Head

Ⅰ. Boundaries : lower border of mandible —the angle of mandible —the mastoid process —the superior nuchal line —the external occipital protuberance Ⅱ. Divisions: the face the cranium — supra-orbital margin— zygomatic arch— superior margin of external acoustic meatus— mastoid process.

Region and parts Landmaeks Cranium 颅部 Face 面部 Superciliary Supraorbital notch Infraorbital foramen Mental foramen Pterion Zygomatic arch Mastoid process External occipital protuberance

Pterion Epidural hemorrhage

Muscles of head Facial muscles 面肌 Platysma 颈阔肌 Epicranius 颅顶肌 (oddipitofrontalis) 枕额肌 Frontal belly 额腹 Occipital belly 枕腹 Galea aponeurotica 帽状腱膜 Orbicularis oculi 眼轮匝肌 Buccinator 颊肌 Orbicularis oris 口轮匝肌 Nasalis 鼻肌 Platysma 颈阔肌

The skin of face is very thin and connected to the facial bones by loose connective tissue. There is no deep fascia. The facial muscles lie in this connective tissue.

Masticatory muscles Masseter 咬肌 Temporalis 颞肌 lateral pterygoid 翼外肌 Origin－inferior border and medial surface of zygomatic arch Insertion－lateral surface of ramus of mandible and angle of mandible Action－elevates mandible Temporalis 颞肌 Origin－temporal fossa Insertion－coronoid process of mandible Action－elevates and retracts mandible lateral pterygoid 翼外肌 Medial pterygoid 翼内肌

Arteries of head Facial a. 面动脉 Branch of external caroteid a. Runs forward over digastric and submandibular gland Loops around mandible (where it is palpable), at anterior border of masseter, to enter the face Follows a tortuous course to medial angle of eye Lies deep to most facial muscles Branches Inferior labial a. 下唇动脉 Superior labial a. 上唇动脉 Angular a. 内眦动脉

Superficial temporal a.颞浅动脉 Terminal branch of external carotid a. Ascends in front of ear (where it is palpable) to supply temporal and anterior portion of scalp Transverse facial a. 面横动脉－runs above parotid duct to supply the cheek region

Maxillary artery 上颌动脉 Branch of external carotid a. Entrance to infratemporal fossa medial to neck of mandible

Branches Inferior alveolar a. 下牙槽动脉 Middle meningeal a. 脑膜中动脉 enters the skull through foremen spinosum Supplies cranium and dura mater Posterior superior alveolar a.上牙槽后动脉

Veins of head Facial vein 面静脉 Begins at medial angle of eye (angular vein) Runs downward and backward through the face, posterior to the facial artery Below angle of mandible, joins anterior branch of retromandibular vein to form common facial vein, which drains into internal jugular vein

Connections with cavernous sinus 海绵窦through the ophthalmic vein眼静脉, and also through pteygoid plexus 翼静脉丛 via the deep facial vein 面深静脉

“Danger area” 危险三角－lies between root of nose and two angles of mouth; in this area the facial vein has no valves

Retromandibular vein 下颌后静脉 Formed by union of superficial temporal and maxillary veins Divides into an anterior branch that unites with facial vein and a posterior branch that joins posterior auricular vein to become external jugular vein

Pteygoid plexus 翼静脉丛 Located between and around muscles of mastication Receives blood from all regions supplied by maxillary a. Communicates with Face by deep facial veins Cavernous sinus by veins draining base of skull Provides possible pathway for spread of infection to cranial cavity

The lymphatic drainage of head Lymph nodes of head Located at junction of head and neck Consist of occipital, mastoid, parotid, submandibular, submental lymph nodes Drain into deep cervical lymph nodes Submandibular lymph node 下颌下淋巴结 lies near the submandibular gland, receive lymphatic vessels from the face, nose and mouth

Nerves of head Facial nerve (Ⅶ) 面神经 Leaves skull through internal acoustic meatus, facial canal and stylomastoid foramen Divided three parts First part－between stylomastoid foramen and parotid gland Second part－within parotid gland Third part－outside of parotid gland

Enters parotid gland and divides into its five terminal branches for muscles of facial expression Temporal 颞支 Zygomatic 颧支 Buccal 颊支 Marginal mandibular 下颌缘支 Cervical 颈支

Trigeminal nerve (Ⅴ) 三叉神经 Ophthalmic nerve 眼神经 (Ⅴ1) → supraorbital n. 眶上神经 Maxillary nerve 上颌神经 (Ⅴ2) → infraorbital n. 眶下神经 Mandibular nerve 下颌神经 (Ⅴ3) →mental n. 颏神经

Parotid gland 腮腺 Position: situated below the external auditory meatus and lies in a deep hollow behind the ramus of mandibular and in front of the sternocleidomastoid Superficial part: triangular in shape, lies below and in front of the external acoustic meatus, and partially covers the masseter. Deep part: lies deep to medial pterygoid .

