耳鼻咽喉應用解剖肖雪培訓課件

1、The NoseExternal nose 外鼻Nasal cavity 鼻腔Paranasal sinuses 副鼻竇1耳鼻咽喉應用解剖肖雪10/3/2022The NoseExternal nose 外鼻1耳鼻咽喉應The External NoseNasal root 鼻根Nasal back 鼻背Nasal apex 鼻尖Alae nasi 鼻翼Nostrils 鼻孔Lateral nasal cartilage鼻外側軟骨2耳鼻咽喉應用解剖肖雪10/3/2022The External NoseNasal root 鼻外鼻靜脈特點主要經面靜脈和內眥靜脈回流到頸內靜脈。內眥靜脈經眼上、眼

2、下靜脈與顱內海綿竇相通，該區(qū)靜脈無瓣膜內眥靜脈 面靜脈 頸內靜脈 眼上/ 下靜脈 海綿竇3耳鼻咽喉應用解剖肖雪10/3/2022外鼻靜脈特點主要經面靜脈和內眥靜脈回流到頸內靜脈。內眥靜脈經Nasal cavity 鼻腔Nasal vestibule 鼻前庭Nasal vestibule is the anterior and inferior part of nasal cavity. It is lined by skin and contains sebaceous glands, hair follicles and hair.Nasal cavity proper 固有鼻腔4耳鼻咽喉應

3、用解剖肖雪10/3/2022Nasal cavity 鼻腔Nasal vestibuleNasal cavity properThe roof. Anterior sloping part of the roof is formed by nasal bones; Posterior sloping part by the body of sphenoid bone; The middle horizontal part, by the cribriform plate (篩板).5耳鼻咽喉應用解剖肖雪10/3/2022Nasal cavity properThe roof. Nasal ca

4、vity properThe floor . formed by the palatal process of the maxilla（上頜骨腭突）and the horizontal process of the palate bones（腭骨水平部）.3/41/46耳鼻咽喉應用解剖肖雪10/3/2022Nasal cavity properThe floor .Nasal cavity properNasal septum. 鼻中隔鼻中隔軟骨犁骨篩骨正中板上頜骨腭突7耳鼻咽喉應用解剖肖雪10/3/2022Nasal cavity properNasal septuLittles area

5、（plexus）利特爾區(qū) (動脈叢)Littles area （plexus）利特爾區(qū) (動脈叢)Confluence of :Anterior Ethmoidal a. 篩前動脈 Greater Palatine a. 腭大動脈Sphenopalatine a. 蝶腭動脈Sup. Labial a. 上唇動脈8耳鼻咽喉應用解剖肖雪10/3/2022Littles area （plexus）利特爾區(qū) (動Nasal cavity properLateral wall.three scroll-like bone projections called turbinate or conchae（鼻

6、甲）. Below and lateral to each turbinate is the corresponding meatus（鼻道）.9耳鼻咽喉應用解剖肖雪10/3/2022Nasal cavity properLateral walNasal cavity proper Lateral wall.Nasolacrimal duct (鼻淚管) opens in the anterior part of inferior meatus.鼻淚管開口于下鼻道的前方The anterior group of sinuses (frontal, marxillary and anterior

7、 ethmoidal sinuses) open to the infundibulum （篩漏斗）in middle meatus.前組鼻竇（額竇，前組篩竇，上頜竇）開口于中鼻道的篩漏斗。Posterior ethmoidal sinuses open into superior meatus.后組篩竇開口于上鼻道。The openning of sphenoid sinus situate is phenoethmoidal recess （蝶篩隱窩）lies above the superior turbinate.蝶竇開口位于上鼻甲上方的蝶篩隱窩10耳鼻咽喉應用解剖肖雪10/3/202

8、2Nasal cavity proper LateraPosterior naris (choanae) 后鼻孔Nasal septum鼻中隔 Inferior turbinate下鼻甲 Nasal cavity proper11耳鼻咽喉應用解剖肖雪10/3/2022Posterior naris (choanae) 后鼻Paranasal sinuses 副鼻竇The sinuses are air-filled bony cavities located in the face and skull adjacent to the nose. 12耳鼻咽喉應用解剖肖雪10/3/2022Par

9、anasal sinuses 副鼻竇The sinusMaxillary sinus 上頜竇 The maxillary sinus is the largest one, present in the maxilla bone. Drains into the nasal cavity through its ostium that is situated in the middle meatus. 13耳鼻咽喉應用解剖肖雪10/3/2022Maxillary sinus Ethmoid sinus 篩竇 Comprises a group of air cells, which form

