局部解剖学头文档资料.ppt

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1、第一章 头Chapter 1 Head,Section 1 IntroductionI.Boundary and Division The head is separated from the neck by an imaginary line linking with lower border of mandible,mandibular angle,mastoid process,superior nuchal line and external occipital protuberance.,The head is roughly divided into Cranium and Fac

2、e by an imaginary line linking with the supraorbital margin,zygomatic arch,superior margin of external acoustic meatus and mastoid process.,Cranium,Face,II.Surface Anatomy(Landmaeks)1.Frontal tuber is slight prominence of forehead on each side just opposite to the middle gyrus of cerebral hemisphere

3、.2.Supraorbital notch situates on the superior margin of orbit about 2.5cm from median line and transmits supraortital a.,v.&n.,3.Infraorbital foramen locates about 0.50.8cm below the infraorbital margin,about 2.5cm from median line and transmits infraorbital a.,v.&n.4.Mental foramen lies about 2.5c

4、m from median fusion and half way between the edge of gum and the lower border of mandible.The mental vesels&nerve emerge from it.,1.,2.,3.,4.,5.Zygomatic arch spans the interval between ear and eye about 5 6cm in length.Its upper border corresponds to the lower border of anterior portion of the tem

5、poral lobe of cerebrum.6.Mandibular angle is the posteroinferior part of mandibular ramus.The incidence of fracture is rather frequent at this angle because of its thinner bony structure.,7.Mastoid process is a cone-shaped protuberance of temporal bone behind lower part of auricle.Stylomastoid foram

6、en,locating anteromedially to its root,is the pass way of the facial nerve out of the cranium.,8.Pterion is located at the point about 3.8cm above the midpoint of zygomatic arch.It is formed by the junctionof sphenoid,frontal,parietal and temporal bones,and in most cases is H-shaped.The bony structu

7、re of pterion is rather thin and is easy fracture.Since the anterior branch of middle meningeal artery passing through its inner surface,so it is obvious that a fracture in the pterion may tear this artery,producing an epidural hematoma.,pterion,Middle meningeal artery,Fracture of Pterion and Epidur

8、al HematomaEpidural hematoma:a blood clot that forms between the skull and the cerebral dura mater.Pressure from this clot may cause damage to the brain and fast changes in the intercranial pressure.It may cause a short loss of consciousness,headaches,nausea,vomiting,dizziness,and problems with memo

9、ry and concentration.The size of the clot will determine if surgery is needed(to relieve the pressure).,Pterion,Middle meningeal artery,fracture in pterion,Epidural hematoma,III.Dissection&Skin incisions Put the cadaver in the supine position.Place a block under the neck to raise the head to a conve

10、nient level.Make some incisions through the skin in accordance with the following pictures.,superior nuchal line,I.Frontoparietooccipital Region I)Boundaries Anterior supraorbital margin;Posterior external occipital protuberance and superior nuchal line;Lateral superior temporal line.,Section 2 Cran

11、ium,II)Layers The scalp covers the vertex of skull and consists of five layers.They spell scalp:S-skin C-connective tissue A-aponeurosis L-loose connective tissue P-periosteum The superficial 3 layer are closely knit together,called scalp clinically.,S,C,A,L,P,The makeup of scalp is important clinic

12、ally because trauma to scalp is frequent and it is up to the clinician to determine by palpation and observation just how serious the trauma is.1.Skin is thick and dense,consists of the hair bulbs,sweat glands and sebaceous glands and has abundant blood supply.It is a region of frequent site of furu

13、ncles and sebaceous cysts.Also liable to bleeding and healing,if it is traumatized.(皮厚、腺多、血运丰富),2.Superficial fascia is connective tissue that binds skin strongly to the underlying epicranial aponeurosis.The vasculature of scalp runs primarily in this layer.The connective tissue has a special relati

14、onship with arteries in this area.When an artery is severed,the connective tissue fibers around the vessel contract and pull artery open.This results is more hemorrhage than in other places.With scalp hemorrhage,compression must be used to stop the bleeding.,The inflammation shall be limited in this

15、 layer because of the special construction of pockets,but severe pain will be induced earlier by accumulation and pressure of exudation.Blood vessels and nerves come into the scalp from three different regions:,1)anterior supratrochlear 3)posterior occipital a.v.,greater occipital n.,There is free a

16、nastomoses from side to side.With all of this blood supply,lacerations of the scalp are usually profuse and because of the nerve supply,very sensitive.(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),3.Epicranial aponeurosis and occipitofrontalis Epicranial aponeurosis is interposed between the fro

17、ntal and occipital portions of the occipitofrontal 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),4.Subaponeurotic space(loose connective tissue)locates between scalp proper and pericranium which is limited by t

18、he attachment of aponeurosis.Blood or pus may spread over the cranium in this space during trauma or inflammation.It can extend posteriorly,to superior nuchal line;anteriorly,into eyelids to produce the“black eye”;and lateraliy,to temporal line.,The loose connective tissue layer provides the plane o

