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Head

Wu huiqun

The human anatomy department

 

Layers

n     consists of five layers:

q     Skin

q     Superficial fascia

q     Galea aponeurotica and occipitofrontalis

q     Subaponeurotic space (loose connective tissue) 腱膜下隙

q     Pericranium  

q     The superficial 3 layer are closely knit together, called scalp

 

n     The skin has the greatest concentration of hair and sebaceous皮脂腺glands

n     The superficial fascia is dense connective tissue that binds the skin strongly to the underlying galea aponeurotica

q    Wounds of the scalp bleed profusely but heal well.

   

 

Arteries, veins and nerves

n     Anterior group

q     Supratrochlear a. v. n.滑车上的

q     Supraorbital a.  v.  n.

n     Posterior group

q     Occipital a.  v.

q     Greater occipital n.

 

n     Galea aponeurotica

q     It is interposed between the frontalis and occipitalis portions of the occipitofrontalis muscle.

q     These muscles place the aponeurosis under tension so that deep transverse lacerations of the scalp gape widely .

 

n     Subaponeurotic space (loose connective tissue)

q     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 eyelids to produce the “black eye”; and laterally, to the temporal line.

q     The loose connective tissue layer provides the plane of separation in any injury that tears the scalp from the calvaria颅盖or for the surgeon elevating the scalp from the periosteum.

 

q     Contains  a rich network of deep arteries and veins. Therefore, this layer has been called the “dangerous area”.

q     Infaction may spread to the substance of the bones, to venous channels within the cranial cavity, or to the brain.

 

n     Pericranium

    Fuses firmly with bone at the sutures and with the periosteum of the adjacent bone, thus limiting the subperiosteal space.

Arteries of head

Facial a.

n          Branch of external carotoid a.

n          Runs forward over digastric and submandibular gland

n          Loops around mandible (where it is palpable), at anterior border of masseter, to enter the face

n          Follows a tortuous扭曲的course to medial angle of eye

n          Lies deep to most facial muscles

n  &bsp;       Branches

q        Inferior labial a. 下唇动脉

q        Superior labial a.

q        Angular a.

 

 

Superficial temporal a. Terminal branch of external carotid a.

n         Ascends in front of ear (where it is palpable) to supply temporal and anterior portion of scalp

n         Transverse facial a.

n         －runs above parotid duct to supply the cheek region

 

Maxillary artery

n         Branch of external carotid a.

n         Entrance to infratemporal fossa medial to neck of mandible

 

n     Branches

q     Inferior alveolar a. Middle meningeal a. enters the skull through foreman spinosum蝶骨棘

n      Supplies cranium and dura mater

q     Posterior superior alveolar a.

 

Veins of head

Facial vein

n      Begins at medial angle of eye (angular vein)

n      Runs downward and backward through the face, posterior to the facial artery

n      Below angle of mandible, joins anterior branch of retromandibular vein to form common facial vein, which drains into internal jugular vein

 

n     Connections with cavernous sinus through the ophthalmic vein, and also through pteygoid plexus 翼静脉丛 via the deep facial vein

 

 

n     “Danger area”

n     －lies between root of nose and two angles of mouth; in this area the facial vein has no valves

 

 

 

Retromandibular vein Formed by union of superficial temporal and maxillary veins

n     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

   Receives blood from all regions supplied by maxillary a.

n     Communicates with

q     Face by deep facial veins

q     Cavernous sinus by veins draining base of skull

n     Provides possible pathway for spread of infection to cranial cavity

 

The lymphatic drainage of head

 Lymph nodes of head

n      Located at junction of head and neck

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

n      Drain into deep cervical lymph nodes

n      Submandibular lymph node lies near the submandibular gland, receive lymphatic vessels from the face, nose and mouth

Nerves of head

Facial nerve (Ⅶ)

Leaves skull through internal acoustic meatus, facial canal and stylomastoid foramen

n          Divided three parts

q        First part－between stylomastoid foramen and parotid gland

q        Second part－within parotid gland

q        Third part－outside of parotid gland

 

 

 

 

 

n     Enters parotid gland and divides into its five terminal branches for muscles of facial expression

q     Temporal              

q     Zygomatic

q     Buccal

q     Marginal mandibular

q      Cervical

 

 

Trigeminal nerve (Ⅴ)

n     Ophthalmic nerve

(Ⅴ1) → supraorbital n.

n     Maxillary nerve

(Ⅴ2) → infraorbital n.

n     Mandibular nerve

n     (Ⅴ3) →mental n. 颏神经

Parotid gland

n     Position: situated below the external auditory meatus and lies in a deep hollow behind the ramus of mandibular and in front of the sternocleidomastoid

n     Superficial part: triangular in shape, lies below and in front of the external acoustic meatus, and partially covers the masseter.

n      Deep part: lies deep to medial pterygoid .

