局部解剖學（九）頸部的局部解剖與操作（1）本文檔共57頁；當前第1頁；編輯于星期二\22點31分頸部Neck概述introduction淺層結(jié)構(gòu)superificalstructures下頜下三角submandibulartriangle頦下三角submentaltriangle本文檔共57頁；當前第2頁；編輯于星期二\22點31分一、概述Introduction境界和分區(qū)boundaryandregions表面解剖surfaceanatomy表面標志surfacelandmark體表投影surfaceprojection本文檔共57頁；當前第3頁；編輯于星期二\22點31分上界：為下頜骨下緣、下頜角、乳突、上項線與枕外隆突的連線。Superiorly：anlinelinkingwiththelowerborderofmandible,theangleofmandible,themastoidprocess,thesuperiornuchallineandtheexternaloccipitalprotuberance;

下界：由胸骨上緣、鎖骨和肩峰至第7頸椎棘突的連線。Inferiorly：bytheupperborderofsternum,theclavicleandalineextendingfromtheacromiontothespineof7thcervicalvertebra.1.頸部的境界boundaryoftheneck本文檔共57頁；當前第4頁；編輯于星期二\22點31分2.頸部分區(qū)頸部:分為固有頸部（properneck）和項部（nape）。固有頸部:又可分為頸前區(qū)anteriorregion、胸鎖乳突肌區(qū)sternocleidomastoidregion和頸外側(cè)區(qū)lateralregion。本文檔共57頁；當前第5頁；編輯于星期二\22點31分頸前區(qū)：被舌骨hyoid分為舌骨上區(qū)suprahyoidregion（包括2個下頜下三角和1個頦下三角）和舌骨下區(qū)infrahyoidregion（包括成對的頸動脈三角和肌三角）。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。本文檔共57頁；當前第6頁；編輯于星期二\22點31分3.表面標志surfacelandmarkLessersupraclavicularfossa(Greater)supraclavicularfossaSuprasternalfossa本文檔共57頁；當前第7頁；編輯于星期二\22點31分表面標志

SurfaceLandmark舌骨Hyhoid(H)甲狀軟骨Thyroidcartilage(T)喉結(jié)節(jié)Laryngealprominence(P)環(huán)狀軟骨Cricoidcartilage(C)第1氣管環(huán)Thefirsttrachealringe(1)甲狀腺峽Isthmus(S)本文檔共57頁；當前第8頁；編輯于星期二\22點31分環(huán)狀軟骨(弓)的意義第6頸椎水平Thelevelofthe6thcervicalvertebra.喉與氣管交界Thejunctionofthelarynxwiththetrachea.咽與食管交界Thejunctionofthepharynxwiththeesophagus.本文檔共57頁；當前第9頁；編輯于星期二\22點31分Thelevelatwhichthevertebralarteryentersthetransverseforamenofthe6thcervicalvertebra.Thesiteatwhichthecarotidarterycanbepressedagainstthecarotidtubercleofthe6thcervicalvertebra.本文檔共57頁；當前第10頁；編輯于星期二\22點31分Thelevelatwhichtheinferiorthyroidarteryandthemiddlethyroidveinenterorleavethethyroidgland.本文檔共57頁；當前第11頁；編輯于星期二\22點31分Thelevelatwhichthesuperiorbellyoftheomohyoidmusclecrossesthecarotidsheath.本文檔共57頁；當前第12頁；編輯于星期二\22點31分Thelevelofthemiddlesympatheticganglion.本文檔共57頁；當前第13頁；編輯于星期二\22點31分二、頸部淺層結(jié)構(gòu)

Thesuperficialstructuresoftheneck皮膚Theskin(thinandpliable)淺筋膜及其內(nèi)容Thesuperficialfasciaanditscontentsathinlayeroffatasheetofplatysmatheanteriorjugularveinthelateraljugularveinthesuperficial(lateralandanerior)cervicallymphnodesthecutaneousbranchesofthecervicalplexusthecervicalbranchofthefacialnerve本文檔共57頁；當前第14頁；編輯于星期二\22點31分1.頸闊肌

