颈部解剖课件

局部解剖学（九）

颈部的局部解剖与操作（1）颈部解剖1颈部

Neck概述introduction浅层结构superificalstructures下颌下三角submandibulartriangle颏下三角submentaltriangle颈部解剖1一、概述Introduction境界和分区boundaryandregions表面解剖surfaceanatomy表面标志surfacelandmark体表投影surfaceprojection颈部解剖1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：anlinelinkingwiththelowerborderofmandible,theangleofmandible,themastoidprocess,thesuperiornuchallineandtheexternaloccipitalprotuberance;

下界：由胸骨上缘、锁骨和肩峰至第7颈椎棘突的连线。Inferiorly：bytheupperborderofsternum,theclavicleandalineextendingfromtheacromiontothespineof7thcervicalvertebra.1.颈部的境界boundaryoftheneck颈部解剖12.颈部分区颈部:分为固有颈部（properneck）和项部（nape）。固有颈部:又可分为颈前区anteriorregion、胸锁乳突肌区sternocleidomastoidregion和颈外侧区lateralregion。颈部解剖1颈前区：被舌骨hyoid分为舌骨上区suprahyoidregion（包括2个下颌下三角和1个颏下三角）和舌骨下区infrahyoidregion（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。颈部解剖13.表面标志

surfacelandmarkLessersupraclavicularfossa(Greater)supraclavicularfossaSuprasternalfossa颈部解剖1表面标志

SurfaceLandmark舌骨Hyhoid(H)甲状软骨

Thyroidcartilage(T)喉结节Laryngealprominence(P)环状软骨

Cricoidcartilage(C)第1气管环

Thefirsttrachealringe(1)甲状腺峡Isthmus(S)颈部解剖1环状软骨(弓)的意义第6颈椎水平Thelevelofthe6thcervicalvertebra.喉与气管交界Thejunctionofthelarynxwiththetrachea.咽与食管交界Thejunctionofthepharynxwiththeesophagus.颈部解剖1Thelevelatwhichthevertebralarteryentersthetransverseforamenofthe6thcervicalvertebra.Thesiteatwhichthecarotidarterycanbepressedagainstthecarotidtubercleofthe6thcervicalvertebra.颈部解剖1Thelevelatwhichtheinferiorthyroidarteryandthemiddlethyroidveinenterorleavethethyroidgland.颈部解剖1Thelevelatwhichthesuperiorbellyoftheomohyoidmusclecrossesthecarotidsheath.颈部解剖1Thelevelofthemiddlesympatheticganglion.颈部解剖1二、颈部浅层结构

Thesuperficialstructuresoftheneck皮肤

Theskin(thinandpliable)浅筋膜及其内容Thesuperficialfasciaanditscontentsathinlayeroffatasheetofplatysmatheanteriorjugularveinthelateraljugularveinthesuperficial(lateralandanerior)cervicallymphnodesthecutaneousbranchesofthecervicalplexusthecervicalbranchofthefacialnerve颈部解剖11.颈阔肌

TheplatysmaIsabroad,thinsheetofmuscleinthesubcutaneoustissue.Coverstheanterolateralaspectoftheneck.Aariseinfasciacoveringsuperiorpartsofthedeltoidandpectoralismajormusclesandsweepsuperomediallyovertheclavicletotheinferiorborderofthemandible,skin,andsubcutaneoustissueoflowerface.Isoneofthemusclesoffacialexpression.Isinnervatedbythecervicalbranchofthefacialnerve.颈部解剖1Thesuperficialcervicalveinsandnervesarelocateddeeptotheplatysma.颈部解剖1Themainactionoftheplatysma:①drawscornersofmouthinferiorlyandwidensitasinexpressionsofsadnessandfright;②drawstheskinofnecksuperiorlywhenteethare“clenched”.颈部解剖12.颈前静脉或颈前正中静脉、颈外静脉颈部解剖1颈静脉弓Jugularvenousarch颈部解剖13.颈浅淋巴结Superficialcervicallymphnodes颈部解剖14.SuperficialcervicalnervesCutaneousbranchesofthecervicalplexusNervepointofneckCervicalbranchofthefacialnerve颈部解剖1面神经的颈支Cervicalbranchoffacialnerve颈部解剖1三、颈筋膜及筋膜间隙

CervicalFasciaandFascialSpace

颈部解剖11.

