系統(tǒng)解剖學(xué)-顱腦

1、Head 山東大學(xué)醫(yī)學(xué)院山東大學(xué)醫(yī)學(xué)院 解剖教研室解剖教研室李振華李振華Region and partsnCranium 顱部顱部nFace 面部面部Landmaeks nSuperciliary nSupraorbital notch nInfraorbital foramennMental foramennPterionnZygomatic arch nMastoid process nExternal occipital protuberanceEpidural hemorrhagePterionMuscles of head Facial muscles 面肌面肌nEpicranius

2、 顱頂肌顱頂肌 (oddipitofrontalis) 枕額枕額肌肌qFrontal belly 額腹額腹qOccipital belly 枕腹枕腹qGalea aponeurotica 帽帽狀腱膜狀腱膜nOrbicularis oculi 眼眼輪匝肌輪匝肌nBuccinator 頰肌頰肌nOrbicularis oris 口口輪匝肌輪匝肌nNasalis 鼻肌鼻肌Platysma 頸闊肌頸闊肌nThe skin of face is very thin and connected to the facial bones by loose connective tissue. There is

3、 no deep fascia. The facial muscles lie in this connective tissue.Masticatory musclesnMasseter 咬肌咬肌qOrigininferior border and medial surface of zygomatic archqInsertionlateral surface of ramus of mandible and angle of mandibleqActionelevates mandiblenTemporalis 顳肌顳肌qOrigintemporal fossaqInsertioncor

4、onoid process of mandibleqActionelevates and retracts mandiblenlateral pterygoid 翼外肌翼外肌nMedial pterygoid 翼內(nèi)肌翼內(nèi)肌Arteries of headFacial a. 面動脈面動脈nBranch of external caroteid a. nRuns forward over digastric and submandibular glandnLoops around mandible (where it is palpable), at anterior border of mass

5、eter, to enter the facenFollows a tortuous course to medial angle of eye nLies deep to most facial musclesnBranchesqInferior labial a. 下唇動脈下唇動脈qSuperior labial a. 上唇動脈上唇動脈 qAngular a. 內(nèi)眥動脈內(nèi)眥動脈Superficial temporal a.顳淺動脈顳淺動脈nTerminal branch of external carotid a.nAscends in front of ear (where it is

6、palpable) to supply temporal and anterior portion of scalpnTransverse facial a. 面面橫動脈橫動脈runs above parotid duct to supply the cheek regionMaxillary artery 上頜動脈上頜動脈nBranch of external carotid a.nEntrance to infratemporal fossa medial to neck of mandiblenBranchesqInferior alveolar a. 下牙槽動脈下牙槽動脈qMiddle

7、 meningeal a. 腦膜中動脈腦膜中動脈 nenters the skull through foremen spinosumnSupplies cranium and dura materqPosterior superior alveolar a.上牙槽后動脈上牙槽后動脈Veins of head Facial vein 面靜脈面靜脈nBegins at medial angle of eye (angular vein)nRuns downward and backward through the face, posterior to the facial arterynBelo

8、w angle of mandible, joins anterior branch of retromandibular vein to form common facial vein, which drains into internal jugular veinnConnections with cavernous sinus 海綿竇海綿竇through the ophthalmic vein眼靜脈眼靜脈, and also through pteygoid plexus 翼靜脈叢翼靜脈叢 via the deep facial vein 面深靜脈面深靜脈 n“Danger area”

9、危險三角危險三角lies between root of nose and two angles of mouth; in this area the facial vein has no valvesRetromandibular vein 下頜后靜脈下頜后靜脈nFormed by union of superficial temporal and maxillary veinsnDivides into an anterior branch that unites with facial vein and a posterior branch that joins posterior au

10、ricular vein to become external jugular veinPteygoid plexus 翼靜脈叢翼靜脈叢nLocated between and around muscles of masticationnReceives blood from all regions supplied by maxillary a. nCommunicates with qFace by deep facial veinsqCavernous sinus by veins draining base of skullnProvides possible pathway for

11、spread of infection to cranial cavityThe lymphatic drainage of head Lymph nodes of headnLocated at junction of head and necknConsist of occipital, mastoid, parotid, submandibular, submental lymph nodesnDrain into deep cervical lymph nodes nSubmandibular lymph node 下頜下淋巴結(jié)下頜下淋巴結(jié) lies near the submandi

12、bular gland, receive lymphatic vessels from the face, nose and mouthNerves of head Facial nerve () 面神面神經(jīng)經(jīng)nLeaves skull through internal acoustic meatus, facial canal and stylomastoid foramennDivided three parts qFirst partbetween stylomastoid foramen and parotid gland qSecond partwithin parotid glan

