The Local Anatomy of Oral Maxillo-Facial and Neck
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Transcript of The Local Anatomy of Oral Maxillo-Facial and Neck
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The Local Anatomy of Oral Ma
xillo-Facial and Neck
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口腔颌面颈部局部解剖
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The oral cavity
• The boundaries and superficial anatomy of
oral cavity
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第一节 口腔局部解剖
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一 口腔境界及表面标志(一)口腔的境界境界及分部(二)口腔前庭的表面标志定义1.口腔前庭沟(唇颊龈沟) 2.上、下唇系带 3.颊系带
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4. 腮腺导管口 5. 磨牙后区 由磨牙后三角和磨牙后垫组成。6.翼下颌皱襞 7.舌系带
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Lip
• The boundaries of lip
• Superficial anatomy of lip
• Layers of lip
• The blood vessels 、 lymphatic vessels and
nerves
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二 唇(一)唇的境界(二)表面标志(三)唇的解剖层次1.皮肤 2. 浅筋膜 比较疏松。3.肌层 主要为口轮匝肌。4. 粘膜下层 有粘液腺和上、下唇动脉。5.粘膜 有粘液腺开口。
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(四)唇的血管、淋巴管及神经1. 主要血供为颌外动脉的分支上、下唇动脉,静脉血经面前静脉回流。2.淋巴管很丰富3. 唇的感觉神经来自上、下颌神经的分支,运动则由面神经支配。
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Bucca
• Boundaries
• Layers and constructures
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三、颊(一)境界(二)层次1.皮肤。2. 皮下组织3. 颊筋膜 4. 颊肌。5. 粘膜下层 含有粘液腺。6.粘膜 有腮腺导管的开口。
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Palate
• Superficial anatomy
• The features of hard and soft palate
• The muscles of soft palate
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四 腭分为前 2/3的硬腭和后 1/3的软腭两部分。(一)硬腭的表面标志1.腭中缝 2.切牙乳头(腭乳头) 3.腭皱襞 4.上颌硬区和上颌隆突 5.腭大孔 6.蝶骨翼突钩 7.腭小凹
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(二)硬腭软组织的特点1. 粘膜下层前部含有少量脂肪,无腺体;后部则有较多的腭腺。2. 硬腭的骨膜与粘膜下层附着紧密,而与骨面附着则不太紧密。3. 粘骨膜不易移动,能耐受磨擦和咀嚼压力。(三)软腭的肌群
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Tongue
• The dorrum of the tongue
• The inferior surface of the tongue
• The lymphatic vessles of the tongue
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五 . 舌
(一)舌背
舌背以“人”形界沟为界,分为舌前 2/3和舌后 1/3 。舌前 2/3 又称为舌体,舌后 1/3 称为舌根。舌前 2/3 分布有四种舌乳头:
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• 1. 丝状乳头
• 2. 菌状乳头
• 3. 轮廓乳头
• 4. 叶状乳头
•舌后 1/3 粘膜无舌乳头,但有结节状淋巴组织,称舌扁桃体。
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(二) 舌腹
标志
1舌系带
2伞襞
3舌下肉阜
4舌下襞
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(三)舌的淋巴管
1.舌尖淋巴管
大部分至颏下淋巴结,小部分至颈肩胛舌骨肌淋巴结。
2.舌体边缘或外侧淋巴管
部分至颌下淋巴结,另一部分至颈深上淋巴结。
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3. 舌中央淋巴管
汇入颈深上淋巴结,亦有汇入颌下淋巴结者。
4. 舌根淋巴管
汇入两侧颈深上淋巴结。
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The floor of the mouth
• Boundaries
• Constructures
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六 口底舌下区
(一)境界(二)内容1.舌下腺及颌下腺深部 2.颌下腺导管及舌神经 3.舌下神经及其伴行静脉 4.舌下动脉
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The Local Anatomy of Maxillo-Facial Area
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第二节 颌面部局部解剖
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一、颌面部表面标志及软组织特点
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(一) 表面解剖标志鼻根、鼻尖和鼻背鼻底和鼻前孔鼻小柱和鼻翼鼻面沟 唇面沟 鼻唇沟
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鼻唇沟鼻下点口裂口角颏唇沟颏前点颏下点耳屏
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体表投影眶下孔、颏孔、腮腺导管、面神经出茎乳孔的位置
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(二)面部比例
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(三)对称(四)美容角
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鼻额角鼻面角鼻唇角鼻颏角颏颈角
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(五) X线头影测量(cephalometric radiography)是将 X线头颅定位照相所得的影像转描于描图纸上,显示各标志点并构成线、角、面进行测量分析,用于正颌外科、口腔正畸科及研究颅面生长发育。
