局部解剖学（九）
? 颈部的局部解剖与操作（ 1）
颈 部 Neck
? 概述 introduction
? 浅层结构 superifical structures
? 下颌下三角 submandibular triangle
? 颏下三角 submental triangle
一、概述 Introduction
? 境界和分区 boundary and regions
? 表面解剖 surface anatomy
– 表面标志 surface landmark
– 体表投影 surface projection
上界,为下颌骨下缘、下颌角、乳突、上项线与枕外隆突的连线。
Superiorly,an line linking with the lower border of mandible,
the angle of mandible,the mastoid process,the superior
nuchal line and the external occipital protuberance;
下界,由胸骨上缘、锁骨和肩峰至第 7颈椎棘突的连线。 Inferiorly：
by the upper border of sternum,the clavicle and a line
extending from the acromion to the spine of 7th cervical
vertebra,
1,颈部的境界 boundary of the neck
2.颈部分区
? 颈部,分为固有颈部（ proper neck）和项部（ nape）。
? 固有颈部,又可分为颈前区 anterior region、胸锁乳突肌区
sternocleidomastoid region和颈外侧区 lateral region。
? 颈前区：被舌骨 hyoid分为舌骨上区 suprahyoid region（包括 2
个下颌下三角和 1个颏下三角）和舌骨下区 infrahyoid region
（包括成对的颈动脉三角和肌三角）。
? 颈外侧区：被肩胛舌骨肌下腹分为枕三角和锁骨上三角。
3.表面标志 surface landmark
Lesser supraclavicular fossa
(Greater) supraclavicular fossa
Suprasternal fossa
表面标志
Surface Landmark
? 舌骨 Hyhoid(H)
? 甲状软骨
Thyroid cartilage(T)
? 喉结节
Laryngeal prominence(P)
? 环状软骨
Cricoid cartilage (C)
? 第 1气管环
The first tracheal ringe(1)
? 甲状腺峡 Isthmus(S)
?环状软骨 (弓 )的意义
?第 6颈椎水平
The level of the 6th
cervical vertebra,
?喉与气管交界 The
junction of the larynx
with the trachea,
?咽与食管交界 The
junction of the
pharynx with the
esophagus,
?The level at which
the vertebral artery
enters the
transverse foramen
of the 6th cervical
vertebra,
?The site at which
the carotid artery
can be pressed
against the carotid
tubercle of the 6th
cervical vertebra,
?The level at which
the inferior thyroid
artery and the middle
thyroid vein enter or
leave the thyroid
gland,
?The level
at which
the
superior
belly of the
omohyoid
muscle
crosses
the carotid
sheath,
?The level of
the middle
sympathetic
ganglion,
二、颈部浅层结构
The superficial structures of the neck
? 皮肤 The skin( thin and pliable)
? 浅筋膜及其内容 The superficial fascia and its contents
? a thin layer of fat
? a sheet of platysma
? the anterior jugular vein
? the lateral jugular vein
? the superficial(lateral and anerior)cervical lymph
nodes
? the cutaneous branches of the cervical plexus
? the cervical branch of the facial nerve
1,颈阔肌
The platysma
? Is a broad,thin sheet of
muscle in the
subcutaneous tissue,
? Covers the anterolateral
aspect of the neck,
? Aarise in fascia covering
superior parts of the
deltoid and pectoralis
major muscles and
sweep superomedially
over the clavicle to the
inferior border of the
mandible,skin,and
subcutaneous tissue of
lower face,
? Is one of the muscles of
facial expression,
? Is innervated by the
cervical branch of the
facial nerve,
? The
superficial
cervical
veins and
nerves are
located deep
to the
platysma,
? The main action of the platysma:① draws corners of mouth
inferiorly and widens it as in expressions of sadness and fright;
② draws the skin of neck superiorly when teeth are,clenched”,
2,
? 颈前静脉或颈前正中静脉、颈外静脉
颈
静
脉
弓
