局部解剖学（九局部解剖学（九）颈部的局部解剖与操作（颈部的局部解剖与操作（1）颈 部 Neck概述概述 introduction浅层结构浅层结构 superifical structures下颌下三角下颌下三角 submandibular triangle颏下三角颏下三角 submental triangle一、概述一、概述 Introduction境界和分区境界和分区 boundary and regions表面解剖表面解剖 surface anatomy表面标志表面标志 surface landmark体表投影体表投影 surface projection上界：上界：为下颌骨下缘、下颌角、乳突、上项线与枕外隆突的连线为下颌骨下缘、下颌角、乳突、上项线与枕外隆突的连线Superiorly：an line linking with the lower border of mandible,the angle of mandible,the mastoid process,the superior nuchal line and the external occipital protuberance;下界：下界：由胸骨上缘、锁骨和肩峰至第由胸骨上缘、锁骨和肩峰至第7颈椎棘突的连线。
颈椎棘突的连线Inferiorly：by the upper border of sternum,the clavicle and a line extending from the acromion to the spine of 7th cervical vertebra.1.颈部的境界颈部的境界 boundary of the neck2.颈部分区颈部分区颈部颈部:分为固有颈部（分为固有颈部（proper neck）和项部（和项部（nape）固有颈部固有颈部:又可分为颈前区又可分为颈前区anterior region、胸锁乳突肌区胸锁乳突肌区sternocleidomastoid region和颈外侧区和颈外侧区lateral region颈前区：被舌骨颈前区：被舌骨hyoid分为舌骨上区分为舌骨上区suprahyoid region（包括包括2个下颌下三角和个下颌下三角和1个颏下三角）和舌骨下区个颏下三角）和舌骨下区infrahyoid region（包括成对的颈动脉三角和肌三角包括成对的颈动脉三角和肌三角）颈外侧区：被肩胛舌骨肌下腹分为枕三角和锁骨上三角颈外侧区：被肩胛舌骨肌下腹分为枕三角和锁骨上三角。
3.表面标志表面标志 surface landmarkLesser supraclavicular fossa(Greater)supraclavicular fossaSuprasternal fossa表面标志表面标志Surface Landmark舌骨舌骨 Hyhoid(H)甲状软骨甲状软骨 Thyroid cartilage(T)喉结节喉结节 Laryngeal prominence(P)环状软骨环状软骨 Cricoid cartilage(C)第第1气管环气管环 The first tracheal ringe(1)甲状腺峡甲状腺峡 Isthmus(S)v环状软骨环状软骨(弓弓)的意义的意义第第6颈椎水平颈椎水平The level of the 6th cervical vertebra.喉与气管交界喉与气管交界 The junction of the larynx with the trachea.咽与食管交界咽与食管交界 The junction of the pharynx with the esophagus.The level at which the vertebral artery enters the transverse foramen of the 6th cervical vertebra.The site at which the carotid artery can be pressed against the carotid tubercle of the 6th cervical vertebra.The level at which the inferior thyroid artery and the middle thyroid vein enter or leave the thyroid gland.The level at which the superior belly of the omohyoid muscle crosses the carotid sheath.The level of the middle sympathetic ganglion.二、颈部浅层结构二、颈部浅层结构The superficial structures of the neck皮肤 The skin(thin and pliable)浅筋膜及其内容The superficial fascia and its contents a thin layer of fat a sheet of platysma the anterior jugular vein the lateral jugular vein the superficial(lateral and anerior)cervical lymph nodes the cutaneous branches of the cervical plexus the cervical branch of the facial nerve1.颈阔肌The platysmaIs a broad,thin sheet of muscle in the subcutaneous tissue.Covers the anterolateral aspect of the neck.Aarise in fascia covering superior parts of the deltoid and pectoralis major muscles and sweep superomedially over the clavicle to the inferior border of the mandible,skin,and subcutaneous tissue of lower face.Is one of the muscles of facial expression.Is innervated by the cervical branch of the facial nerve.The superficial cervical veins and nerves are located deep to the platysma.The main action of the platysma:draws corners of mouth inferiorly and widens it as in expressions of sadness and fright;draws the skin of neck superiorly when teeth are“clenched”.2.颈前静脉或颈前正中静脉、颈外静脉颈前静脉或颈前正中静脉、颈外静脉颈颈静静脉脉弓弓Jugular venous arch3.颈浅淋巴结颈浅淋巴结Superficial cervical lymph nodes4.Superficial cervical nervesCutaneous branches of the cervical plexusNerve point of neck Cervical branch of the facial nerve面神经的颈支Cervical branch of facial nerve三、颈筋膜及筋膜间隙三、颈筋膜及筋膜间隙Cervical Fasciaand Fascial Space1.颈筋膜 Cervical Fascia 颈深筋膜分为三层 Deep cervical fascia consists of three fascial layers:浅层浅层 Superficial layer 封套筋膜封套筋膜 Investing fascia中层中层 Middle layer 气管前筋膜气管前筋膜 Prechacheal fascia 内脏筋膜内脏筋膜 Visceral fascia深层深层 Deep layer 椎前筋膜椎前筋膜 Prevertebral fascia封套筋膜封套筋膜、气管前筋膜、椎前筋膜气管前筋膜、椎前筋膜颈动脉鞘、气管前筋膜、甲状腺鞘、甲状腺悬韧带颈动脉鞘、气管前筋膜、甲状腺鞘、甲状腺悬韧带2.颈筋膜间隙 Cervical Fascial Spaces胸骨上间隙胸骨上间隙 Suprasternal space咽后间隙咽后间隙 Retropharyngeal space气管前间隙气管前间隙 Prechacheal space椎前间隙椎前间隙 Prevertebral space胸骨上间隙、咽后间隙、气管前间隙、椎前间隙胸骨上间隙、咽后间隙、气管前间隙、椎前间隙胸胸 骨骨 上上 间间 隙的内容隙的内容Contents of the Suprasternal spaceInclude the:颈前筋膜下端颈前筋膜下端 Inferior ends of the anterior jugular veins颈静脉弓颈静脉弓 Jugular venous arch疏松结缔组织疏松结缔组织 Loose connective tissue12个淋巴结个淋巴结 One or two deep lymph nodes 胸锁乳突胸骨头 Sternal heads of the ternocleidomastoid 锁骨间韧带 Interclavicular ligament锁骨上间隙的内容锁骨上间隙的内容Contents of the supraclavicular spaceInclude the:颈外静脉 A part of the external jugular vein锁骨上神经 Supraclavicular nerves 颈横静脉 Transverse cervical vein 肩胛上静脉 Suprascapular vein 淋巴管 A few lymph vessels四、颏四、颏 下下 三三 角角Submental Triangle境界境界 Boundary内容内容 Contents颏下三角颏下三角 Boundaris of submental triangleBody of hyoid bone颏颏 下下 三三 角角 的的 内内 容容Contents of the submental triangleInclude the:几个小的颏下淋巴结几个小的颏下淋巴结 Several small submental lymph nodes.几条小静脉，汇合成颈前静脉几条小静脉，汇合成颈前静脉 Small veins that unite to form the anterior jugular vein.五、下五、下 颌颌 下下 三三 角角Submandibular Triangle境界境界 Boundary内容内容 Contents1.下下 颌颌 下下 三三 角角Boundaris of the submandibular triangle A roof of the submandibular triangle is formed by the skin,superficial fascia,platysma and investing fascia.A floor of the submandibular triangle is formed by the mylohyoid。