Vessels and nerves of the neck
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Vessels and nerves of the neck. 陳建榮. http://web.nchu.edu.tw/~chenjr/index.htm. Fascia 筋膜 Superficial fascia 淺筋膜 Deep fascia 深筋膜. Fascia of cervical: Superficial fascia Deep fascia Superficial lamina Prevertebral lamina Pretracheal lamina Common carotid sheath 總頸動脈鞘 Vagosympathetic n.

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Vessels and nerves of the neck

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Vessels and nerves of the neck

陳建榮

http://web.nchu.edu.tw/~chenjr/index.htm


  • Fascia筋膜

  • Superficial fascia淺筋膜

  • Deep fascia深筋膜


  • Fascia of cervical:

  • Superficial fascia

  • Deep fascia

    • Superficial lamina

    • Prevertebral lamina

    • Pretracheal lamina

    • Common carotid sheath總頸動脈鞘

      • Vagosympathetic n.

      • Common carotid a.

      • Internal jugular v.


  • Spinal nerve脊神經

  • Root segment

    • Dorsal root背根

      • Dorsal root ganglion背根神經節 (spinal ganglion脊神經節)

    • Ventral root腹根

  • Meningeal branch脊膜支

  • Communicating branch交通支

  • Dorsal ramus背支 (dorsal branch)

  • Ventral ramus腹支 (ventral branch)


x

x


Area innervated by spinal n.

Lateral br.

Ventral br.

Dorsal br.


Dermatomes皮節

Refer pain


Refer pain反射痛

phantom pain幻肢痛


Nerves in cervical region

  • C1~C5 spinal nerves

  • Accessory nerve (CN XI)

  • Vagus nerve (CN X)


  • C1 (lateral vertebral foramen)

  • Dorsal ramus  suboccipital n.枕骨下神經  m. of suboccipital area

  • Ventral ramus  ansa cervicalis頸環  sternothyroideus, sternohyoideus, thyrohyoideus m.


  • Suboccipital region:

  • Rectus capitis dorsalis major背大頭直肌 (C2  occipital)

  • Rectus capitis dorsalis intermedius背小頭直肌 (C1 occipital)

  • Obliquus capitis cranialis前頭斜肌 (occipital  C1)

  • Obliquus capitis caudalis後頭斜肌 (C1C2)

Occi

C1

C2


Ansa cervicalis頸環

C1

- No cutaneous br. of dorsal

and ventral branches


  • C2 (first intervertebral forament)

  • Dorsal ramus

  •  greater occipital n.大枕骨神經

  • Ventral ramus

  •  great auricular n.大耳殼神經

  •  transverse cervical n.橫頸神經


Innervation of C2 spinal n.


Spinal n. of C2


C3 – C5


Accessory n. (CN XI) 副神經

  • CN XI:

  • Sternocephalicus m.胸骨頭肌

    • Sternomastoideus m.胸骨乳突肌

    • Sternooccipitalis m.胸骨枕骨肌

  • Cleidomastoideus m.鎖骨乳突肌

  • Cleidocervicalis m.鎖骨頸肌

  • Trapezius m.斜方肌

Cleidobrachialis m.鎖骨肱肌

-(brachiocephalicus n.)


  • Brachiocephalicus肱頭肌

  • Cleidobrachialis

  • Cleidomastoideus

  • Cleidocervialis

Human:

Sternocleidomastoid m.

Dog:

Sternocephalicus

- sternooccipitalis

- sternomastoideus

Cleidomastoideus

Cleidocervicalis


  • Vagus n. (CN X)迷走神經

  • Vagosympathetic trunk

  • Carotid sheath

  • Cranial laryngeal n.

  • Recurrent laryngeal n. (caudal laryngeal n.)


Recurrent laryngeal n. (caudal laryngeal n.)

-Left recurrent laryngeal n.

-Right recurrent laryngeal n.


  • Vessels in cervical region

  • Common carotid a.總頸動脈 ( brachiocephalic a.)

  • Subclavian a.鎖骨下動脈

    • Vertebral a.脊椎動脈

    • Costocervical a.肋頸動脈

    • Superficial cervical a.淺頸動脈

    • Axillary a.腋動脈

    • Internal thoracic a.內胸動脈

  • Internal jugular v.內頸靜脈

  • External jugular v.外頸靜脈


  • Branches of Subclavian a.

  • Internal thoracic a.

  • Vertebral a.

  • Costocervical a.

  • Superficial cervical a.

  • Axillary a.


  • Common carotid a.總頸動脈

    • Caudal thyroid a.

    • Cranial thyroid a.

    • External carotid a.

    • Internal carrotid a.


  • Blood supply of cervical vertebrae

  • Vertebral a. (subclavian a.)

  • Blood supply of brain:

  • Veterbral a.

  • Internal carotid a.


Superficial cervical a.淺頸動脈

  • Superficial cervical a.

  • Deltoideus br.

  • Suprascapular a.

  • Prescapular br.

  • Ascending br.

Superficial cervical lymph nodes 淺頸淋巴結


Costocervical trunk肋頸動脈幹

  • Costocervical trunk

  • Deep cervical a.

  • Thoracic vertebral a.

  • Dorsal scapular a.


  • External jugular v.外頸靜脈

    • Linguofacial v.舌顏靜脈

    • Maxillary v.上頜靜脈

    • Omobrachial v.肩肱靜脈

    • Superficial cervical v.淺頸靜脈

    • Cephalic v.頭靜脈

  • Internal jugular v.

  • Caudal thyroid v.

  •  Brachiocephalic v.


Thyroid gland

Parathyroid gland

Medial retropharyngeal lymph node內咽後淋巴結


  • Blood supply of thyroid gland

  • Cranial thyroid a.

  • Caudal thyroid a.


  • 將右側頸部及肩胛上方之皮膚掀開。

  • 2. 注意以下幾個構造:

    • 1. C2、C3及C4的背側枝及腹側枝。

    • 2. 外頸靜脈


  • 3. 將闊頸肌移除,清理以下幾個構造:

    • 1. C2的腹側枝(great auricular n. and transverse cervical n.)

    • 2. 清理肱頭肌及斜方肌間的空隙,找出淺頸淋巴結、(副神經)及(淺頸動脈)

    • 3. 找出跨過肱頭肌的肩肱靜脈及其頭端的分枝舌顏靜脈及上頜靜脈。

    • 4. 辨認出下頜腺。


在肱頭肌表面可找到肩肱靜脈。


4. 將鎖骨頸肌及胸骨枕骨肌於中段剪開,找出副神經,並確認其支配之肌肉有那些。

1. 認出匯入外頸靜脈的頭靜脈、淺頸靜脈。

2. 清理淺頸動脈的分枝。


5. 剪開鎖骨乳突肌及胸骨乳突肌,找出頸環之構造及其支配肌肉。

找出咽後淋巴節


6. 清理總頸動脈鞘,找出總頸動脈、迷走交感神經鏈、內頸靜脈。

1. 找出甲狀腺及其周圍的動靜脈。

2. 清理氣管及食道,注意喉返神經。

Splenius m. 夾肌


7. 剪開夾肌找出:Biventer cervicalis 頸二腹肌、

Complexus 複合肌、

Longissimus capitis 頭最長肌


Nuchal lig.

Deep cervical a. (costocervical a.)

8. 剪開頸二腹肌、複合肌、頭最長肌,找出項韌帶及肋頸動脈,並辨認C2、C3及C4背側枝


9. 清理枕骨下三角找出背大頭肌、背小頭肌、前斜肌及後斜肌,並找出枕骨下神經


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