Jugular venous arch
3,颈浅淋巴结 Superficial cervical lymph nodes
4,Superficial
cervical nerves
? Cutaneous
branches of the
cervical plexus
? Nerve point of
neck
? Cervical branch
of the facial
nerve
? 面神经的颈支 Cervical branch of facial nerve
三、颈筋膜及筋膜间隙
Cervical Fasciaand
Fascial Space
1,颈筋膜 Cervical Fascia
? 颈深筋膜分为三层
Deep cervical fascia consists of three fascial layers,
– 浅层 Superficial layer
封套筋膜 Investing fascia
– 中层 Middle layer
气管前筋膜 Prechacheal fascia
内脏筋膜 Visceral fascia
– 深层 Deep layer
椎前筋膜 Prevertebral fascia
? 封套筋膜,气管前筋膜、椎前筋膜
? 颈动脉鞘、气管前筋膜、甲状腺鞘、甲状腺悬韧带
2,颈筋膜间隙 Cervical Fascial Spaces
? 胸骨上间隙 Suprasternal space
? 咽后间隙 Retropharyngeal space
? 气管前间隙 Prechacheal space
? 椎前间隙 Prevertebral space
? 胸骨上间隙、咽后间隙、气管前间隙、椎前间隙
胸 骨 上 间 隙的内容
Contents of the Suprasternal space
Include the,
? 颈前筋膜下端
Inferior ends of the anterior jugular veins
? 颈静脉弓 Jugular venous arch
? 疏松结缔组织 Loose connective tissue
? 1~2个淋巴结 One or two deep lymph nodes
? 胸锁乳突胸骨头
Sternal heads of the ternocleidomastoid
? 锁骨间韧带 Interclavicular ligament
锁骨上间隙的内容
Contents of the supraclavicular space
Include the,
? 颈外静脉 A part of the external jugular vein
? 锁骨上神经 Supraclavicular nerves
? 颈横静脉 Transverse cervical vein
? 肩胛上静脉 Suprascapular vein
? 淋巴管 A few lymph vessels
四、颏 下 三 角
Submental Triangle
? 境界 Boundary
? 内容 Contents
颏下三角 Boundaris of submental triangle
Body of hyoid bone
颏 下 三 角 的 内 容
Contents of the submental triangle
Include the,
? 几个小的颏下淋巴结
Several small submental lymph nodes,
? 几条小静脉，汇合成颈前静脉
Small veins that unite to form the anterior jugular
vein,
五、下 颌 下 三 角
Submandibular Triangle
? 境界 Boundary
? 内容 Contents
1,下 颌 下 三 角
Boundaris of the submandibular triangle
? A roof of the submandibular triangle is formed by the skin,
superficial fascia,platysma and investing fascia,
?A floor of the submandibular triangle is formed by the
mylohyoid,hyoglossus and middle pharyngeal constrictor,
Middle
pharyngeal
constrictor
Mylohyoid
Hyoglossus
下
颌
下
三
角
的
底
下
颌
下
三
角
的
顶
与
底
2.下颌下三角的主要结构
Main contents of the submandibular triangle
? 下颌腺及其导管 Submandibular gland and its duct
? 面静脉 Facial vein
? 面神经的颈支 Cervical branch of facial nerve
? 下颌下淋巴结 Submandibular lymph nodes
? 面动脉 Facial artery
? 颏下动、静脉 Submental artery and vein
? 下颌舌骨肌神经 Mylohyoid nerve
? 舌下神经 Hypoglossal nerve
? 舌动、静脉 Lingual artery and vein
? 舌神经 Lingual Nerve,
? 下颌下神经节 Submandibular ganglion
1,在下颌下腺的浅面有,
面静脉、面神经的颈支、下颌下淋巴结
Cervical branches of facial nerve
Mylohyoid
2,The submandibular gland is divided into the
superficial and deep parts by the posterior border of
mylohyoid,its duct emerges from the deep of the gland and
then opens on the sublingual papilla,
3,在下颌下腺的深面：①在下颌舌骨肌浅面的结构有颏下动脉和静
脉、下颌舌骨肌神经；②在舌骨舌肌浅面的结构有舌静脉、面动脉、
舌下神经、下颌下神经节和舌神经；③在舌骨舌肌深面的结构有舌
动脉。
4.下颌下腺深部及其导管的毗邻：自上而下为舌神经、下颌下神经
节、下颌下腺及其导管、舌下神经、舌动脉和静脉。
六、解剖与观察
Dissection and Observation
?1.Make a median skin incision
?2.Reflect the skin flaps
?3.Reflect the platysma
?4.Dissect the superficial structures
?5.Dissect the submental triangle
