1、脊脊 神神 经经Spinal Nerves男，男，24岁，岁，背部被刺伤背部被刺伤，立刻跌倒，两下，立刻跌倒，两下肢失去运动。数日右腿稍能活动。又过一周后肢失去运动。数日右腿稍能活动。又过一周后右下肢几乎恢复了运动，但右下肢几乎恢复了运动，但左下肢完全瘫痪左下肢完全瘫痪。检查发现：左下肢无随意运动，检查发现：左下肢无随意运动，腱反射亢进腱反射亢进，Babinski征阳性征阳性。右侧躯干胸骨剑突水平右侧躯干胸骨剑突水平以下以下和和右下肢痛、温度觉丧失右下肢痛、温度觉丧失，但触觉、位置和运，但触觉、位置和运动觉正常。左侧躯干剑突以下和动觉正常。左侧躯干剑突以下和左下肢左下肢痛、温痛、温度觉完好，但
2、度觉完好，但触觉减弱，位置和运动觉丧失触觉减弱，位置和运动觉丧失。病例分析病例分析腱反射亢进腱反射亢进BabinskiBabinski征阳性征阳性左下肢完全瘫痪左下肢完全瘫痪右下肢痛、温度觉丧失右下肢痛、温度觉丧失左下肢位置觉、运动觉丧失左下肢位置觉、运动觉丧失上运动神经元损伤上运动神经元损伤背部被刺伤背部被刺伤脊髓损伤脊髓损伤左侧皮质脊髓束受损左侧皮质脊髓束受损左侧脊髓丘系受损左侧脊髓丘系受损左侧薄束受损左侧薄束受损T4胸髓左侧半边横断右侧剑突以下痛温度觉丧失右侧剑突以下痛温度觉丧失提问Answer questions1.侧角侧角2.脊神经节脊神经节用模型说明用模型说明及英文名称及英文名称提
3、问Answer questions1.侧角侧角2.脊神经节脊神经节3.纤维束纤维束4.脊髓丘脑束脊髓丘脑束Nervous Systemcentral N.S.brainspinal cordperipheral N.S.cranial n.spinal n.visceral n.Spinal Cordq 2 enlargements:cervical,lumbarq 1 cone:conus medullarisq 6 grooves and fissureq 2 groups of nerve roots anterior,posteriorq 31 segments C8,T12,L5,S
4、5,Co1脊神经的区分脊神经的区分Classification颈神经颈神经 cervical nerves胸神经胸神经 thoracic nerves腰神经腰神经 lumbar nerves骶神经骶神经 sacral nerves尾神经尾神经 coccygeal nerve8对对12对对5对对5对对1对对脊神经的组成脊神经的组成 formation后根后根posterior root前根前根anterior root脊神经节脊神经节spinal ganglion脊神经脊神经spinal nerve脊神经的纤维成分脊神经的纤维成分 Components内脏感觉纤维内脏感觉纤维Visceral s
5、ensory fibers躯体感觉纤维躯体感觉纤维Somatic sensoryfibers躯体运动纤维躯体运动纤维Somatic motor fibers内脏运动纤维内脏运动纤维Visceral motor fibers 脊神经纤维成份脊神经纤维成份躯体感觉纤维躯体感觉纤维somatic sensory fiberssomatic sensory fibers躯体运动纤维躯体运动纤维somatic motor fiberssomatic motor fibers内脏感觉纤维内脏感觉纤维visceral sensory fibersvisceral sensory fibers内脏运动纤维内脏
6、运动纤维visceral motor fibersvisceral motor fibers皮肤、骨骼肌和关节皮肤、骨骼肌和关节 skin,skeletal muscles,skin,skeletal muscles,joints joints心肌、平滑肌和腺体心肌、平滑肌和腺体 cardiac muscles,smoothcardiac muscles,smooth muscles,glands muscles,glands脊神经的分支脊神经的分支 branches后支后支posterior b.前支前支anterior b.脊神经节脊神经节spinal ganglion脊神经脊神经spin