TheplatysmaIsabroad,thinsheetofmuscleinthesubcutaneoustissue.Coverstheanterolateralaspectoftheneck.Aariseinfasciacoveringsuperiorpartsofthedeltoidandpectoralismajormusclesandsweepsuperomediallyovertheclavicletotheinferiorborderofthemandible,skin,andsubcutaneoustissueoflowerface.Isoneofthemusclesoffacialexpression.Isinnervatedbythecervicalbranchofthefacialnerve.本文檔共57頁；當前第15頁；編輯于星期二\22點31分Thesuperficialcervicalveinsandnervesarelocateddeeptotheplatysma.本文檔共57頁；當前第16頁；編輯于星期二\22點31分Themainactionoftheplatysma:①drawscornersofmouthinferiorlyandwidensitasinexpressionsofsadnessandfright;②drawstheskinofnecksuperiorlywhenteethare“clenched”.本文檔共57頁；當前第17頁；編輯于星期二\22點31分2.頸前靜脈或頸前正中靜脈、頸外靜脈本文檔共57頁；當前第18頁；編輯于星期二\22點31分頸靜脈弓Jugularvenousarch本文檔共57頁；當前第19頁；編輯于星期二\22點31分3.頸淺淋巴結(jié)Superficialcervicallymphnodes本文檔共57頁；當前第20頁；編輯于星期二\22點31分4.SuperficialcervicalnervesCutaneousbranchesofthecervicalplexusNervepointofneckCervicalbranchofthefacialnerve本文檔共57頁；當前第21頁；編輯于星期二\22點31分面神經(jīng)的頸支Cervicalbranchoffacialnerve本文檔共57頁；當前第22頁；編輯于星期二\22點31分三、頸筋膜及筋膜間隙

CervicalFasciaandFascialSpace

本文檔共57頁；當前第23頁；編輯于星期二\22點31分1.

頸筋膜CervicalFascia

頸深筋膜分為三層

Deepcervicalfasciaconsistsofthreefasciallayers:淺層Superficiallayer封套筋膜Investingfascia中層Middlelayer氣管前筋膜Prechachealfascia內(nèi)臟筋膜Visceralfascia深層Deeplayer椎前筋膜Prevertebralfascia本文檔共57頁；當前第24頁；編輯于星期二\22點31分本文檔共57頁；當前第25頁；編輯于星期二\22點31分封套筋膜、氣管前筋膜、椎前筋膜本文檔共57頁；當前第26頁；編輯于星期二\22點31分頸動脈鞘、氣管前筋膜、甲狀腺鞘、甲狀腺懸韌帶本文檔共57頁；當前第27頁；編輯于星期二\22點31分2.頸筋膜間隙

CervicalFascialSpaces胸骨上間隙Suprasternalspace咽后間隙Retropharyngealspace氣管前間隙Prechachealspace椎前間隙Prevertebralspace本文檔共57頁；當前第28頁；編輯于星期二\22點31分胸骨上間隙、咽后間隙、氣管前間隙、椎前間隙本文檔共57頁；當前第29頁；編輯于星期二\22點31分本文檔共57頁；當前第30頁；編輯于星期二\22點31分胸骨上間隙的內(nèi)容

ContentsoftheSuprasternalspaceIncludethe:頸前筋膜下端Inferiorendsoftheanteriorjugularveins頸靜脈弓Jugularvenousarch疏松結(jié)締組織Looseconnectivetissue1~2個淋巴結(jié)Oneortwodeeplymphnodes

胸鎖乳突胸骨頭Sternalheadsoftheternocleidomastoid鎖骨間韌帶Interclavicularligament本文檔共57頁；當前第31頁；編輯于星期二\22點31分鎖骨上間隙的內(nèi)容

ContentsofthesupraclavicularspaceIncludethe:頸外靜脈Apartoftheexternaljugularvein鎖骨上神經(jīng)Supraclavicularnerves

頸橫靜脈Transversecervicalvein肩胛上靜脈Suprascapularvein淋巴管Afewlymphvessels本文檔共57頁；當前第32頁；編輯于星期二\22點31分四、頦下三角

SubmentalTriangle

境界Boundary內(nèi)容Contents本文檔共57頁；當前第33頁；編輯于星期二\22點31分頦下三角BoundarisofsubmentaltriangleBodyofhyoidbone本文檔共57頁；當前第34頁；編輯于星期二\22點31分頦下三角的內(nèi)容

ContentsofthesubmentaltriangleIncludethe:幾個小的頦下淋巴結(jié)Severalsmallsubmentallymphnodes.幾條小靜脈，匯合成頸前靜脈Smallveinsthatunitetoformtheanteriorjugularvein.本文檔共57頁；當前第35頁；編輯于星期二\22點31分五、下頜下三角