颈筋膜CervicalFascia

颈深筋膜分为三层

Deepcervicalfasciaconsistsofthreefasciallayers:浅层Superficiallayer

封套筋膜Investingfascia中层Middlelayer

气管前筋膜Prechachealfascia

内脏筋膜Visceralfascia深层Deeplayer

椎前筋膜Prevertebralfascia颈部解剖1颈部解剖1封套筋膜、气管前筋膜、椎前筋膜颈部解剖1颈动脉鞘、气管前筋膜、甲状腺鞘、甲状腺悬韧带颈部解剖12.颈筋膜间隙

CervicalFascialSpaces胸骨上间隙Suprasternalspace咽后间隙Retropharyngealspace气管前间隙Prechachealspace椎前间隙Prevertebralspace颈部解剖1胸骨上间隙、咽后间隙、气管前间隙、椎前间隙颈部解剖1颈部解剖1胸骨上间隙的内容

ContentsoftheSuprasternalspaceIncludethe:颈前筋膜下端

Inferiorendsoftheanteriorjugularveins颈静脉弓Jugularvenousarch疏松结缔组织Looseconnectivetissue1~2个淋巴结Oneortwodeeplymphnodes

胸锁乳突胸骨头Sternalheadsoftheternocleidomastoid

锁骨间韧带Interclavicularligament颈部解剖1锁骨上间隙的内容

ContentsofthesupraclavicularspaceIncludethe:颈外静脉Apartoftheexternaljugularvein锁骨上神经Supraclavicularnerves

颈横静脉Transversecervicalvein

肩胛上静脉Suprascapularvein

淋巴管Afewlymphvessels颈部解剖1四、颏下三角

SubmentalTriangle

境界Boundary内容Contents颈部解剖1颏下三角BoundarisofsubmentaltriangleBodyofhyoidbone颈部解剖1颏下三角的内容

ContentsofthesubmentaltriangleIncludethe:几个小的颏下淋巴结

Severalsmallsubmentallymphnodes.几条小静脉，汇合成颈前静脉

Smallveinsthatunitetoformtheanteriorjugularvein.颈部解剖1五、下颌下三角

SubmandibularTriangle境界Boundary内容Contents颈部解剖11.下颌下三角

Boundarisofthesubmandibulartriangle颈部解剖1Aroofofthesubmandibulartriangleisformedbytheskin,superficialfascia,platysmaandinvestingfascia.颈部解剖1Afloorofthesubmandibulartriangleisformedbythemylohyoid,hyoglossusandmiddlepharyngealconstrictor.MiddlepharyngealconstrictorMylohyoidHyoglossus颈部解剖1下颌下三角的底颈部解剖1下颌下三角的顶与底颈部解剖12.下颌下三角的主要结构

Maincontentsofthesubmandibulartriangle下颌腺及其导管Submandibularglandanditsduct

面静脉Facialvein

面神经的颈支Cervicalbranchoffacialnerve

下颌下淋巴结Submandibularlymphnodes

面动脉Facialartery

颏下动、静脉Submentalarteryandvein

下颌舌骨肌神经Mylohyoidnerve

舌下神经Hypoglossalnerve

舌动、静脉Lingualarteryandvein

舌神经LingualNerve,

下颌下神经节Submandibularganglion颈部解剖11.在下颌下腺的浅面有：

面静脉、面神经的颈支、下颌下淋巴结Cervicalbranchesoffacialnerve颈部解剖1Mylohyoid2.

Thesubmandibularglandisdividedintothesuperficialanddeeppartsbytheposteriorborderofmylohyoid,itsductemergesfromthedeepoftheglandandthenopensonthesublingualpapilla.颈部解剖13.在下颌下腺的深面：①在下颌舌骨肌浅面的结构有颏下动脉和静脉、下颌舌骨肌神经；②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；③在舌骨舌肌深面的结构有舌动脉。颈部解剖1颈部解剖14.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。颈部解剖1六、解剖与观察

DissectionandObservation

1.Makeamedianskinincision2.Reflecttheskinflaps3.Reflecttheplatysma4.Dissectthesuperficialstructures5.Dissectthesubmentaltriangle6.Dissectthesubmandibulartriangle颈部解剖11.Makeamedianskinincisionfromthementalsymphysistothesuprasternalnotch.颈部解剖12.Reflecttheskinflapslaterallytotheanteriorborderofthetrapeziustoexposetheplatysmadirectly.

3.Dividetheplatysmaalongtheupperborderoftheclavicleandreflectitupwardstothemandible.Donotdamagetheunderlyingstructures.颈部解剖14.Lookforandexposethesuperficialstructuresoftheneck.颈部解剖15.Cleanboundarisofthesubmentaltriangle颈部解剖16.Cutthroughtheinvestingfasciatoexopsethesubmandibulargland,thefacialvein,thecervicalbranchesofthefacialnerveandsubmandibularlymphnodes.颈部解剖1Identifythefacialarteryandfollowittoitsorigin.Dividetheoriginofthe