人体解剖学甲状腺和颈根部thyroid gland and root of the neck

1、人体解剖学甲状腺和颈根部thyroid gland and root of the neckThyroid glandOutlineLocation & superficial featureBlood supplyVenous drainagenerves Relationship of its vessels and arteriesLandmarksLocation & relationshipAnteriorlly: infrahyoid muscles & SCM Posterolaterally: carotid sheath & its contents Medially: la

2、rynx, trachea, pharynx esophagus, external & recurrent laryngeal nerves Posteriorly: parathyroid glandImportant Relationship of Thyroid Glandfalse thyroid capsuleTrue capsuleThyroid -capsules Thyroid external featureright & left lobes isthmuspyramidal lobe Upper pole of its lobe extends upward to ob

3、lique line of thyroid cartilage Lower one downward to level of 6th tracheal ring Isthmus lies in front 2nd to 4th tracheal rings Pyramid lobe is usually to left of median planeThyroid relationshipParathyroid glandsParathyroid glands & thyroid glandThere are two pairs of arteries supplying thyroid gl

4、and. Superior thyroid a. arises from ECA & reaches gland at its upper pole. On its way to gland, STA runs accompanied with external laryngeal nerve.Thyroid arteriesInferior thyroid artery : branch of the thyrocervical trunk, posterior to the carotid sheath to reach the posterior aspect of the gland.

5、 ITA divides into several branches that pierce the false capsule, supply the inferior pole of the gland Before arrived to gland it runs across recurrent laryngeal nerve. Thyroid arteriesThyroid Ima ArteryVeins of thyroid gland connect to form a plexus between its two capsules & finally are drained b

6、y three pairs of veins. Superior & middle thyroid veins empty into IJV but inferior one into brachiocephalic vein. Superior, middle, & inferior thyroid v.Superior, middle, & inferior thyroid v.Nerves & arteriesRoot of the neckThe area between the thorax and neck. It opens into the superior thoracic

7、aperture. The jugular notch opposite posteriorly to disc between the T1 & T2laterally by the first pair of ribs and their costal cartilagesAnteriorly by manubriumPosteriorly by the body of T1 & T2 vertebraeSkeleton of root of neckWhat structures in the root of the neckAll structures going from the h

8、ead to the thorax; from the thorax to the upper limb; from the neck to upper limb and through the superior thoracic aperture. Structures in the root of the neckviscera organs of digestive system and respiratory system: the trachea and esophagus are located in anterior median line .carotid sheath and

9、 structures located in this sheath .Brachial plexus and subclavian vesselsphrenic nerve structures in triangle of the vertebral artery: vertebral a, thyrocervical trunkSympathetic trunk of neckapex of lungs, cervical pleura and sibson fascia Apex of lungsPrevertebral Muscles Scaleneoriginate from tr

10、ansverse process of cervical vertebrae & run downward & laterally (obliquely)Scalenus anterior inserts onto upper surface of 1st rib. It is used as a key structure in root of neck.Scaleni medius & posterior can be separated only at their insertions. The former into 1st rib, the latter 2nd rib.Scalen

11、us spaceStructures on the anterior aspect of scalenus anteriorStructures vertically running: carotid sheath & contents in the sheathphrenic nerve (most lateral)sympathetic trunk of cervical part (medial)Structures on the anterior aspect of scalenus anteriorStructures transversely:subclavian v transv

12、erse cervical asuprascapular aSubclavian veinDirect continuation of axillary vein at outer border of 1st rib. Usually it has only one tributary: external jugular veinTermination of lymphatic trunksLower limb R/L lumbar trunksAbdomen intestinal trunks L subclavian L bronchomediastinal L jugularR subc

13、lavianR bronchomediastinal right lymphatic ductR jugular Thoracic ductAortic foramenStructures on the posterior aspect of scalenus anteriorsubclavian artery lies inferiorly to the brachial plexusThe subclavian artery is divided into three parts by the scalenus anterior. 1st part is medial to this mu

14、scle,2nd part is behind to it, 3rd located laterally to it .At outer border of 1st rib, it continue as axillary artery. brachial plexus : upper, middle, lower trunks lie superior to subclavian arteryBranches of the subclavian arteryThe right subclavian artery originates from the brachiocephalic trun

15、k posterior to the sternoclavicular jointthe left originates from the arch of aorta. Branches of subclavian artery Vertebral a., internal thoracic a., & thyrocervical trunk Costocervical trunk Dorsal scapular arteryVertebral boundary:Base is the 1st part of subclavian aContent: vertebaral a.Brachial

16、 plexusStructures in the root of the necklymphatic drainage of the neckDeep cervical lymph nodes jugular trunksthoracic duct right lymphatic ductSuperficial lymph nodeslymphatic drainage of the necklymphatic drainage of the neckTypical cases患者，女性，36岁，颈部前方有一包块，主诉体重下降且精神紧张。家人抱怨该患者易急躁、激动和哭泣。查体：颈部两侧各检查到

17、一个肿块，位于喉下方。从后方触诊可感觉肿大的甲状腺，可随吞咽上下移动。其他体征：眼球突出、脉搏加快、手指震颤、手掌潮湿。诊断：甲状腺功能亢进。治疗：药物治疗无效，对患者进行了部分甲状腺切除。术后患者出现声音嘶哑。问题：1. 肿大的甲状腺虽吞咽上、下移动的解剖学基础是？ 2. 由于患者甲状腺肿大，可能受压迫的神经为？ 3. 为什么要进行部分甲状腺切除？ 4. 患者出现声音嘶哑的原因可能是什么？Detach sternothyroid from its insertion & reflect it downward. Identify & expose right & left lobes of thyroid gland, which are connected by an isthmus