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1.常用 X 线头影测量标志点
1) 硬组织标志点• 蝶鞍点 (S.Sella)
• 鼻根点 (N.Nasion)
• 耳点 (P.Porion)
• 眶点 (O.Orbitale)
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•翼上颌裂点 (Ptm.pterygommaxillary fissure)
•前鼻点 (ANS.Anterior nasal spine)•后鼻点 (A.Subspinale)•下牙槽座点 (B.Supramental)•颏前点 (Pg.Pogonion)•颏下点 (Me.Menton)
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2) 软组织标志点(略)
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2.常用 X 线头影测量平面、角及线 距1) 测量平面(硬组织)
前颅底平面 (SN.SN plane)眼耳平面 (FH.Frankfortt horizontal plane)牙合平面 (OP.Occlusal plane)
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2) 角度测量(硬组织)
• SAN角• SNB角• ANB角• NA-PgA角 (Angle of convexity,颌凸角)
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3 )线距测量(硬组织)
•前全面高(Anterior total facial height,ATFH)
•前上面高(Anterior upper facial height ,AUFH)
•前下面高(Anterior lower facial height, ALFH)
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3. 临床应用
• 上颌骨水平位置
• 上颌骨垂直位置
• 下颌骨水平位置
• 下颌骨垂直位置
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(六)协调
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The superficial anatomy and the featuser of soft tissues
• Superficial anatomy
• The Proportion of the face
• Symmetry
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• Cosmetoloyg angles
• Cephalometric analysis
• Coordination
• The features of The maxillo-facial soft tiss
ue
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二 .颌面部软组织的特点
1. 皮肤薄而柔软,皮下组织疏松,易于伸展移动。但鼻翼与颏部皮肤与皮下组织结合紧密,不易伸展。
2.富于皮脂腺、毛囊和汗腺。
3.血管密集,血运丰富。
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4. 有皮肤皱纹,走向有一定的规律。
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5. 皮下组织中有表情肌,手术或创伤处理
时应注意表情肌的缝合,以避免影响表
情肌功能。
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The area of the parotid gland and masseter muscle
• Boundaries
• Constructures
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三 .腮腺咬肌区
(一)境界
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(二)内容
1.腮腺
腮腺鞘的特点
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腮腺与神经血管的关系
( 1 )腮腺内神经血管纵行的有:颞浅动静脉、耳颞神经、面后静脉、颈外动。
横行的有:面神经、颌内动静脉及面横动脉。
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( 2)腮腺浅叶上缘神经血管排列
从后向前依次为颞浅静脉、耳颞神经、颞浅动脉、面神经颧支和颞支
( 3 )腮腺浅叶前缘结构从上到下依次排列为面横动脉、面神经颧支、面神经上颊支、腮腺导管、面神经下颊支及下颌缘支。
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( 4 )腮腺浅叶下端神经血管的排列从前向后依次为面神经下颌缘支、面神经颈支、面后静脉
( 5 )腮腺深叶面的神经血管腮腺深叶的深面与茎突诸肌及深部血管神经包括颈内动、静脉和第Ⅸ~Ⅻ对脑神经
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2.咬肌 位于腮腺咬肌筋膜的深面。
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Lateral deep face
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四、面侧深区(一)境界(二)内容1.翼丛2.颌内动脉 3.翼外肌 4.下颌神经及其分支
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Space
• Infraorbital space
• Buccal space
• Massetric space
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• Pterygomandibular space
• Infratemporal space
• Temporal space
• Parapharyngeal space
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• Sublingeal space
• Submandibular space
• Submental space
• Pterygopalatine space (fossa)
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五、 蜂窝组织间隙
(一)眶下间隙
位于眼眶前部的下方。上界眶下缘,
下界上颌骨牙槽突,内界鼻侧缘,
外以颧肌为界。
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(二)颊间隙
位于颊肌与咬肌之间。前界咬肌前缘,
后界下颌支前缘,后界下颌支前缘及
颞肌前缘。
广义的颊间隙应为颊部皮肤与粘膜之
间。
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(三)咬肌间隙
位于咬肌与下颌支之间。前界为磨牙
后区粘膜,后界腮腺。
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(四)翼颌间隙(翼下颌间隙)
位于下颌支与翼内肌之间,前界颞肌
及颊肌,后界腮腺,上界翼外肌下缘,
下以翼内肌附着于下颌支处为界。
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(五)颞下颌间隙
位于翼颌间隙上方。前界上颌骨后面,后