?6.Dissect the submandibular triangle
1.Make a median skin incision from the mental symphysis to
the suprasternal notch,
2.Reflect the skin flaps
laterally to the anterior
border of the trapezius
to expose the platysma
directly,
3.Divide the platysma
along the upper border
of the clavicle and
reflect it upwards to
the mandible,Do not
damage the underlying
structures,
4.Look for and
expose the
superficial
structures of
the neck,
5.Clean boundaris of the submental triangle
?6,Cut through the investing fascia to exopse the
submandibular gland,the facial vein,the cervical branches of
the facial nerve and submandibular lymph nodes,
? Identify the facial artery and follow it to its origin,
? Divide the origin of the anterior belly of the digastric and
reflect it downwards,Look for the submental vessels and the
mylohyoid nerve on the mylohyoid,
Clean mylohyoid and cut it along the medi n line and
immed ately above the hyoid.Reflect the mylohyoid upwards
to expose th hypoglossal nerve on the hyoglossus,
? Look for the
lingual
artery and
vein
between the
hypoglossus
nerve and
the greater
horn of the
hyoid,trace
it to the
submandibul
ar triangle,
? Look for
the duct of
submandibular
gland,the
submandibular
ganglion,and
lingual nerve,
? 解剖下颌下三角
?清理下颌下三角的边界、面神经的颈支、面静脉
和下颌下淋巴结。
?切开封套筋膜暴露下颌下腺。
?在咬肌的前下方找到面动脉，追踪其至起点。
?切断二腹肌前腹在下颌骨上的附着点,并翻向下
清理下颌舌骨肌，寻找下颌舌骨肌神经及颏下血
管。
?切断下颌舌骨肌在舌骨上的附着部,将其翻向上
暴露舌骨舌肌，寻找舌下神经、下颌下腺深部及
其导管、下颌下神经节、舌神经、咽中缩肌。
?在舌骨大角与舌下神经之间处寻找舌动脉和舌静
脉，追踪至下颌下三角。
? 颈部的局部解剖与操作（ 1）
颈 部 Neck
? 概述 introduction
? 浅层结构 superifical structures
? 下颌下三角 submandibular triangle
? 颏下三角 submental triangle
一、概述 Introduction
? 境界和分区 boundary and regions
? 表面解剖 surface anatomy
– 表面标志 surface landmark
– 体表投影 surface projection
上界,为下颌骨下缘、下颌角、乳突、上项线与枕外隆突的连线。
Superiorly,an line linking with the lower border of mandible,
the angle of mandible,the mastoid process,the superior
nuchal line and the external occipital protuberance;
下界,由胸骨上缘、锁骨和肩峰至第 7颈椎棘突的连线。 Inferiorly：
by the upper border of sternum,the clavicle and a line
extending from the acromion to the spine of 7th cervical
vertebra,
1,颈部的境界 boundary of the neck
2.颈部分区
? 颈部,分为固有颈部（ proper neck）和项部（ nape）。
? 固有颈部,又可分为颈前区 anterior region、胸锁乳突肌区
sternocleidomastoid region和颈外侧区 lateral region。
? 颈前区：被舌骨 hyoid分为舌骨上区 suprahyoid region（包括 2
个下颌下三角和 1个颏下三角）和舌骨下区 infrahyoid region
（包括成对的颈动脉三角和肌三角）。
? 颈外侧区：被肩胛舌骨肌下腹分为枕三角和锁骨上三角。
3.表面标志 surface landmark
Lesser supraclavicular fossa
(Greater) supraclavicular fossa
Suprasternal fossa
表面标志
Surface Landmark
? 舌骨 Hyhoid(H)
? 甲状软骨
Thyroid cartilage(T)
? 喉结节
Laryngeal prominence(P)
? 环状软骨
Cricoid cartilage (C)
? 第 1气管环
The first tracheal ringe(1)
? 甲状腺峡 Isthmus(S)
?环状软骨 (弓 )的意义
?第 6颈椎水平
The level of the 6th
cervical vertebra,
?喉与气管交界 The
junction of the larynx
with the trachea,
?咽与食管交界 The
junction of the
pharynx with the
esophagus,
?The level at which
the vertebral artery
enters the
transverse foramen
of the 6th cervical
vertebra,
?The site at which
