頭部的局部解剖與操作-人體局解剖學-課件-

1、局部解剖學（八）局部解剖學（八） 頭部的局部解剖與操作頭部的局部解剖與操作頭部頭部 headv顱部顱部 顱頂顱頂額頂枕區(qū)額頂枕區(qū) frontoparietooccipital region顳區(qū)顳區(qū) temporal region 顱底與顱腔及其內容物顱底與顱腔及其內容物v 面部面部面淺部面淺部 superficial part of the face腮腺咬肌區(qū)腮腺咬肌區(qū) Parotid and masseteric region 面深部面深部 deep part of the face一、概一、概 述述 境界與分區(qū)境界與分區(qū) Boundary and region of head 表面解剖表面

2、解剖體表標志體表標志 surface landmark體表投影體表投影 surface projection境境 界界 與與 分分 區(qū)區(qū)表表面面解解剖剖Mental foramenFrontal tuberSupraorbital foramenInfraorbital foramenSupraorbital notchFrontal tuberPterionZygomatic archAngle of mandibleMastoid processExternal occipital protuberanceTemporal line superiorEyebrow體體 表表 投投 影影 S

3、urface projection1.Middle meningeal a.2.Central sulcus3.Lateral sulcus二、顱二、顱頂頂 額頂枕區(qū)軟組織的層次及其特點額頂枕區(qū)軟組織的層次及其特點 顳區(qū)軟組織的層次及其特點顳區(qū)軟組織的層次及其特點（一）（一）Layers of Scalp (Frontal Section) Skin 皮膚皮膚 Connective tissue 結締組織結締組織 Aponeurosis 帽狀腱膜帽狀腱膜 Loose connective tissue 疏松結締組織疏松結締組織 Pericarnium 骨膜骨膜淺筋膜內的淺筋膜內的血管神經(jīng)血管神

4、經(jīng) 分組分組 行徑與分布行徑與分布特點及其臨特點及其臨床意義床意義 Layers of Scalp (lateral aspect )（二）（二）Layers of Temporal Region1. 皮膚皮膚 skin2. 淺筋膜淺筋膜 Superficial fascia3. 顳筋膜顳筋膜 Temporal fascia4. 顳肌顳肌 Temporalis 5. 骨膜骨膜 Pericranium咬咬 肌肌Masseter顳顳 肌肌Temporalis顳區(qū)各層次顳區(qū)各層次的結構特點的結構特點 皮膚皮膚 淺筋膜內淺筋膜內的血管和的血管和神經(jīng)神經(jīng) 顳筋膜的顳筋膜的淺、深層淺、深層 顳肌顳肌 顳肌

5、深部顳肌深部的血管和的血管和神經(jīng)神經(jīng)顳間隙 顳淺間隙：位于顳筋膜與顳肌之間。 顳筋膜間隙：位于顳筋膜下部兩層之間。 顳深間隙：位于顳肌(筋膜)與骨膜之間。三、面部三、面部 面部淺層結構面部淺層結構the superficial structures of the face 面?zhèn)葏^(qū)面?zhèn)葏^(qū)the lateral region of the face腮腺咬肌區(qū)腮腺咬肌區(qū) the Parotid and masseteric region 面?zhèn)壬畈棵鎮(zhèn)壬畈?the deep part of the face面部淺層結構面部淺層結構 Superficial structures of face皮膚皮膚

6、skin 淺筋膜淺筋膜 superficial fascia面表情肌面表情肌 muscles of expression腮腺管腮腺管 parotid duct 面動、靜脈面動、靜脈 facial artery and vein淋巴結淋巴結 lymph nodes三叉神經(jīng)三叉神經(jīng) Trigeminal nerve面神經(jīng)面神經(jīng) facial nerve 面動脈面動脈 Facial Artery 三叉神經(jīng)三叉神經(jīng)Trigeminal Nerve面神經(jīng)面神經(jīng) Facial Nerve頭頭 部部 淋淋 巴巴 回回 流流Lymphatic drainage of the head（二）腮腺咬肌區(qū)（二）腮腺