13、d qThird partoutside of parotid gland nEnters parotid gland and divides into its five terminal branches for muscles of facial expressionqTemporal 顳支顳支 qZygomatic 顴支顴支 qBuccal 頰支頰支qMarginal mandibular 下頜緣支下頜緣支 q Cervical 頸支頸支Trigeminal nerve () 三叉神經(jīng)三叉神經(jīng)nOphthalmic nerve 眼神經(jīng)眼神經(jīng) (1) supraorbital n. 眶上神

14、經(jīng)眶上神經(jīng)nMaxillary nerve 上頜神經(jīng)上頜神經(jīng) (2) infraorbital n. 眶下神經(jīng)眶下神經(jīng)nMandibular nerve 下下頜神經(jīng)頜神經(jīng) (3) mental n. 頦神經(jīng)頦神經(jīng)Parotid gland 腮腺腮腺nPosition: situated below the external auditory meatus and lies in a deep hollow behind the ramus of mandibular and in front of the sternocleidomastoidnSuperficial part: triang

15、ular in shape, lies below and in front of the external acoustic meatus, and partially covers the masseter.n Deep part: lies deep to medial pterygoid .Parotid duct 腮腺管腮腺管 nArises front anterior border of gland nLies 1.5 cm below and parallel to zygomatic arch nPasses forward over masseter, pierces th

16、e buccinator and oral mucosa to open opposite second upper molar toothCapsule of the parotid glandnThe parotid gland is enclosed within a well-defined capsule which extension of the investing fascia of the neck. nThe superficial capsule is thick and unyielding and tightly affixed to the underlying g

17、landular tissue by numerous fibrous septa.nThe deep capsule id quite thin and easily disrupted.Structures passing through the parotid glandnVertical qExternal carotid a.qRetromandibular veinqSuperficial temporal a. & v.qAuriculotemporal n.nTransversal qMaxillary a. & v.qTranverse facial a. & v.qBran

18、ches of facial n. Relationships of parotid glandnSuperiorexternal acostic meatus, poterior margin of temporomandibular jointnAnteromedialymasseter, ramus of mandible, posterior part of medial pterygoidnPoateromedialmastoid process, sternocleidomastoid, posterior belly of digastric, styloid process,

19、internal carotid a., internal jugular v., cranial nervesn“Parotid bed”internal carotid a., internal jugular v., cranial nervesMasseter space 咬肌間隙咬肌間隙nLies between the masseter, and ramus of mandiblePterygomandibual space 翼下頜間隙翼下頜間隙 nLies between ramus of mandible and medial pterygoidSublingual space

20、 舌下間隙舌下間隙nBetween mucous membrane of floor of mouth and mylohyoid and hyoglossus Dissection Skin incisionsThe cranial partFrontal parietal occipital region額頂枕區(qū)額頂枕區(qū)BoundariesnAnteriorsupraorbital marginnPosteriorexternal occipital protuberance and superior nuchal linenLateralsuperior temporal lineLay

21、ers nconsists of five layers: qSkin 皮膚皮膚qSuperficial fascia 淺筋膜淺筋膜 qGalea aponeurotica and occipitofrontalis 帽狀腱膜和枕額肌帽狀腱膜和枕額肌qSubaponeurotic space (loose connective tissue) 腱膜下隙腱膜下隙qPericranium 顱骨外膜顱骨外膜nThe superficial 3 layer are closely knit together, called scalp頭皮nThe skin has the greatest conce

22、ntration of hair and sebaceous glands 皮厚、腺多、血運豐富皮厚、腺多、血運豐富nThe superficial fascia is dense connective tissue that binds the skin strongly to the underlying galea aponeurotica qThe vasculature of the scalp runs primarily in the. lt is richand widely anastornotic-qWounds of the scalp bleed profusely b

23、ut heal well. Arteries, veins and nervesnAnterior groupqSupratrochlear a. v. n.qSupraorbital a. v. n.nPosterior groupqOccipital a. v. qGreater occipital n.n炎癥不易擴散，腫脹疼痛劇烈，血管吻合多，止血應(yīng)呈環(huán)狀，局麻范圍要廣，切口呈放射狀，皮瓣蒂在下方nGalea aponeuroticaqIt is interposed between the frontalis and occipitalis portions of the occipi

24、tofrontalis muscle.qThese muscles place the aponeurosis under tension so that deep transverse lacerations of the scalp gape widely . n堅韌致密，前連額腹，后連枕腹，1、2、3層，合稱頭皮nSubaponeurotic space (loose connective tissue)qExtracranial hematoma, the result of bleeding in the subaponeurotic space, can extend over t

25、he cranium. lt can extend posteriorly, to the superior nuchal line; anteriorly, into the eyelids to produce the “black eye”; and lateraliy, to the temporal line.qThe loose connective tissue layer provides the plane of separation inany injury that tears the scalp from the calvaria or for the surgeon elevating thescalp from the periosteum.qContains a rich network of deep arteries and veins. Therefore, this layer has been called the “dangero