the carotid artery
can be pressed
against the carotid
tubercle of the 6th
cervical vertebra,
?The level at which
the inferior thyroid
artery and the middle
thyroid vein enter or
leave the thyroid
gland,
?The level
at which
the
superior
belly of the
omohyoid
muscle
crosses
the carotid
sheath,
?The level of
the middle
sympathetic
ganglion,
二、颈部浅层结构
The superficial structures of the neck
? 皮肤 The skin( thin and pliable)
? 浅筋膜及其内容 The superficial fascia and its contents
? a thin layer of fat
? a sheet of platysma
? the anterior jugular vein
? the lateral jugular vein
? the superficial(lateral and anerior)cervical lymph
nodes
? the cutaneous branches of the cervical plexus
? the cervical branch of the facial nerve
1,颈阔肌
The platysma
? Is a broad,thin sheet of
muscle in the
subcutaneous tissue,
? Covers the anterolateral
aspect of the neck,
? Aarise in fascia covering
superior parts of the
deltoid and pectoralis
major muscles and
sweep superomedially
over the clavicle to the
inferior border of the
mandible,skin,and
subcutaneous tissue of
lower face,
? Is one of the muscles of
facial expression,
? Is innervated by the
cervical branch of the
facial nerve,
? The
superficial
cervical
veins and
nerves are
located deep
to the
platysma,
? The main action of the platysma:① draws corners of mouth
inferiorly and widens it as in expressions of sadness and fright;
② draws the skin of neck superiorly when teeth are,clenched”,
2,
? 颈前静脉或颈前正中静脉、颈外静脉
颈
静
脉
弓
Jugular venous arch
3,颈浅淋巴结 Superficial cervical lymph nodes
4,Superficial
cervical nerves
? Cutaneous
branches of the
cervical plexus
? Nerve point of
neck
? Cervical branch
of the facial
nerve
? 面神经的颈支 Cervical branch of facial nerve
三、颈筋膜及筋膜间隙
Cervical Fasciaand
Fascial Space
1,颈筋膜 Cervical Fascia
? 颈深筋膜分为三层
Deep cervical fascia consists of three fascial layers,
– 浅层 Superficial layer
封套筋膜 Investing fascia
– 中层 Middle layer
气管前筋膜 Prechacheal fascia
内脏筋膜 Visceral fascia
– 深层 Deep layer
椎前筋膜 Prevertebral fascia
? 封套筋膜,气管前筋膜、椎前筋膜
? 颈动脉鞘、气管前筋膜、甲状腺鞘、甲状腺悬韧带
2,颈筋膜间隙 Cervical Fascial Spaces
? 胸骨上间隙 Suprasternal space
? 咽后间隙 Retropharyngeal space
? 气管前间隙 Prechacheal space
? 椎前间隙 Prevertebral space
? 胸骨上间隙、咽后间隙、气管前间隙、椎前间隙
胸 骨 上 间 隙的内容
Contents of the Suprasternal space
Include the,
? 颈前筋膜下端
Inferior ends of the anterior jugular veins
? 颈静脉弓 Jugular venous arch
? 疏松结缔组织 Loose connective tissue
? 1~2个淋巴结 One or two deep lymph nodes
? 胸锁乳突胸骨头
Sternal heads of the ternocleidomastoid
? 锁骨间韧带 Interclavicular ligament
锁骨上间隙的内容
Contents of the supraclavicular space
Include the,
? 颈外静脉 A part of the external jugular vein
? 锁骨上神经 Supraclavicular nerves
? 颈横静脉 Transverse cervical vein
? 肩胛上静脉 Suprascapular vein
? 淋巴管 A few lymph vessels
四、颏 下 三 角
Submental Triangle
? 境界 Boundary
? 内容 Contents
颏下三角 Boundaris of submental triangle
Body of hyoid bone
颏 下 三 角 的 内 容
Contents of the submental triangle
Include the,
? 几个小的颏下淋巴结
Several small submental lymph nodes,
? 几条小静脉，汇合成颈前静脉