7、咬肌區(qū)Parotid and Masseteric Region 腮腮 腺腺 parotid gland 位置和形態(tài)位置和形態(tài) morphology and location腮腺管腮腺管 parotid duct 腮腺咬肌筋膜腮腺咬肌筋膜 Parotid-masseteric fascia腮腺淋巴結腮腺淋巴結 Parotid lymph node腮腺內主要血管、神經(jīng)的排列腮腺內主要血管、神經(jīng)的排列 Arrangement of main vessels and nerves in the parotid gland腮腺的毗鄰腮腺的毗鄰 Relation of the parotid gland

8、 咬肌咬肌 Masseter1.腮腺咬肌筋膜：咬肌筋膜和腮腺鞘腮腺咬肌筋膜：咬肌筋膜和腮腺鞘 2. 腮腺腮腺parotid gland （1） 位置位置（2）形態(tài)：）形態(tài)：呈不規(guī)則的楔形，底向外，尖向內突至咽旁；被面呈不規(guī)則的楔形，底向外，尖向內突至咽旁；被面神經(jīng)叢或下頜支后緣分為淺部和深部。神經(jīng)叢或下頜支后緣分為淺部和深部。（3）腮腺腮腺管管parotid duct：行程、體表投影、開口部位行程、體表投影、開口部位Opening of the parotid duct3. 腮腺的淋巴結：腮腺的淋巴結：分為淺淋巴結（位于腮腺表面，引流耳廓、分為淺淋巴結（位于腮腺表面，引流耳廓、顱頂前部和面上部

9、的淋巴）和深淋巴結（位于腮腺實質內，引流外顱頂前部和面上部的淋巴）和深淋巴結（位于腮腺實質內，引流外耳道、中耳、鼻、腭和頰部深部的淋巴），其輸出淋巴管注入頸外耳道、中耳、鼻、腭和頰部深部的淋巴），其輸出淋巴管注入頸外側深淋巴結。側深淋巴結。4.穿經(jīng)腮腺的結構v 縱行穿行腮腺縱行穿行腮腺的結構：的結構： Auriculotemporal n. Superficial temporal a .&.v. External carotid a. Retromandibular v. v 橫行穿行腮腺橫行穿行腮腺的結構：的結構： Transverse facial v. Facial n. Maxill

10、ary a.面面神神經(jīng)經(jīng)的的顱顱外外行行程程及及分分段段下下頜頜后后靜靜脈脈頸頸外外動動脈、脈、耳耳顳顳神神經(jīng)經(jīng)“parotid bed”styloid process and its attached m.Internal jugular v. Internal carotid a.Stylopharyngeus m.Styloglossus m.Stylohyoid m.5. 腮腺的毗鄰腮腺的毗鄰 relation of parotid gland腮腮腺腺的的毗毗鄰鄰咬咬肌肌及及其其淺淺面面的的結結構構 咬肌、咬咬肌、咬肌筋膜、肌筋膜、咬肌神經(jīng)咬肌神經(jīng) 面神經(jīng)面神經(jīng) 面橫血管面橫血管 腮腺

11、管腮腺管 腮腺淺部腮腺淺部二、面?zhèn)壬顓^(qū)結構二、面?zhèn)壬顓^(qū)結構The deep structures of the lateral face 位置與境界位置與境界 location and boundary 翼內、外肌翼內、外肌medial and lateral pterygoid musceles 翼靜脈叢翼靜脈叢 pterygoid venous plexus 上頜動脈上頜動脈 maxillary artery and its branches 下頜神經(jīng)下頜神經(jīng) mandibular nerve顳下窩顳下窩 boundaris of infratemporal fossa上界：蝶骨大翼的顳下

12、面。superiorly - the infratemporal surface of the greater wing of the sphenoid bone and a portion of the squamous part of the temporal bone.內側界：蝶骨的翼突外側板。Medially- the outer plate of the pterygoid process of the sphenoid bone外側界：下頜支的上部和顴弓。laterally- the upper portion of the ramus of mandible and the zy

