腦神經(jīng)PPT課件介紹

1、第二節(jié) 腦 神 經(jīng) The Cranial Nerve概 述 腦神經(jīng)的名稱、順序 腦神經(jīng)的纖維成份、性質(zhì) 腦神經(jīng)分類 CN Olfactory nerve 嗅神經(jīng)1. 腦神經(jīng)的名稱、順序CN Optic nerve 視神經(jīng)CN Oculomtor n. 動(dòng)眼神經(jīng)CN Trochlear nerve 滑車神經(jīng)CNTrigeminal nerve 三叉神經(jīng)CN Abducent nerve 展神經(jīng)CN 面神經(jīng) Facial nerveCN 前庭蝸神經(jīng) Vestibulocochlear n.CN 舌咽神經(jīng) Glossopharyngeal n.CN 迷走神經(jīng) Vagus nerveCN 副神經(jīng) A

2、ccessory nerveCN 舌下神經(jīng) Hypoglossal n.1. 腦神經(jīng)的名稱、順序腦神經(jīng)記憶口訣一嗅二視三動(dòng)眼四滑五叉六外展七面八庭九舌咽十迷一副舌下全 脊神經(jīng)的（4種）纖維成分 The component of the spinal nerves2. 腦神經(jīng)的（7種）纖維成分 The component of the cranial nerves一般軀體感覺纖維（GSS)General somatic sensory 一般軀體運(yùn)動(dòng)纖維（GSM)General somatic motor 一般內(nèi)臟感覺纖維（GVS)General visceral sensory 一般內(nèi)臟運(yùn)動(dòng)纖維

3、（GVM)General visceral motor 特殊軀體感覺纖維：分布于外胚層衍化來的特殊感覺器官，如視器和前庭蝸器，傳導(dǎo)聽覺、視覺、平衡覺沖動(dòng)。特殊內(nèi)臟感覺纖維：分布于味蕾和嗅器，傳導(dǎo)味覺和嗅覺。特殊內(nèi)臟運(yùn)動(dòng)纖維：分布于由腮弓衍化來的橫紋肌，如咀嚼肌、面肌和咽喉肌等。特殊軀體感覺纖維（SSS)Special somatic sensory 特殊內(nèi)臟感覺纖維（SVS) Special visceral sensory 特殊內(nèi)臟運(yùn)動(dòng)纖維（SVM)Special visceral motor3. 腦神經(jīng)的分類Sensory cranial nerve 感覺性腦神經(jīng)： Motor crani

4、al nerve 運(yùn)動(dòng)性腦神經(jīng)： Mixed cranial nerve 混合性腦神經(jīng) ，, 腦神經(jīng) Cranial Nerve順序 Order名稱 Name與腦相連的部 Location of attachment to the brain 出入顱的部位 Cranial exit and entrance 纖維成份 Components主要分支及分布 Mainly divisions and distribution 一、The Olfactory Nerve嗅 神 經(jīng)嗅神經(jīng)CN：感覺性腦神經(jīng)，傳導(dǎo)嗅覺沖動(dòng)，經(jīng)篩板的篩孔入顱，與端腦的嗅球相連。嗅神經(jīng)CN嗅神經(jīng)嗅球篩骨的篩板嗅神經(jīng)：起自鼻腔嗅

5、區(qū)粘膜內(nèi)的嗅細(xì)胞。CN 嗅神經(jīng)嗅神經(jīng)起自鼻腔嗅區(qū)粘膜內(nèi)的嗅細(xì)胞，嗅細(xì)胞為雙極神經(jīng)元，其周圍突分布于嗅粘膜上皮，中樞突聚集成的1520條嗅絲，上穿篩板的篩孔入顱前窩，止于端腦的嗅球，傳導(dǎo)嗅覺。嗅感受神經(jīng)元（神經(jīng)感覺細(xì)胞）嗅球篩骨的篩板嗅上皮臨床意義：顱前窩骨折累及篩板時(shí)，可撕脫嗅絲和腦膜，造成嗅覺障礙和腦脊液鼻漏。鼻炎時(shí)，可造成暫時(shí)性嗅覺遲鈍。嗅神經(jīng)損傷二、The Optic Nerve視 神 經(jīng)視神經(jīng)管視神經(jīng)視神經(jīng)視神經(jīng)交叉視束視神經(jīng)CN 視神經(jīng)CN 視神經(jīng)：為感覺性腦神經(jīng)，經(jīng)視神經(jīng)管入顱腔，與間腦的視交叉相連，傳導(dǎo)視覺沖動(dòng)。節(jié)細(xì)胞CN 視神經(jīng)視神經(jīng)由視網(wǎng)膜神經(jīng)層內(nèi)的節(jié)細(xì)胞的軸突，在視網(wǎng)膜后部

6、先集中形成視神經(jīng)盤，然后穿出鞏膜而形成。眼球視神經(jīng)管視神經(jīng)視交叉視束外側(cè)膝狀體CN 視神經(jīng)CN 視神經(jīng)：視神經(jīng)離開眼球后，經(jīng)視神經(jīng)管入顱中窩，連于視交叉，再經(jīng)視束，止于間腦的外側(cè)膝狀體。傳導(dǎo)視覺沖動(dòng)。在視交叉處，來自視網(wǎng)膜鼻側(cè)或內(nèi)側(cè)的纖維在視交叉的中央部交叉，來自視網(wǎng)膜顳側(cè)的纖維在視交叉處不交叉，行于視交叉的外側(cè)部。視束：是由來自同側(cè)眼視網(wǎng)膜顳側(cè)的纖維（未交叉纖維）與來自對(duì)側(cè)眼視網(wǎng)膜鼻側(cè)的纖維（交叉纖維）組成的，多數(shù)止于外側(cè)膝狀體核。視神經(jīng)、視交叉、視束顳側(cè)視野鼻側(cè)視野顳側(cè)視野鼻側(cè)視野顳側(cè)視網(wǎng)膜鼻側(cè)視網(wǎng)膜顳側(cè)視網(wǎng)膜臨床意義：視交叉中央部的交叉纖維損傷：雙眼視野顳側(cè)偏盲。視交叉外側(cè)部的未交叉纖維

