface Landmark舌骨 Hyhoid(H)甲状软骨 Thyroid cartilage(T)喉结节 Laryngeal prominence(P)环状软骨 Cricoid cartilage (C)第1气管环 The first tracheal ringe(1)甲状腺峡 Isthmus(S)第8页，共57页。环状软骨(弓)的意义第6颈椎水平T

5、he level of the 6th cervical vertebra.喉与气管交界 The junction of the larynx with the trachea. 咽与食管交界 The junction of the pharynx with the esophagus.第9页，共57页。The level at which the vertebral artery enters the transverse foramen of the 6th cervical vertebra.The site at which the carotid artery can be pres

6、sed against the carotid tubercle of the 6th cervical vertebra.第10页，共57页。The level at which the inferior thyroid artery and the middle thyroid vein enter or leave the thyroid gland.第11页，共57页。The level at which the superior belly of the omohyoid muscle crosses the carotid sheath.第12页，共57页。The level of

7、 the middle sympathetic ganglion.第13页，共57页。二、颈部浅层结构The superficial structures of the neck皮肤 The skin( thin and pliable)浅筋膜及其内容The superficial fascia and its contents a thin layer of fat a sheet of platysma the anterior jugular vein the lateral jugular vein the superficial(lateral and anerior)cervica

8、l lymph nodes the cutaneous branches of the cervical plexus the cervical branch of the facial nerve第14页，共57页。1. 颈阔肌The platysmaIs a broad, thin sheet of muscle in the subcutaneous tissue.Covers the anterolateral aspect of the neck.Aarise in fascia covering superior parts of the deltoid and pectorali

9、s major muscles and sweep superomedially over the clavicle to the inferior border of the mandible, skin, and subcutaneous tissue of lower face.Is one of the muscles of facial expression.Is innervated by the cervical branch of the facial nerve.第15页，共57页。The superficial cervical veins and nerves are l

10、ocated deep to the platysma.第16页，共57页。The main action of the platysma:draws corners of mouth inferiorly and widens it as in expressions of sadness and fright; draws the skin of neck superiorly when teeth are “clenched”.第17页，共57页。2.颈前静脉或颈前正中静脉、颈外静脉第18页，共57页。颈静脉弓Jugular venous arch第19页，共57页。3. 颈浅淋巴结Su

11、perficial cervical lymph nodes第20页，共57页。4. Superficial cervical nervesCutaneous branches of the cervical plexusNerve point of neck Cervical branch of the facial nerve第21页，共57页。面神经的颈支Cervical branch of facial nerve第22页，共57页。三、颈筋膜及筋膜间隙Cervical Fasciaand Fascial Space第23页，共57页。1. 颈筋膜 Cervical Fascia 颈深

12、筋膜分为三层 Deep cervical fascia consists of three fascial layers:浅层 Superficial layer 封套筋膜 Investing fascia中层 Middle layer 气管前筋膜 Prechacheal fascia 内脏筋膜 Visceral fascia深层 Deep layer 椎前筋膜 Prevertebral fascia第24页，共57页。第25页，共57页。封套筋膜、 气管前筋膜、椎前筋膜第26页，共57页。颈动脉鞘、气管前筋膜、甲状腺鞘、甲状腺悬韧带第27页，共57页。2. 颈筋膜间隙 Cervical Fa

13、scial Spaces胸骨上间隙 Suprasternal space咽后间隙 Retropharyngeal space气管前间隙 Prechacheal space椎前间隙 Prevertebral space第28页，共57页。胸骨上间隙、咽后间隙、气管前间隙、椎前间隙第29页，共57页。第30页，共57页。胸 骨 上 间 隙的内容Contents of the Suprasternal spaceInclude the:颈前筋膜下端 Inferior ends of the anterior jugular veins颈静脉弓 Jugular venous arch疏松结缔组织 Lo