 

Parotid duct  

n    Arises front anterior border of gland

n    Lies 1.5 cm below and parallel to zygomatic arch

n    Passes forward over masseter, pierces the buccinator and oral mucosa to open opposite second upper molar tooth

 

 

Capsule of the parotid gland

n      The parotid gland is enclosed within a well-defined capsule which extension of the investing fascia of the neck.

n      The superficial capsule is thick and tightly affixed to the underlying glandular tissue by numerous fibrous septa.

n      The deep capsule is quite thin and easily disrupted.

Structures passing through the parotid gland

n     Vertical

q     External carotid a.

q     Retromandibular vein

q     Superficial temporal a. & v.

q     Auriculotemporal n.

n     Transversal

q     Maxillary a. & v.

q     Tranverse facial a. & v.

q     Branches of facial n.

Relationships of parotid gland

n      Superior－external acostic meatus, poterior margin of temporomandibular joint

n      Anteromedialy－masseter, ramus of mandible, posterior part of medial pterygoid

n      Poateromedial－mastoid process, sternocleidomastoid, posterior belly of digastric, styloid process, internal carotid a., internal jugular v., Ⅸ～Ⅻ cranial nerves

n      “Parotid bed”－internal carotid a., internal jugular v., Ⅸ～Ⅻ cranial nerves

 

Masseter space

n     Lies between the masseter, and ramus of mandible

Pterygomandibual space 翼下颌间隙

n     Lies between ramus of mandible and medial pterygoid

 

 

 

Sublingual space 舌下间隙

n     Between mucous membrane of floor of mouth and mylohyoid下颌舌骨的and hyoglossus舌骨舌肌

 

Temporal region

Boundaries

n     Superior－superior temporal line

n     Inferior－superior border of zygomatic arch

n     Anterior－the junction of frontal and zygomatic bones

n     Posterior－posterior portion of superior temporal line

 

Layers

n     consists of five layers:

q     Skin

q     Superficial fascia

q     Temporal fascia

q     Temporalis

q     Periosteum

 

Superficial fascia

n     Anterior auricular group

q     Superficial temporal a. & v.

q     Auriculotemporal n.

n     Posterior auricular group

q     Posterior auricular a. & v.

q     Lesser occipital n.

topic:                          speaker

neck vessels and nerves     stalin

grape                           

Neck

 Stalin

 

The arteries of neck

Common carotid artery    颈总动脉

n    Origin (arises from)

q   Brachiocephalic trunk   on the right

q   Aortic arch on the left

n    Ascends in neck to upper border of thyroid cartilage; bifurcates into internal     and external carotid arteries

 

n      Carotid sinus 颈动脉窦(baroreceptor), located at a localizes dilation of terminal part of common carotid artery or beginning of internal carotid artery, sensitive to blood pressure changes

n      Carotid glomus 颈动脉小球 (chemoreceptor), lies posterior to the point of bifurcation of common carotid artery, senses changes in blood carbon dioxide (oxygen) levels

 

 

Branches of external carotid a.        

n      Superior thyroid a.              甲状腺上动脉－descends to supply upper pole of thyroid gland and larynx

n      Lingual a. 舌动脉

n      Facial a. 面动脉

n      Occipital a.枕动脉

n      Posterior auricular a.             耳后动脉

n      Maxillary a. 上颌动脉

n      Superficial temporal a.        颞浅动脉

 

 Subclavian artery         锁骨下动脉

n      Origin (arises from)

q     Brachiocephalic trunk on right

q     Aortic arch on left

n      Becomes axillary artery at lateral border of first rib

n      Branches

q     Vertebral a. 椎动脉

q     Internal thoracic a. 胸廓内动脉

q     Thyrocervical trunk 甲状颈干

n      Inferior thyroid artery 甲状腺下动脉－supplies inferior pole of thyroid gland

q     Costocervical trunk 肋颈干

 

