Download NECK

neck
Lu tingting
Regional anatomy department
1
brief
Review
Muscle
Vessel
Fascia and fasical space
division of the neck
Thyroid and parathyroid glands
Root of the neck
Lymphatics of the neck
2
review
anterior
posterior
3
4
platysma
5
platysma
Sternocleidomastoid
6
sternocleidomastoid
7
Infrahyoid muscles
Omohyoid
thyrohyoid
(superior and
inferior belly)
sternothyroid
sternohyoid
8
Suprahyoid muscles
stylohyoid
digastric (anterior and
posterior belly)
mylohyoid
9
Thyroid gland
Parathyroid glands
10
Hyoid bone(between c3 and c4)
Thyroid cartiliage
Cricoid cartilage(c6)
Crico-thyroid membrane
Tracheal cartilage (“c”)
11
mastoid
Hyoid bone(between
c3 and c4)
Thyroid cartiliage
Laryngeal
Cricoid cartilage(c6)
prominence
scapula
sternum
12
scalenus
Vertebral column
13
vessel
14
Artery :
Common carotid artery( upper border of
thyroid cartilige level)
internal and external carotid artery
Vein:
Internal and external jugular vein
15
artery
Internal
jugular vein
External jugular vein
16
artery
Common carotid artery
Subclavian artery
(Anterior and middle
scalenus)
Brachiocephalic artery
17
upper
border of
the thyroid
cartilage
18
Internal carotid artery
External carotid artery
Carotid sinus
19
vein
Internal jugular vein
External jugular vein
Anterior jugular vein
20
Analysis
Give drug
Parenteral nutrition
（give nutrition from the
recirculating system not
digestive system ）
Subclavian vein
21
Fascia and fasical space
22
Superificial fascia:
Skin ,platysma
Anterior jugular vein ,External jugular vein
Nerve:cervical branch of facial nerve(platysma)
cervical nerve
Cervical fascia※
( Investing layer
Pretracheal layer
Prevertebral layer)
23
Cervical fascia
24
pretracheal fascia
Infrahyoid m.
thyroid
Pretracheal layer
s.c.m
Carotid sheath
Buccopharyngeal
fascia
trachea esophagus
Internal jungular vein
Common carotid a.
Vagus n.
scalenus
Investing layer
Trapezius
Prevertebral
layer
25
carotid sheath
Posterointernal-common and internal carotid artery
Anteroexternal-internal jugular vein
Between and behind them-vagus nerve
anterior
posterior
26
recurrent laryngeal nerve
sympathetic trunk
Vagus nerve
27
Fascial space:
Pretracheal space
Retropharyngeal space
Fascial space within Pretracheal
laryer
28
Buccopharyngeal
fascia
Prevertebe-
Pretracheal
space
al laryer
Retropharyngeal space
Fascial space within Prevertebral laryer
29
Pretracheal space: Thyroid ima artery,
Inferior thyroid vein and thymus gland
in baby
Retropharyngeal space:
Fascial space within Pretracheal laryer:
cervical tuberculosis become axillary
abscess and transfer to mediastinum
30
division
31
trapezius
Nape
Neck ※
32
s.c.m
Anterior triangle
Posterior triangle
33
Anterior belly of digastric m.
Hyoid bone
Superior belly of omohyoid m.
34
Submandibular triangle-submandibular gland
Submental triangle-submental gland
Carotid triangle-carotid sheath
35
division of the neck
Anterior triangle
Suprahyoid region: submental triangle
submandibular triangle
Infrehyoid region: muscular triangle※
carotid triangle※
Posterior triangle
36
muscular triangle
Position
Neighborhood
Thyroid gland
Artery
Vein
Nerve
Superior laryngeal nerve
Recurrent laryngeal nerve
37
SHAPE:
H-shaped, isthmus, lateral lobes and pyramidal lobe
50%
38
POSITION：
Two lateral lobes: at lower part of larynx and
anterolateral sides of upper part of trachea
Isthmus: anterior to 2nd--4th tracheal
cartilages
Upper pole: mid-point of thyroid cartilage
Lower pole：6th tracheal cartilage
39
COVERING OF THE THYROID GLAND
THYROID SHEATH (false capsule):
formed by pretracheal fascia
FIBROUS CAPSULE (true capsule):
external membrane of thyroid gland
40
CAPSULE-SHEATH SPACE :
between false and true capsules, contains loose
connective tissue, blood vessels, nerves and
parathyroid gland.
