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1、January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,系 统 解 剖 学局 部 解 剖 学Regional anatomy主讲人：侯一平 教授兰州大学基础医学院解剖教研室,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,头 部,面 部
2、,颅部,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,境界与分区,头部与颈界线是：下颌骨下缘、下颌角、乳突、上项线和枕外隆凸间的连线。头部分为后上方的颅部和前下方的面部，界线是：眶上缘、颧弓、外耳门和乳突连线,头部与颈：下颌骨下缘、下颌角、乳突、上项线和枕外隆凸间的连线。头部分为颅部和面部，界线是：眶上缘、颧弓、外耳门和乳突连线,January,2007,Copyright Depart.Anatomy,Sc
3、hool of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第一节 面 部,一、浅层结构二、肌肉三、面部的血管神经四、面侧区,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,1.皮肤：薄而软血管较丰富及含大量的毛囊、皮脂腺和汗腺，三个特点很突出。2.浅筋膜：内含丰富血管、神经、大量的表情肌。,一、浅层结构,Januar
4、y,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,二、面部肌肉,表情肌,咀嚼肌,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,重要的面肌有：,1.眼轮匝肌 2.口轮匝肌 3.枕额肌和帽状腱膜,January,2007,Copyright D
5、epart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,4、咀嚼肌:四对,翼内肌,翼外肌,颞 肌,咬 肌,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,三、面部的血管神经,1.血管（1）面部血供丰富，面浅层动脉主要是面动脉。（2）面静脉和“危险三角”,January,2007,Co
6、pyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,（1）分布于面部的感觉神经和支配咀嚼肌的神经为三叉神经,2.面部神经分布,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,（2）支配表情肌活动的为 面神经，分为五组分支：1）颞支2）颧支3）颊支4）下颌缘支5）
7、颈支,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,四、面侧区,（一）腮腺咬肌区,（二）面侧深区,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,（一）腮腺咬肌区,主要结构为腮腺及穿腮腺的结构。,January,2007,Co
8、pyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,以下颌支后缘为标志分为浅、深二部。浅部略呈锥形。,1.腮腺的位置和外形,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,由颈部深筋膜浅层在腮腺后缘分为两层包裹腮腺而成。特点：1，与腮腺结合紧密；2，浅层致密，深
9、层薄弱不完整,2.腮腺鞘：,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,3.穿腮腺的结构,（1）纵行结构,（2）横行结构,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,颈外动脉 颞浅动、静脉 耳颞神经 下颌后静脉,(1)纵
10、行结构,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,上颌动、静脉面横动、静脉 面神经的分支,(2)横行结构,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,4.面神经颅外段与腮腺的关系,分为三段：第一段（腮腺前段）第二段（腮
11、腺内段）第三段（腮腺后段）,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,5.腮腺深部的位置,位于下颌支的深面。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,6.腮腺床,为紧贴腮腺深面的血管神经，包括：颈内动、静脉 舌咽神
12、经 迷走神经 副神经 舌下神经,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,(二)面侧深区,位于颅底颞下窝的下方，口腔和咽的外侧。,1.位置：,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,(1)上颌动脉及分支(2)下颌神
13、经及分支(3)翼内、外肌(4)翼丛,2.内容：,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,(1).上颌动脉的主要分支,下牙槽动脉 脑膜中动脉 眶下动脉 颊动脉上牙槽后动脉,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,(
14、2).下颌神经的分支,下牙槽神经舌神经 耳颞神经 颊神经咀嚼肌支,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,(3).翼静脉丛,位置：于颞下窝内，翼内肌、翼外肌和颞肌之间。组成:与上颌动脉分支伴行的静脉均参与组成翼静脉丛。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserve
15、d by YP HOU and YF SONG,4.面部的间隙,位置：颅底与上、下颌骨之间，是散在于骨、肌肉与筋膜之间的间隙彼此相通。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,主要有两个间隙：,（1）咬肌间隙（2）翼下颌间隙,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right rese
16、rved by YP HOU and YF SONG,(1)咬肌间隙,位于咬肌深部与下颌支上部之间。此间隙前邻第3磨牙，如牙周炎，牙槽脓肿和下颌骨骨髓炎均可扩散到此间隙。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,(2)翼下颌间隙,位于翼内肌与下颌支之间，与咬肌间隙仅隔以下颌支，两间隙经下颌切迹相通。内有舌神经、下牙槽神经和动脉、静脉通过。,January,2007,Copyright Depart.An
