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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

Vessels and nerves of the neck

陳建榮

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

slide2

Fascia筋膜

  • Superficial fascia淺筋膜
  • Deep fascia深筋膜
slide3

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.
slide5

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)
slide7

x

x

slide10

Area innervated by spinal n.

Lateral br.

Ventral br.

Dorsal br.

slide12

Refer pain反射痛

phantom pain幻肢痛

nerves in cervical region
Nerves in cervical region
  • C1~C5 spinal nerves
  • Accessory nerve (CN XI)
  • Vagus nerve (CN X)
slide15

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.
slide16

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

slide18

Ansa cervicalis頸環

C1

- No cutaneous br. of dorsal

and ventral branches

slide19

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
slide26

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.)

slide27

Brachiocephalicus肱頭肌

  • Cleidobrachialis
  • Cleidomastoideus
  • Cleidocervialis

Human:

Sternocleidomastoid m.

Dog:

Sternocephalicus

- sternooccipitalis

- sternomastoideus

Cleidomastoideus

Cleidocervicalis

slide28

Vagus n. (CN X)迷走神經

  • Vagosympathetic trunk
  • Carotid sheath
  • Cranial laryngeal n.
  • Recurrent laryngeal n. (caudal laryngeal n.)
slide29

Recurrent laryngeal n. (caudal laryngeal n.)

-Left recurrent laryngeal n.

-Right recurrent laryngeal n.

slide31

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
slide32

Branches of Subclavian a.

  • Internal thoracic a.
  • Vertebral a.
  • Costocervical a.
  • Superficial cervical a.
  • Axillary a.
slide34

Common carotid a.總頸動脈

    • Caudal thyroid a.
    • Cranial thyroid a.
    • External carotid a.
    • Internal carrotid a.
slide35

Blood supply of cervical vertebrae

  • Vertebral a. (subclavian a.)
  • Blood supply of brain:
  • Veterbral a.
  • Internal carotid a.
slide36

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

slide37

Costocervical trunk肋頸動脈幹

  • Costocervical trunk
  • Deep cervical a.
  • Thoracic vertebral a.
  • Dorsal scapular a.
slide38

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.
slide41

Thyroid gland

Parathyroid gland

Medial retropharyngeal lymph node內咽後淋巴結

slide42

Blood supply of thyroid gland

  • Cranial thyroid a.
  • Caudal thyroid a.
slide43

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
slide45

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。
slide47

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。

slide48

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

slide50

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

slide51

7. 剪開夾肌找出:Biventer cervicalis 頸二腹肌、

Complexus 複合肌、

Longissimus capitis 頭最長肌

slide52

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

slide53

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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