14、ose connective tissue12个淋巴结 One or two deep lymph nodes 胸锁乳突胸骨头 Sternal heads of the ternocleidomastoid 锁骨间韧带 Interclavicular ligament第31页，共57页。锁骨上间隙的内容Contents of the supraclavicular spaceInclude the:颈外静脉 A part of the external jugular vein锁骨上神经 Supraclavicular nerves 颈横静脉 Transverse cervical vein

15、肩胛上静脉 Suprascapular vein 淋巴管 A few lymph vessels第32页，共57页。四、颏 下 三 角Submental Triangle境界 Boundary内容 Contents第33页，共57页。颏下三角 Boundaris of submental triangleBody of hyoid bone第34页，共57页。颏 下 三 角 的 内 容Contents of the submental triangleInclude the:几个小的颏下淋巴结 Several small submental lymph nodes.几条小静脉，汇合成颈前静脉

16、Small veins that unite to form the anterior jugular vein.第35页，共57页。五、下 颌 下 三 角Submandibular Triangle境界 Boundary内容 Contents第36页，共57页。1. 下 颌 下 三 角Boundaris of the submandibular triangle第37页，共57页。 A roof of the submandibular triangle is formed by the skin, superficial fascia, platysma and investing fas

17、cia.第38页，共57页。A floor of the submandibular triangle is formed by the mylohyoid, hyoglossus and middle pharyngeal constrictor.Middle pharyngeal constrictorMylohyoidHyoglossus第39页，共57页。下颌下三角的底第40页，共57页。下颌下三角的顶与底第41页，共57页。2.下颌下三角的主要结构Main contents of the submandibular triangle下颌腺及其导管Submandibular gland

18、 and its duct 面静脉 Facial vein 面神经的颈支 Cervical branch of facial nerve 下颌下淋巴结 Submandibular lymph nodes 面动脉 Facial artery 颏下动、静脉 Submental artery and vein 下颌舌骨肌神经 Mylohyoid nerve 舌下神经 Hypoglossal nerve 舌动、静脉 Lingual artery and vein 舌神经Lingual Nerve , 下颌下神经节Submandibular ganglion第42页，共57页。1. 在下颌下腺的浅面有：

19、 面静脉、面神经的颈支、下颌下淋巴结Cervical branches of facial nerve第43页，共57页。Mylohyoid 2. The submandibular gland is divided into the superficial and deep parts by the posterior border of mylohyoid,its duct emerges from the deep of the gland and then opens on the sublingual papilla.第44页，共57页。3. 在下颌下腺的深面：在下颌舌骨肌浅面的结构

20、有颏下动脉和静脉、下颌舌骨肌神经；在舌骨舌肌浅面的结构有舌静脉、面动脉、舌下神经、下颌下神经节和舌神经；在舌骨舌肌深面的结构有舌动脉。第45页，共57页。第46页，共57页。4.下颌下腺深部及其导管的毗邻：自上而下为舌神经、下颌下神经节、下颌下腺及其导管、舌下神经、舌动脉和静脉。第47页，共57页。六、解剖与观察Dissection and Observation 1.Make a median skin incision2.Reflect the skin flaps3.Reflect the platysma4.Dissect the superficial structures 5.Di

21、ssect the submental triangle6.Dissect the submandibular triangle第48页，共57页。1.Make a median skin incision from the mental symphysis to the suprasternal notch.第49页，共57页。2.Reflect the skin flaps laterally to the anterior border of the trapezius to expose the platysma directly. 3.Divide the platysma alon

22、g the upper border of the clavicle and reflect it upwards to the mandible. Do not damage the underlying structures.第50页，共57页。4.Look for and expose the superficial structures of the neck.第51页，共57页。5.Clean boundaris of the submental triangle第52页，共57页。6. Cut through the investing fascia to exopse the submandibular gland, the facial vein, the cervical branches of the facial nerve and submandibular lymph nodes.第53页，共57页。 Identify the facial artery and follow it to its origin. Divide the origin of the anterior belly of