7、al nerve后根（感觉性）后根（感觉性）前根（运动性）前根（运动性）前支前支后支后支脊膜支脊膜支交通支交通支椎间孔椎间孔脊神经（混合性）脊神经（混合性）Anterior branch Communicating branch Posterior branchPosterior root脊神经的分支脊神经的分支 branchesAnterior rootBranches后支posterior branchesl 人体后正中线附人体后正中线附近的皮肤和肌近的皮肤和肌l 具节段性具节段性前支anterior branchl 躯干和前外侧的皮躯干和前外侧的皮肤和肌肤和肌l 仅胸神经具节段性仅胸神经
8、具节段性颈丛颈丛 cervical plexus臂丛臂丛 brachial plexus胸神经胸神经 thoracic n.腰丛腰丛 lumbar plexus骶丛骶丛 sacral plexusSpinal nervesnThere are 31 pairs of spinal nerves,which leave the spinal cord and pass through intervertebral foramina.Each spinal nerve is connected to the spinal cord by the anterior root and the post
9、erior root.The anterior root consists of(somatic,visceral)motor fibers.The posterior root consists of(somatic,visceral)sensory fibers.The cell bodies of those nerve fibers are situated in the spinal ganglion.So each spinal nerve is made up of a mixture of motor and sensory fibers.Spinal nervesnAfter
10、 emerging through the intervertebral foramen,a typical spinal nerve immediately divides into four branches:the meningeal branch,communicating branch,posterior and anterior branches.Except in thoracic nerves T2 through T1,the anterior branches of the spinal nerves combine and then slit again to form
11、four plexuses of spinal nerves which are the cervical,the brachial,the lumbar,and the sacral plexuses.Composition:C14Location：胸锁乳突肌胸锁乳突肌 上部的深面上部的深面Cervical plexus 颈丛颈丛浅支：浅支：Superficial branches枕小枕小N.N.耳大耳大N.N.颈横颈横N.N.锁骨上锁骨上N.N.深支深支 deep branches颈部大部分肌颈部大部分肌前斜角肌表面前斜角肌表面胸廓上口胸廓上口肺根前方肺根前方心包外侧心包外侧膈膈膈神经膈神
12、经(C C3 3 5 5 )：phrenic n.Composition：C58 +T1 C5C6C7C8T1上干上干下干下干中干中干根根支支束束股股干干臂臂 丛丛 brachial plexus斜角肌间隙斜角肌间隙锁骨中点后方锁骨中点后方腋窝腋窝腋动脉周围腋动脉周围Location：腋神经腋神经axillary n.后束后束穿穿四边孔四边孔 绕绕肱骨外科颈肱骨外科颈三三角肌角肌深面分布深面分布三角肌、小圆肌，三角肌、小圆肌，肩部和臂外侧上肩部和臂外侧上部皮肤部皮肤臂丛分支臂丛分支肌皮神经肌皮神经 musculocutaneous n.外侧束外侧束穿穿喙肱肌喙肱肌 肱肱二头肌二头肌深面至其外侧
13、缘深面至其外侧缘改名为改名为前臂外侧皮神前臂外侧皮神经经（肘窝稍下方，穿深（肘窝稍下方，穿深筋膜）筋膜）喙肱肌、肱二头肌、喙肱肌、肱二头肌、肱肌、前臂外侧皮肱肌、前臂外侧皮肤肤正中神经正中神经median n.外侧束、内侧束外侧束、内侧束肱肱二头肌二头肌内侧内侧穿过穿过旋旋前圆肌前圆肌（肘窝）（肘窝）指指深、浅屈肌深、浅屈肌之间（前之间（前臂）臂）腕管腕管手掌手掌 大部分前臂屈肌大部分前臂屈肌鱼际（拇收肌例鱼际（拇收肌例外）、外）、1 1，2 2蚓状蚓状肌肌尺神经尺神经ulnar n.内侧束内侧束尺神经尺神经沟沟伴伴尺动脉尺动脉下行下行（前臂）（前臂）腕关节腕关节近侧近侧5cm5cm处分为手处