SubmandibularTriangle境界Boundary內(nèi)容Contents本文檔共57頁；當前第36頁；編輯于星期二\22點31分1.下頜下三角

Boundarisofthesubmandibulartriangle本文檔共57頁；當前第37頁；編輯于星期二\22點31分Aroofofthesubmandibulartriangleisformedbytheskin,superficialfascia,platysmaandinvestingfascia.本文檔共57頁；當前第38頁；編輯于星期二\22點31分Afloorofthesubmandibulartriangleisformedbythemylohyoid,hyoglossusandmiddlepharyngealconstrictor.MiddlepharyngealconstrictorMylohyoidHyoglossus本文檔共57頁；當前第39頁；編輯于星期二\22點31分下頜下三角的底本文檔共57頁；當前第40頁；編輯于星期二\22點31分下頜下三角的頂與底本文檔共57頁；當前第41頁；編輯于星期二\22點31分2.下頜下三角的主要結(jié)構(gòu)

Maincontentsofthesubmandibulartriangle下頜腺及其導管Submandibularglandanditsduct

面靜脈Facialvein面神經(jīng)的頸支Cervicalbranchoffacialnerve下頜下淋巴結(jié)Submandibularlymphnodes

面動脈Facialartery頦下動、靜脈Submentalarteryandvein下頜舌骨肌神經(jīng)Mylohyoidnerve舌下神經(jīng)Hypoglossalnerve舌動、靜脈Lingualarteryandvein舌神經(jīng)LingualNerve,下頜下神經(jīng)節(jié)Submandibularganglion本文檔共57頁；當前第42頁；編輯于星期二\22點31分1.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)Cervicalbranchesoffacialnerve本文檔共57頁；當前第43頁；編輯于星期二\22點31分Mylohyoid2.

Thesubmandibularglandisdividedintothesuperficialanddeeppartsbytheposteriorborderofmylohyoid,itsductemergesfromthedeepoftheglandandthenopensonthesublingualpapilla.本文檔共57頁；當前第44頁；編輯于星期二\22點31分3.在下頜下腺的深面：①在下頜舌骨肌淺面的結(jié)構(gòu)有頦下動脈和靜脈、下頜舌骨肌神經(jīng)；②在舌骨舌肌淺面的結(jié)構(gòu)有舌靜脈、面動脈、舌下神經(jīng)、下頜下神經(jīng)節(jié)和舌神經(jīng)；③在舌骨舌肌深面的結(jié)構(gòu)有舌動脈。本文檔共57頁；當前第45頁；編輯于星期二\22點31分本文檔共57頁；當前第46頁；編輯于星期二\22點31分4.下頜下腺深部及其導管的毗鄰：自上而下為舌神經(jīng)、下頜下神經(jīng)節(jié)、下頜下腺及其導管、舌下神經(jīng)、舌動脈和靜脈。本文檔共57頁；當前第47頁；編輯于星期二\22點31分六、解剖與觀察

DissectionandObservation

1.Makeamedianskinincision2.Reflecttheskinflaps3.Reflecttheplatysma4.Dissectthesuperficialstructures5.Dissectthesubmentaltriangle6.Dissectthesubmandibulartriangle本文檔共57頁；當前第48頁；編輯于星期二\22點31分1.Makeamedianskinincisionfromthementalsymphysistothesuprasternalnotch.本文檔共57頁；當前第49頁；編輯于星期二\22點31分2.Reflecttheskinflapslaterallytotheanteriorborderofthetrapeziustoexposetheplatysmadirectly.

3.Dividetheplatysmaalongtheupperborderoftheclavicleandreflectitupwardstothemandible.Donotdamagetheunderlyingstructures.本文檔共57頁；當前第50頁；編輯于星期二\22點31分4.Lookforandexposethesuperficialstructuresoftheneck.本文檔共57頁；當前第51頁；編輯于星期二\22點31分5.Cleanboundarisofthesubmentaltriangle本文檔共57頁；當前第52頁；編輯于星期二\22點31分6.Cutthroughtheinvestingfasciatoexopsethesubmandibulargland,thefacialvein,thecervicalbranchesofthefacialnerveandsubmandibularlymphnodes.本文檔共57頁；當前第53頁；編輯于星期二\22點31分Identifythefacialarteryandfollowitto