SUSPENSORY LIG. OF THYROID GLAND:
formed by false capsule, fix the gland at larynx
and trachea, and moves up and down when
swallowing
41
Neighborhood：
Anterior：superficial fascia(skin,platysma…)
investing fascia （s.c.m. infrahyoid muscles ）
pretracheal fascia
42
posteromedial：trachea, esophagus, recurrent
laryngeal nerve
posterolateral: carotid sheath(common carotid artery,
internal jugular vein and vagus nerve)
cervical sympathetic trunk behind pretracheal fascia
43
CLINICAL SIGNIFICANCE
tracheal compression-dyspnea（can not breath)
esophageal compression-dysphagia（can not swallow)
compression of recurrent laryngeal nerve-hoarse
voice
sympathetic trunk-Horner syndrome
44
ARTERIES OF THYROID GLAND
Superior thyroid artery: arise from the anterior
aspect of the origin of the external carotid a.
Inferior thyroid artery ：branch of thyrocervical
trunk
Thyroid ima artery (10%): arise from brachiocephalic
trunk of aortic arch
45
Thyrocervical
trunk
46
VEINS OF THYROID GLAND
Superior thyroid vein：accompanied by homonymous
artery and joins internal jugular vein.
Middle thyroid vein: one, or two, three, or absent;
joins internal jugular vein which is thin, preventing
bleeding or air embolus when ligation
Inferior thyroid vein: joins brachiocephalic veins in
front of trachea.
Plexus thyroideus impar: formed by anastomosis of
branches of two inferior thyroid veins with
tributaries of isthmus in front of trachea.
47
48
49
NERVES RELATED TO THYROID GLAND
Superior laryngeal nerve
Internal branch: distribute in the laryngeal mucous
membrane above glottis vocalis , accompanying
the superior laryngeal artery
External branch: goes inferioanteriorly accompanying
the superior thyroid artery, separates with the
artery at 1 cm distant to upper pole of lateral lobe
to supply cricothyroid muscles and inferior
pharyngeal constrictor
50
51
Recurrent laryngeal nerve
in charge of all the muscles’ movements except the
cricothyroid muscle
Left: turn around aortic arch, long,deep,posterior to
inferior thyroid artery.
right: turn around subclavian artery, short, superficial,
anterior to inferior thyroid artery.
52
anterior
posterior
53
SUBTOTAL THYROIDECTOMY
Ligate superior thyroid artery close to the
upper pole.
Ligate inferior thyroid artery far from the
lower pole.
54
Nerve: superior laryngeal n.
vagus n.(recurrent laryngeal n.)
cervical part of sympathetic truck (horner S)
ansa cervicalis
cervical plexus
accessory nerve
hypoglossal nerve
spinal nerve
Cranial nerve
55
Cervical part of sympathetic trunk
56
ansa cervicalis-spinal nerve
Cricoid cartilage
(c6)
57
Cervical plexus-spinal nerve
Great aricular
nerve
Lesser occipital
nerve
Supraclavicular
Transverse
cervical nerve
nerve
58
Local
anesthesia
59
Accessory nerve-cranial nerve
s.c.m
60
Hypoglossal nerve-cranial nerve
tongue
61
Root of the neck
62
63
Brachial plexus
C5-8 T1
64
Lymphatics of the neck
Superficial lymph nodes:occipital nodes
mastoid nodes
parotid nodes
submandibular nodes
submental nodes
Superificial cervical lymph(external jugular vein)
Deep cervical lymph(internal jugular vein):
65
Jugular trunk
Deep cervical
nodes
Superficial cervical
Nodes
66
Jugular trunk
Right lymphatic duct
Thoracic duct
R
L
67
68