Small veins that unite to form the anterior jugular
vein,
五、下 颌 下 三 角
Submandibular Triangle
? 境界 Boundary
? 内容 Contents
1,下 颌 下 三 角
Boundaris of the submandibular triangle
? A roof of the submandibular triangle is formed by the skin,
superficial fascia,platysma and investing fascia,
?A floor of the submandibular triangle is formed by the
mylohyoid,hyoglossus and middle pharyngeal constrictor,
Middle
pharyngeal
constrictor
Mylohyoid
Hyoglossus
下
颌
下
三
角
的
底
下
颌
下
三
角
的
顶
与
底
2.下颌下三角的主要结构
Main contents of the submandibular triangle
? 下颌腺及其导管 Submandibular gland and its duct
? 面静脉 Facial vein
? 面神经的颈支 Cervical branch of facial nerve
? 下颌下淋巴结 Submandibular lymph nodes
? 面动脉 Facial artery
? 颏下动、静脉 Submental artery and vein
? 下颌舌骨肌神经 Mylohyoid nerve
? 舌下神经 Hypoglossal nerve
? 舌动、静脉 Lingual artery and vein
? 舌神经 Lingual Nerve,
? 下颌下神经节 Submandibular ganglion
1,在下颌下腺的浅面有,
面静脉、面神经的颈支、下颌下淋巴结
Cervical branches of facial nerve
Mylohyoid
2,The submandibular gland is divided into the
superficial and deep parts by the posterior border of
mylohyoid,its duct emerges from the deep of the gland and
then opens on the sublingual papilla,
3,在下颌下腺的深面：①在下颌舌骨肌浅面的结构有颏下动脉和静
脉、下颌舌骨肌神经；②在舌骨舌肌浅面的结构有舌静脉、面动脉、
舌下神经、下颌下神经节和舌神经；③在舌骨舌肌深面的结构有舌
动脉。
4.下颌下腺深部及其导管的毗邻：自上而下为舌神经、下颌下神经
节、下颌下腺及其导管、舌下神经、舌动脉和静脉。
六、解剖与观察
Dissection and Observation
?1.Make a median skin incision
?2.Reflect the skin flaps
?3.Reflect the platysma
?4.Dissect the superficial structures
?5.Dissect the submental triangle
?6.Dissect the submandibular triangle
1.Make a median skin incision from the mental symphysis to
the suprasternal notch,
2.Reflect the skin flaps
laterally to the anterior
border of the trapezius
to expose the platysma
directly,
3.Divide the platysma
along the upper border
of the clavicle and
reflect it upwards to
the mandible,Do not
damage the underlying
structures,
4.Look for and
expose the
superficial
structures of
the neck,
5.Clean boundaris of the submental triangle
?6,Cut through the investing fascia to exopse the
submandibular gland,the facial vein,the cervical branches of
the facial nerve and submandibular lymph nodes,
? Identify the facial artery and follow it to its origin,
? Divide the origin of the anterior belly of the digastric and
reflect it downwards,Look for the submental vessels and the
mylohyoid nerve on the mylohyoid,
Clean mylohyoid and cut it along the medi n line and
immed ately above the hyoid.Reflect the mylohyoid upwards
to expose th hypoglossal nerve on the hyoglossus,
? Look for the
lingual
artery and
vein
between the
hypoglossus
nerve and
the greater
horn of the
hyoid,trace
it to the
submandibul
ar triangle,
? Look for
the duct of
submandibular
gland,the
submandibular
ganglion,and
lingual nerve,
? 解剖下颌下三角
?清理下颌下三角的边界、面神经的颈支、面静脉
和下颌下淋巴结。
?切开封套筋膜暴露下颌下腺。
?在咬肌的前下方找到面动脉，追踪其至起点。
?切断二腹肌前腹在下颌骨上的附着点,并翻向下
清理下颌舌骨肌，寻找下颌舌骨肌神经及颏下血
管。
?切断下颌舌骨肌在舌骨上的附着部,将其翻向上
暴露舌骨舌肌，寻找舌下神经、下颌下腺深部及
其导管、下颌下神经节、舌神经、咽中缩肌。
?在舌骨大角与舌下神经之间处寻找舌动脉和舌静
脉，追踪至下颌下三角。