14、分为手掌支、手背支掌支、手背支尺侧腕屈肌、指深尺侧腕屈肌、指深屈肌尺侧半、小鱼屈肌尺侧半、小鱼际肌、际肌、骨间肌骨间肌、3，4蚓状肌、拇收肌蚓状肌、拇收肌桡神经桡神经radial n.后束后束腋动脉腋动脉后方后方下行下行伴伴肱深动脉肱深动脉桡神经沟桡神经沟、肱肌、肱肌与肱桡肌之间。与肱桡肌之间。臂、前臂后群所臂、前臂后群所有伸肌和肱桡肌有伸肌和肱桡肌;臂、前臂后面皮臂、前臂后面皮肤。肤。手掌、背面神经分布示意图手掌、背面神经分布示意图正中神经正中神经尺神经尺神经桡神经桡神经手部神经分布手部神经分布手掌正中三指半，剩下尺侧一指半；手背桡尺各一半，正中侵占三指半。肋间神经肋间神经intercost
15、al n.肋下神经肋下神经subcostal n.Thoracic Nerve胸神经前支胸神经前支12对对T2 胸骨角平面胸骨角平面T4 男性乳头平面男性乳头平面T6 剑突平面剑突平面T8 肋弓平面肋弓平面T10 脐平面脐平面T12-耻骨联合与脐耻骨联合与脐 连线中点平面连线中点平面腰丛腰丛lumbar plexus组成：组成：部分部分T12+L13+部分部分L4前支前支位置：位置：腹后壁，腰大肌深面腹后壁，腰大肌深面闭孔神经闭孔神经obturator n.股神经股神经 femoral n.髂肌与腰大肌髂肌与腰大肌之间下行之间下行 腹股沟韧带深腹股沟韧带深面面 股前部股前部 隐神经隐神经（终支
16、）（终支）髌下、小腿内侧面、髌下、小腿内侧面、足内侧缘皮肤足内侧缘皮肤隐神经隐神经 saphenous n.大腿前群肌大腿前群肌股神经股神经 femoral n.闭孔神经闭孔神经 obturator n.腰大肌内侧缘腰大肌内侧缘 循小骨循小骨盆侧壁盆侧壁 穿闭膜管穿闭膜管 出小出小骨盆骨盆 （前、后支）（前、后支）股内收股内收肌群肌群肌支：肌支：闭孔外肌、股内侧肌群闭孔外肌、股内侧肌群皮支：皮支：大腿内侧面皮肤大腿内侧面皮肤骶丛骶丛sacral plexus组成组成：L4，5（腰骶干）（腰骶干）+S15+Co1位置：位置：盆腔后壁，骶骨及梨盆腔后壁，骶骨及梨状肌前方状肌前方 u 臀上神经臀上神
17、经 superior gluteal n.伴臀上动脉伴臀上动脉 梨状肌上孔梨状肌上孔 臀中、臀中、小肌、阔筋膜张肌小肌、阔筋膜张肌u 臀下神经臀下神经 inferior gluteal n.伴臀下动脉伴臀下动脉 梨状肌下孔梨状肌下孔 臀大肌臀大肌 骶丛分支骶丛分支uu 阴部神经阴部神经 pudendal n.伴阴部内动脉伴阴部内动脉 梨状肌下孔梨状肌下孔 坐骨小孔坐骨小孔 坐骨直肠窝坐骨直肠窝 肛门、会阴肌、皮肤肛门、会阴肌、皮肤 坐骨神经坐骨神经 sciatic n.梨状肌下孔梨状肌下孔 坐骨结节、坐骨结节、大转子之间大转子之间大腿后面，股大腿后面，股二头肌深面二头肌深面 腘窝上方腘窝上方
18、胫神经、腓总神经胫神经、腓总神经胫神经胫神经 tibial n.腘窝正中腘窝正中小腿后浅、深肌之间小腿后浅、深肌之间 内踝后方内踝后方足底内、外侧神经足底内、外侧神经 小腿后群肌、足底肌小腿后群肌、足底肌小腿后面、足底皮肤小腿后面、足底皮肤腓总神经腓总神经 common peroneal n.股二头肌内侧向外下股二头肌内侧向外下 绕腓骨颈绕腓骨颈 穿腓骨长肌穿腓骨长肌 腓浅神经、腓深神经腓浅神经、腓深神经l 腓浅神经腓浅神经 superficial peroneal n.腓骨长、短肌及趾长伸肌间下行腓骨长、短肌及趾长伸肌间下行l 腓深神经腓深神经 deep peroneal n.伴胫前动脉伴胫
19、前动脉 胫骨前肌、趾长胫骨前肌、趾长 伸肌间伸肌间 胫骨前肌、胫骨前肌、mumu长伸肌长伸肌 间间 足背足背Spinal nerveslSpinal nerves：connected with the spinal cord by two roots.lThirty-one pairs of spinal nerves：8 cervical,12 thoracic,5 lumbar,5 sacral,and 1 coccygeal.lThe anterior（ventral）root：motor(efferent)fibers from motor neurons in the ventral