界茎突及茎突诸肌,内界蝶骨翼突外侧板,
外界下颌支上份及颧弓,上界蝶骨大翼的
颞下面和颞下嵴,下以翼外肌下缘平面为
界。
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(六)颞间隙
位于颞区,借颧弓与颞下嵴的平面和颞下
间隙分界,可分为颞浅间隙和颞深间隙两
部分。
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(七)咽旁间隙(咽侧间隙)
位于翼内肌,腮腺深叶与咽侧壁之间,上
达颅底,下至舌骨平面,前界翼下颌韧带,
后界椎前筋膜
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(八)舌下间隙
位于舌和口底粘膜之下,下颌舌骨肌及舌
骨舌肌之上。前界及两侧为下颌体的内侧
面;后部止于舌根。
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(九)下颌下间隙
位于下颌下三角内,周界与下颌下三角相
同。上界为下颌下缘,下界为二腹肌的前
后腹。其底由下颌舌骨肌、舌骨舌肌和咽
上缩肌等构成。
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(十)颏下间隙
位于舌骨上区,为以颏下三角为界的单一
间隙。
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(十一)翼腭间隙(翼腭窝)
位于眶尖的下方、颞下窝的内侧。前界上
颌骨体部,后界蝶骨翼突,上为蝶骨大翼,
内以腭骨垂直板为界。
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The Local Anatomy of the Neck
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Concept
• Boundaries
• Superficial anatomy
• Neck fascia
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第三节 颈部局部解剖
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一概述
(一)颈部境界和分区
1.以斜方肌前缘为界
2.以胸锁乳突肌前、后缘为界
1)颈前三角
2)胸锁乳突肌区
3)颈后三角
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(二)体表标志和体表头影
1. 舌骨
2.甲状软骨
3.环状软骨
4.气管颈段(略)
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5.胸锁乳突肌 6.锁骨上窝7.胸骨上窝8. 颈总动脉和颈外动脉9.锁骨下动脉10. 颈外静脉11.副神经12.胸膜顶
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(三)颈筋膜
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1.颈浅筋膜
2.颈深筋膜浅层
形成完整的封套包绕部
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3.颈深筋膜中层 上连舌骨,两侧至肩胛舌骨肌外缘,向下附着于锁骨和胸骨柄的后缘,并包被舌骨下肌群。
4.颈脏器筋膜 包被颈部脏器,如喉、气管、甲状腺、咽及食管等。
5.椎前筋膜(颈深筋膜深层)
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Cervical part of trachea
• Boundaries and constructures
• Attention of tracheotony
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二 .气管颈段
(一)气管颈段前方的层次
(二)气管切开的注意点
1. 采取头正中后仰位,以免伤及颈总动脉,并使气管位置变浅。
2. 一般在第 3 ~ 5 气管软骨环的范围内切开。
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3. 切开时注意深度,以免伤及气管后壁,甚至伤及食管。
4. 勿切第一气管软骨环,以免术后发生喉部狭窄。
5. 切开不应低于第 5 气管软骨环,以免引起无名动脉等损伤。
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Submandibular area
• Boundaries
• Constructures
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三 .颌下区(一)境界
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(二)内容
1.颌下腺
2.颌下淋巴结
3.面前静脉
4.颌外动脉
5.颌下神经节
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6.舌神经、颌下腺导管和舌下神经
三者位于颌下腺深面,在舌骨舌肌的浅面,自上而下依此排列:
舌神经、颌下腺导管、舌下神经。
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舌神经与颌下腺导管关系密切,从解剖关系上可作以下鉴别:1. 联系 舌神经连于颌下神经节,导管则直接发自颌下腺。
2. 位置 在舌骨舌肌表面,舌神经位于导管的上方。
3. 形态 舌神经比颌下腺导管粗而略扁,且坚韧。
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Carotid triangles
• Boundaries
• Constructures
• Common carotid artery
• Internal carotid artey
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• External carotid artey
• Internal jugutar vein
• Common facial vein
• External maxillary artery
• Hypoglossal nerve
• Superior laryngeal nerve
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四 .颈动脉三角 (一)境界
前上界为二腹肌后腹,前下界为肩胛舌
骨肌上腹,后以胸锁乳突肌为界。
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(二)内容1.颈总动脉 2.颈内动脉和颈外动脉 3.颈内静脉4.面总静脉 5.颌外动脉 6.舌下神经
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7.喉上神经
8.二腹肌后腹深面至该肌下缘,自后向前依次排列的血管神经为:副神经、颈内神经、颈外神经舌下神经、颈内动脉、颈外动脉及颌外动脉 .
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Posteria triangles of neck
• Boundaries
• Constructures
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五 颈后三角(一)境界
前界胸锁乳突肌,后界斜方肌前缘,下以
锁骨 1/3为界。
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(二)内容
1.皮肤
2.颈浅筋膜
3.颈深筋膜浅层
4.颈深筋膜中层
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5.副神经、脊副淋巴结、颈横动脉及锁骨上淋巴结
6.椎前筋膜
7.臂丛及锁骨下血管