Transcript Head - 山东大学医学院人体解剖学教研室

Head
山东大学医学院 解剖教研室
李振华
Region and parts
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Cranium 颅部
Face 面部
Landmaeks
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Superciliary
Supraorbital notch
Infraorbital foramen
Mental foramen
Pterion
Zygomatic arch
Mastoid process
External occipital
protuberance
Pterion
Epidural hemorrhage
Muscles of head
Facial muscles 面肌
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Epicranius 颅顶肌
(oddipitofrontalis) 枕额
肌
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Frontal belly 额腹
Occipital belly 枕腹
Galea aponeurotica 帽
状腱膜
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Orbicularis oculi
眼
轮匝肌
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Buccinator 颊肌
Orbicularis oris
轮匝肌
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Nasalis 鼻肌
Platysma 颈阔肌
口
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The skin of face is very
thin and connected to the
facial bones by loose
connective tissue. There
is no deep fascia. The
facial muscles lie in this
connective tissue.
Masticatory muscles
Masseter 咬肌
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Origin－inferior border and
medial surface of
zygomatic arch
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Insertion－lateral surface
of ramus of mandible and
angle of mandible
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Action－elevates mandible
Temporalis 颞肌
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Origin－temporal fossa
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Insertion－coronoid
process of mandible
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Action－elevates and
retracts mandible
lateral pterygoid 翼外肌
Medial pterygoid 翼内肌
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Arteries of head
Facial a. 面动脉
Branch of external caroteid a.
Runs forward over digastric
and submandibular gland
Loops around mandible
(where it is palpable), at
anterior border of masseter,
to enter the face
Follows a tortuous course to
medial angle of eye
Lies deep to most facial
muscles
Branches
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Inferior labial a. 下唇动脉
Superior labial a. 上唇动脉
Angular a. 内眦动脉
Superficial temporal a.
颞浅动脉
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Terminal branch of
external carotid a.
Ascends in front of ear
(where it is palpable)
to supply temporal and
anterior portion of
scalp
Transverse facial a. 面
横动脉－runs above
parotid duct to supply
the cheek region
Maxillary artery 上颌动脉
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Branch of external
carotid a.
Entrance to
infratemporal fossa
medial to neck of
mandible
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Branches
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Inferior alveolar a.
下牙槽动脉
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Middle meningeal a.
脑膜中动脉
 enters the skull through
foremen spinosum
 Supplies cranium and
dura mater
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Posterior superior
alveolar a.上牙槽后动脉
Veins of head
Facial vein 面静脉
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Begins at medial angle of
eye (angular vein)
Runs downward and
backward through the face,
posterior to the facial artery
Below angle of mandible,
joins anterior branch of
retromandibular vein to form
common facial vein, which
drains into internal jugular
vein
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Connections with
cavernous sinus 海绵窦
through the ophthalmic
vein眼静脉, and also
through pteygoid plexus
翼静脉丛 via the deep
facial vein 面深静脉
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“Danger area” 危险三角
－lies between root of
nose and two angles of
mouth; in this area the
facial vein has no
valves
Retromandibular vein
下颌后静脉
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Formed by union of
superficial temporal and
maxillary veins
Divides into an anterior
branch that unites with
facial vein and a posterior
branch that joins posterior
auricular vein to become
external jugular vein
Pteygoid plexus
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翼静脉丛
Located between and
around muscles of
mastication
Receives blood from all
regions supplied by
maxillary a.
Communicates with
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Face by deep facial veins
Cavernous sinus by veins
draining base of skull
Provides possible
pathway for spread of
infection to cranial cavity
The lymphatic drainage of head
Lymph nodes of head
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Located at junction of head
and neck
Consist of occipital, mastoid,
parotid, submandibular,
submental lymph nodes
Drain into deep cervical lymph
nodes
Submandibular lymph node
下颌下淋巴结 lies near the
submandibular gland, receive
lymphatic vessels from the
face, nose and mouth
Nerves of head
Facial nerve (Ⅶ)
面神
经
Leaves skull through
internal acoustic meatus,
facial canal and
stylomastoid foramen
Divided three parts
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First part－between
stylomastoid foramen and
parotid gland
Second part－within
parotid gland
Third part－outside of
parotid gland
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Enters parotid gland
and divides into its five
terminal branches for
muscles of facial
expression
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Temporal 颞支
Zygomatic 颧支
Buccal 颊支
Marginal mandibular
下颌缘支
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Cervical 颈支
Trigeminal nerve (Ⅴ) 三叉神经
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Ophthalmic nerve
眼神经 (Ⅴ1) →
supraorbital n. 眶上神经
Maxillary nerve
上颌神经 (Ⅴ2) →
infraorbital n. 眶下神经
Mandibular nerve
下颌神经 (Ⅴ3) →mental
n. 颏神经
Parotid gland 腮腺
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Position: situated below
the external auditory
meatus and lies in a deep
hollow behind the ramus of
mandibular and in front of
the sternocleidomastoid
Superficial part: triangular
in shape, lies below and in
front of the external
acoustic meatus, and
partially covers the
masseter.
