神經(jīng)解剖學(xué)未用thyroid glandroot of the neck

Thyroidgland&RootofneckDept.ofHumanAnatomyZhouHongYingThyroidglandOutlineLocation&superficialfeatureBloodsupplyVenousdrainagenervesRelationshipofitsvesselsandarteriesLocation&relationshipAnteriorlly:infrahyoidmuscles&SCMPosterolaterally:carotidsheath&itscontentsMedially:larynx,trachea,pharynxesophagus,external&recurrentlaryngealnervesPosteriorly:parathyroidglandImportantRelationshipofThyroidGlandfalsethyroidcapsuleTruecapsuleThyroid---capsulesThyroid–externalfeatureright&leftlobesisthmuspyramidallobeUpperpoleofitslobeextendsupwardtoobliquelineofthyroidcartilageLoweronedownwardtolevelof6thtrachealringIsthmusliesinfront2ndto4thtrachealringsPyramidlobeisusuallytoleftofmedianplaneThyroid–externalfeatureParathyroidglandsParathyroidglands&thyroidglandTherearetwopairsofarteriessupplyingthyroidgland.Superiorthyroida.arisesfromECA&reachesglandatitsupperpole.Onitswaytogland,STArunspaniedwithexternallaryngealnerve.Thyroid–arteriesInferiorthyroidartery:branchofthethyrocervicaltrunk,posteriortothecarotidsheathtoreachtheposterioraspectofthegland.ITAdividesintoseveralbranchesthatpiercethefalsecapsule,supplytheinferiorpoleoftheglandBeforearrivedtoglanditrunsacrossrecurrentlaryngealnerve.Thyroid–arteriesThyroidImaArteryVeinsofthyroidglandconnecttoformaplexusbetweenitstwocapsules&finallyaredrainedbythreepairsofveins.Superior&middlethyroidveinsemptyintoIJVbutinferioroneintobrachiocephalicvein.Superior,middle,&inferiorthyroidv.Superior,middle,&inferiorthyroidv.Nerves&arteriesRootoftheneckTheareabetweenthethoraxandneck.Itopensintothesuperiorthoracicaperture.ThejugularnotchoppositeposteriorlytodiscbetweentheT1&T2laterallybythefirstpairofribsandtheircostalcartilagesAnteriorlybymanubriumPosteriorlybythebodyofT1&T2vertebraeSkeletonofrootofneckWhatstructuresintherootoftheneckAllstructuresgoingfromtheheadtothethorax;fromthethoraxtotheupperlimb;fromthenecktoupperlimbandthroughthesuperiorthoracicaperture.Structuresintherootoftheneckvisceraorgansofdigestivesystemandrespiratorysystem:thetracheaandesophagusarelocatedinanteriormedianline.carotidsheathandstructureslocatedinthissheath.Brachialplexusandsubclavianvesselsphrenicnervestructuresintriangleofthevertebralartery:vertebrala,thyrocervicaltrunkSympathetictrunkofneckapexoflungs,cervicalpleuraandsibsonfasciaApexoflungsPrevertebralMusclesScaleneoriginatefromtransverseprocessofcervicalvertebrae&rundownward&laterally(obliquely)Scalenusanteriorinsertsontouppersurfaceof1strib.Itisusedasakeystructureinrootofneck.Scalenimedius&posteriorcanbeseparatedonlyattheirinsertions.Theformerinto1strib,thelatter2ndrib.ScalenusspaceScalenusspace

isboundedbythescalenusanteriorandmediusand1strib.Thebrachialplexusandsubclaviana.passthroughthespace.ScalenusspaceStructuresontheanterioraspectofscalenusanteriorStructuresverticallyrunning:carotidsheath&contentsinthesheathphrenicnerve(mostlateral)sympathetictrunkofcervicalpart(medial)StructuresontheanterioraspectofscalenusanteriorStructurestransversely:subclavianvtransversecervicalasuprascapularaSubclavianveinDirectcontinuationofaxillary腋靜脈veinatouterborderof1strib.Usuallyithasonlyonetributary:externaljugularvein頸外靜脈TerminationoflymphatictrunksStructuresontheposterioraspectofscalenusanteriorsubclavianarteryliesinferiorlytothebrachialplexusThesubclavianarteryisdividedintothreeparts

bythescalenusanterior.Atouterborderof1strib,itcontinueasaxillaryartery.brachialplexus

:upper,middle,lowertrunksliesuperiortosubclavianarteryBranchesofthesubclavianarteryTherightsubclavianarteryoriginatesfromthebrachiocephalictrunkposteriortothesternoclavicularjointtheleftoriginatesfromthearchofaorta.

Branchesofsubclavianartery

Vertebrala.,internalthoracica.,&thyrocervicaltrunkCostocervicaltrunkDorsalscapulararteryVertebral△

boundary:Baseisthe1stpartofsubclavianaContent:vertebarala.BrachialplexusStructuresintherootofthenecklymphaticdrainageoftheneckDeepcervicallymphnodesjugulartrunksthoracicductrightlymphaticductSuperficiallymphnodeslymphaticdrainageofthenecklymphaticdrainageoftheneckTypicalcases患者，女性，36歲，頸部前方有一包塊，主訴體重下降且精神緊張。家人抱怨該患者易急躁、激動和哭泣。查體：頸部兩側(cè)各檢查到一個腫塊，位于喉下方。從后方觸診可感覺腫大的甲狀腺，可隨吞咽上下移動。其他體征：眼球突出、脈搏加快、手指震顫、手掌潮濕。診斷：甲狀腺功能亢進(jìn)。治療：藥物治療無效，對患者進(jìn)行了部分甲狀腺切除。術(shù)后患者出現(xiàn)聲音嘶啞。問題：1.腫大的甲狀腺雖吞咽上、下移動的解剖學(xué)基礎(chǔ)是？

2.由于患者甲狀腺腫大，可能受壓迫的神經(jīng)為？

3.為什么要進(jìn)行部分甲狀腺切除？

4.患者出現(xiàn)聲音嘶啞的原因可能是什么？Detachsternothyroidfromitsinsertion&reflectitdownward.Identify&exposeright&leftlobesofthyroidgland,whichareconnectedby