Veins Draining the neck

Internal jugular vein   颈内静脉

n      Begin at jugular foramen, descending to join the subclavian vein to form brachiocephalic vein

n      Lies lateral first to internal and then to common carotid a. within carotid sheath

n      Chief extracranial tributaries

q     Common facial vein 面总静脉

q     Lingual v. 舌静脉

q     Pharyngeal v. 咽静脉

q     Superior thyroid v.甲状腺上静脉

q     Middle thyroid v. 甲状腺中静脉

 

 

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Subclavian vein

n     It is an continuation of axillary vein at the lateral border of first rib

n     Joins internal jugular vein to form the brachiocephalic vein. Angle of union is termed venous angle 静脉角

 

External jugular vein 颈外静脉

n      Formed behind angle of mandible by union of posterior auricular, posterior branch of retromandibular and occipital vein

n      Crossing sternocleidomastoid to enter subclavian vein

 

Anterior jugular vein 颈前静脉

n      Drains submandibular and anterior neck regions

n      Descends near midline, runs posterior to sternal end of sternocleidomastoid to drain into external jugular vein or subclavian vein

Lymph nodes of neck

Anterior cervical lymph nodes

n     Superficial anterior cervical lymph nodes

n     Deep anterior cervical lymph nodes

Lateral cervical lymph node

n     Superficial lateral cervical lymph nodes－lie along the external jugular vein

 

Deep lateral cervical lymph nodes

n      Extend along the internal jugular vein from the base of skull to the root of neck, divided into superior deep lateral cervical lymph nodes and inferior deep lateral cervical lymph nodes

n      Receive lymphatic vessels from head, neck, tongue, larynx, cervical parts of esophagus and trachea, thyroid gland, upper parts of the thoracic wall and breast

n      Efferent vessels form the jugular trunk－the left jugular trunk joins the thoracic duct and right may joint the right lymphatic duct

 

Superior deep lateral cervical lymph nodes 颈外侧上深淋巴结

n      Jugulodigastric lymph node       颈内静脉二腹肌淋巴结: lies at the junction of posterior  belly of digastric and internal jugular vein

 

Inferior deep lateral cervical lymph nodes 颈外侧下深淋巴结

n      Juguloomohyoid lymph node     颈内静脉肩胛舌骨肌淋巴结: lies at the junction of the intermediate tendon of omohyoid and internal jugular vein

n      Supraclavicular lymph nodes     锁骨上淋巴结: lie along the subclavian artery

 

Right lymphatic duct 右淋巴导管

n      Formed by union of right jugular, subclavian, and bronchomediastinal trunks

n      Ends by entering the right venous angle

n      Receives lymph from right half of head, neck, thorax and right upper limb

Thoracic duct 胸导管

n      At the roof of the neck, it turns laterally and arches forwards and descends to enter the left venous angle

n      Just before termination, it receives the left jugular, subclavian and bronchomediastinal trunks

Cervical plexus

Formation: formed by anterior rami of C1-C4 spinal nerves

Position: lies in front of the origin of levator scapulae and scalenus medius and deep to the superior part of the sternocleidomastoid

 

Branches

n     Cutaneous branches: emerge around middle of posterior border of sternocleidomastoid, to supply skin of neck and scalp between auricle and external occipital protuberance

q     Lesser occipital n. 枕小神经

q     Greet auricular n. 耳大神经

q     Transverse nerve of neck     颈横神经

q     Supraclavicular n.  锁骨上神经

 

 

n      Muscular branches: supply the deep muscles of neck

n      Phrenic nerve 膈神经(anterior rami of C3-C5)

q     Lies on anterior scalene, deep to fascia

q     To diaphragm (motor and sensory)

n      Ansa cervicalis 颈袢:

q     Hypoglossal nerve gives off superior root of ansa (descendens hypoglossi), composed of fibers picked up from nerve C1

q     Joins inferior root of ansa (descendens cervicalis, C2and C3) to form a loop, the ansa cervicalis, which supplies infrahyoid muscles

 

 

 

 

Vagus nerve (Ⅹ)

n         Leaves skull via jugular foramen

n         Descends in the neck in carotid sheath between internal (or common) carotid artery and internal jugular vein

