2018年局部解剖学-头-文档资料.ppt
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1、第一章 头 Chapter 1 Head,Section 1 Introduction I. 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 a
2、nd Face 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 cereb
3、ral hemisphere. 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
4、 foramen lies about 2.5cm 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 o
5、f anterior portion of the temporal 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 p
6、art of auricle. Stylomastoid foramen, 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 i
7、n most cases is H-shaped. The bony structure 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 me
8、ningeal artery,Fracture of Pterion and Epidural Hematoma Epidural 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, headache
9、s, nausea, vomiting, dizziness, and problems with memory 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 posit
10、ion. Place a block under the neck to raise the head to a convenient 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 s
11、uperior nuchal line; Lateral superior temporal line.,Section 2 Cranium,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 tog
12、ether, called scalp clinically.,S,C,A,L,P,The makeup of scalp is important clinically 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 s
13、ebaceous glands and has abundant blood supply. It is a region of frequent site of furuncles 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
14、 vasculature of scalp runs primarily in this layer. The connective tissue has a special relationship 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 h
15、emorrhage, compression must be used to stop the bleeding.,The inflammation shall be limited in this 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 differe
16、nt regions:,1) anterior supratrochlear 3) posterior occipital a. v., greater occipital n,There is free anastomoses 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
17、,皮瓣蒂在下方 ),3. Epicranial aponeurosis and occipitofrontalis Epicranial aponeurosis is interposed between the frontal 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
18、. Subaponeurotic space ( loose connective tissue ) locates between scalp proper and pericranium which is limited by the 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, int
19、o eyelids to produce the “black eye”; and lateraliy, to temporal line.,The loose connective tissue layer provides the plane of 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
20、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 ),5. Pericranium is thin and dense, fuses firmly with bone at the sutures and wit
21、h the periosteum of the adjacent bone, thus limiting the subperiosteal space. That is why the subpericranial hematoma usually limites within 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 arc
22、h; Anterior the junction of frontal and zygomatic bones; Posterior posterior portion of superior temporal line.,II) Layers It consists of five layers: Skin, Superficial fascia, Temporal fascia, Temporalis, and Periosteum.,1. Skin and Superficial fascia The skin is thin in the anterior part, while it
23、 is thick in the posterior part of this region.,The superficial fascia is rich of fat which contains the superficial temporal and posterior auricular vessels as well as the auroculotemporal, lesser occipital, greater auricular nerves and temporal branch of facial nerve.,2. Temporal fascia is a dense
24、 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 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. Tem
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