7、損傷：患眼視野鼻側(cè)偏盲。視神經(jīng)損傷：患側(cè)眼全盲。視束損傷：雙眼視野對(duì)側(cè)同向性偏盲.視神經(jīng)鞘：由腦的三層被膜延續(xù)而來。顱內(nèi)壓增高時(shí)，常出現(xiàn)視神經(jīng)盤水腫；腦膜或視神經(jīng)的疾患也常此途徑互相累及。蛛網(wǎng)膜下隙蛛網(wǎng)膜下隙外鞘內(nèi)鞘三、 The Oculomotor Nerve動(dòng) 眼 神 經(jīng)CN 動(dòng)眼神經(jīng)CN 動(dòng)眼神經(jīng)：為運(yùn)動(dòng)性腦神經(jīng)，與中腦的相連，經(jīng)眶上裂出顱入眶。動(dòng)眼神經(jīng)眶上裂CN 動(dòng)眼神經(jīng)CN 動(dòng)眼神經(jīng)：由起于動(dòng)眼神經(jīng)核的一般軀體運(yùn)動(dòng)纖維和起于動(dòng)眼神經(jīng)副核的一般內(nèi)臟運(yùn)動(dòng)纖維出中腦腳間窩后合并而成。動(dòng)眼神經(jīng)動(dòng)眼神經(jīng)出腦后，穿海綿竇外側(cè)壁，經(jīng)眶上裂出顱入眶，分為上、下支。上支布于提上瞼肌和上直肌，下支布于內(nèi)

8、直肌、下直肌和下斜肌。內(nèi)直肌下直肌下斜肌上瞼提肌上直肌下支 上支睫狀肌瞳孔括約肌動(dòng)眼神經(jīng)內(nèi)的一般內(nèi)臟運(yùn)動(dòng)纖維動(dòng)眼神經(jīng)內(nèi)的內(nèi)臟運(yùn)動(dòng)纖維經(jīng)下支下斜肌支睫狀神經(jīng)節(jié)ciliary ganglion換元，節(jié)后纖維經(jīng)睫狀短神經(jīng)入眼球，布于睫狀肌和瞳孔括約肌，參與視覺調(diào)節(jié)和瞳孔對(duì)光反射。睫狀肌瞳孔括約肌睫狀神經(jīng)節(jié) ciliary ganglion睫狀神經(jīng)節(jié)：為副交感神經(jīng)節(jié)，位于視神經(jīng)和外直肌之間的后份，來自動(dòng)眼神經(jīng)副核發(fā)出的軸突在此節(jié)內(nèi)換神經(jīng)元，發(fā)出節(jié)后纖維支配瞳孔括約肌和睫狀肌右動(dòng)眼神經(jīng)損傷的臨床表現(xiàn)和解剖學(xué)基礎(chǔ)動(dòng)眼神經(jīng)損傷:導(dǎo)致提上瞼肌癱瘓，表現(xiàn)為上瞼下垂； 上直肌、內(nèi)直肌、下直肌、下斜肌癱瘓，其拮抗肌

9、外直肌、上斜肌收縮導(dǎo)致瞳孔斜向下外斜視；瞳孔括約肌和睫狀肌癱瘓，其拮抗肌瞳孔開大肌收縮，導(dǎo)致瞳孔散大，瞳孔對(duì)光反射消失等癥狀.The Oculomotor NerveThe general somatic efferent fibers arise from the oculomotor nucleus. The general visceral efferent fibers arise from the cells of the accessory oculomotor nucleus.It emerges from the on the medial side of the cerebr

10、al peduncle.It traverses the lateral wall of the cavernous sinus and enters the orbit through the superior orbital fissure. Then it divides into a superior and an inferior division. The superior division supplies the superior rectus and the levator palpebrae superioris. The inferior division supplie

11、s the inferior rectus,medial rectus and inferior oblique muscles.四、The Trochlear Nerve滑 車 神 經(jīng)CN 滑車神經(jīng)CN 滑車神經(jīng)：為運(yùn)動(dòng)性腦神經(jīng)，與中腦的相連，經(jīng)眶上裂出顱入眶?；嚿窠?jīng)滑車神經(jīng)眶上裂CN 滑車神經(jīng)CN 滑車神經(jīng)：由起于滑車神經(jīng)核的一般軀體運(yùn)動(dòng)纖維，經(jīng)中腦背側(cè)左、右交叉出腦后組成?；嚿窠?jīng)：穿海綿竇外側(cè)壁眶上裂出顱入眶，支配上斜肌。動(dòng)眼神經(jīng)支配大部分眼球外?。ㄌ嵘喜€肌、上直肌、內(nèi)直肌、下直肌和下斜?。┖脱矍騼?nèi)肌（瞳孔括約肌、睫狀?。?。上斜肌滑車神經(jīng)損傷造成眼上斜肌癱瘓，患眼不能向外下運(yùn)動(dòng)，主要

12、是向下看困難，尤其是下樓梯或向下凝視時(shí)出現(xiàn)復(fù)視，病人常訴下樓梯時(shí)出現(xiàn)雙影，移步艱難，故多采取頭部歪向?qū)?cè)肩部的姿勢(shì)，以減輕復(fù)視。Trochlear NerveThe trochlear nerve contains the general somatic efferent fibers, which arise from the throchlear nucleus. It merges from the dorsal surface of the midbrain, winds around the brainstem.The trochlear nerve passes forwards

