頸部的局部解剖與操作

1、局部解剖學(xué)（九）局部解剖學(xué)（九） 頸部的局部解剖與操作（頸部的局部解剖與操作（1）頸 部 Neck 概述概述 introduction 淺層結(jié)構(gòu)淺層結(jié)構(gòu) superifical structures 下頜下三角下頜下三角 submandibular triangle 頦下三角頦下三角 submental triangle一、概述一、概述 Introduction 境界和分區(qū)境界和分區(qū) boundary and regions 表面解剖表面解剖 surface anatomy 表面標(biāo)志表面標(biāo)志 surface landmark 體表投影體表投影 surface projection上界：上界：為

2、下頜骨下緣、下頜角、乳突、上項(xiàng)線與枕外隆突的連線。為下頜骨下緣、下頜角、乳突、上項(xiàng)線與枕外隆突的連線。Superiorly：an 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：下界：由胸骨上緣、鎖骨和肩峰至第由胸骨上緣、鎖骨和肩峰至第7頸椎棘突的連線。頸椎棘突的連線。Inferiorly：by the upper bord

3、er of sternum, the clavicle and a line extending from the acromion to the spine of 7th cervical vertebra.1. 頸部的境界頸部的境界 boundary of the neck2.頸部分區(qū)頸部分區(qū) 頸部頸部:分為固有頸部（分為固有頸部（proper neck）和項(xiàng)部（）和項(xiàng)部（nape）。）。 固有頸部固有頸部:又可分為頸前區(qū)又可分為頸前區(qū)anterior region、胸鎖乳突肌區(qū)、胸鎖乳突肌區(qū)sternocleidomastoid region和頸外側(cè)區(qū)和頸外側(cè)區(qū)lateral regio

4、n。 頸前區(qū)：被舌骨頸前區(qū)：被舌骨hyoid分為舌骨上區(qū)分為舌骨上區(qū)suprahyoid region（包括（包括2個(gè)下頜下三角和個(gè)下頜下三角和1個(gè)頦下三角）和舌骨下區(qū)個(gè)頦下三角）和舌骨下區(qū)infrahyoid region（包括成對(duì)的頸動(dòng)脈三角和肌三角）。（包括成對(duì)的頸動(dòng)脈三角和肌三角）。 頸外側(cè)區(qū)：被肩胛舌骨肌下腹分為枕三角和鎖骨上三角。頸外側(cè)區(qū)：被肩胛舌骨肌下腹分為枕三角和鎖骨上三角。3.表面標(biāo)志表面標(biāo)志 surface landmarkLesser supraclavicular fossa(Greater) supraclavicular fossaSuprasternal foss

5、a表面標(biāo)志表面標(biāo)志Surface Landmark舌骨舌骨 Hyhoid(H)甲狀軟骨甲狀軟骨 Thyroid cartilage(T)喉結(jié)節(jié)喉結(jié)節(jié) Laryngeal prominence(P)環(huán)狀軟骨環(huán)狀軟骨 Cricoid cartilage (C)第第1氣管環(huán)氣管環(huán) The first tracheal ringe(1)甲狀腺峽甲狀腺峽 Isthmus(S)v環(huán)狀軟骨環(huán)狀軟骨(弓弓)的意義的意義第第6頸椎水平頸椎水平The level of the 6th cervical vertebra.喉與氣管交界喉與氣管交界 The junction of the larynx with th

6、e trachea. 咽與食管交界咽與食管交界 The junction of the pharynx with the esophagus.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 pressed against the carotid tubercle of the 6th cervical vertebra.The level at which t

7、he inferior thyroid artery and the middle thyroid vein enter or leave the thyroid gland.The level at which the superior belly of the omohyoid muscle crosses the carotid sheath.The level of the middle sympathetic ganglion.二、頸部淺層結(jié)構(gòu)二、頸部淺層結(jié)構(gòu)The superficial structures of the neck 皮膚 The skin( thin and pl

8、iable) 淺筋膜及其內(nèi)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)cervical lymph nodes the cutaneous branches of the cervical plexus the cervical branch of the facial nerve1. 頸闊肌The pla

9、tysmaIs 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 pectoralis major muscles and sweep superomedially over the clavicle to the inferior border of the mandible, skin, and subcutaneous

