1、局部解剖学（九局部解剖学（九） 颈部的局部解剖与操作（颈部的局部解剖与操作（1）颈 部 Neck 概述概述 introduction 浅层结构浅层结构 superifical structures 下颌下三角下颌下三角 submandibular triangle 颏下三角颏下三角 submental triangle一、概述一、概述 Introduction 境界和分区境界和分区 boundary and regions 表面解剖表面解剖 surface anatomy 表面标志表面标志 surface landmark 体表投影体表投影 surface projection上界：上界：为下
2、颌骨下缘、下颌角、乳突、上项线与枕外隆突的连线。为下颌骨下缘、下颌角、乳突、上项线与枕外隆突的连线。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：由胸骨上缘、锁骨和肩峰至第由胸骨上缘、锁骨和肩峰至第7颈椎棘突的连线。颈椎棘突的连线。Inferiorly：by the upper borde
3、r of sternum, the clavicle and a line extending from the acromion to the spine of 7th cervical vertebra.1. 颈部的境界颈部的境界 boundary of the neck2.颈部分区颈部分区 颈部颈部:分为固有颈部（分为固有颈部（proper neck）和项部（）和项部（nape）。）。 固有颈部固有颈部:又可分为颈前区又可分为颈前区anterior region、胸锁乳突肌区、胸锁乳突肌区sternocleidomastoid region和颈外侧区和颈外侧区lateral region
4、。 颈前区：被舌骨颈前区：被舌骨hyoid分为舌骨上区分为舌骨上区suprahyoid region（包括（包括2个下颌下三角和个下颌下三角和1个颏下三角）和舌骨下区个颏下三角）和舌骨下区infrahyoid region（包括成对的颈动脉三角和肌三角（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。颈外侧区：被肩胛舌骨肌下腹分为枕三角和锁骨上三角。3.表面标志表面标志 surface landmarkLesser supraclavicular fossa(Greater) supraclavicular fossaSuprasternal fossa
5、表面标志表面标志Surface Landmark舌骨舌骨 Hyhoid(H)甲状软骨甲状软骨 Thyroid cartilage(T)喉结节喉结节 Laryngeal prominence(P)环状软骨环状软骨 Cricoid cartilage (C)第第1气管环气管环 The first tracheal ringe(1)甲状腺峡甲状腺峡 Isthmus(S)v环状软骨环状软骨(弓弓)的意义的意义第第6颈椎水平颈椎水平The level of the 6th cervical vertebra.喉与气管交界喉与气管交界 The junction of the larynx with the
6、 trachea. 咽与食管交界咽与食管交界 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 th
7、e 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、颈部浅层结构二、颈部浅层结构The superficial structures of the neck 皮肤 The skin( thin and pli
8、able) 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)cervical lymph nodes the cutaneous branches of the cervical plexus the cervical branch of the facial nerve1. 颈阔肌The plat
9、ysmaIs 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 t
10、issue 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 sa
11、dness and fright; draws the skin of neck superiorly when teeth are “clenched”.2. 颈前静脉或颈前正中静脉、颈外静脉颈前静脉或颈前正中静脉、颈外静脉颈颈静静脉脉弓弓Jugular venous arch3. 颈浅淋巴结颈浅淋巴结Superficial cervical lymph nodes4. Superficial cervical nerves Cutaneous branches of the cervical plexus Nerve point of neck Cervical branch of the
12、 facial nerve 面神经的颈支Cervical branch of facial nerve三、颈筋膜及筋膜间隙三、颈筋膜及筋膜间隙Cervical Fasciaand Fascial Space1. 颈筋膜 Cervical Fascia 颈深筋膜分为三层 Deep cervical fascia consists of three fascial layers: 浅层浅层 Superficial layer 封套筋膜封套筋膜 Investing fascia 中层中层 Middle layer 气管前筋膜气管前筋膜 Prechacheal fascia 内脏筋膜内脏筋膜 Visc
13、eral fascia 深层深层 Deep layer 椎前筋膜椎前筋膜 Prevertebral fascia 封套筋膜、封套筋膜、 气管前筋膜、椎前筋膜气管前筋膜、椎前筋膜 颈动脉鞘、气管前筋膜、甲状腺鞘、甲状腺悬韧带颈动脉鞘、气管前筋膜、甲状腺鞘、甲状腺悬韧带2. 颈筋膜间隙 Cervical Fascial Spaces 胸骨上间隙胸骨上间隙 Suprasternal space 咽后间隙咽后间隙 Retropharyngeal space 气管前间隙气管前间隙 Prechacheal space 椎前间隙椎前间隙 Prevertebral space 胸骨上间隙、咽后间隙、气管前间隙