10、one of the most complex structures in the body. Drains through the middle meatus and above the superior turbinate.14耳鼻咽喉應用解剖肖雪10/3/2022Ethmoid sinus 篩竇 ComprFrontal sinus 額竇 The frontal sinuses are situated beneath the bone of the forehead and just in front of the bone overlying the brain. And drain

11、s through the frontal recess（額隱窩）to the middle meatus.15耳鼻咽喉應用解剖肖雪10/3/2022Frontal sinus 額竇 The fSphenoid sinus 蝶竇 The sphenoid sinuses open in the upper part of anterior wall and drains into the sphenoethmoidal recess （蝶篩隱窩）. 16耳鼻咽喉應用解剖肖雪10/3/2022Sphenoid sinus 蝶竇 The spOstiomeatal complex 竇口鼻道復合體

12、The ostiomeatal complex is the sinus hot spot, one of the most important anatomical regions with regard to sinus health and disease. That comprises maxillary sinus ostia,anterior ethmoid cells and their ostia,ethmoid infundibulum, hiatus semilunaris, and middle meatus.篩漏斗及其周圍的中鼻甲、鉤突、篩泡、半月裂以及額竇、前組篩竇和

13、上頜竇的自然開口等結構形成的區(qū)域，稱為鼻道竇口復合體(ostiomeatal complex)，是內窺鏡鼻竇手術以后提出的新概念，對指導手術有重要意義。17耳鼻咽喉應用解剖肖雪10/3/2022Ostiomeatal complex 竇口鼻道復合體 鼻瓣膜區(qū)nasal valve area生理性鼻甲周期 physiological turbinal cycle/鼻周期nasal cycle鼻肺反射 nasopulmonary reflex噴嚏反射sneeze reflex18耳鼻咽喉應用解剖肖雪10/3/2022鼻瓣膜區(qū)nasal valve area18耳鼻咽喉應用解剖The Ear19耳鼻

14、咽喉應用解剖肖雪10/3/2022The Ear19耳鼻咽喉應用解剖肖雪10/3/2022External, Middle, and Inner ear.Each serves different aspects of the auditory sensation.集音傳音感音 20耳鼻咽喉應用解剖肖雪10/3/2022External, Middle, and Inner eThe External Ear 外耳The auricle 耳廓The external acoustic meatus 外耳道 略呈S狀彎曲，長約2.53.5cm。外13為軟骨部，內23為骨部，外耳道有兩處較狹窄，一

15、為骨部與軟骨部交界處，另一處為骨部距鼓膜0.5cm處較狹窄處，稱為外耳道狹部。軟骨部是耳癤的好發(fā)部位。The external Ear 外耳21耳鼻咽喉應用解剖肖雪10/3/2022The External Ear 外耳The auricleThe Middle Ear 中耳Tympanic cavityMastoid Process 乳突Auditory tube咽鼓管Consists of the tympanic cavity(鼓室), auditory tube(咽鼓管), tympanic antrum(鼓竇) and mastoid process(乳突).22耳鼻咽喉應用解剖肖雪

16、10/3/2022The Middle Ear 中耳Tympanic caviThe tympanic Cavity 鼓室The epitympanumThe mesotympanumThe hypotympana23耳鼻咽喉應用解剖肖雪10/3/2022The tympanic Cavity 鼓室The epi鼓室六壁 上壁 為鼓室蓋，與中顱窩大腦顳葉相隔。下壁 以薄骨板與頸靜脈球相隔。內壁 即內耳外壁。有“一岬兩窗兩凸”，鼓岬、前庭窗、圓窗、面神經管隆凸、外半規(guī)管隆凸24耳鼻咽喉應用解剖肖雪10/3/2022鼓室六壁上壁 為鼓室蓋，與中顱窩大腦顳葉相隔。24耳鼻咽喉外壁 大部分為鼓膜所封閉