10、tissue of lower face.Is one of the muscles of facial expression.Is innervated by the cervical branch of the facial nerve. The superficial cervical veins and nerves are located deep to the platysma. The main action of the platysma:draws corners of mouth inferiorly and widens it as in expressions of s

11、adness and fright; draws the skin of neck superiorly when teeth are “clenched”.2. 頸前靜脈或頸前正中靜脈、頸外靜脈頸前靜脈或頸前正中靜脈、頸外靜脈頸頸靜靜脈脈弓弓Jugular venous arch3. 頸淺淋巴結(jié)頸淺淋巴結(jié)Superficial cervical lymph nodes4. Superficial cervical nerves Cutaneous branches of the cervical plexus Nerve point of neck Cervical branch of th

12、e facial nerve 面神經(jīng)的頸支Cervical branch of facial nerve三、頸筋膜及筋膜間隙三、頸筋膜及筋膜間隙Cervical Fasciaand Fascial Space1. 頸筋膜 Cervical Fascia 頸深筋膜分為三層 Deep cervical fascia consists of three fascial layers: 淺層淺層 Superficial layer 封套筋膜封套筋膜 Investing fascia 中層中層 Middle layer 氣管前筋膜氣管前筋膜 Prechacheal fascia 內(nèi)臟筋膜內(nèi)臟筋膜 Vis

13、ceral fascia 深層深層 Deep layer 椎前筋膜椎前筋膜 Prevertebral fascia 封套筋膜、封套筋膜、 氣管前筋膜、椎前筋膜氣管前筋膜、椎前筋膜 頸動(dòng)脈鞘、氣管前筋膜、甲狀腺鞘、甲狀腺懸韌帶頸動(dòng)脈鞘、氣管前筋膜、甲狀腺鞘、甲狀腺懸韌帶2. 頸筋膜間隙 Cervical Fascial Spaces 胸骨上間隙胸骨上間隙 Suprasternal space 咽后間隙咽后間隙 Retropharyngeal space 氣管前間隙氣管前間隙 Prechacheal space 椎前間隙椎前間隙 Prevertebral space 胸骨上間隙、咽后間隙、氣管前間

14、隙、椎前間隙胸骨上間隙、咽后間隙、氣管前間隙、椎前間隙胸胸 骨骨 上上 間間 隙的內(nèi)容隙的內(nèi)容Contents of the Suprasternal spaceInclude the: 頸前筋膜下端頸前筋膜下端 Inferior ends of the anterior jugular veins 頸靜脈弓頸靜脈弓 Jugular venous arch 疏松結(jié)締組織疏松結(jié)締組織 Loose connective tissue 12個(gè)淋巴結(jié)個(gè)淋巴結(jié) One or two deep lymph nodes 胸鎖乳突胸骨頭 Sternal heads of the ternocleidomast

15、oid 鎖骨間韌帶 Interclavicular ligament鎖骨上間隙的內(nèi)容鎖骨上間隙的內(nèi)容Contents of the supraclavicular spaceInclude the: 頸外靜脈 A part of the external jugular vein 鎖骨上神經(jīng) Supraclavicular nerves 頸橫靜脈 Transverse cervical vein 肩胛上靜脈 Suprascapular vein 淋巴管 A few lymph vessels四、頦四、頦 下下 三三 角角Submental Triangle 境界境界 Boundary 內(nèi)容內(nèi)容

16、 Contents頦下三角頦下三角 Boundaris of submental triangleBody of hyoid bone頦頦 下下 三三 角角 的的 內(nèi)內(nèi) 容容Contents of the submental triangleInclude the: 幾個(gè)小的頦下淋巴結(jié)幾個(gè)小的頦下淋巴結(jié) Several small submental lymph nodes. 幾條小靜脈，匯合成頸前靜脈幾條小靜脈，匯合成頸前靜脈 Small veins that unite to form the anterior jugular vein.五、下五、下 頜頜 下下 三三 角角Submandi

17、bular Triangle 境界境界 Boundary 內(nèi)容內(nèi)容 Contents1. 下下 頜頜 下下 三三 角角Boundaris of the submandibular triangle A roof of the submandibular triangle is formed by the skin, superficial fascia, platysma and investing fascia.A floor of the submandibular triangle is formed by the mylohyoid, hyoglossus and middle pha