13、gomatic arch前界：顴骨的下部和上頜骨的顳下面。Anteriorly-the lower portion of the zygomatic bone and the infratemporal surface of the maxillary bone.翼翼內、內、外外肌肌翼靜脈叢翼靜脈叢 Pterygoid venous plexus上頜靜脈上頜靜脈Maxillary vein上頜動脈上頜動脈Maxillary artery：行徑、分段及其分支行徑、分段及其分支v 下頜段下頜段 下牙槽動脈下牙槽動脈 腦膜中動脈腦膜中動脈v 翼肌段翼肌段 咀嚼肌動脈咀嚼肌動脈 頰動脈頰動脈v 翼腭窩

14、段翼腭窩段 上牙槽動脈上牙槽動脈 眶下動脈眶下動脈下頜神經(jīng)下頜神經(jīng) mandibular nerve頰神經(jīng)頰神經(jīng) buccal nerve耳顳神經(jīng)耳顳神經(jīng)auriculotemporal nerve舌神經(jīng)舌神經(jīng)Lingual nerve下牙槽神經(jīng)下牙槽神經(jīng)Inferior alveolar nerve三、面部的間隙三、面部的間隙Spaces of face 咬肌間隙咬肌間隙Masseteric space 翼下頜間隙翼下頜間隙Pterygomandibular space 舌下間隙舌下間隙sublingual space顳深間隙顳深間隙顴弓深面顴弓深面顳下間隙顳下間隙翼下頜翼下頜間隙間隙翼內肌

15、后緣翼內肌后緣咽旁間隙咽旁間隙咽后間隙咽后間隙向后向后下頜切跡下頜切跡咬肌咬肌間隙間隙咽旁間隙咽旁間隙咽后間隙咽后間隙顳淺間隙顳淺間隙顴弓深面顴弓深面解剖步驟和注意事項解剖步驟和注意事項Dissection notes and procedure切口Incision 皮膚皮膚 Skin incision 翻皮瓣翻皮瓣 Reflect the skin flaps The scalp: identify the layers of the scalp顳區(qū)淺層結構顳區(qū)淺層結構 The superficial part of temporal region 在耳屏前方解剖顳在耳屏前方解剖顳淺動、靜脈

16、和耳顳淺動、靜脈和耳顳神經(jīng)。神經(jīng)。In front of the tragus dissect the superficial temporal artery and vein and auriculotemporal n. 面淺層結構面淺層結構 The superficial part of the face1. 暴露重要的面表情肌暴露重要的面表情肌Expose the major facial muscles.2.2.解剖面神經(jīng)的分支解剖面神經(jīng)的分支清理腮腺的表面，尋找腮清理腮腺的表面，尋找腮腺管和面神經(jīng)的頦支，或腺管和面神經(jīng)的頦支，或在面神經(jīng)淺面的下頜緣支。在面神經(jīng)淺面的下頜緣支。循著面

17、神經(jīng)分支逆行追蹤循著面神經(jīng)分支逆行追蹤至腮腺內面神經(jīng)主干，然至腮腺內面神經(jīng)主干，然后循著面神經(jīng)主干找到其后循著面神經(jīng)主干找到其分支，并追蹤至所支配的分支，并追蹤至所支配的面表情肌。面表情肌。 2. Dissect the branches of the facial nerve Clean the surface of the parotid gland, find out the parotid duct and the buccal branches of the facial nerve, or the marginal mandibular branches of the facial

18、 nerve superficial to the facial artery. Follow one of the branches of the facial nerve back through the parotid gland to the trunk of the nerve, and then trace the other branches of the facial nerve following the trunk of the nerve to the muscles of expression.3. 解剖面動、靜脈解剖面動、靜脈在下頜骨下緣與咬肌前在下頜骨下緣與咬肌前緣

19、交界處找到面動脈，并緣交界處找到面動脈，并追蹤至眼的內眥。追蹤至眼的內眥。注意保護跨過面動脈淺注意保護跨過面動脈淺面的下頜緣支。面的下頜緣支。找出并清理位于面動脈找出并清理位于面動脈后方的面靜脈。后方的面靜脈。3.dissect the facial artery and vein Find the artery at the junction of the lower border of the mandible of the anterior border of the masseter and then trace it to the medial angle of the eye. Preserve the marginal mandibular branches superfical to the facial artery. Find and