13、in the lateral wall of the cavernous sinus.Through the superior orbital fissure, it supplies superior oblique.五、The Trigeminal Nerve三 叉 神 經(jīng)CN 三叉神經(jīng)CN 三叉神經(jīng)：為混合性腦神經(jīng)，借感覺根和運(yùn)動(dòng)根與腦橋的相連，其分支眼神經(jīng)、上頜神經(jīng)、下頜神經(jīng)分別經(jīng)眶上裂、圓孔、卵圓孔出顱。三叉神經(jīng)眼神經(jīng)眼神經(jīng)上頜神經(jīng)上頜神經(jīng)下頜神經(jīng)下頜神經(jīng)眶上裂圓孔卵圓孔運(yùn)動(dòng)根特殊內(nèi)臟運(yùn)動(dòng)纖維：一般軀體感覺纖維：支配咀嚼肌、腭帆張肌、鼓膜張肌、下頜舌骨肌和二腹肌前腹等。分布于面部皮膚

14、、眼及眶內(nèi)、口腔、鼻腔、鼻旁竇的粘膜、牙、腦膜等，傳導(dǎo)痛溫觸等感覺。（起自三叉神經(jīng)中腦核的纖維）分布于咀嚼肌，傳導(dǎo)其本體感覺。2. 三叉神經(jīng)的纖維成分CN 三叉神經(jīng)：其感覺根的一般軀體感覺纖維入腦后終止于三叉神經(jīng)脊束核、三叉神經(jīng)腦橋核和三叉神經(jīng)中腦核。運(yùn)動(dòng)根是由起自三叉神經(jīng)運(yùn)動(dòng)核的特殊內(nèi)臟運(yùn)動(dòng)纖維出腦后組成。三叉神經(jīng)節(jié)三叉神經(jīng)節(jié)三叉神經(jīng)節(jié)：位于顳骨巖部尖端前面的三叉神經(jīng)壓跡內(nèi)。三叉神經(jīng)在頭、面部的分布范圍三叉神經(jīng)節(jié)：主要由感覺神經(jīng)元胞體聚集而成，其中樞突組成三叉神經(jīng)感覺根，周圍突形成眼神經(jīng)、上頜神經(jīng)和下頜神經(jīng)。三叉神經(jīng)節(jié)三叉神經(jīng)的眼神經(jīng)1：為感覺神經(jīng)；向前沿海綿竇外側(cè)壁，經(jīng)眶上裂出顱入眶;分為

15、鼻睫神經(jīng)（布于鼻背、淚囊、鼻粘膜、眼瞼皮膚和眼球壁）、額神經(jīng)（又分為眶上神經(jīng)和滑車上神經(jīng)，分布于上瞼及額頂部皮膚）、淚腺神經(jīng)（布于淚腺、結(jié)膜及上瞼皮膚）。三叉神經(jīng)的眼神經(jīng)1眼神經(jīng)額神經(jīng)鼻睫神經(jīng)淚腺神經(jīng)三叉神經(jīng)的眼神經(jīng)1：為感覺神經(jīng)；向前沿海綿竇外側(cè)壁，經(jīng)眶上裂出顱入眶;分為鼻睫神經(jīng)（布于鼻背、淚囊、鼻粘膜、眼瞼皮膚和眼球壁）、額神經(jīng)（又分為眶上神經(jīng)和滑車上神經(jīng)，分布于上瞼及額頂部皮膚）、淚腺神經(jīng)（布于淚腺、結(jié)膜及上瞼皮膚）。三叉神經(jīng)的眼神經(jīng)1眼神經(jīng) Ophthalmic Nerve名稱和序號(hào)：三叉神經(jīng)的眼神經(jīng) CN 1組成：由三叉神經(jīng)節(jié)細(xì)胞的周圍突構(gòu)成。行程：穿海綿竇外側(cè)壁，經(jīng)眶上裂出顱入眶;

16、分支：分為額神經(jīng)（又分為眶上神經(jīng)和滑車上神經(jīng)）、淚腺神經(jīng)、鼻睫神經(jīng)（又分為篩前神經(jīng)、篩后神經(jīng)、睫狀長(zhǎng)神經(jīng)、滑車下神經(jīng)、感覺根）等.分布：布于眼裂以上皮膚、眼球及附屬器、篩竇和鼻腔粘膜等處。上頜神經(jīng)2Maxillary nerve(2)Infraorbital nerveMiddle superior alveolar nerveAnterior superior alveolar nervePosterior superior alveolar nerve上頜神經(jīng)眶下神經(jīng)上牙槽后神經(jīng)上牙槽前神經(jīng)上牙槽中神經(jīng)上頜神經(jīng)2腭大神經(jīng)腭小神經(jīng)鼻外側(cè)后下神經(jīng)鼻外側(cè)后上神經(jīng)翼腭神經(jīng)節(jié)上頜神經(jīng) Maxilla

17、ry Nerve名稱和序號(hào)：三叉神經(jīng)的上頜神經(jīng) CN 2組成：由三叉神經(jīng)節(jié)細(xì)胞的周圍突構(gòu)成。行程：穿海綿竇外側(cè)壁，經(jīng)圓孔出顱進(jìn)入翼腭窩;分支：分為眶下神經(jīng)、顴神經(jīng)、上牙槽神經(jīng)、翼腭神經(jīng)等。分布：布于眼裂與口裂之間的皮膚、上頜牙齒牙齦和上頜竇粘膜，以及腭、鼻腔的粘膜和腭扁桃體等處。下頜神經(jīng)3Foramen ovaleMaxillary nerve(3)卵圓孔下頜神經(jīng)下頜神經(jīng)3 Maxillary nerve(3)下頜神經(jīng)Auriculotemporal nerve耳顳神經(jīng)Buccal nerve頰神經(jīng)Mental nerve頦神經(jīng)Inferior alveolar nerve下牙槽神經(jīng)Myloh