17、。前壁 上有鼓膜張肌半管，下有咽鼓管鼓室口。前壁下部借一薄骨板與頸內動脈管相隔。后壁 即乳突前壁，乃骨部外聽道的延續(xù)，上部有鼓竇入口通鼓竇，后壁有面神經的垂直段通過25耳鼻咽喉應用解剖肖雪10/3/2022外壁 大部分為鼓膜所封閉。25耳鼻咽喉應用解剖肖雪10/3Tympanic Membrane 鼓膜光錐Cone of light緊張部Pars tense松弛部Pars flaccid錘紋 Malleolar stria錘骨短突Short process of malleus外耳道皮膚26耳鼻咽喉應用解剖肖雪10/3/2022Tympanic Membrane 鼓膜光錐緊張部松弛部錘Late

18、ral & Anterior WallsAnterior wall面神經頸內動脈咽鼓管鼓膜張肌鼓索神經27耳鼻咽喉應用解剖肖雪10/3/2022Lateral & Anterior WallsAnterMedial Wall鼓岬圓窗鼓竇28耳鼻咽喉應用解剖肖雪10/3/2022Medial Wall鼓岬圓窗鼓竇28耳鼻咽喉應用解剖肖雪1malleus incusstapes Tympanic vestibular Membrane windowMalleus 錘骨Incus砧骨 Stapes 鐙骨Auditory ossicles and Ossicular chain聽骨 &聽骨鏈29耳鼻咽

19、喉應用解剖肖雪10/3/2022malleus incusstapesMalleus The Auditory Tube (Eustachian tube)咽鼓管 Two parts: bony & cartiliginous parts （外1/3為骨部，內2/3為軟骨部）Two openings: the pharyngeal & the tympanic orificesVariety with anatomy between infant and adult30耳鼻咽喉應用解剖肖雪10/3/2022The Auditory Tube (Eustachian The Inner Ear

20、內耳 / Labyrinth 迷路The inner earosseous labyrinth（骨迷路） contains the vestibule（前庭）, semicircular canals（半規(guī)管） and cochlea（耳蝸）membranous labyrinth（膜迷路）. utricle(橢圓囊), saccule(球囊), membranous semicircular canals(膜半規(guī)管), membranous cochlea duct(膜蝸管), 內淋巴管囊(endolymphatic duct)Vestibule前庭Cochlea耳蝸Semicircular

21、 canals半規(guī)管31耳鼻咽喉應用解剖肖雪10/3/2022The Inner Ear 內耳 / Labyrinth Osseous labyrinth 骨迷路Lateral semicircular canal水平半規(guī)管Posterior semicircular canal后半規(guī)管Superior semicircular Canal上半規(guī)管Vestibule window前庭窗Cochlea window蝸 窗Cochlea耳蝸Osseous labyrinth（骨迷路）vestibule（前庭） semicircular canals（半規(guī)管） cochlea（耳蝸）32耳鼻咽喉應用

22、解剖肖雪10/3/2022Osseous labyrinth 骨迷路Lateral ssemicircular canals半規(guī)管Lateral semicircular canal外（水平）半規(guī)管Posterior semicircular canal后半規(guī)管Superior semicircular Canal上半規(guī)管位于前庭后方，為上、后、外三個弓形互相垂直的骨管，5孔開口于前庭，膨大端為壺腹，另一端為單腳。上半規(guī)管與后半規(guī)管單腳合并為總角。33耳鼻咽喉應用解剖肖雪10/3/2022semicircular canals半規(guī)管LateralVestibule 前庭lateral wall

23、the vestibular window，the cochlear window 為鼓室內壁的一部分，有前庭窗及蝸窗，分別為鐙骨底板及圓窗膜所封閉；posterior wall- 5 orifices of semicircular canals Anterior wall - an opening communicates with scala vestibuli（前庭階）Vestibular window前庭窗Cochlear window蝸窗34耳鼻咽喉應用解剖肖雪10/3/2022Vestibule 前庭Vestibular windowCbony canals of cochlea

24、 winding for 2.2-2.75 around central modiolus.The Cochlea Scala tympani 鼓階Scala vestibuli 前庭階Cochlear duct 蝸管 前庭膜于前庭的前下方，為螺旋形骨管，繞蝸軸旋轉兩圈半，形似蝸牛。骨蝸管由骨螺旋板、基底膜和前庭膜將蝸管分為前庭階、中階和鼓階三個管腔。中階(膜蝸管)內儲內淋巴，系膜迷路，為一封閉的盲管。 35耳鼻咽喉應用解剖肖雪10/3/2022bony canals of cochlea windingSemicircularcanalsCochlearDuct蝸管Utricle橢圓囊Sac