 

n      Branches

q     Superior laryngeal nerve 喉上神经 passes down side of pharynx and given rise to

n      Internal branch 内支                           which pierces thyrohyoid membrane to innervates mucous membrane of larynx above fissure of glottis

n      External branch 外支                            which innervates cricothyroid

q     Cervical cardiac branches 颈心支 : descending to terminate in cardiac plexus

q     Recurrent laryngeal nerves 喉返神经

n      Ascend in tracheo-esophageal groove

n      Enter larynx posterior to cricothyroid joint, the nerve is now called inferior laryngeal nerve

n      Innervations: laryngeal mucosa below fissure of glottis , all laryngeal laryngeal muscles except cricothyroid

 

Accessory n. (Ⅺ ) 副神经

n      Deep to posterior belly of digastric

n      Supplies sternoclidomastoid and trapezius muscle

 

Hypoglossal n.(Ⅻ) 舌下神经

n      Descends between internal carotid a. and internal jugular v., hooks around external carotid a., to lie on the hyoglossus before entering tongue

n      Supplies muscles of tongue

 

Cervical part of sympathetic trunk 颈交感干

n      Formed by superior , middle and inferior cervical ganglia and interganglionic branches

n      Superior cervical ganglion: largest, situated in front of transverse processes of C1~C3 vertebra

n      Middle cervical ganglion: smallest, is at level of  transverse processes of C6 vertebra

n      Inferior cervical ganglion: situated at level of C7 vertebra, and may be fused with first thoracic ganglion to form cervicothoracic ganglion    颈胸神经节

Thyroid gland 甲状腺

Shape and position

n      H-shape

n      Left and right lobes: lie on either side of inferior part of larynx and superior part of trachea, extend from middle of thyroid cartilage to level of sixth trachea cartilage

n      Isthmus: overlies 2nd to 4th tracheal cartilage

n      Pyramidal lobe: some times arises from isthmus

Fibrous capsule:

     A sheath of pretracheal fascia which is attached to arch of cricoid and thyroid cartilages, hence, the thyroid gland moves with larynx during swallowing and oscillates during speaking

 

Relations

n      Anteriorlly－skin , superficial fascia, investing fascia, infrahyoid muscles and pretracheal layer

n      Posteromedialy－ larynx and trachea, pharynx and esophagus, recurrent laryngeal n.

n      Posterolateraly－carotid sheath and cervical part of sympathetic trunk

Arteries of thyroid gland and nerves of larynx

Superior thyroid a.

n      Branch of external carotid a.

n      Runs superficial and parallel to the external branch of superior laryngeal n. to reach the upper pole of thyroid gland

n      Gives off superior laryngeal a. in company with internal branch of superior laryngeal n.

 

 

Superior laryngeal nerve

n      Internal branch which pierces thyrohyoid membrane to innervates mucous membrane of larynx above fissure of glottis

n      External branch is fine n., which descends in company with the superior thyroid a. and supplies  cricothyroid

 

 

 

Inferior thyroid artery 甲状腺下动脉

n      Branch of thyrocervical trunk off subclavian a.

n      Turns medially and downward, reaches the posterior border of the thyroid gland and is closely related to the recurrent laryngeal n.

n      Supplies inferior pole of thyroid gland

Recurrent laryngeal nerves 喉返神经

n      Ascend in tracheo-esophageal groove

n      Pass deep to the lobe of the thyroid gland and come into close relationship with the inferior thyroid a.

n      Cross either in front of or behind the artery of may pass between its branches

n      Nerves enter larynx posterior to cricothyroid joint, the nerve is now called inferior laryngeal nerve

n      Innervations: laryngeal mucosa below fissure of glottis , all laryngeal laryngeal muscles except cricothyroid  

 

 

Arteria thyroid ima 甲状腺最下动脉

n      May arise (4%) from the brachiocephalic a. or aortic arch

Venous drainage

n      Superior and middle thyroid veins into internal jugular vein

n      Inferior thyroid veins to left brachiocephalic vein

 

 

 

Parathyroid gland 甲状旁腺

n      Yellowish-brown, ovoid bodies

n      Position

q     Two superior parathyroid glands: lie at junction of superior and middle third of posterior border of thyroid gland

q     Two inferior parathyroid glands: lie near the inferior thyroid artery, close to the inferior poles of thyroid gland

n      Function: regulate calcium and phosphate balance and is therefore essential for life