14、、椎前间隙胸骨上间隙、咽后间隙、气管前间隙、椎前间隙胸胸 骨骨 上上 间间 隙的内容隙的内容Contents of the Suprasternal spaceInclude the: 颈前筋膜下端颈前筋膜下端 Inferior ends of the anterior jugular veins 颈静脉弓颈静脉弓 Jugular venous arch 疏松结缔组织疏松结缔组织 Loose connective tissue 12个淋巴结个淋巴结 One or two deep lymph nodes 胸锁乳突胸骨头 Sternal heads of the ternocleidomasto
15、id 锁骨间韧带 Interclavicular ligament锁骨上间隙的内容锁骨上间隙的内容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 肩胛上静脉 Suprascapular vein 淋巴管 A few lymph vessels四、颏四、颏 下下 三三 角角Submental Triangle 境界境界 Boundary 内容内容
16、Contents颏下三角颏下三角 Boundaris of submental triangleBody of hyoid bone颏颏 下下 三三 角角 的的 内内 容容Contents of the submental triangleInclude the: 几个小的颏下淋巴结几个小的颏下淋巴结 Several small submental lymph nodes. 几条小静脉，汇合成颈前静脉几条小静脉，汇合成颈前静脉 Small veins that unite to form the anterior jugular vein.五、下五、下 颌颌 下下 三三 角角Submandib
17、ular Triangle 境界境界 Boundary 内容内容 Contents1. 下下 颌颌 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 phar
18、yngeal constrictor.Middle pharyngeal constrictorMylohyoidHyoglossus下颌下三角的底下下颌颌下下三三角角的的顶顶与与底底2.下颌下三角的主要结构下颌下三角的主要结构Main contents of the submandibular triangle 下颌腺及其导管下颌腺及其导管Submandibular gland and its duct 面静脉面静脉 Facial vein 面神经的颈支面神经的颈支 Cervical branch of facial nerve 下颌下淋巴结下颌下淋巴结 Submandibular lymp
19、h nodes 面动脉面动脉 Facial artery 颏下动、静脉颏下动、静脉 Submental artery and vein 下颌舌骨肌神经下颌舌骨肌神经 Mylohyoid nerve 舌下神经舌下神经 Hypoglossal nerve 舌动、静脉舌动、静脉 Lingual artery and vein 舌神经舌神经Lingual Nerve , 下颌下神经节下颌下神经节Submandibular ganglion1. 在下颌下腺的浅面有：在下颌下腺的浅面有： 面静脉、面神经的颈支、下颌下淋巴结面静脉、面神经的颈支、下颌下淋巴结Cervical branches of faci
20、al 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. 在下颌下腺的深面：在下颌下腺的深面：在下颌舌骨肌浅面的结构有颏下动脉和静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；脉、下颌舌骨肌神经；在舌骨舌肌浅面的结
21、构有舌静脉、面动脉、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；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在舌骨舌肌深面的结构有舌动脉。动脉。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。节、下颌下腺及其导管、舌下神经、舌动脉和静脉。六、解剖与观察六、解剖与观察Dissection and Observation 1.Make a median skin incision2.Reflect the skin flaps3.Reflect t
22、he 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 dire
23、ctly. 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 the
24、 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
25、nerve on the mylohyoid. Clean the mylohyoid and cut it along the median line and immediately above the hyoid.Reflect the mylohyoid upwards to expose the hypoglossal nerve on the hyoglossus. Look for the lingual artery and vein between the hypoglossus nerve and the greater horn of the hyoid, trace it
26、 to the submandibular triangle. Look forthe duct of submandibular gland , the submandibular ganglion, and lingual nerve. 解剖下颌下三角解剖下颌下三角清理下颌下三角的边界、面神经的颈支、面静脉清理下颌下三角的边界、面神经的颈支、面静脉和下颌下淋巴结。和下颌下淋巴结。切开封套筋膜暴露下颌下腺。切开封套筋膜暴露下颌下腺。在咬肌的前下方找到面动脉，追踪其至起点。在咬肌的前下方找到面动脉，追踪其至起点。切断二腹肌前腹在下颌骨上的附着点切断二腹肌前腹在下颌骨上的附着点，并翻向下，并翻向下清理下颌舌骨肌，寻找下颌舌骨肌神经及颏下血清理下颌舌骨肌，寻找下颌舌骨肌神经及颏下血管。管。切断下颌舌骨肌在舌骨上的附着部切断下颌舌骨肌在舌骨上的附着部，将其翻向上，将其翻向上暴露舌骨舌肌，寻找舌下神经、下颌下腺深部及暴露舌骨舌肌，寻找舌下神经、下颌下腺深部及其导管、下颌下神经节、舌神经、咽中缩肌。其导管、下颌下神经节、舌神经、咽中缩肌。在舌骨大角与舌下神经之间处寻找舌动脉和舌静在舌骨大角与舌下神经之间处寻找舌动脉和舌静脉，追踪至下颌下三角。脉，追踪至下颌下三角。