20、 horn of the spinal cord.lThe posterior（dorsal）root：sensory（afferent）fibers of cells in the spinal ganglionlThe anterior and posterior root：form a spinal nerve in the intervertebral foramen.lThe spinal nerve divides into four parts：anterior，posterior，communicating and meningeal branches.lCervical pl
21、exus(C1 4)is located deep to the sternocleidomastoid muscle.The phrenic nerve is an important one.lBrachial plexus(C5-T1)supplies nerves to the upper limb.Its five important branches:axillary,musculocutaneous,median,ulnar and radial nerve.l Thoracic nerves supply the skin of the thorax,the intercost
22、al muscles,and the abdominal and back muscles.l Lumbar plexuse(T12-L4)is behind the psoas major.We should pay attention to the following nerve:femoral,obturator nerve.l Sacral plexuse(L4-Co)is located to the anterior surface of the pirifomis.We should pay attention to the following nerve:sciatic,com
23、mon peroneal,tibial nerve.The median nerve arises by two roots from the lateral and medial cord of the brachial plexus,which embrace the axillary artery and descend with the brachial artery to the cubital fossa.Then it descends in front of the forearm and passes beneath the flexor retinaculum into t
24、he palm of the hand.It supply the most of the muscles in front of the forearm except the brachioradialis,the flexor carpi ulnaris,the medial half of the flexor digitorum profundus，the thenar muscles except for the adductor pollicis and the first and second lumbrical muscles.Its cutaneous branches di
25、stribute to the skin of thenar,central part of the palm,the palmar aspect of the thumb,second,third and the lateral half of the fourth fingers,as well as the skin on the dorsum of the terminal phalanges.The sciatic nerve leaves the pelvis through the greater sciatic foramen inferior to the piriformi
