38头部解剖.pptx

January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG系系 统统 解解 剖剖 学学局局 部部 解解 剖剖 学学Regional anatomy主讲人：侯一平主讲人：侯一平 教授教授兰州大学基础医学院解剖教研室兰州大学基础医学院解剖教研室January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG头头部部面面部部颅部颅部January,2007Copyright 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头部与颈界线是：下颌线是：下颌骨下缘、下骨下缘、下颌角、乳突、颌角、乳突、上项线和枕上项线和枕外隆凸间的外隆凸间的连线。头部连线。头部分为后上方分为后上方的颅部和前的颅部和前下方的面部，下方的面部，界线是：眶界线是：眶上缘、颧弓、上缘、颧弓、外耳门和乳外耳门和乳突连线突连线头部与颈：下颌骨头部与颈：下颌骨下缘、下颌角、乳下缘、下颌角、乳突、上项线和枕外突、上项线和枕外隆凸间的连线。隆凸间的连线。头部分为颅部和面头部分为颅部和面部，界线是：眶上部，界线是：眶上缘、颧弓、外耳门缘、颧弓、外耳门和乳突连线。和乳突连线。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG第一节第一节 面面 部部一、浅层结构一、浅层结构二、肌肉二、肌肉三、面部的血管神经三、面部的血管神经四、面侧区四、面侧区January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG1.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、浅层结构一、浅层结构January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG二、面部肌肉二、面部肌肉表情肌表情肌咀嚼肌咀嚼肌January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG重要的面肌有：重要的面肌有：1.眼轮匝肌眼轮匝肌2.口轮匝肌口轮匝肌3.枕额肌和帽枕额肌和帽状腱膜状腱膜January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 4、咀嚼肌咀嚼肌:四对四对 翼内肌翼内肌翼外肌翼外肌颞颞 肌肌咬咬 肌肌January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG三、面部的血管神经三、面部的血管神经1.血管血管（1）面部血供丰）面部血供丰富，面浅层动脉富，面浅层动脉主要是主要是面动脉面动脉。（2）面静脉和）面静脉和“危险三角危险三角”January,2007Copyright 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三三叉叉神经神经2.面部神经分布面部神经分布 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG（2）支配表情）支配表情肌活动的为肌活动的为面面神经神经，分为五，分为五组分支：组分支：1）颞支）颞支2）颧支）颧支3）颊支）颊支4）下颌缘支）下颌缘支5）颈支）颈支January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG四、面侧区四、面侧区（一）腮腺咬肌区（一）腮腺咬肌区（二）面侧深区（二）面侧深区January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG（一）腮腺咬肌区腮腺咬肌区主要结构为主要结构为腮腺及穿腮腮腺及穿腮腺的结构。腺的结构。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG以下颌支后以下颌支后缘为标志分缘为标志分为浅、深二为浅、深二部。浅部略部。浅部略呈锥形。呈锥形。1.腮腺的位置和外形腮腺的位置和外形January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG由颈部深筋膜浅层由颈部深筋膜浅层在腮腺后缘分为两在腮腺后缘分为两层包裹腮腺而成。层包裹腮腺而成。特点：特点：1，与腮腺，与腮腺结合紧密；结合紧密；2，浅，浅层致密，深层薄弱层致密，深层薄弱不完整不完整2.腮腺鞘：腮腺鞘：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG3.穿腮腺的结构穿腮腺的结构（1）纵行结构）纵行结构（2）横行结构）横行结构January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG颈外动脉颈外动脉颞浅动、静脉颞浅动、静脉耳颞神经耳颞神经下颌后静脉下颌后静脉(1)纵行结构纵行结构January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG上颌动、静脉上颌动、静脉面横动、静脉面横动、静脉面神经的分支面神经的分支(2)横行结构横行结构January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG4.面神经颅外段与腮腺的关系面神经颅外段与腮腺的关系分为三段：分为三段：第一段（腮腺前段）第一段（腮腺前段）第二段（腮腺内段）第二段（腮腺内段）第三段（腮腺后段）第三段（腮腺后段）January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG5.腮腺深部的位置腮腺深部的位置位位于于下下颌颌支支的深面。