Chapter 3 Head

The Department of Anatomy

扬州大学医学院 解剖教研室 Frontal tuber Frontal tuber

Supraorbital Supraorbital foramen notch

Infraorbital foramen

Landmarks

Mental foramen superior Temporal line Pterion

Eyebrow

Zygomatic arch

Mastoid process

External occipital protuberance Angle of mandible Pterion

Epidural hemorrhage Region and parts  Cranium 颅部

1)颅顶 The ckull cap

 额顶枕区 frontoparietooccipital region

 颞区 temporal region 2)颅底与颅腔及其内容 The base of skull(self study) The cranial cavity and its contents(self-study)  Face 面部

The skull cap

Frontal parietal occipital region 额顶枕区 Boundaries

 Anterior－supraorbital margin

 Posterior－external occipital 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 (头皮)  Ⅰ.The skin has the greatest concentration of hair and sebaceous glands 皮厚、腺多、血运丰富  Ⅱ.The superficial fascia is dense connective tissue that binds the skin strongly to the underlying galea aponeurotica

 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  Ⅲ.Galea aponeurotica

 It lies between the frontalis and occipitalis.

 These muscles place the aponeurosis under tension so that deep transverse lacerations of the scalp gape widely (severance) .

 坚韧致密，前连额腹，后 连枕腹，1、2、3层，合 称头皮  Ⅳ.Subaponeurotic space (loose connective tissue)  Extracranial hematoma, the result of bleeding in the subaponeurotic space, can extend over the cranium. lt can extend posteriorly to the superior nuchal line; anteriorly, into the to produce the “black eye”; and laterally, to the temporal region.  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 the scalp from the periosteum.  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, 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  Ⅴ.Pericranium It is thin and dense．closely adherents with sutural ligaments at the site of the sutures of cranial bones and continues to the outer layer of dura mater．That is why the subpericranial hematoma usually limits within a piece of cranial bone． 薄而致密，易于颅骨分离， 如有血肿，与骨一致 Temporal region Boundaries  Superior－superior temporal line  Inferior－superior border of  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

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 三、面 部 face

1.面部浅层结构和面侧区 the superficial structures and the lateral region of the face 2.腮腺咬肌区 the Parotid and masseteric region 3.面侧深部

the deep part of the face 1.面部浅层结构 the superficial structures of the face

 The skin of face is very thin and connected to the facial bones by loose connective tissue. There is no deep fascia. The lie in this connective tissue. Facial muscles 面肌

 Epicranius muscle颅顶肌 (occipitofrontalis) 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

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 process of mandible  Action－elevates and retracts mandible  lateral pterygoid 翼外肌  Medial pterygoid 翼内肌 Arteries of face Facial a. 面动脉  Branch of external caroteid a.  Runs forward over digastric and submandibular gland  Loops around mandible (where 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 (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 Veins of face Facial vein 面静脉  Begins at medial angle of eye (angular vein)  Runs downward and backward 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 with pterygoid plexus 翼静脉 丛 via the deep facial vein 面深静脉

 “Facial dangerous triangle ”--危险三角  －lies between root of nose and two angles of mouth; in this area the facial vein has no valves. and the infections of this region can easily invade to the cranial cavity through the communic- ating ways of facial vein．

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 Pterygoid plexus 翼静脉丛  Located in the inferior fossa.  Receives blood from all regions supplied by maxillary a.  Communicates with  Face by deep facial veins  Cavernous sinus by veins draining base of skull  Provides possible pathway for spread of infection to cranial cavity

Nerves of face Facial nerve (Ⅶ) 面神 经  Leaves skull through internal acoustic meatus, facial canal and stylomastoid foramen  Divided three parts  First part－between stylomastoid foramen and  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 (Ⅴ1) → supraorbital n. 眶上神经

 Maxillary nerve 上颌神经 (Ⅴ2) → infraorbital n. 眶下神经

 Mandibular nerve 下颌神经 (Ⅴ3) →mental n. 颏神经 The lymphatic drainage of head Lymph nodes of head

