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Head
Ⅰ. Boundaries :lower border of mandible—the angle of mandible—the mastoid process—the superior nuchal line—the external occipital protuberance
Ⅱ. Divisions:• the face• the cranium
— supra-orbital margin—zygomatic arch— superior margin of external acoustic meatus— mastoid process.
Ⅰ. Boundaries :lower border of mandible—the angle of mandible—the mastoid process—the superior nuchal line—the external occipital protuberance
Ⅱ. Divisions:• the face• the cranium
— supra-orbital margin—zygomatic arch— superior margin of external acoustic meatus— mastoid process.
Region and parts Cranium 颅部 Face 面部
Landmaeks Superciliary Supraorbital notch Infraorbital foramen Mental foramen Pterion Zygomatic arch Mastoid process External occipital protubera
nce
Epidural hemorrhage
Pterion
Muscles of head Facial muscles 面肌 Epicranius 颅顶肌 (oddi
pitofrontalis) 枕额肌 Frontal belly 额腹 Occipital belly 枕腹 Galea aponeurotica 帽
状腱膜 Orbicularis oculi 眼
轮匝肌 Buccinator 颊肌 Orbicularis oris 口
轮匝肌 Nasalis 鼻肌Platysma 颈阔肌
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
Origin - inferior border and medial surface of zygomatic arch
Insertion - lateral surface of ramus of mandible and angle of mandible
Action - elevates mandible
Temporalis 颞肌 Origin - temporal fossa Insertion - coronoid proce
ss of mandible Action - elevates and retr
acts mandible lateral pterygoid 翼外肌 Medial pterygoid 翼内肌
Arteries of headFacial a. 面动脉 Branch of external caroteid a. Runs forward over digastric a
nd submandibular gland Loops around mandible (whe
re 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 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
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 Branch of external caroti
d a. Entrance to infratempora
l fossa medial to neck of mandible
Branches Inferior alveolar a.
下牙槽动脉 Middle meningeal a.
脑膜中动脉 enters the skull through f
oremen spinosum Supplies cranium and du
ra mater Posterior superior alveola
r a. 上牙槽后动脉
Veins of head Facial vein 面静脉 Begins at medial angle of ey
e (angular vein) Runs downward and backw
ard 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
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
“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
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 翼静脉丛
Located between and around muscles of mastication
Receives blood from all regions supplied by maxillary a.
Communicates with Face by deep facial veins Cavernous sinus by veins d
raining base of skull Provides possible pathwa
y for spread of infection to cranial cavity
The lymphatic drainage of head Lymph nodes of head Located at junction of head an
d neck Consist of occipital, mastoid, p
arotid, 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 intern
al acoustic meatus, facial canal and stylomastoid foramen
Divided three parts First part - between stylo
mastoid foramen and parotid gland
Second part - within parotid gland
Third part - outside of parotid gland
Enters parotid gland and divides into its five terminal branches for muscles of facial expression Temporal 颞支 Zygomatic 颧支 Buccal 颊支 Marginal mandibular
下颌缘支 Cervical 颈支
Trigeminal nerve (Ⅴ) 三叉神经
Ophthalmic nerve 眼神经 ( 1) → supraorⅤbital n. 眶上神经
Maxillary nerve 上颌神经 ( 2) → infraorⅤbital n. 眶下神经
Mandibular nerve 下颌神经 ( 3) →mental Ⅴn. 颏神经
Parotid gland 腮腺 Position: situated below th
e 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 Arises front anterior
border of gland Lies 1.5 cm below an
d 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
The parotid gland is enclosed within a well-defined 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 Vertical
External carotid a. Retromandibular vein Superficial temporal a. &
v. Auriculotemporal n.
Transversal Maxillary a. & v. Tranverse facial a. & v. Branches of facial n.
Relationships of parotid gland 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
Lies between the masseter, and ramus of mandible
Pterygomandibual space 翼下颌间隙 Lies between ramus of
mandible and medial pterygoid
Sublingual space 舌下间隙 Between mucous membrane of floor of mouth and m
ylohyoid and hyoglossus
Dissection
Skin incisions
The cranial part
Frontal parietal occipital region额顶枕区
Boundaries Anterior - supraorbital
margin Posterior - external oc
cipital protuberance and superior nuchal line
Lateral - superior temporal line
Layers consists of five layers:
Skin 皮肤 Superficial fascia 浅筋膜 Galea aponeurotica and
occipitofrontalis 帽状腱膜和枕额肌
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
The skin has the greatest concentration of hair and sebaceous glands
皮厚、腺多、血运丰富 The superficial fascia is de
nse connective tissue that binds the skin strongly to the underlying galea aponeurotica The vasculature of the sc
alp runs primarily in the. lt is richand widely anastornotic-
Wounds of the scalp bleed profusely but heal well.
Arteries, veins and nerves Anterior group
Supratrochlear a. v. n. Supraorbital a. v. n.
Posterior group 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
Galea aponeurotica It is interposed between t
he 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
Subaponeurotic space (loose connective tissue) Extracranial hematoma, the resul
t 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 in any injury that tears the scalp from the calvaria or for the surgeon elevating thescalp from the periosteum.
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
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 te
mporal line Inferior - superior bord
er of zygomatic arch Anterior - the junction
of frontal and zygomatic bones
Posterior - posterior portion of superior temporal line
Layers consists of five layers:
Skin 皮肤 Superficial fascia 浅筋
膜 Temporal fascia 颞筋
膜 Temporalis 颞肌 Periosteum 骨膜
Superficial fascia 浅筋膜 Anterior auricular group
Superficial temporal a. & v.
Auriculotemporal n. Posterior auricular group
Posterior auricular a. & v. Lesser occipital n.
Temporal fascia 颞筋膜
Temporalis
Periosteum
Cerebral dural materCharacters A thick and dense inelast
ic membrane that composed of two layers, an inner or meningeal and outer or endosteal
It is in loose contact with calvaria, and most strongly adherent to base of skull
Four septa Cerebral falx Tentorium of cerebellum - in front there is a gap, the tento
rial incisure, for passage of midbrain Cerebellar falx Diaphragma sellae
Sinuses of duramater Superior sagittal sinus Inferior sagittal sinus
Straight sinus Confluence of sinus
Transverse sinus
Sigmoid sinus
Superior petrosal sinuse
s
inferior petrosal sinuses