18、yoid nerve下頜舌骨肌支Masseteric nerve咀嚼肌神經(jīng)Deep temporal verve顳深神經(jīng)Lingual nerve舌神經(jīng)下頜神經(jīng)Mandibular Nerve三叉神經(jīng)的下頜神經(jīng)（CN 3 ）。由三叉神經(jīng)節(jié)細(xì)胞的周圍突和三叉神經(jīng)運(yùn)動(dòng)根的纖維構(gòu)成;穿海綿竇外側(cè)壁，經(jīng)卵圓孔出顱進(jìn)入顳下窩;分為耳顳神經(jīng)、頰神經(jīng)、舌神經(jīng)、下牙槽神經(jīng)等，布于口裂以下的皮膚、下頜牙齒牙齦和口腔底粘膜;咀嚼肌神經(jīng)支配咀嚼肌。Mandibular nerve 3Ophthalmic nerve1Maxillary nerve2三叉神經(jīng)在頭、面部皮膚的分布范圍下頜神經(jīng)上頜神經(jīng)眼神經(jīng)三叉神經(jīng)在頭、

19、面部的分布范圍Trigeminal NerveIt emerges from the pons by a small motor root and a large sensory root. The motor root contains the special visceral motor fibers which arise from the motor nucleus of the trigeminal nerve. The peripheral processes of the trigeminal ganglion form the ophthalmic nerve(CN 1), t

20、he maxillary nerve (CN 2) and the mandibular nerve (CN 3). The sensory root is made up by the central processes of neurons which are located in the trigeminal ganglion and enters the pons. In the pons, these fibers end in the main sensory nucleus and nucleus of the spinal tract of the trigeminal ner

21、ve.六、The Abducent Nerve展 神 經(jīng)CN 展神經(jīng)CN 展神經(jīng)：為運(yùn)動(dòng)性腦神經(jīng)，與腦橋的相連，經(jīng)眶上裂出顱入眶。展神經(jīng)展神經(jīng)眶上裂CN 展神經(jīng)CN 展神經(jīng)：由起于展神經(jīng)核的一般軀體運(yùn)動(dòng)纖維組成。經(jīng)延髓腦橋溝的錐體上方出腦。展神經(jīng)外直肌CN 展神經(jīng)展神經(jīng)：出腦后向前穿海綿竇，經(jīng)眶上裂出顱入眶，支配外直肌。左展神經(jīng)損傷的臨床表現(xiàn)和解剖學(xué)基礎(chǔ)展神經(jīng)損傷：導(dǎo)致外直肌癱瘓，患側(cè)眼球不能向外凝視，出現(xiàn) 眼內(nèi)斜視（其拮抗肌內(nèi)直肌收縮所致）。Abducent NerveIt contains the general somatic efferent fibers, which arise f

22、rom the abducent nucleus. It pass forwards through the pons,and emerge from the medial part of the pontomedullary groove, then traverses the cavernous sinus, lateral to the internal carotid artery , and enters the orbital cavity through the superior orbital fissure. It supplies the lateral rectus. I

23、t is very thin, the result of the damage of this nerve is the paralysis of the lateral rectus, medial squint.七、The Facial Nerve面 神 經(jīng)CN 面神經(jīng)CN 面神經(jīng)：為混合性腦神經(jīng)，借運(yùn)動(dòng)根和中間神經(jīng)與腦橋的相連，經(jīng)內(nèi)耳門、內(nèi)耳道、面神經(jīng)管、莖乳孔出入顱。中間神經(jīng)運(yùn)動(dòng)根內(nèi)耳門面神經(jīng)1. CN 面神經(jīng)：為混合性腦神經(jīng)，借運(yùn)動(dòng)根和中間神經(jīng)與腦橋的相連，經(jīng)內(nèi)耳門、內(nèi)耳道、面神經(jīng)管、莖乳孔出入顱。CN 面神經(jīng)：為混合性腦神經(jīng)，借運(yùn)動(dòng)根和中間神經(jīng)與腦橋的相連，經(jīng)內(nèi)耳門、內(nèi)耳道、面神

24、經(jīng)管、莖乳孔出入顱。莖乳孔特殊內(nèi)臟運(yùn)動(dòng)纖維：一般內(nèi)臟運(yùn)動(dòng)纖維：特殊內(nèi)臟感覺纖維：一般軀體感覺纖維：支配鐙骨肌、面表情肌等。分布于淚腺、下頜下腺、舌下腺、鼻和腭粘膜腺體，控制其分泌。分布于舌前2/3味蕾，傳導(dǎo)舌前2/3味覺。傳導(dǎo)耳部皮膚的軀體感覺和表情肌的本體感覺。2. 面神經(jīng)的纖維成分2. CN 面神經(jīng)纖維成分的起、止核團(tuán)面神經(jīng)的纖維成份 特殊內(nèi)臟運(yùn)動(dòng)纖維：起自面神經(jīng)核，支配鐙骨肌、面表情肌等。The special visceral efferent fibers(SVE) take origin from the facial nucleus and supply the muscles

25、of facial expression.一般內(nèi)臟運(yùn)動(dòng)纖維：起自上泌涎核，在翼腭神經(jīng)節(jié)和下頜下神經(jīng)節(jié)換元，節(jié)后纖維至淚腺、下頜下腺、舌下腺、鼻和腭粘膜腺體，控制其分泌。 The general visceral efferent fibers(GVE) arise from the superior salivatory nucleus and are relayed in pterygopalatine and inframandibular ganglion, whose postganglion fibers supply to the lacrimal gland, the gland

26、s of nasal and palate mucosa. 面神經(jīng)的纖維成份（2）The special visceral afferent fibers(SVA) arise from the cells of the geniculate ganglion. The central processes of these cells terminate in the nucleus of the tractus solitarius. The periphery processes of this ganglionic cells are distributed to the taste b

27、uds on the anterior 2/3 of the tongue. 特殊內(nèi)臟傳入纖維：起自膝神經(jīng)節(jié)細(xì)胞，其中樞突止于孤束核，周圍突分布于舌前2/3味蕾，傳導(dǎo)舌前2/3味覺。The general somatic afferent fibers (GSA) arise from the cell the geniculate ganglion. The central processes of these cells terminate in the e trigeminal spinal nucleus and the trigeminal pontine nucleus. The