的深面。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG6.腮腺床腮腺床为为紧紧贴贴腮腮腺腺深深面面的的血管神经，包括：血管神经，包括：颈内动、静脉颈内动、静脉舌咽神经舌咽神经迷走神经迷走神经副神经副神经舌下神经舌下神经January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG(二二)面侧深区面侧深区位位于于颅颅底底颞颞下下窝窝的的下下方方，口口腔和咽的外侧腔和咽的外侧。1.位置位置：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG(1)上颌动脉及分支上颌动脉及分支(2)下颌神经及分支下颌神经及分支(3)翼内、外肌翼内、外肌(4)翼丛翼丛 2.2.内容：内容：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG(1).上颌动脉的上颌动脉的主要分支主要分支下牙槽动脉下牙槽动脉脑膜中动脉脑膜中动脉眶下动脉眶下动脉颊动脉颊动脉上牙槽后动脉上牙槽后动脉January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG(2).下颌神经下颌神经的分支的分支下牙槽神经下牙槽神经舌神经舌神经耳颞神经耳颞神经颊神经颊神经咀嚼肌支咀嚼肌支January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG(3).翼静脉丛翼静脉丛位位置置：于于颞颞下下窝窝内内，翼翼内内肌肌、翼翼外外肌肌和和颞肌之间。颞肌之间。组组成成:与与上上颌颌动动脉脉分分支支伴伴行行的的静静脉脉均均参参与与组成翼静脉丛。组成翼静脉丛。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG4.面部的间隙面部的间隙位位置置：颅颅底底与与上上、下下颌颌骨骨之之间间，是是散散在在于于骨骨、肌肌肉肉与与筋筋膜膜之之间间的的间间隙彼此相通。隙彼此相通。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG主要有两个间隙：主要有两个间隙：（1）咬肌间隙）咬肌间隙（2）翼下颌间隙）翼下颌间隙January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG(1)咬肌间隙咬肌间隙位位于于咬咬肌肌深深部部与与下下颌颌支支上上部部之之间间。此此间间隙隙前前邻邻第第3磨磨牙牙，如如牙牙周周炎炎，牙牙槽槽脓脓肿肿和和下下颌颌骨骨骨骨髓髓炎炎均均可扩散到此间隙。可扩散到此间隙。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG(2)翼下颌间隙翼下颌间隙位位于于翼翼内内肌肌与与下下颌颌支支之之间间，与与咬咬肌肌间间隙隙仅仅隔隔以以下下颌颌支支，两两间间隙隙经经下下颌颌切切迹迹相相通通。内内有有舌舌神神经经、下下牙牙槽槽神神经和动脉、静脉通过。经和动脉、静脉通过。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG第二节第二节颅部颅部颅顶颅顶颅底：蝶鞍区颅底：蝶鞍区颅腔及其内容物颅腔及其内容物颅部颅部额顶枕区额顶枕区颞区颞区January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG一、一、颅颅顶顶（一）额顶枕区（一）额顶枕区1.境界：境界：前界：前界：眶上缘眶上缘后界：后界：枕外隆突及枕外隆突及上项线上项线两侧界：借上颞线两侧界：借上颞线与颞区分界与颞区分界January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG2.层次及结构特点层次及结构特点层次：五层层次：五层(1)皮肤皮肤(2)浅筋膜浅筋膜(3)帽状腱膜帽状腱膜(4)腱膜下间隙腱膜下间隙(5)颅骨外膜颅骨外膜January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG结构特点：结构特点：(1)皮肤皮肤有有大大量量汗汗腺腺、皮皮脂脂腺腺，易易发发生生疖肿。疖肿。有有丰丰富富的的血血管管,外外伤伤易易出出血血，但但愈合快。愈合快。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG(2)浅筋膜浅筋膜有有许许多多垂垂直直的的纤纤维维隔隔连连接接皮皮肤肤和和帽帽状状腱腱膜膜，形形成成许许多多小小隔隔，内内有有脂脂肪肪、血血管神经。管神经。结构特点：结构特点：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG(3)帽状腱膜帽状腱膜前前连连额额肌肌后后连连枕枕肌肌，两两侧侧变变薄薄续续颞深筋膜浅层。颞深筋膜浅层。以以上上3层层紧紧密密相相连称头皮。连称头皮。结构特点：结构特点：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG(4)腱膜下间隙腱膜下间隙为帽状腱膜与颅骨为帽状腱膜与颅骨骨膜之间的区域，骨膜之间的区域，因头皮与颅骨骨膜因头皮与颅骨骨膜疏松相连，故移动疏松相连，故移动性大，头皮撕脱伤性大，头皮撕脱伤多沿此层分离。多沿此层分离。结构特点：结构特点：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG腱膜下间隙内腱膜下间隙内有导静脉与颅有导静脉与颅骨的板障静脉骨的板障静脉及脑膜窦相交及脑膜窦相交通，此层感染通，此层感染可向板障及颅可向板障及颅内扩散，此间内扩散，此间隙称为颅顶的隙称为颅顶的危险区。危险区。