Parotid duct 腮腺管 Arises front anterior border of gland Lies 1.5 cm below and parallel to zygomatic arch Passes forward over masseter, pierces the buccinator and oral mucosa to open opposite second upper molar tooth

Capsule of the parotid gland The parotid gland is enclosed within a well-defined capsule which extension of the investing fascia of the neck. The superficial capsule is thick and unyielding and tightly affixed to the underlying glandular tissue by numerous fibrous septa. The deep capsule id quite thin and easily disrupted.

Structures passing through the parotid gland Vertical External carotid a. Retromandibular vein Superficial temporal a. & v. Auriculotemporal n. Transversal Maxillary a. & v. Tranverse facial a. & v. Branches of facial n.

Relationships of parotid gland Superior－external acostic meatus, poterior margin of temporomandibular joint Anteromedialy－masseter, ramus of mandible, posterior part of medial pterygoid Poateromedial－mastoid process, sternocleidomastoid, posterior belly of digastric, styloid process, internal carotid a., internal jugular v., Ⅸ～Ⅻ cranial nerves “Parotid bed”－internal carotid a., internal jugular v., Ⅸ～Ⅻ cranial nerves

Masseter space 咬肌间隙 Lies between the masseter, and ramus of mandible

Pterygomandibual space 翼下颌间隙 Lies between ramus of mandible and medial pterygoid

Sublingual space 舌下间隙 Between mucous membrane of floor of mouth and mylohyoid and hyoglossus

Dissection Skin incisions

The cranial part

Frontal parietal occipital region 额顶枕区 Boundaries Anterior－supraorbital margin Posterior－external occipital protuberance and superior nuchal line Lateral－superior temporal line

Layers consists of five layers: Skin 皮肤 Superficial fascia 浅筋膜 Galea aponeurotica and occipitofrontalis 帽状腱膜和枕额肌 Subaponeurotic space (loose connective tissue) 腱膜下隙 Pericranium 颅骨外膜 The superficial 3 layer are closely knit together, called scalp头皮

The skin has the greatest concentration of hair and sebaceous glands 皮厚、腺多、血运丰富 The superficial fascia is dense connective tissue that binds the skin strongly to the underlying galea aponeurotica The vasculature of the scalp runs primarily in the. lt is richand widely anastornotic- Wounds of the scalp bleed profusely but heal well.

Arteries, veins and nerves Anterior group Supratrochlear a. v. n. Supraorbital a. v. n. Posterior group Occipital a. v. Greater occipital n. 炎症不易扩散，肿胀疼痛剧烈，血管吻合多，止血应呈环状，局麻范围要广，切口呈放射状，皮瓣蒂在下方

Galea aponeurotica 坚韧致密，前连额腹，后连枕腹，1、2、3层，合称头皮 It is interposed between the frontalis and occipitalis portions of the occipitofrontalis muscle. These muscles place the aponeurosis under tension so that deep transverse lacerations of the scalp gape widely . 坚韧致密，前连额腹，后连枕腹，1、2、3层，合称头皮

Subaponeurotic space (loose connective tissue) Extracranial hematoma, the result of bleeding in the subaponeurotic space, can extend over the cranium. lt can extend posteriorly, to the superior nuchal line; anteriorly, into the eyelids to produce the “black eye”; and lateraliy, to the temporal line. The loose connective tissue layer provides the plane of separation in any injury that tears the scalp from the calvaria or for the surgeon elevating thescalp from the periosteum.

出血化脓，漫及全顶，有导血管， 颅内外交通 Contains a rich network of deep arteries and veins. Therefore, this layer has been called the “dangerous area”. Infaction may spread to the substance of the bones, to venous channels within the cranial cavity, or to the brain. 出血化脓，漫及全顶，有导血管， 颅内外交通

Pericranium Fuses firmly with bone at the sutures and with the periosteum of theadjacent bone, thus limiting the subperiosteal space. 薄而致密，易于颅骨分离，如有血肿，与骨一致

Temporal region Boundaries Superior－superior temporal line Inferior－superior border of zygomatic arch Anterior－the junction of frontal and zygomatic bones Posterior－posterior portion of superior temporal line

Layers consists of five layers: Temporal fascia 颞筋膜 Temporalis 颞肌 Skin 皮肤 Superficial fascia 浅筋膜 Temporal fascia 颞筋膜 Temporalis 颞肌 Periosteum 骨膜

Superficial fascia 浅筋膜 Anterior auricular group Superficial temporal a. & v. Auriculotemporal n. Posterior auricular group Posterior auricular a. & v. Lesser occipital n.

Temporal fascia 颞筋膜

Temporalis

Periosteum

Cerebral dural mater Characters A thick and dense inelastic membrane that composed of two layers, an inner or meningeal and outer or endosteal It is in loose contact with calvaria, and most strongly adherent to base of skull

Four septa Cerebral falx Tentorium of cerebellum－in front there is a gap, the tentorial incisure, for passage of midbrain Cerebellar falx Diaphragma sellae

Sinuses of duramater Superior sagittal sinus Inferior sagittal sinus Straight sinus Confluence of sinus

Transverse sinus Sigmoid sinus Superior petrosal sinuses inferior petrosal sinuses

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