28、periphery processes of this ganglionic cells are distributed to the skin of the ear and the muscles of expression. 一般軀體傳入纖維：起自膝神經(jīng)節(jié)細(xì)胞，其中樞突止于三叉神經(jīng)脊束核，周圍突分布于耳部皮膚和表情肌，傳導(dǎo)耳部皮膚的軀體感覺和表情肌的本體感覺。3. 膝神經(jīng)節(jié)geniculate ganglion3. 膝神經(jīng)節(jié)geniculate ganglion：為特殊內(nèi)臟感覺special visceral sensory和一般軀體感覺general somatic sensory的假單

29、極神經(jīng)元胞體聚集形成，是與面神經(jīng)相連的腦神經(jīng)節(jié)。面部表情肌支鐙骨肌神經(jīng)4. 面神經(jīng)的分支4. 面神經(jīng)的分支：巖大神經(jīng)greater petrosal nerve、鼓索chorda tympani nerve、鐙骨肌神經(jīng)nerve to the stapedius m. 和面部表情肌支 branches of the muscles of facial expression.鐙骨肌支（1）面神經(jīng)的巖大神經(jīng)顴神經(jīng)面神經(jīng)膝神經(jīng)節(jié)巖大神經(jīng)淚腺神經(jīng)翼管神經(jīng)翼腭神經(jīng)節(jié)巖深神經(jīng)（1）面神經(jīng)的巖大神經(jīng)面神經(jīng)巖大神經(jīng)翼管神經(jīng)面神經(jīng)頸內(nèi)動(dòng)脈叢（1）面神經(jīng)的巖大神經(jīng)內(nèi)一般內(nèi)臟運(yùn)動(dòng)纖維面神經(jīng)的巖大神經(jīng)含有起自腦橋的上

30、泌涎核一般內(nèi)臟運(yùn)動(dòng)纖維，為副交感的分泌纖維；腦橋的上泌涎核發(fā)出纖維經(jīng)面神經(jīng)、膝神經(jīng)節(jié)加入巖大神經(jīng)；巖大神經(jīng)自膝神經(jīng)節(jié)處發(fā)出后經(jīng)巖大神經(jīng)裂孔破裂孔翼管翼腭窩，進(jìn)入翼腭神經(jīng)節(jié)內(nèi)換元；翼腭神經(jīng)節(jié)的節(jié)后纖維經(jīng)翼腭神經(jīng)顴神經(jīng)交通支淚腺神經(jīng)淚腺，或經(jīng)鼻后上外側(cè)支鼻粘膜腺體， 或經(jīng)腭大神經(jīng)、腭小神經(jīng)腭粘膜腺體，管理其分泌。The Greater Petrosal NerveIt contains the parasympathetic secretomotor fibers which arises from the superior salivatory nucleus.It runs forward a

31、nd passes through the greater petrosal nervous fissure, foramen lacerum, pterygoid canal to the pterygopalatine fossa. Its parasympathetic fibers synapse in the pterygopalatine ganglion. the postganglionic fibers continue along the pterygopalatine nerve, zygomatic nerve, communication, lacrimal nerv

32、e to the lacrimal gland or the nasal braches to the glands of nasal mucosa, the lesser and greater palatine nerve to the glands of the palate mucosa to control the secretion of these glands.（2） 面神經(jīng)的鐙骨肌神經(jīng)鐙骨肌神經(jīng)nerve to the stapedius muscle：innervates the stapedius muscle.支配鼓室內(nèi)的鐙骨肌。鐙骨肌神經(jīng)損傷：導(dǎo)致鐙骨肌癱瘓，出現(xiàn)聽覺

33、過敏。Nerve to the stapedius muscle至鐙骨肌神經(jīng)(3)面神經(jīng)的鼓索鼓索：在面神經(jīng)穿出莖乳孔上方6mm處發(fā)出，經(jīng)鼓室?guī)r鼓裂顳下窩，加入舌神經(jīng)。鼓索舌神經(jīng)鼓索內(nèi)一般內(nèi)臟運(yùn)動(dòng)纖維（副交感纖維或分泌纖維）(3)鼓索內(nèi)副交感的分泌纖維：起自腦橋的上泌涎核，經(jīng)面神經(jīng)鼓索舌神經(jīng)下頜神經(jīng)節(jié)（換元）節(jié)后纖維下頜下腺和舌下腺，管理其分泌。鼓索內(nèi)特殊內(nèi)臟感覺纖維（味覺纖維）(3)鼓索內(nèi)的內(nèi)臟感覺纖維（味覺纖維）：由膝神經(jīng)節(jié)細(xì)胞的周圍突構(gòu)成，經(jīng)鼓索、舌神經(jīng)至舌前2/3的味蕾；膝神經(jīng)節(jié)細(xì)胞的中樞突經(jīng)面神經(jīng)入腦，止于孤束核的頂端。舌面神經(jīng)的鼓索鼓索在面神經(jīng)穿出莖乳孔上方6mm處發(fā)出，經(jīng)鼓室?guī)r鼓

34、裂顳下窩，加入舌神經(jīng)。其內(nèi)含有兩種纖維成份：一般內(nèi)臟運(yùn)動(dòng)纖維（分泌纖維或副交感纖維）：起自腦橋的上泌涎核，經(jīng)面神經(jīng)鼓索舌神經(jīng)下頜神經(jīng)節(jié)（換元）節(jié)后纖維下頜下腺和舌下腺，管理其分泌。特殊內(nèi)臟感覺纖維：至舌前2/3的味蕾，傳導(dǎo)舌前2/3味覺。The chorda tympani nerveIt arises from the facial nerve about 6mm above the stylomastoid. It passes forwards through the tympanic cavity and pierces the petrotympanic fissure to inf