Deep part: lies deep to
medial pterygoid .
Parotid duct 腮腺管
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Arises front anterior
border of gland
Lies 1.5 cm below
and parallel to
zygomatic arch
Passes forward over
masseter, pierces the
buccinator and oral
mucosa to open
opposite second
upper molar tooth
Capsule of the parotid
gland
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The parotid gland is
enclosed within a welldefined capsule which
extension of the investing
fascia of the neck.
The superficial capsule is
thick and unyielding and
tightly affixed to the
underlying glandular
tissue by numerous
fibrous septa.
The deep capsule id quite
thin and easily disrupted.
Structures passing through the parotid gland
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Vertical
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External carotid a.
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Retromandibular vein
Superficial temporal a. & v.
Auriculotemporal n.
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Transversal
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Maxillary a. & v.
Tranverse facial a. & v.
Branches of facial n.
Relationships of parotid gland
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Superior－external acostic
meatus, poterior margin of
temporomandibular joint
Anteromedialy－masseter,
ramus of mandible,
posterior part of medial
pterygoid
Poateromedial－mastoid
process,
sternocleidomastoid,
posterior belly of digastric,
styloid process, internal
carotid a., internal jugular v.,
Ⅸ～Ⅻ cranial nerves
“Parotid bed”－internal
carotid a., internal jugular v.,
Ⅸ～Ⅻ cranial nerves
Masseter space 咬肌间隙
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Lies between the
masseter, and ramus of
mandible
Pterygomandibual space 翼下颌间隙
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Lies between ramus of
mandible and medial
pterygoid
Sublingual space 舌下间隙
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Between mucous membrane of floor of mouth and
mylohyoid and hyoglossus
Dissection
Skin incisions
The cranial part
Frontal parietal occipital region
额顶枕区
Boundaries
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Anterior－supraorbital
margin
Posterior－external
occipital protuberance
and superior nuchal line
Lateral－superior
temporal line
Layers
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consists of five layers:
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Skin 皮肤
Superficial fascia 浅筋膜
Galea aponeurotica and
occipitofrontalis
帽状腱膜和枕额肌
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Subaponeurotic space
(loose connective
tissue) 腱膜下隙
Pericranium 颅骨外膜
The superficial 3 layer are
closely knit together,
called scalp头皮
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The skin has the greatest
concentration of hair and
sebaceous glands
皮厚、腺多、血运丰富
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The superficial fascia is
dense connective tissue
that binds the skin strongly
to the underlying galea
aponeurotica
 The vasculature of the
scalp runs primarily in the.
lt is richand widely
anastornotic Wounds of the scalp
bleed profusely but heal
well.
Arteries, veins and nerves
 Anterior group
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Posterior group
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Supratrochlear a. v. n.
Supraorbital a. v. n.
Occipital a. v.
Greater occipital n.
炎症不易扩散，肿胀疼痛剧
烈，血管吻合多，止血应呈
环状，局麻范围要广，切口
呈放射状，皮瓣蒂在下方
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Galea aponeurotica
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It is interposed between
the frontalis and
occipitalis portions of the
occipitofrontalis muscle.
These muscles place the
aponeurosis under
tension so that deep
transverse lacerations of
the scalp gape widely .
坚韧致密，前连额腹，后
连枕腹，1、2、3层，合
称头皮
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Subaponeurotic space
(loose connective tissue)
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Extracranial hematoma, the
result of bleeding in the
subaponeurotic space, can
extend over the 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.
The 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.
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Contains a rich network of
deep arteries and veins.
Therefore, this layer has been
called the “dangerous area”.
Infaction may spread to the
substance of the bones, to
venous channels within the
cranial cavity, or to the brain.
出血化脓，漫及全顶，有导
血管， 颅内外交通
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Pericranium
Fuses firmly with bone
at the sutures and with
the periosteum of
theadjacent bone, thus
limiting the
subperiosteal space.
薄而致密，易于颅骨分
离，如有血肿，与骨一
致
Temporal region
Boundaries
 Superior－superior
temporal line
 Inferior－superior
border of zygomatic
arch
 Anterior－the junction
of frontal and zygomatic
bones
 Posterior－posterior
portion of superior
temporal line
Layers
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consists of five layers:
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Skin 皮肤
Superficial fascia 浅筋膜
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Temporal fascia 颞筋膜
Temporalis 颞肌
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Periosteum 骨膜
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Superficial fascia 浅筋膜
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Anterior auricular group
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Superficial temporal a. & v.
Auriculotemporal n.
Posterior auricular group
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Posterior auricular a. & v.
Lesser occipital n.
Temporal fascia 颞筋膜
Temporalis
Periosteum