31头部解剖-PPT文档资料.ppt
January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,头 部,面 部,颅部,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,境界与分区,头部与颈界线是：下颌骨下缘、下颌角、乳突、上项线和枕外隆凸间的连线。头部分为后上方的颅部和前下方的面部，界线是：眶上缘、颧弓、外耳门和乳突连线,头部与颈：下颌骨下缘、下颌角、乳突、上项线和枕外隆凸间的连线。 头部分为颅部和面部，界线是：眶上缘、颧弓、外耳门和乳突连线,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,第一节 面 部,一、浅层结构 二、肌肉 三、面部的血管神经 四、面侧区,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,1.皮肤： 薄而软血管较丰富及含大量的毛囊、皮脂腺和汗腺，三个特点很突出。 2.浅筋膜：内含丰富血管、神经、大量的表情肌。,一、浅层结构,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,二、面部肌肉,表情肌,咀嚼肌,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,重要的面肌有：,1.眼轮匝肌 2. 口轮匝肌 3.枕额肌和帽状腱膜,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,4、 咀嚼肌: 四对,翼内肌,翼外肌,颞 肌,咬 肌,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,三、面部的血管神经,1. 血管 （1）面部血供丰富，面浅层动脉主要是面动脉。 （2）面静脉和“危险三角”,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,（1）分布于面部的感觉神经和支配咀嚼肌的神经为三叉神经,2.面部神经分布,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,（2）支配表情肌活动的为 面神经，分为五组分支： 1）颞支 2）颧支 3）颊支 4）下颌缘支 5）颈支,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,四、面侧区,（一）腮腺咬肌区,（二）面侧深区,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,（一）腮腺咬肌区,主要结构为腮腺及穿腮腺的结构。,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,以下颌支后缘为标志分为浅、深二部。浅部略呈锥形。,1. 腮腺的位置和外形,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,由颈部深筋膜浅层在腮腺后缘分为两层包裹腮腺而成。特点：1，与腮腺结合紧密；2，浅层致密，深层薄弱不完整,2.腮腺鞘：,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,3. 穿腮腺的结构,（1）纵行结构,（2）横行结构,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,颈外动脉 颞浅动、静脉 耳颞神经 下颌后静脉,(1)纵行结构,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,上颌动、静脉 面横动、静脉 面神经的分支,(2)横行结构,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,4. 面神经颅外段与腮腺的关系,分为三段： 第一段（腮腺前段） 第二段（腮腺内段） 第三段（腮腺后段）,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,5. 腮腺深部的位置,位于下颌支的深面。,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,6. 腮腺床,为紧贴腮腺深面的血管神经，包括： 颈内动、静脉 舌咽神经 迷走神经 副神经 舌下神经,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,(二)面侧深区,位于颅底颞下窝的下方，口腔和咽的外侧。,1.位置：,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,(1)上颌动脉及分支 (2)下颌神经及分支 (3)翼内、外肌 (4)翼丛,2.内容：,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,(1). 上颌动脉的主要分支,下牙槽动脉 脑膜中动脉 眶下动脉 颊动脉 上牙槽后动脉,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,(2). 下颌神经的分支,下牙槽神经 舌神经 耳颞神经 颊神经 咀嚼肌支,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,(3). 翼静脉丛,位置：于颞下窝内，翼内肌、翼外肌和颞肌之间。 组成: 与上颌动脉分支伴行的静脉均参与组成翼静脉丛。,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,4. 面部的间隙,位置：颅底与上、下颌骨之间，是散在于骨、肌肉与筋膜之间的间隙彼此相通。,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,主要有两个间隙：,（ 1）咬肌间隙 （2）翼下颌间隙,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,(1)咬肌间隙,位于咬肌深部与下颌支上部之间。此间隙前邻第3磨牙，如牙周炎，牙槽脓肿和下颌骨骨髓炎均可扩散到此间隙。,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,(2)翼下颌间隙,位于翼内肌与下颌支之间，与咬肌间隙仅隔以下颌支，两间隙经下颌切迹相通。内有舌神经、下牙槽神经和动脉、静脉通过。