35、ratemporal fossa , then runs downwards and forwards to join the lingual nerve. Its taste fibers are distributed to the taste buds on the anterior two-thirds of the tongue convey taste from the anterior two-thirds of the tongue. Its preganglionic parasympathetic fibers synaps in the submandibular gan

36、glion, which sends postganglionic fibers to the submandibular and sublingual glands to control the secretion of these glands.(4)面神經(jīng)的顱外分支面神經(jīng)面神經(jīng)膝神經(jīng)節(jié)巖大神經(jīng)鼓索面神經(jīng)管莖乳孔面神經(jīng)的莖突舌骨肌支面神經(jīng)的二腹肌支(4)面神經(jīng)的顱外分支耳后支至二腹肌后腹和莖突舌骨肌神經(jīng)顳支顴支頰支下頜緣支頸支(4)面神經(jīng)的顱外分支耳后支至二腹肌后腹和莖突舌骨肌神經(jīng)顳支顴支頰支下頜緣支頸支從莖乳孔穿出的面神經(jīng)主干面神經(jīng)的顱外分支含有面神經(jīng)核發(fā)出的特殊內(nèi)臟運(yùn)動(dòng)纖維。面神經(jīng)出莖

37、乳孔后發(fā)出耳后支支配枕肌、耳周圍肌,以及至二腹肌后腹和莖突舌骨肌的神經(jīng)。主干在腮腺內(nèi)形成腮腺內(nèi)叢，再發(fā)出顳支、顴支、頰支、下頜緣支和頸支分布于面部表情肌和頸闊肌。顳支temporal branches：支配額肌和眼輪匝肌等。顴支zygomatic branches：支配眼輪匝肌和顴肌。頰支buccal branches：支配頰肌、口輪匝肌和其它口周圍肌。下頜緣支mandibular branches：支配下唇諸肌。頸支cervical branches：支配頸闊肌。面表情肌癱瘓；舌前2/3味覺障礙、下頜下腺和舌下腺分泌障礙；聽覺過敏；淚腺和腭、鼻腔粘膜腺體分泌障礙;面神經(jīng)損傷Terminal

38、branch of facial nerve面神經(jīng)損傷的臨床表現(xiàn)及解剖學(xué)基礎(chǔ)面神經(jīng)顱外損傷：損傷側(cè)面表情肌癱瘓，如笑時(shí)口角偏向健側(cè)、不能鼓腮；說話時(shí)唾液從口角流出；傷側(cè)額紋消失、鼻唇溝變平坦；不能閉眼、角膜反射消失等。面神經(jīng)管內(nèi)損傷：在鐙骨肌神經(jīng)與鼓索發(fā)出點(diǎn)之間損傷：導(dǎo)致同側(cè)面表情肌癱瘓、舌前2/3味覺障礙、下頜下腺和舌下腺分泌障礙；在鼓索與巖大神經(jīng)發(fā)出點(diǎn)之間損傷：導(dǎo)致同側(cè)面肌癱瘓、舌前2/3味覺障礙、下頜下腺和舌下腺分泌障礙、鐙骨肌肉癱瘓導(dǎo)致聽覺過敏；在巖大神經(jīng)發(fā)出點(diǎn)之前損傷：導(dǎo)致同側(cè)面肌癱瘓、舌前2/3味覺障礙、下頜下腺和舌下腺分泌障礙、鐙骨肌肉癱瘓導(dǎo)致聽覺過敏、淚腺和腭、鼻腔粘膜腺體分泌

39、障礙；與面神經(jīng)相連的神經(jīng)節(jié)：膝神經(jīng)節(jié)(為腦神經(jīng)節(jié))、翼腭神經(jīng)節(jié)(副交感神經(jīng)節(jié))、下頜下頜神經(jīng)節(jié)(副交感神經(jīng)節(jié)) 。八、前庭蝸神經(jīng)Vestibulocochlear n.CN 第8對(duì)腦神經(jīng)為感覺性腦神經(jīng)由前庭神經(jīng)和蝸神經(jīng)組成與腦橋相連前庭蝸神經(jīng)：經(jīng)內(nèi)耳道、內(nèi)耳門入顱腔。前庭蝸神經(jīng)前庭神經(jīng)蝸神經(jīng)1.前庭神經(jīng)前庭神經(jīng)節(jié)前庭神經(jīng)The Vestibular Nerve前庭神經(jīng)：傳導(dǎo)平衡覺沖動(dòng)。其雙極神經(jīng)元胞體在內(nèi)耳道底附近，聚集成前庭神經(jīng)節(jié)（為腦神經(jīng)節(jié)）。其周圍突分布于壺腹嵴、橢圓囊斑、球囊斑；中樞突構(gòu)成前庭神經(jīng)，出內(nèi)耳門入腦橋，止于前庭神經(jīng)核。The vestibular ganglion cons

40、ists of bipolar cells situated in the bottom of the internal acoustic meatus.The vestibular nerve is made up by the central processes of cells of the vestibular ganglionand and passes to the vestibular nucleus at the pontocereellar angle through the internal acoustic meatus.whose peripheral processe

41、s cells of the vestibular ganglionand terminate in the crista ampullaris and the maculae of the utricle and saccule. The vestibular nerve conveys the equilibrium impulse.2.蝸神經(jīng)蝸神經(jīng)蝸螺旋神經(jīng)節(jié)蝸神經(jīng)核The Cochlear Nerve蝸神經(jīng)：傳導(dǎo)聽覺沖動(dòng)。其雙極神經(jīng)元胞體在內(nèi)耳的蝸軸內(nèi)聚集成蝸神經(jīng)節(jié)（為腦神經(jīng)節(jié)）。其周圍突分布于螺旋器；中樞突在內(nèi)耳道內(nèi)構(gòu)成蝸神經(jīng)，出內(nèi)耳門入腦橋，止于蝸神經(jīng)核。The cochlear