25、cule球囊The Membranous Labyrinth 膜迷路亦分前庭、半規(guī)管及耳蝸三部（內有聽覺和位覺感受器）36耳鼻咽喉應用解剖肖雪10/3/2022SemicircularCochlearUtricleSacOuter Hair CellsInner Hair CellsSupporting cells.stereociliaThe organ of Corti （Corti器）位于耳蝸基底膜上，為耳蝸神經的末梢感受器37耳鼻咽喉應用解剖肖雪10/3/2022Outer Hair CellsInner Hair CelUtricle & Saccule 橢圓囊和球囊-位于前庭，感受

26、直線加速度運動的刺激38耳鼻咽喉應用解剖肖雪10/3/2022Utricle & Saccule 橢圓囊和球囊-位于前Ampulla 壺腹Cupula 壺腹嵴Membranous semicircular canals 膜半規(guī)管Cupula 壺腹嵴（位于半規(guī)管壺腹端 ，主要感受正負角加速度的刺激）39耳鼻咽喉應用解剖肖雪10/3/2022Ampulla Cupula Membranous semi蝸神經的傳導徑路耳蝸神經核上橄欖核外側丘系核下丘聽覺皮層耳蝸40耳鼻咽喉應用解剖肖雪10/3/2022蝸神經的傳導徑路耳蝸神經核上橄欖核外側丘系核下丘聽覺皮層耳蝸The Pharynx41耳鼻咽喉應用

27、解剖肖雪10/3/2022The Pharynx41耳鼻咽喉應用解剖肖雪10/3/2042耳鼻咽喉應用解剖肖雪10/3/202242耳鼻咽喉應用解剖肖雪10/3/2022Nasopharynx 鼻咽43耳鼻咽喉應用解剖肖雪10/3/2022Nasopharynx 鼻咽43耳鼻咽喉應用解剖肖雪10/后鼻孔下鼻甲中鼻甲上鼻甲咽隱窩咽鼓管圓枕腺樣體（Adenoid）：頂部與后壁交界處的豐富淋巴組織團塊，過分肥大可引起耳鼻咽喉等處的癥狀，10歲以后逐漸萎縮。咽鼓管咽口（The orifice of Eustachian tube）：下鼻甲后端后方約1-1.5cm處咽鼓管圓枕（Torus tubalis

28、）：咽口上方隆起的部分咽隱窩（Pharyngeal recess）：咽鼓管圓枕后上方的凹陷區(qū)，為鼻咽癌的好發(fā)部位。該處接近顱底破裂孔，鼻咽癌可循此自然孔道侵入顱內。鼻咽 （nasopharynx）Posterior naris (choanae) 44耳鼻咽喉應用解剖肖雪10/3/2022后鼻孔下鼻甲中鼻甲上鼻甲咽隱窩咽鼓管圓枕腺樣體（AdenoiThe Oropharynx 口咽Palatopharyngeal arch 腭咽弓Palatoglossal arch 腭舌弓45耳鼻咽喉應用解剖肖雪10/3/2022The Oropharynx 口咽Palatopharyn口咽 (orophar

29、ynx)咽峽：上-懸雍垂(uvula)、軟腭游離緣(soft palate)，側-舌腭弓(palatoglossal arch)、扁桃體(tonsil)、咽腭弓(palatopharyngeal arch)，下-舌背。腭扁桃體：咽側索：每側咽腭弓的后方的縱行條索狀淋巴組織46耳鼻咽喉應用解剖肖雪10/3/2022口咽 (oropharynx)咽峽：46耳鼻咽喉應用解剖肖雪Laryngopharynx 喉咽Post-cricoid region 環(huán)后區(qū)Pyriform sinuses 梨狀窩47耳鼻咽喉應用解剖肖雪10/3/2022Laryngopharynx 喉咽Post-cricoidWal

30、deyers Ring 咽淋巴環(huán)Adenoid 腺樣體Tubal Tonsils. 咽鼓管扁桃體Palatine Tonsils. 腭扁桃體Lingual Tonsils. 舌扁桃體Lat. Pharyngeal bands. 咽側索Definition: Ring of Lymphoid tissue guarding entrance to the digestive & respiratory tracts.48耳鼻咽喉應用解剖肖雪10/3/2022Waldeyers Ring 咽淋巴環(huán)Adenoid 咽旁間隙咽后間隙Parapharyngeal and retroparyngeal s