26、s.Then it descends along the posterior compartment of the thigh to enter the popliteal fossa,and terminates by dividing into the tibial and common peroneal nerves.The branches of the sciatic nerve supply the muscles of the foot,leg and the posterior compartment of the thigh.It also supplies the skin
27、 of the leg and foot.小小 结结 上、下肢肌的神经支配上、下肢肌的神经支配 脊神经的四种纤维成分及与中枢的联系，脊脊神经的四种纤维成分及与中枢的联系，脊 神经前根、后根、前支和后支的区别神经前根、后根、前支和后支的区别 颈、臂、腰、骶丛的组成、位置和颈、臂、腰、骶丛的组成、位置和重要分支重要分支，各支的名称、起始、走行特点各支的名称、起始、走行特点和分布和分布 学习脊神经时，注意联系中枢、骨骼肌和血学习脊神经时，注意联系中枢、骨骼肌和血 管，注意穿肌、贴骨、浅表部位管，注意穿肌、贴骨、浅表部位复习思考题复习思考题1.脊神经前根与后根、前支与后支的脊神经前根与后根、前支与后支
28、的区别。区别。2.上、下肢主要神经干的走行特点、上、下肢主要神经干的走行特点、分布范围和易受损伤的部位。分布范围和易受损伤的部位。3.膝关节运动肌的神经支配？膝关节运动肌的神经支配？膝关节运动肌的神经支配膝关节运动肌的神经支配n屈屈 肌：肌：缝匠肌，缝匠肌，股二头肌股二头肌，半腱肌，半，半腱肌，半 膜肌，腘肌，膜肌，腘肌，腓肠肌腓肠肌n伸伸 肌：肌：股四头肌股四头肌n旋外肌：旋外肌：股二头肌股二头肌n旋内肌：旋内肌：缝匠肌，半腱肌，半膜肌，腘肌缝匠肌，半腱肌，半膜肌，腘肌Cranial Nerves脑脑 神神 经经郑州大学解剖学教研室郑州大学解剖学教研室脑神经概述脑神经概述名称及序数名称及序数
29、嗅、嗅、视、视、动眼；动眼；滑、滑、叉、叉、外展；外展；面、面、听、听、舌咽；舌咽；迷、副、舌下神经全。迷、副、舌下神经全。嗅嗅N视视N动眼动眼N滑车滑车N展展N三叉三叉N面面N前庭蜗前庭蜗N舌咽舌咽N迷走迷走N副副N舌下舌下NCranial nervesn The 12 pairs of cranial nerves are attached to the brain and traverse openings in the skull.n The cranial nerves:olfactory nerve(I),optic nerve(II),oculomotor nerve(III),
30、trochlear nerve(IV),trigeminal nerve(V),abducent nerve(VI),facial nerve(VII),vestibulocochlear nerve(VIII),glossopharyngeal nerve(IX),vagus nerve(X),accessory nerve(XI),and hypoglossal nerve(XII).纤维成分（七种）纤维成分（七种）一般内脏运动纤维一般内脏运动纤维特殊内脏运动纤维特殊内脏运动纤维躯体运动纤维躯体运动纤维内脏运动纤维内脏运动纤维运动纤维运动纤维一般躯体感觉纤维一般躯体感觉纤维特殊躯体感觉纤维
31、特殊躯体感觉纤维一般内脏感觉纤维一般内脏感觉纤维特殊内脏感觉纤维特殊内脏感觉纤维躯体感觉纤维躯体感觉纤维内脏感觉纤维内脏感觉纤维感觉纤维感觉纤维（嗅器、味器）（嗅器、味器）（位听器、视器）（位听器、视器）（咀嚼肌、面肌、咽喉肌）（咀嚼肌、面肌、咽喉肌）脑神经分类脑神经分类感觉神经：感觉神经：嗅神经、嗅神经、视神经、视神经、前庭蜗神经前庭蜗神经运动神经：运动神经：动眼神经、动眼神经、滑车神经、滑车神经、展神经、展神经、副神经、副神经、舌下神经舌下神经混合神经：混合神经：三叉神经、三叉神经、面神经、面神经、舌咽神经、舌咽神经、迷走神经迷走神经 含副交感纤维的神经：含副交感纤维的神经：动眼神经、动眼