42、nerve is made up by the central processes of cells of the spiral ganglion and passes to the brain through the internal acoustic meatus. The spiral ganglion consists of bipolar cells situated in the modious, whose peripheral processes terminate in the spiral organ.The cochlear nerve conveys the audit

43、ory impulse. 前庭蝸神經(jīng)損傷一側(cè)前庭神經(jīng)損傷：平衡功能障礙。一側(cè)蝸神經(jīng)損傷：表現(xiàn)為同側(cè)耳聾。九、舌咽神經(jīng)Glossopharyngeal n.舌咽神經(jīng) CN 舌咽神經(jīng) CN ：為混合性腦神經(jīng)，相連延髓，于延髓橄欖后溝上部出腦，經(jīng)頸靜脈孔出入顱腔。頸靜脈孔特殊內(nèi)臟運(yùn)動(dòng)纖維：一般內(nèi)臟運(yùn)動(dòng)纖維：特殊內(nèi)臟感覺纖維：一般內(nèi)臟感覺纖維：一般軀體感覺纖維：支配莖突咽肌等。在耳神經(jīng)節(jié)換元，節(jié)后纖維至腮腺，控制其分泌。布于舌后1/3味蕾，傳導(dǎo)舌后1/3的味覺。布于咽、腭扁桃體、中耳、舌后1/3粘膜、頸動(dòng)脈體和頸動(dòng)脈竇，傳導(dǎo)一般內(nèi)臟感覺。布于耳廓后的皮膚，傳導(dǎo)一般軀體感覺。舌咽神經(jīng)纖維成份的起、止核團(tuán)

44、舌咽神經(jīng)：有五種纖維成份，即特殊內(nèi)臟運(yùn)動(dòng)纖維（起自疑核）、一般軀體感覺纖維（終于三叉神經(jīng)脊束核）、一般內(nèi)臟運(yùn)動(dòng)纖維（起自下泌涎核）、一般和特殊內(nèi)臟感覺纖維（止于孤束核）。 舌咽神經(jīng)分支：有鼓室神經(jīng)(布于鼓室、乳突小房和咽鼓管粘膜，內(nèi)臟運(yùn)動(dòng)纖維換元后至腮腺) 、舌支（布于舌后1/3粘膜和味蕾，管理其一般內(nèi)臟感覺和味覺）、咽支 (為嘔吐反射的傳入神經(jīng)，布于咽肌和咽粘膜）、扁桃體支（布于腭扁桃體、軟腭及咽峽粘膜）、頸動(dòng)脈竇支（布于頸動(dòng)脈竇和頸動(dòng)脈小球）。扁桃體支咽支頸動(dòng)脈竇支鼓室神經(jīng)莖突咽支巖小神經(jīng)：其內(nèi)臟運(yùn)動(dòng)纖維(分泌纖維，起自下泌涎核)，經(jīng)鼓小管出鼓室，穿卵圓孔出顱，在耳神經(jīng)節(jié)內(nèi)換元，節(jié)后纖維經(jīng)

45、至腮腺，管理其分泌活動(dòng)。耳神經(jīng)節(jié)巖小神經(jīng)耳顳神經(jīng)巖小神經(jīng)：其內(nèi)臟運(yùn)動(dòng)纖維(分泌纖維，起自下泌涎核)，經(jīng)鼓小管出鼓室，穿卵圓孔出顱，在耳神經(jīng)節(jié)內(nèi)換元，節(jié)后纖維經(jīng)至腮腺，管理其分泌活動(dòng)。舌咽神經(jīng)內(nèi)纖維的起、止核團(tuán)及其分布(1)The special visceral efferent fibers take origin from the nucleus ambiguus and supply the the stylopharyngeus and middle pharyngeal constrictor. 特殊內(nèi)臟傳出纖維：起自疑核，支配莖突咽肌和咽中縮肌。The general viscer

46、al efferent fibers arise from the inferior salivatory nucleus and are relayed in otic ganglion, its postgnglionic fibers supply to the parotid gland. 一般內(nèi)臟傳出纖維：起自下泌涎核，在耳神經(jīng)節(jié)換元，節(jié)后纖維至腮腺，控制其分泌。舌咽神經(jīng)內(nèi)纖維的起、止核團(tuán)及其分布(2)The special visceral afferent fibers arise from the cells of the inferior ganglion. The cent

47、ral processes of these cells terminate in the nucleus of the tractus solitaarius. The periphery processes of this ganglionic cells are distributed to the taste buds on the posterior one-third of the tongue. 特殊內(nèi)臟傳入纖維：起自舌咽神經(jīng)的下神經(jīng)節(jié)，其中樞突止于孤束核，周圍突布于舌后1/3味蕾，傳導(dǎo)舌后1/3的味覺。舌咽神經(jīng)內(nèi)纖維的起、止核團(tuán)及其分布 (3) The general visc

48、eral afferent fibers arise from the cells of the inferior ganglion. The central processes of these cells terminate in the nucleus of the tractus solitarius. The periphery processes of this ganglionic cells are distributed to pharynx, the tonsils, the middle ear, the posterior one-third of the tongue

49、, the chemoreceptors and pressure receptors in the carotid sinus. 一般內(nèi)臟傳入纖維：起自舌咽神經(jīng)的下神經(jīng)節(jié)，其中樞突止于孤束核下部，周圍突布于咽、腭扁桃體、中耳、舌后1/3粘膜、頸動(dòng)脈體和頸動(dòng)脈竇，傳導(dǎo)一般內(nèi)臟感覺。舌咽神經(jīng)內(nèi)纖維的起、止核團(tuán)及其分布(4)The general somatic afferent fibers arise from the cells of the superior ganglion. The central processes of these cells terminate in the tr