,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,第二节 颅部,颅顶,颅底：蝶鞍区,颅腔及其内容物,颅部,额顶枕区,颞区,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,一、 颅 顶,（一）额顶枕区 1.境界： 前界： 眶上缘 后界： 枕外隆突及 上项线 两侧界：借上颞线 与颞区分界,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,2. 层次及结构特点,层次：五层 (1)皮肤 (2)浅筋膜 (3)帽状腱膜 (4)腱膜下间隙 (5)颅骨外膜,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,结构特点：,(1)皮肤 有大量汗腺、皮脂腺，易发生疖肿。 有丰富的血管,外伤易出血，但愈合快。,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,(2)浅筋膜 有许多垂直的纤维隔连接皮肤和帽状腱膜，形成许多小隔，内有脂肪、血管神经。,结构特点：,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,(3)帽状腱膜 前连额肌后连枕肌，两侧变薄续颞深筋膜浅层。 以上3层紧密相连称头皮。,结构特点：,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,(4)腱膜下间隙 为帽状腱膜与颅骨骨膜之间的区域，因头皮与颅骨骨膜疏松相连，故移动性大，头皮撕脱伤多沿此层分离。,结构特点：,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,腱膜下间隙内有导静脉与颅骨的板障静脉及脑膜窦相交通，此层感染可向板障及颅内扩散，此间隙称为颅顶的危险区。,颅顶的“危险区”,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,(5)颅骨外膜 在颅骨表面疏松贴附，在骨缝处结合紧密。,结构特点：,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,3. 颅顶部的血管神经及其特点,血管神经行于浅筋膜内，以耳廓为界分为前、后两组。,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,前组： 滑车上血管神经（动脉为眼A终支） 眶上血管神经（动脉为眼A分支） 颞浅血管与耳颞 神经,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,后组： 耳后A与枕小N 枕A与枕大N （为第2颈N后支）,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,颅顶部血管神经的特点：,呈放射状分布 吻合丰富 血供丰富,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,（二）颞 区,1.范围 颅顶两侧，位于上颞线与颧弓上缘之间。,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,2.颞区软组织层次,（1）皮肤 （2）浅筋膜 （3）颞筋膜（浅、深层） （4）颞肌 （5）颅骨外膜。,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,（1）颞区皮肤,较薄且移动性大，手术切口易于缝合，愈合后瘢痕也不明显。,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,（2）颞区浅筋膜,含脂肪组织较少，上方连颅顶浅筋膜，下方续面部浅筋膜，,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,浅筋膜内的血管神经可分为耳前和耳后两组： 耳前组： 颞浅动、静脉 耳颞神经 分布于颞区和额顶区,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,耳后组： 耳后动、静脉， 枕小神经 主要分布于耳后和枕外侧部。,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,（3）颞筋膜temporal fascia,较致密，上方附于上颞线，向下分为浅、深两层，浅层附于颧弓上缘的外面，深层附于颧弓上缘的内面。,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,（4）颞肌temporal muscle,呈扇形，起自颞窝和颞筋膜深面，肌纤维向下集中，经颧弓深面止于下颌骨的冠突。,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,（5）骨膜periosteum,较薄，与颞骨连接紧密，骨膜与颞肌之间为颞深间隙，内含大量脂肪组织，向下经颧弓深面与颞下间隙相通，向前则与面部的颊脂体相连续。,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,1.结构特点 2.临床意义,二、颅底内面,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,蝶鞍区：指颅中窝中央部的蝶鞍及其周围的区域 （1）蝶鞍: (Sella turcica ) 位于颅中窝蝶骨体中央的凹陷区，其内为垂体窝，容纳垂体。,3.蝶鞍区,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,主要结构：蝶鞍、垂体、鞍隔、视神经与视交叉、海绵窦,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,上方有鞍隔被覆，中有鞍隔孔；外侧无骨壁，直接与海绵窦组织及其内的颈内动脉相邻。,（2）垂体 Hypothesis,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,位于蝶鞍与蝶窦的两侧，向下延伸至颅中窝底。,（ 3）海绵窦 Cavernous Sinus,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,外侧壁：III、IV、V1、V2 内侧壁：与垂体相邻 窦腔内：颈内动脉、VI,海绵窦的毗邻,January, 2007,Copyright© Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,复习思考,1. 面部皮肤、肌肉的神经分布 2. 穿腮腺的结构 3. 腮腺床 4. 额顶枕区的层次结构及颅顶部的“危险区”,