32、神经、面神经、面神经、舌咽神经、舌咽神经、迷走神经迷走神经 The cranial nerves provide input to the brain from(1)the special sense organs of smell(I),sight(II),hearing and balance(VIII),and taste(VII,IX and X);and(2)the general sensory receptors for pain and temperature,simple and fine touch,pressure,position sense,and vibration
33、(V,VII,IX,and X).The cranial nerves convey output of the brain to the voluntary muscles concerned with movements of the head,eyes,mouth,face,tongue,pharynx,and larynx.The cranial nerves are also the major outlet for the parasympathetic nervous system.sensory n.(3)olfactory n.optic n.vestibulocochlea
34、r n.locomotive n.(5)oculomotor n.trochlear n.abducent n.accessory n.hypoglossal n.mixed n.(4)trigeminal n.facial n.golssopharyngeal n.vagus n.Cranial N.颅底内面观颅底内面观脑脑 Encephalon,Brain端脑端脑 telencephalon 间脑间脑 diencephalon 中脑中脑 mesencephalon后脑后脑 metencephalon 脑桥脑桥 pons 小脑小脑 cerebellum 延髓延髓 medulla oblong
35、ata感觉神经名称、起源、入颅部位、名称、起源、入颅部位、连脑部位、传导冲动连脑部位、传导冲动上鼻甲上部、鼻中隔上部上鼻甲上部、鼻中隔上部粘膜内嗅细胞粘膜内嗅细胞中枢突中枢突嗅神经嗅神经 筛孔筛孔cribriform foramen嗅球嗅球olfactory bulb嗅神经嗅神经 olfactory n.视神经视神经 optic n.视网膜中的节细胞视网膜中的节细胞轴突轴突视神经盘视神经盘optic disc巩膜巩膜视神经视神经视神经管视神经管optic canal视交叉视交叉前庭蜗神经前庭蜗神经 vestibulocochlear n.壶腹嵴壶腹嵴 球囊斑球囊斑椭圆囊斑椭圆囊斑 前庭神经节前
36、庭神经节 前庭神经前庭神经 螺旋器螺旋器 蜗神经节蜗神经节 蜗神经蜗神经 内耳门内耳门internal acoustic pore 脑桥延髓沟脑桥延髓沟运动神经名称、起源、连脑部位、名称、起源、连脑部位、走行特点、出颅部位、分布走行特点、出颅部位、分布中脑脚间窝中脑脚间窝海绵窦海绵窦眶上裂眶上裂眶眶躯体运动纤维躯体运动纤维内脏运动纤维内脏运动纤维眼球外肌（上斜肌、外直肌除外）眼球外肌（上斜肌、外直肌除外）睫状神经节睫状神经节睫状肌、瞳孔括约肌睫状肌、瞳孔括约肌 动眼神经动眼神经 oculomotor n.动眼神经动眼神经 oculomotor n.It enters the orbit thr
37、ough the superior orbital fissure and supplies the superior rectus,the levator palpebrae superioris,the inferior rectus,medial rectus and inferior obliquus.From the nerve to the inferior obliquus a short thick branch is given to the ciliary ganglion.This branch contains the parasympathetic（副交感）（副交感）
38、preganglionic fibers,which pass in the short ciliary nerves to the sphincter pupillae.The oculomotor nerve is a motor nerve.滑车神经滑车神经 trochlear n.中脑背侧中脑背侧绕大脑脚绕大脑脚海绵窦海绵窦眶上裂眶上裂眶眶上斜肌上斜肌展神经展神经 abducent n.海绵窦海绵窦外直肌外直肌眶上裂眶上裂眶眶延髓脑桥沟延髓脑桥沟眼外肌神经支配展神经展神经滑车神经滑车神经动眼神经动眼神经Oculomotor paralysisAbducent nerve injury