31、pace 咽旁隙和咽后隙Parapharyngeal space 咽旁隙internal carotid a. 頸內動脈jugular v. 頸內靜脈cranial nerves sympathetic chain 交感干cervical lymphnodes 頸淋巴結49耳鼻咽喉應用解剖肖雪10/3/2022咽旁間隙咽后間隙Parapharyngeal and ret咽后隙 retropharyngeal space 上界：起于顱底。下界：止于第一、二胸椎平面。前界：頰咽筋膜、咽后壁。后界：椎前筋膜。外界：以薄層筋膜與咽旁隙相隔。內界：為咽縫將其分為左右兩部分。內容：疏松結締組織和淋巴結，易

32、形成咽后壁膿腫，小兒多見。 50耳鼻咽喉應用解剖肖雪10/3/2022咽后隙 retropharyngeal space 上界：起The Larynx喉部位于頸前正中，舌骨之下；上接喉咽部，下連氣管；是呼吸的重要通道，下呼吸道的門戶；由軟骨組成支架，附以肌肉、韌帶、粘膜等；為呼吸和發(fā)音器官。51耳鼻咽喉應用解剖肖雪10/3/2022The Larynx喉部位于頸前正中，舌骨之下；51耳鼻咽喉Epiglottic cartilage 會厭軟骨 52耳鼻咽喉應用解剖肖雪10/3/2022Epiglottic cartilage 會厭軟骨 52耳Thyroid cartilage 甲狀軟骨 The

33、largest cartilage of larynx53耳鼻咽喉應用解剖肖雪10/3/2022Thyroid cartilage 甲狀軟骨 The lCricoid cartilage 環(huán)狀軟骨The only complete cartilaginous ring54耳鼻咽喉應用解剖肖雪10/3/2022Cricoid cartilage 環(huán)狀軟骨The oArytenoid cartilage 杓狀軟骨paired, pyramidal shaped聲帶突：聲帶附著處肌突：環(huán)杓后肌及環(huán)杓側肌附著55耳鼻咽喉應用解剖肖雪10/3/2022Arytenoid cartilage 杓狀軟骨pa

34、ir喉的韌帶與膜 喉軟骨之間有纖維狀韌帶相連接，有甲狀舌骨膜、舌骨會厭韌帶、舌會厭韌帶、甲狀會厭韌帶、喉彈性膜、環(huán)甲膜等，環(huán)甲膜正位于聲門下，是緊急氣管切開的部位環(huán)甲膜穿刺或切開術56耳鼻咽喉應用解剖肖雪10/3/2022喉的韌帶與膜 喉軟骨之間有纖維狀韌帶相連接，有甲狀舌骨Muscles of larynx extrinsic laryngeal muscles喉外肌 intrinsic laryngeal muscles喉內肌 57耳鼻咽喉應用解剖肖雪10/3/2022Muscles of larynx Intrinsic laryngeal muscles 喉內肌Abductor 外展P

35、osterior cricoarytenoid 環(huán)杓后肌Adductors 內收Lateral cricoarytenoid 環(huán)杓側肌Transverse arytenoid 杓橫肌Adjust tension of the vocal cord: Cricothyroid 環(huán)甲肌Thyroarytenoid 甲杓肌Move the epiglottic: Thyreo-epiglotticus 甲狀會厭肌58耳鼻咽喉應用解剖肖雪10/3/2022Intrinsic laryngeal muscles 喉內Extrinsic laryngeal muscles 喉外肌Suprahyoid Mu

36、scles 舌骨上肌群Mylohyoid 下頜舌骨肌Digastric 二腹肌Geniohyoid 頦舌骨肌Stylohyoid 莖突舌骨Genioglossus 頦舌肌Styloglossus 莖突舌肌Infrahyoid Muscles 舌骨下肌群Thyrohyoid 甲狀舌骨肌Omohyoid 肩胛舌骨肌Sternohyoid 胸骨舌骨肌Sternothyroid 胸骨甲狀肌59耳鼻咽喉應用解剖肖雪10/3/2022Extrinsic laryngeal muscles 喉Intrinsic laryngeal muscles 喉內肌 環(huán)甲肌Cricothyroid環(huán)杓側肌Lateral crico-arytenoid 環(huán)杓后肌Posterior crico-arytenoid杓肌Arytenoid甲杓肌Thyroarytenoid60耳鼻咽喉應用解剖肖雪10/3/2022Intrinsic laryngeal muscles Laryngeal ne