 Located at junction of head and neck

 Consist of occipital, mastoid, parotid, submandibular, submental lymph nodes

 Drain into deep cervical lymph nodes （二）腮腺咬肌区 Parotid and Masseteric Region

 腮 腺 parotid gland

 位置和形态 morphology and location

 腮腺管 parotid duct

 腮腺咬肌筋膜 Parotid-masseteric fascia

 腮腺淋巴结 Parotid lymph node

 腮腺内主要血管、神经的排列 Arrangement of main vessels and nerves in the parotid gland

 咬肌 Masseter Parotid gland 腮腺  Position: situated below the external auditory meatus and lies in a deep hollow behind the ramus of mandible 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 from anterior border of gland  Lies 1.5 cm below and 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 is 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 is quite thin and easily disrupted. 3.面侧深部 the deep part of the face Artery

Maxillary artery 上颌动脉  Branch of external carotid a.  Entrance to infratemporal 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 foremen spinosum  Supplies cranium and dura mater 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 mylohyoid and

解剖步骤和注意事项 Dissection notes and procedure 切口 Incision • 皮肤 Skin incision • 翻皮瓣 Reflect the skin flaps

 The scalp: identify the layers of the scalp

 颞区浅层结构 The superficial part of temporal region 在耳屏前方解剖颞浅 动、静脉和耳颞神经。 In front of the tragus dissect the superficial temporal artery and vein and auriculotemporal n. • 面浅层结构 The superficial part of the face

1. 暴露重要的面表情肌 Expose the major facial muscles.

2.dissect the facial artery and vein  Find the artery at the 3. 解剖面动、静脉 junction of the lower border在下颌骨下缘与咬肌前 of the mandible 缘交界处找到面动脉，并of the anterior border of 追踪至眼的内眦。the masseter and then trace注意保护跨过面动脉浅 it to the medial angle of the eye. 面的下颌缘支。 Preserve the marginal mandibular找出并清理位于面动脉 branches 后方的面静脉。superfical to the facial artery.  Find and clean the facial vein posterior to the facial artery. 3.dissect the Parotid duct Parotid duct 腮腺管  Arises from anterior border of gland  Lies 1.5 cm below and parallel to zygomatic arch  Passes forward over masseter, pierces the buccinator and oral mucosa to open opposite second upper molar tooth

4. Dissect the branches of the facial nerve  Clean the surface of the parotid gland, find out the parotid2.解剖面神经的分支 duct and the buccal清理腮腺的表面，寻找腮 branches of the facial腺管和面神经的颏支，或 nerve, or the marginal mandibular branches在面神经浅面的下颌缘支。 of the facial nerve循着面神经分支逆行追踪 superficial to the facial至腮腺内面神经主干，然 artery. Follow one of the branches of the facial后循着面神经主干找到其 nerve back through the分支，并追踪至所支配的 parotid gland to the trunk面表情肌。 of the nerve, and then trace the other branches of the facial nerve following the trunk of the nerve to the muscles of expression.  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

5.Dissect the inferior alveolar nerve Estimate the location of the mandibular canal and chisel the outer plate of the ramus of mandible to identify the mandibular canal in the spongy substance of the bone. Break down the neck of mandible below the insertion of the lateral pterygoid. Gradually remove the bony structure, and carefully protect the vessels, nerves Artery

Maxillary artery 上颌动脉  Branch of external carotid a.  Entrance to infratemporal 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 foremen spinosum  Supplies cranium and dura mater 6. Dissect three terminal branches of the trigeminal nerve Cut between the frontalis and the orbicularis oculi to find out the supraobital nerve and vessels. Cut between the the orbicularis oculi and the levator labii superoris to find out the infraorbital nerve and vessels Cut between the depressor anguli oris and the depressor labii inferioris at the lower border of the mandible to find out the mental nerve and vessels.