19、f separation in any injury that tears scalp from the calvaria or for the surgeon elevating the scalp from the periosteum.Subaponeurotic space contains a rich network of deep arteries and veins.Therefore,this layer has been called the“dangerous area”.Infection may spread to the substance of the bones

20、,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),5.Pericranium is thin and dense,fuses firmly with bone at the sutures and with the periosteum of the adjacent bone,thus limiting the subperiosteal space.That is why the subpericranial hematoma usually limites within

21、 a piece of cranial bpne.,(薄而致密，易于颅骨分离，如有血肿，与骨一致),II.Temporal Region I)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.,II)Layers It consists of five layer

22、s:Skin,Superficial fascia,Temporal fascia,Temporalis,and Periosteum.,1.Skin and Superficial fascia The skin is thin in the anterior part,while it is thick in the posterior part of this region.,The superficial fascia is rich of fat which contains the superficial temporal and posterior auricular vesse

23、ls as well as the auroculotemporal,lesser occipital,greater auricular nerves and temporal branch of facial nerve.,2.Temporal fascia is a dense fascia and covers the temporalis.Above the zygomatic arch it is separated into 2 layers with some fatty tissue between.,The superficial layer is attached to

24、the upper border and outer surface of zygomatic arch while the deep one is attached to the upper border and inner surface of the arch.,3.Temporalis and Periosteum Temporalis is a fan shaped mastication muscle and locates the temporal fossa.,III.Cranial CavityI)Open Cranium to remove Brain Put the ca

25、daver in supine position.Reflect four flaps over the calvaria thoroughly.Make a circle line passing 1cm above the superciliary arch and 1cm below the external occipital protuberance.,Make a saw cut along this line.Cut and raise the skull cap upwards.,Take care the depth of the cut and avoid injury t

26、o the dura matter and brain.Observe and cut the dura matter from the each side of midpoint of superior sagittal sinus and then turn four flaps downwards.Expose all structures in the cranial cavity.Remove the brain and dissect the cranial nerves and other structures.,II)Main Contents 1.Internal surfa

27、ce of base of skull It is divided into three well-marked fossa to adapt the corresponding parts of the brain at different levels.1)Anterior cranial fossa The cribiform plate forms the superior wall of nasal cavity.Each side of this,plate is the orbital plate of frontal bone,which forms the superior

28、orbital wall.The cribriform foramina of cribiform plate transmit the olfactory filaments(the).Because the bony plate of the floor is thin,fracture in the anterior cranial fossa is relatively common.,Fracture of anterior cranial fossa It may involve the frontal,ethmoidal and sphenoidal bones and sinu

29、ses and be accompanied by bleeding and CSF(cerebrospinal fluid)leakaging into the eye,the nose or mouth.Loss of consciousness and inability to see,or smell.,2)Middle cranial fossa It is divided into one median part and two lateral parts.In the center of median portion is the hypophysial fossa,which

30、lodges the hypophysis.,In front of this fossa is the chiasmatic sulcus,which leads into the optic canal on each side.The optic canal opens into the orbit and transmits the optic nerve(the)and ophthalmic artery.,There are a series of foramina for nerves and vessels in the lateral part of this fossa.B

31、etween the greater and lesser wings of sphenoid,the superior orbital fissure communicates with the orbit and,transmits several cranial nerves(the-oculomotor,the-trochlear,the-abducent,and the1-ophthalmic nerve).Below the fissure,the foramen rotundum conducts the maxillary nerve(the V2).Behind that i

32、s the foramen ovale,which transmits the mandibular nerve(the V3).,The foramen spinosum is near the posterolateral margin of the foramen ovale,and transmits the middle meningeal vessels.,Fracture of the middle cranial fossa,The middle cranial fossa is the weakest,with thin bones and multiple foramina

33、.Fracture of middle cranial fossa may produce bleeding or CSF leakage from the eye and ear,“black eye”,facial and vestibulocochlear nerves injury.Loss of consciousness and inability to see or hear.,3)Posterior cranial fossa It is the largest and deepest of the three cranial fossa.,The lowest part of

34、 this fossa presents the foramen magnum.Through it,the brain stem continues with the spinal cord.A little above the anterolateral margin of foramen magnum,the hypoglossal canal on each side transmits the hypoglossal nerve().,Lateral to the foramen magnum is the jugular foramen,which transmits the gl

35、ossopharyngeal(the),vagus(the)and accessory(the)nerves and the internal jugular vein.,In the posterior surface of the petrous part of temporal bone presents a circular opening,the internal acoustic pore.It transmits the facial(the)and vestibulocochlear(the)nerves,and the labyrinthine vessels.,2.Cere