39、副神经副神经 accessory n.延髓根纤维延髓根纤维颈静脉孔颈静脉孔延髓根、延髓根、脊髓根脊髓根脊髓根纤维脊髓根纤维迷走神经迷走神经咽喉肌咽喉肌斜方肌斜方肌胸锁乳突肌胸锁乳突肌舌下神经舌下神经 hypoglossal n.延髓前外侧沟延髓前外侧沟舌下神经管舌下神经管颈内动静脉之间颈内动静脉之间舌神经下方舌神经下方穿颏舌肌穿颏舌肌舌内、外肌舌内、外肌混合神经名称、性质、走行、名称、性质、走行、分支、分布分支、分布三叉神经三叉神经 trigeminal n.脑桥腹侧与脑桥臂交界处脑桥腹侧与脑桥臂交界处三叉神经节三叉神经节眼神经眼神经上颌神经上颌神经下颌神经下颌神经V 三叉神经三叉神经 tri
40、geminal n.（混合性）（混合性）眼神经眼神经 ophthalmic n.海绵窦海绵窦眶上裂眶上裂superior obitalfissure眶眶 orbit泪腺泪腺N N、鼻睫鼻睫N N、额、额N N泪腺、泪腺、眼睑、眼球眼睑、眼球、筛窦、鼻腔粘膜、筛窦、鼻腔粘膜及鼻背及鼻背、额部皮肤、额部皮肤眶内神经眶内神经:,V 三叉神经三叉神经 trigeminal n.（混合性）（混合性）上颌神经上颌神经 maxillary n.海绵窦海绵窦眼裂和口裂间皮肤、眼裂和口裂间皮肤、上颌牙及鼻、口腔上颌牙及鼻、口腔粘膜粘膜眶下眶下N N、颧、颧N N、上牙槽上牙槽N N、翼腭、翼腭N N圆孔圆孔fo
41、ramen rotundum翼腭窝翼腭窝眶下裂眶下裂眶眶q 下颌神经下颌神经 mandibular n.经卵圆孔经卵圆孔翼外肌深面翼外肌深面耳耳颞颞N N咀咀嚼嚼肌肌N N舌舌N N下下牙牙槽槽N N下颌孔下颌孔下颌管下颌管颏孔颏孔颏颏N N舌前舌前2/32/3及口腔底粘膜及口腔底粘膜颊颊N N耳耳颞颞区区皮皮肤肤下下颌颌牙牙、牙牙龈龈颊颊部部皮皮肤肤和和粘粘膜膜口裂以口裂以下皮肤下皮肤三叉神经及其分支三叉神经及其分支VII 面神经面神经 facial n.（混合性）（混合性）延髓延髓内耳门内耳门internal acoustic pore内耳道内耳道meatus面面N N管管茎乳孔茎乳孔st
42、ylomastoid foramen 穿腮腺穿腮腺面部面部膝神经节膝神经节 面神经面神经 facial n.颅外的分支颅外的分支（穿腮腺实质）（穿腮腺实质）颞支颞支颧支颧支颊支颊支下颌缘支下颌缘支颈支颈支面肌面肌Injury to the facial nerven鼓索鼓索 chorda tympani面神经管面神经管副交感纤维副交感纤维 -下颌下神经节下颌下神经节 下颌下腺、舌下腺下颌下腺、舌下腺舌神经舌神经 lingual n.颞下窝颞下窝鼓室鼓室tympanic cavityVII 面神经面神经 facial n.（混合性）（混合性）submandibular g.味觉纤维味觉纤维 舌前
43、舌前2/32/3味蕾味蕾岩鼓裂岩鼓裂n 岩大岩大N N（副交感纤维）（副交感纤维）面面N N管管泪腺、腭及鼻泪腺、腭及鼻 粘膜的腺体粘膜的腺体 翼腭神经节翼腭神经节翼腭窝翼腭窝岩大岩大N N裂孔裂孔VII 面神经面神经 facial n.（混合性）（混合性）pterygopalatine g.破裂孔破裂孔颅底外颅底外翼管翼管IX 舌咽神经舌咽神经 glossopharyngeal n.（混合性）（混合性）走行走行延髓延髓颈颈V V孔孔颈内颈内A A、V V之间之间弓形向前弓形向前舌根舌根分支分支 舌支舌支舌后舌后1/31/3粘膜和味蕾粘膜和味蕾 咽支咽支咽肌咽肌 颈颈A A窦支窦支颈颈A A窦
44、、颈窦、颈A A小球小球 鼓室鼓室N N tympanic n.鼓室鼓室N 鼓室丛鼓室丛岩小岩小N 耳耳N节节耳颞耳颞N 腮腺腮腺 咽、咽鼓管、鼓室咽、咽鼓管、鼓室鼓室鼓室N Ntympanic n.鼓室鼓室N 鼓室丛鼓室丛岩小岩小N 耳耳N节节耳颞耳颞N 腮腺腮腺 咽、咽鼓管、鼓室咽、咽鼓管、鼓室鼓室鼓室N Ntympanic n.迷走神经迷走神经vagus n.颈内颈内A.V.A.V.之间后方之间后方颈静脉孔颈静脉孔延髓延髓左迷走神经左迷走神经右迷走神经右迷走神经主动脉弓前方主动脉弓前方左肺根后方左肺根后方食管前丛食管前丛前干前干锁骨下动脉前方锁骨下动脉前方右肺根后方右肺根后方食管后丛食管