17、atomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,第二节 颅部,颅顶,颅底：蝶鞍区,颅腔及其内容物,颅部,额顶枕区,颞区,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,一、颅 顶,（一）额顶枕区 1.境界：前界：眶上缘 后界：枕外隆突及 上项线 两侧界：借上颞线 与颞区分界,January,
18、2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,2.层次及结构特点,层次：五层(1)皮肤(2)浅筋膜(3)帽状腱膜(4)腱膜下间隙(5)颅骨外膜,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,结构特点：,(1)皮肤 有大量汗腺、皮脂腺，易发生
19、疖肿。有丰富的血管,外伤易出血，但愈合快。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,(2)浅筋膜 有许多垂直的纤维隔连接皮肤和帽状腱膜，形成许多小隔，内有脂肪、血管神经。,结构特点：,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF
20、 SONG,(3)帽状腱膜 前连额肌后连枕肌，两侧变薄续颞深筋膜浅层。以上3层紧密相连称头皮。,结构特点：,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,(4)腱膜下间隙 为帽状腱膜与颅骨骨膜之间的区域，因头皮与颅骨骨膜疏松相连，故移动性大，头皮撕脱伤多沿此层分离。,结构特点：,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou U
21、niversity.All right reserved by YP HOU and YF SONG,腱膜下间隙内有导静脉与颅骨的板障静脉及脑膜窦相交通，此层感染可向板障及颅内扩散，此间隙称为颅顶的危险区。,颅顶的“危险区”,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,(5)颅骨外膜 在颅骨表面疏松贴附，在骨缝处结合紧密。,结构特点：,January,2007,Copyright Depart.Anatom
22、y,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,3.颅顶部的血管神经及其特点,血管神经行于浅筋膜内，以耳廓为界分为前、后两组。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,前组：滑车上血管神经（动脉为眼A终支）眶上血管神经（动脉为眼A分支）颞浅血管与耳颞 神经,January,2007,Copy
23、right Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,后组：耳后A与枕小N 枕A与枕大N（为第2颈N后支）,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,颅顶部血管神经的特点：,呈放射状分布 吻合丰富 血供丰富,January,2007,Copyright Depa
24、rt.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,（二）颞 区,1.范围 颅顶两侧，位于上颞线与颧弓上缘之间。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,2.颞区软组织层次,（1）皮肤（2）浅筋膜（3）颞筋膜（浅、深层）（4）颞肌（5）颅骨外膜。,January,2007,Co
25、pyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,（1）颞区皮肤,较薄且移动性大，手术切口易于缝合，愈合后瘢痕也不明显。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,（2）颞区浅筋膜,含脂肪组织较少，上方连颅顶浅筋膜，下方续面部浅筋膜，,January,2
26、007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,浅筋膜内的血管神经可分为耳前和耳后两组：耳前组：颞浅动、静脉 耳颞神经 分布于颞区和额顶区,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,耳后组：耳后动、静脉，枕小神经 主要分布于耳后和枕外侧部。
27、,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,（3）颞筋膜temporal fascia,较致密，上方附于上颞线，向下分为浅、深两层，浅层附于颧弓上缘的外面，深层附于颧弓上缘的内面。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF S
28、ONG,（4）颞肌temporal muscle,呈扇形，起自颞窝和颞筋膜深面，肌纤维向下集中，经颧弓深面止于下颌骨的冠突。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,（5）骨膜periosteum,较薄，与颞骨连接紧密，骨膜与颞肌之间为颞深间隙，内含大量脂肪组织，向下经颧弓深面与颞下间隙相通，向前则与面部的颊脂体相连续。,January,2007,Copyright Depart.Anatomy,Sch
29、ool of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,1.结构特点 2.临床意义,二、颅底内面,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,蝶鞍区：指颅中窝中央部的蝶鞍及其周围的区域（1）蝶鞍:(Sella turcica)位于颅中窝蝶骨体中央的凹陷区，其内为垂体窝，容纳垂体。,3.蝶鞍区,January,20
30、07,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,主要结构：蝶鞍、垂体、鞍隔、视神经与视交叉、海绵窦,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,上方有鞍隔被覆，中有鞍隔孔；外侧无骨壁，直接与海绵窦组织及其内的颈内动脉相邻。,（2）垂体 Hypo
31、thesis,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,位于蝶鞍与蝶窦的两侧，向下延伸至颅中窝底。,（3）海绵窦 Cavernous Sinus,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,外侧壁：III、IV、V1、V2 内侧壁：与垂体相邻 窦腔内：颈内动脉、VI,海绵窦的毗邻,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,复习思考,1.面部皮肤、肌肉的神经分布 2.穿腮腺的结构3.腮腺床4.额顶枕区的层次结构及颅顶部的“危险区”,