颅顶的颅顶的“危险区危险区”January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG(5)颅骨外膜颅骨外膜在在颅颅骨骨表表面面疏疏松松贴贴附附，在在骨骨缝缝处处结结合紧密。合紧密。结构特点：结构特点：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG3.颅顶部的血管神经及其特点颅顶部的血管神经及其特点血血 管管 神神 经经行行于于浅浅筋筋膜膜内内，以以耳耳廓廓为为界界分分为前、后两组。为前、后两组。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG前组：前组：滑滑车车上上血血管管神神经经（动脉为眼（动脉为眼A终支）终支）眶眶上上血血管管神神经经（动动脉为眼脉为眼A分支）分支）颞浅血管与耳颞颞浅血管与耳颞神经神经January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG后组：后组：耳后耳后A与枕小与枕小N枕枕A与与枕枕大大N（为第（为第2颈颈N后支）后支）January,2007Copyright 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：颅顶部血管神经的特点：呈放射状分布呈放射状分布吻合丰富吻合丰富血供丰富血供丰富January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG（二）颞（二）颞区区1.范围范围颅顶两颅顶两侧，位于上侧，位于上颞线与颧弓颞线与颧弓上缘之间。上缘之间。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG2.颞区软组织层次颞区软组织层次（1）皮肤）皮肤（2）浅筋膜）浅筋膜（3）颞筋膜（浅、）颞筋膜（浅、深层）深层）（4）颞肌）颞肌（5）颅骨外膜。）颅骨外膜。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG（1）颞区皮肤）颞区皮肤较较薄薄且且移移动动性性大大，手手术术切切口口易易于于缝缝合合，愈愈合合后后瘢瘢痕痕也也不不明明显。显。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG（2）颞区浅筋膜）颞区浅筋膜含含脂脂肪肪组组织织较较少少，上上方方连连颅颅顶顶浅浅筋筋膜膜，下下方方续续面部浅筋膜，面部浅筋膜，January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG浅浅筋筋膜膜内内的的血血管管神神经经可可分分为为耳耳前前和和耳耳后后两组：两组：耳前组：耳前组：颞浅动、静脉颞浅动、静脉耳颞神经耳颞神经分布于颞区和额顶区分布于颞区和额顶区January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG耳后组：耳后组：耳耳后后动动、静静脉脉，枕枕小小神神经经主主要要分分布布于于耳耳后后和和枕枕外外侧侧部。部。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG（3）颞筋膜颞筋膜temporalfascia较较致致密密，上上方方附附于于上上颞颞线线，向向下下分分为为浅浅、深深两两层层，浅浅层层附附于于颧颧弓弓上上缘缘的的外外面面，深深层层附附于于颧颧弓弓上上缘缘的内面。的内面。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG（4）颞肌）颞肌temporalmuscle呈呈扇扇形形，起起自自颞颞窝窝和和颞颞筋筋膜膜深深面面，肌肌纤纤维维向向下下集集中中，经经颧颧弓弓深深面面止止于于下下颌颌骨骨的冠突。的冠突。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG（5）骨膜）骨膜periosteum较较薄薄，与与颞颞骨骨连连接接紧紧密密，骨骨膜膜与与颞颞肌肌之之间间为为颞颞深深间间隙隙，内内含含大大量量脂脂肪肪组组织织，向向下下经经颧颧弓弓深深面面与与颞颞下下间间隙隙相相通通，向向前前则则与与面面部部的的颊颊脂脂体体相连续。相连续。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG1.1.结构特点结构特点 2.2.临床意义临床意义二、二、颅底内面颅底内面January,2007Copyright 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,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG主要结构：主要结构：蝶鞍、垂蝶鞍、垂体、鞍隔、体、鞍隔、视神经与视神经与视交叉、视交叉、海绵窦海绵窦January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG上方有鞍隔被上方有鞍隔被覆，中有鞍隔覆，中有鞍隔孔；外侧无骨孔；外侧无骨壁，直接与海壁，直接与海绵窦组织及其绵窦组织及其内的颈内动脉内的颈内动脉相邻。相邻。（2）垂体HypothesisJanuary,2007Copyright 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 SinusJanuary,2007Copyright 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,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG思考题思考题面部皮肤、肌肉的神经分布面部皮肤、肌肉的神经分布穿腮腺的结构穿腮腺的结构腮腺床腮腺床额额顶顶枕枕区区的的层层次次结结构构及及颅颅顶顶部部的的“危险区危险区”