1、局部解剖学（九 ） 颈部的局部解剖与操作（ 1） 颈 部 Neck 概述 introduction 浅层结构 superifical structures 下颌下三角 submandibular triangle 颏下三角 submental triangle 一、概述 Introduction 境界和分区 boundary and regions 表面解剖 surface anatomy 表面标志 surface landmark 体表投影 surface projection 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： an line linkin
2、g with the lower border of mandible, the angle of mandible, the mastoid process, the superior nuchal line and the external occipital protuberance; 下界： 由胸骨上缘、锁骨和肩峰至第 7颈椎棘突的连线。 Inferiorly ： by the upper border of sternum, the clavicle and a line extending from the acromion to the spine of 7th cervical
3、 vertebra. 1. 颈部的境界 boundary of the neck 2.颈部分区 颈部 :分为固有颈部（ proper neck） 和项部（ nape）。 固有颈部 :又可分为颈前区 anterior region、 胸锁乳突肌区 sternocleidomastoid region和颈外侧区 lateral region。 颈前区：被舌骨 hyoid分为舌骨上区 suprahyoid region（ 包括 2 个下颌下三角和 1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 ）。 颈外侧区：被肩胛舌骨肌下腹分为枕三角和锁骨上三角。 3
4、.表面标志 surface landmark Lesser supraclavicular fossa (Greater) supraclavicular fossa Suprasternal fossa 表面标志 Surface Landmark 舌骨 Hyhoid(H) 甲状软骨 Thyroid cartilage(T) 喉结节 Laryngeal prominence(P) 环状软骨 Cricoid cartilage (C) 第 1气管环 The first tracheal ringe(1) 甲状腺峡 Isthmus(S) v环状软骨 (弓 )的意义 第 6颈椎水平 The leve
5、l of the 6th cervical vertebra. 喉与气管交界 The junction of the larynx with the trachea. 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 t
6、he carotid tubercle of the 6th cervical vertebra. The level at which the 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
7、结构 The superficial structures of the neck 皮肤 The skin( thin and pliable) 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 c
8、ervical plexus the cervical branch of the facial nerve 1. 颈阔肌 The platysma Is 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
9、clavicle to the inferior border of the mandible, skin, and subcutaneous 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 platy
10、sma: draws corners of mouth inferiorly and widens it as in expressions of sadness 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 静 脉 弓 Jugular venous arch 3. 颈浅淋巴结 Superficial cervical lymph nodes 4. Superficial cervical nerves Cutaneous branches of th
11、e cervical plexus Nerve point of neck Cervical branch of the facial nerve 面神经的颈支 Cervical branch of facial nerve 三、颈筋膜及筋膜间隙 Cervical Fasciaand Fascial Space 1. 颈筋膜 Cervical Fascia 颈深筋膜分为三层 Deep cervical fascia consists of three fascial layers: 浅层 Superficial layer 封套筋膜 Investing fascia 中层 Middle lay
12、er 气管前筋膜 Prechacheal fascia 内脏筋膜 Visceral fascia 深层 Deep layer 椎前筋膜 Prevertebral fascia 封套筋膜 、 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 2. 颈筋膜间隙 Cervical Fascial Spaces 胸骨上间隙 Suprasternal space 咽后间隙 Retropharyngeal space 气管前间隙 Prechacheal space 椎前间隙 Prevertebral space 胸骨上间隙、咽后间隙、气管前间隙、椎前间隙 胸 骨 上 间 隙的内容 Con
13、tents of the Suprasternal space Include the: 颈前筋膜下端 Inferior ends of the anterior jugular veins 颈静脉弓 Jugular venous arch 疏松结缔组织 Loose connective tissue 12个淋巴结 One or two deep lymph nodes 胸锁乳突胸骨头 Sternal heads of the ternocleidomastoid 锁骨间韧带 Interclavicular ligament 锁骨上间隙的内容 Contents of the supraclav
14、icular space Include 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 下 三 角 Submental Triangle 境界 Boundary 内容 Contents 颏下三角 Boundaris of submental triangle Body of hyoid bone 颏 下 三 角 的 内 容 Co
15、ntents of the submental triangle Include the: 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 Small veins that unite to form the anterior jugular vein. 五、下 颌 下 三 角 Submandibular Triangle 境界 Boundary 内容 Contents 1. 下 颌 下 三 角 Boundaris of the submandibular triangle A roof of the submandib
16、ular 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 pharyngeal constrictor. Middle pharyngeal constrictor Mylohyoid Hyoglossus 下 颌 下 三 角 的 底 下 颌 下 三 角 的 顶 与 底 2.下颌下三角的主要结构 Main
17、 contents of the submandibular triangle 下颌腺及其导管 Submandibular gland and its duct 面静脉 Facial vein 面神经的颈支 Cervical branch of facial nerve 下颌下淋巴结 Submandibular lymph nodes 面动脉 Facial artery 颏下动、静脉 Submental artery and vein 下颌舌骨肌神经 Mylohyoid nerve 舌下神经 Hypoglossal nerve 舌动、静脉 Lingual artery and vein 舌神经
18、 Lingual Nerve , 下颌下神经节 Submandibular ganglion 1. 在下颌下腺的浅面有： 面静脉、面神经的颈支、下颌下淋巴结 Cervical branches of facial nerve Mylohyoid 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
19、sublingual papilla. 3. 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 脉、下颌舌骨肌神经； 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； 在舌骨舌肌深面的结构有 舌动脉。 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 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 Dissection and Observation 1.Make a median skin incision 2.Reflect the skin flaps 3.Reflect the platysma 4.Dissect the s
20、uperficial structures 5.Dissect the submental triangle 6.Dissect the submandibular triangle 1.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 directly. 3.Divide the plat
21、ysma 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 triangle 6. Cut through the investing fascia to exopse the submandibular gland
22、, 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 mylohyo
23、id. 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 to the submandibul
24、ar triangle. Look for the duct of submandibular gland , the submandibular ganglion, and lingual nerve. 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 和下颌下淋巴结。 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。 切断二腹肌前腹在下颌骨上的附着点 ，并翻向下 清理下颌舌骨肌，寻找下颌舌骨肌神经及颏下血 管。 切断下颌舌骨肌在舌骨上的附着部 ，将其翻向上 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。 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。