45、后丛后干后干膈食管裂孔膈食管裂孔膈食管裂孔膈食管裂孔胃后支，腹腔支胃后支，腹腔支胃前支，肝支胃前支，肝支1.1.喉上神经喉上神经环甲肌环甲肌、声门裂、声门裂 以上喉粘膜及会厌、舌根等以上喉粘膜及会厌、舌根等2.2.咽支咽支咽腭肌、咽粘膜咽腭肌、咽粘膜3.3.颈心支颈心支心丛、主心丛、主A A神经神经4.4.喉返喉返 recurrent laryngeal N 右侧绕锁骨下右侧绕锁骨下A A、左侧绕主、左侧绕主A A 弓弓颈部气管、食管间颈部气管、食管间喉喉 肌肌、声门裂以下喉粘膜、声门裂以下喉粘膜5.5.支气管支和食管支支气管支和食管支 6.6.胃前支胃前支胃前半胃前半7.7.肝支肝支:随肝固
46、有随肝固有A A8.8.胃后支胃后支胃后半胃后半9.9.腹腔支腹腔支:随不成对脏支随不成对脏支X 迷走神经分支左左迷迷走走神神经经右右迷迷走走神神经经喉返喉返 N1.1.喉上神经喉上神经环甲肌环甲肌、声门裂、声门裂 以上喉粘膜及会厌、舌根等以上喉粘膜及会厌、舌根等2.2.咽支咽支咽腭肌、咽粘膜咽腭肌、咽粘膜3.3.颈心支颈心支心丛、主心丛、主A A神经神经4.4.喉返喉返 recurrent laryngeal N 右侧绕锁骨下右侧绕锁骨下A A、左侧绕主、左侧绕主A A 弓弓颈部气管、食管间颈部气管、食管间喉喉 肌肌、声门裂以下喉粘膜、声门裂以下喉粘膜5.5.支气管支和食管支支气管支和食管支
47、 6.6.胃前支胃前支胃前半胃前半7.7.肝支肝支:随肝固有随肝固有A A8.8.胃后支胃后支胃后半胃后半9.9.腹腔支腹腔支:随不成对脏支随不成对脏支X 迷走神经分支 The vagus nerve is a mixed nerve.Its course is the longest and its distribution is the most extensive in the cranial nerves.It leaves the skull through the jugular foramen.The left vagus nerve forms the left pulmona
48、ry plexus,anterior part of the esophageal plexus and the anterior vagal trunk at the lower part of the esophagus.The right vagus nerve forms the posterior part of the esophageal plexus and the posterior vagal trunk at the inferior part of the esophagus.The anterior and posterior vagal trunks enter t
49、he abdominal cavity through the esophageal hiatus of the diaphragm and are divided into their terminal branches near the cardia of the stomach.The fibers of the vagus nerve carry somatic motor impulses to pharynx and larynx and sensory fibers from same structure.The very large p o r t i o n i s c o
50、m p o s e d o f parasympathetic motor fibers,which supply heart muscles,smooth muscles and glands of abdominal visceral organs;transmits sensory impulses from viscera.Through cavernous sinus and superior orbital fissure:Oculomotor n.Trochlear n.Abducent n.Ophthalmic n.Cranial N.Through jugular foram