50、igeminal spinal nucleus. The periphery processes of this ganglionic cells are distributed to the skin of the posterior surface of the auricle. 一般軀體傳入纖維：起自舌咽神經(jīng)的上神經(jīng)節(jié)，其中樞突止于三叉神經(jīng)脊束核，周圍突布于耳廓后的皮膚，傳導(dǎo)一般軀體感覺。舌咽神經(jīng)損傷 一側(cè)損傷表現(xiàn)為：同側(cè)舌后1/3味覺消失；舌根及咽峽區(qū)痛覺消失；同側(cè)咽肌無力。十、 The Vagus Nerve迷走神經(jīng)CN 迷走神經(jīng)CN 迷走神經(jīng) ：為混合性腦神經(jīng)，相連延髓，于延髓橄欖

51、后溝中部出腦，經(jīng)頸靜脈孔出入顱腔。特殊內(nèi)臟運(yùn)動(dòng)纖維一般內(nèi)臟運(yùn)動(dòng)纖維特殊內(nèi)臟感覺纖維一般內(nèi)臟感覺纖維一般軀體感覺纖維起自疑核，支配咽喉肌。布于腺體和不隨意?。òㄖ夤?、心、食管、胃和結(jié)腸左曲以上的腸管），控制其活動(dòng)。布于軟腭和會(huì)厭的味蕾，傳導(dǎo)其味覺。布于頸、胸、腹部大部分器官，傳導(dǎo)其內(nèi)臟感覺。布于耳廓和外耳道皮膚，傳導(dǎo)其一般軀體感覺。 迷走神經(jīng)內(nèi)纖維的起、止核團(tuán) 迷走神經(jīng)：有五種纖維成份，即特殊內(nèi)臟運(yùn)動(dòng)纖維（起自疑核）、一般軀體感覺纖維（終于三叉神經(jīng)脊束核）、一般內(nèi)臟運(yùn)動(dòng)纖維（起自迷走神經(jīng)背核）、一般和特殊內(nèi)臟感覺纖維（止于孤束核）。迷走神經(jīng)的行程1. 迷走神經(jīng)在頸部的分支及其分布 喉上神經(jīng)s

52、uperior laryngeal nerve：外支external laryngeal nerve支配環(huán)甲??；內(nèi)支internal laryngeal nerve布于咽、會(huì)厭、舌根及聲門裂以上的喉粘膜。喉上神經(jīng)損傷：環(huán)甲肌癱瘓，不能發(fā)高音，嗆咳或誤咽。1. 迷走神經(jīng)在頸部的分支及其分布頸心支cervical cardiac branches：加入心叢，調(diào)節(jié)心臟的活動(dòng)。耳支：布于耳廓后和外耳道的皮膚。咽支pharyngeal branch：布于咽縮肌、軟腭的肌和咽部粘膜。腦膜支：布于顱后窩的硬腦膜。2. 迷走神經(jīng)在胸部的分支及其分布喉返神經(jīng)recurrent laryngeal nerve：布

53、于除環(huán)甲肌以外的喉?。ê韮?nèi)?。?，聲門裂以下的喉粘膜。喉返神經(jīng)損傷：除環(huán)甲肌以外的喉肌癱瘓，一側(cè)損傷出現(xiàn)聲音嘶啞，雙側(cè)損傷出現(xiàn)呼吸困難或窒息。2. 迷走神經(jīng)在胸部的分支及其分布支氣管支broncheal branches：布于氣管、支氣管和肺粘膜、胸膜、腺體和平滑肌。食管支esophageal branches：布于食管的粘膜、腺體和平滑肌。2. 迷走神經(jīng)的分支及其分布3. 迷走神經(jīng)在腹部的分支及其分布胃前支anterior gastric branches：布于胃前壁，其終支為“鴨爪”支，布于幽門前壁。肝支hepatic br. ：加入肝叢，布于肝、膽囊等。胃后支posterior gast

54、ric branches ：布于胃后壁，其終支為“鴨爪”支，布于幽門后壁。腹腔支celiac br.：加入腹腔叢，布于肝膽胰脾腎及結(jié)腸左曲以上的腹部消化管。高選擇性迷走神經(jīng)切斷術(shù)迷走神經(jīng)損傷迷走神經(jīng)主干損傷：出現(xiàn)內(nèi)臟活動(dòng)障礙，如脈速、心悸、惡心、嘔吐、呼吸深慢和窒息等。咽喉感覺障礙和肌肉癱瘓：出現(xiàn)聲音嘶啞、語言和吞咽困難，腭垂偏向一側(cè)等。迷走神經(jīng)內(nèi)纖維的起、止核團(tuán)及其分布（1）The special visceral efferent fibers take origin from the nucleus ambiguus and supply the the muscles of the l

55、arynx and the pharynx. 特殊內(nèi)臟傳出纖維：起自疑核，支配咽、喉肌。迷走神經(jīng)內(nèi)纖維的起、止核團(tuán)及其分布（2）The general visceral efferent fibers arise from the dorsal nucleus of vagus and are relayed in parasympathetic ganglion situated in or near the walls of the innervated organ, its postgnglionic fibers supply to the glands and involuntary

56、 muscle of the bronchi, heart, esophagus, stomach and the intestines as far as the left colonic flexure. 一般內(nèi)臟傳出纖維：起自迷走神經(jīng)背核，在器官旁節(jié)或器官內(nèi)節(jié)換元，節(jié)后纖維至腺體和不隨意?。òㄖ夤堋⑿?、食管、胃和結(jié)腸左曲以上的腸管），控制其活動(dòng)。迷走神經(jīng)內(nèi)纖維的起、止核團(tuán)及其分布（3）The special visceral afferent fibers arise from the cells of the inferior ganglion. The central processes of these cells terminate in the nucleus of the tractus solitaarius. The periphery processes of this ganglionic cells are distributed to the taste buds on the soft palate and epiglottis 特殊內(nèi)臟傳入纖維：起自迷走神經(jīng)的下神經(jīng)節(jié)，其中樞突終于孤束核頂部，周圍突布于軟腭和會(huì)厭的味蕾，傳導(dǎo)其味覺；迷走神經(jīng)內(nèi)纖維的起、止核團(tuán)及其分布（4） The general vi