18、ryngeal constrictor.Middle pharyngeal constrictorMylohyoidHyoglossus下頜下三角的底下下頜頜下下三三角角的的頂頂與與底底2.下頜下三角的主要結(jié)構(gòu)下頜下三角的主要結(jié)構(gòu)Main contents of the submandibular triangle 下頜腺及其導(dǎo)管下頜腺及其導(dǎo)管Submandibular gland and its duct 面靜脈面靜脈 Facial vein 面神經(jīng)的頸支面神經(jīng)的頸支 Cervical branch of facial nerve 下頜下淋巴結(jié)下頜下淋巴結(jié) Submandibular lym

19、ph nodes 面動(dòng)脈面動(dòng)脈 Facial artery 頦下動(dòng)、靜脈頦下動(dòng)、靜脈 Submental artery and vein 下頜舌骨肌神經(jīng)下頜舌骨肌神經(jīng) Mylohyoid nerve 舌下神經(jīng)舌下神經(jīng) Hypoglossal nerve 舌動(dòng)、靜脈舌動(dòng)、靜脈 Lingual artery and vein 舌神經(jīng)舌神經(jīng)Lingual Nerve , 下頜下神經(jīng)節(jié)下頜下神經(jīng)節(jié)Submandibular ganglion1. 在下頜下腺的淺面有：在下頜下腺的淺面有： 面靜脈、面神經(jīng)的頸支、下頜下淋巴結(jié)面靜脈、面神經(jīng)的頸支、下頜下淋巴結(jié)Cervical branches of fac

20、ial nerveMylohyoid 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.3. 在下頜下腺的深面：在下頜下腺的深面：在下頜舌骨肌淺面的結(jié)構(gòu)有頦下動(dòng)脈和靜在下頜舌骨肌淺面的結(jié)構(gòu)有頦下動(dòng)脈和靜脈、下頜舌骨肌神經(jīng)；脈、下頜舌骨肌神經(jīng)；在舌骨舌肌淺面的

21、結(jié)構(gòu)有舌靜脈、面動(dòng)脈、在舌骨舌肌淺面的結(jié)構(gòu)有舌靜脈、面動(dòng)脈、舌下神經(jīng)、下頜下神經(jīng)節(jié)和舌神經(jīng)；舌下神經(jīng)、下頜下神經(jīng)節(jié)和舌神經(jīng)；在舌骨舌肌深面的結(jié)構(gòu)有舌在舌骨舌肌深面的結(jié)構(gòu)有舌動(dòng)脈。動(dòng)脈。4.下頜下腺深部及其導(dǎo)管的毗鄰：自上而下為舌神經(jīng)、下頜下神經(jīng)下頜下腺深部及其導(dǎo)管的毗鄰：自上而下為舌神經(jīng)、下頜下神經(jīng)節(jié)、下頜下腺及其導(dǎo)管、舌下神經(jīng)、舌動(dòng)脈和靜脈。節(jié)、下頜下腺及其導(dǎo)管、舌下神經(jīng)、舌動(dòng)脈和靜脈。六、解剖與觀察六、解剖與觀察Dissection and Observation 1.Make a median skin incision2.Reflect the skin flaps3.Reflect

22、the platysma4.Dissect the superficial structures 5.Dissect the submental triangle6.Dissect the submandibular triangle1.Make a median skin incision from the mental symphysis to the suprasternal notch.2.Reflect the skin flaps laterally to the anterior border of the trapezius to expose the platysma dir

23、ectly. 3.Divide the platysma along the upper border of the clavicle and reflect it upwards to the mandible. Do not damage the underlying structures.4.Look for and expose the superficial structures of the neck.5.Clean boundaris of the submental triangle6. Cut through the investing fascia to exopse th

24、e submandibular gland, the facial vein, the cervical branches of the facial nerve and submandibular lymph nodes. Identify the facial artery and follow it to its origin. Divide the origin of the anterior belly of the digastric and reflect it downwards. Look for the submental vessels and the mylohyoid nerve on the mylohyoid. Clean th