36、bral dura mater and venous sinus 1)Characters The cerebral dura mater is a thick and dense inelastic membrane that composed of two layers,an inner or meningeal and outer or endosteal.The out layer is in loose contact with calvaria,and most strongly adherent to base of skull.,2)Septa formed by Cerebr

37、al dura mater There are four projections into the cranial cavity from the dura mater:Cerebral falx is a median,sickle-shaped fold of dura mater,which descends between the two cerebral hemispheres.Tentorium of cerebellum is a tent-like reflection of dra mater which forms a partition separating the oc

38、cipital lobes and the cerebellum.Its free anterior margin called Tentorial incisure surrounding the midbrain.,Tentorial incisure,Cerebellar falx extends vertically between the two cerebellum hemispheres.Diaphragma sellae is a horizontal fold of dura mater,which forms a roof for the sella turcica.3)S

39、inuses of duramater At certain sites two layers of cranial dura mater is separated to form dural venous sinuses.They drain the blood from the brain and have no valves.,A hemorrhage caused by an injury of dural sinuses is difficult to stop because wall of dural sinuses lacks smooth muscles.Sinuses of

40、 duramater Including:(1)Superior sagittal sinus lies in the fixed upper margin of the cerebral flax.(2)Inferior sagittal sinus lies in the free lower margin of the flax.,(1),(2),(3),(4),(9),(8),(7),(6),(5),(3),(4),(3)Straight sinus lies in the flax attachment to the tentorium of cerebellum.,(1),(2),

41、(3),(4),(9),(8),(7),(6),(5),(3),(4),(4)Confluence of sinus lies near the internal occipital protuberance.(5)Transverse sinus lies near the sulcus for transverse sinus.(6)Sigmoid sinus lies near the sulcus for sigmoid sinus.(7,8)Superior&Inferior petrosal sinuses.,(9)Cavernous sinus lies on each side

42、 of sella turcica.Relations:Internal carotid artery and abducent nerve run through the sinus;Oculomotor,trochlear,ophthalmic,and maxillary nerves lie in its lateral wall;Superior,Superior&inferior petrosal sinuses drain cavernous sinuses into transverse sinuses and internal jugular veins respectivel

43、y.Carvernous sinus syndrome:the cavernous sinus communicate with the facial vein facial(danger triangle),infection can spread to this sinus resulting in sepsis and thrombosis of venous sinuses,and even involve adjacent cranial nerves.,This diagram points out the structures found within the cavernous

44、 sinus and within its walls In the walls:1.oculomotor 2.trochlear 4.V1 5.V2 Within:3.abducens 6.autonomic plexus 7.internal carotid artery 8.pituitary gland 9.body of sphenoid bone,Sup.sagittal sinus,Inf.sagittal sinus,Straight sinus,Confluence of sinus,Transverse sinus,Cavernous sinus,Sup.petrosal

45、sinus,Inf.petrosal sinus,Internal jugular vein,Sigmoid sinus,Inf.ophthalmic vein,Sup.ophthalmic vein,Flowing of blood in dural sinus(1),Flowing of blood in dural sinus(2),3.Cranial NervesI.Olfactory N.(CN I Sensory n.):SVA fibers Olfactory mucosa 1520 olfactory filaments Cribriform foramina Olfactor

46、y bulb Olfactory tracts Olfactory areas,CN I,II.Optic Nerve(CN Sensory n.):SSA fibers Ganglion cell Optic disc Optic nerve Optic canal Optic chiasma Optic tract Lateral geniculate body Visual areas,CN,III.Oculomotor Nerve(CN):emerges from medial side of cerebral peduncle lateral wall of cavernous si

47、nus enter orbit through superior orbital fissure(1)GSE fibres(,Oculomotor nucleus)Superior,inferior and medial recti;inferior obliquus;levator palpebrae superioris(2)GVE fibres(EW nucleus)Ciliary ganglion(postganglionic fibres)sphincter pupillae and ciliary muscles.,CN III,IV,VI,IV.Trochlear Nerve(C

48、N):GSE fibres(trochlear nucleus)emerges from anterior medullary velum winds forwards round cerebral peduncle then passes forwards in lateral wall of cavernous sinus superior orbital fissure enters superior oblique muscle.,VI.Abducent Nerve(CN):GSE fibres(abducent nucleus)emerge from medial part of b

49、ulbopontine sulcus traverses cavernous sinus lateral to internal carotid a.enters orbital cavity through superior orbital fissure finally sinks into lateral rectus.,CN III,IV,VI,V.Trigeminal Nerve(CN):A mixed nerve is attached to side of pons by two roots:I)Motor root SVE fibres(motor nucleus of tri

50、geminal n.)only take part in CN V3 supply masticatory m.,mylohyoid,anterior belly of digastric,tensor tympni etc.II)Sensory root GSA fibres transmit facial sensation to sensory nuclei of trigeminal n.via trigeminal ganglion peripheral processes enter each of three divisions:CNV1,CNV2,CNV3.,CNV1,V2,V