Head 山东大学医学院 解剖教研室 李振华

Regions and landmarks of head Cranium 颅部 Face 面部

Regions and landmarks of head Superciliary arch Supraorbital notch Infraorbital foramen Mental foramen Pterion Zygomatic arch Mastoid process External occipital protuberance

Landmarks of head Pterion

Face 面部

The skin of face 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.

Muscles of head 头肌 Facial muscles 面肌 Epicranius 颅顶肌 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

Facial muscles 面肌

★Masticatory muscles 咀嚼肌 Temporalis 颞肌 Masseter 咬肌 lateral pterygoid 翼外肌 Medial pterygoid 翼内肌

★ Masticatory muscles 咀嚼肌 Temporalis 颞肌 Origin－temporal fossa Insertion－coronoid process of mandible Action－elevates and retracts mandible Masseter 咬肌 Origin－inferior border and medial surface of zygomatic arch Insertion－lateral surface of ramus of mandible and angle of mandible Action－elevates mandible

★ Masticatory muscles 咀嚼肌 Lateral pterygoid 翼外肌 Medial pterygoid 翼内肌

Arteries of head Inferior labial a. 下唇动脉 Superior labial a. 上唇动脉 ★ 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

Arteries of head 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

Arteries of head 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 内眦静脉) Runs downward and backward through the face, posterior to the facial artery Below angle of mandible, joins anterior branch of retromandibular vein 下颌后静脉 to form common facial vein 面总静脉, which drains into internal jugular vein 颈内静脉

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

Veins of head “Danger triangle of the face” 面部危险三角 lies between root of nose and two angles of mouth In this area the facial vein has no valves

Veins of head Retromandibular v. 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

Veins of head Pteygoid venous plexus 翼静脉丛 Located between and around masticatory muscles Receives blood from all regions supplied by maxillary a. Communicates with Face v. 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 lymph nodes 枕淋巴结 Mastoid lymph nodes 乳突淋巴结 Parotid lymph nodes 腮腺淋巴结 ★ Submandibular lymph nodes 下颌下淋巴结 lies near the submandibular gland, receive lymphatic vessels from the face, nose and mouth submental lymph nodes 颏下淋巴结 Drain into deep cervical lymph nodes

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

Nerves of head ★ Facial nerve (Ⅶ) 面神经 Enters parotid gland and divides into its five terminal branches for muscles of facial expression Branches Temporal branches 颞支 Zygomatic branches 颧支 Buccal branches 颊支 Marginal mandibular branch下颌缘支 Cervical branch 颈支

Facial nerve (Ⅶ) 面神经

Nerves of head Trigeminal nerve 三叉神经 Supraorbital n. 眶上神经 From the ophthalmic n. of trigeminal n. Exit the skull via the superaorbital foramen (or notch) Infraorbital n. 眶下神经 From the maxillary n. of trigeminal n. Exit the skull via the infraorbital foramen Mental n. 颏神经 From the mandibular n. of trigeminal n. Exit the skull via the mental foramen

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: extends forward between the medial pterygoid m. and ramus of mandible

Parotid gland 腮腺 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 is quite thin and easily disrupted.

Parotid gland 腮腺 ★ 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

★ Structures vertical passing through the parotid gland External carotid a. 颈外动脉 Superficial temporal a. 颞浅动脉 Superficial temporal v. 颞浅静脉 Retromandibular vein 下颌后静脉 Auriculotemporal n. 耳颞神经

★ Structures transversal passing through the parotid gland Maxillary a. & v. 上颌动、静脉 Tranverse facial a. & v. 面横动、静脉 Branches of facial n. 面神经的分支

Relations of parotid gland Superiorly External acostic meatus Poterior margin of temporomandibular joint Zygomatic arch Anteromedially Masseter Ramus of mandible Posterior part of medial pterygoid

Relations of parotid gland Posteromedially Mastoid process Sternocleidomastoid Posterior belly of digastric Styloid process Internal carotid a. Internal jugular v. Ⅸ～Ⅻ cranial nerves “Parotid bed” 腮腺床 Ⅹ Ⅸ Ⅺ Ⅻ

Spaces of face Masseter space 咬肌间隙 Position: lies between the masseter, and ramus of mandible Contens: vessels and nerves of masseter

Spaces of face Pterygomandibual space 翼下颌间隙 Lies between ramus of mandible and medial pterygoid Contents: Lingual n. Inferior alveolar n., a., v.

Spaces of face Pterygomandibual space 翼下颌间隙 Lies between ramus of mandible and medial pterygoid Contents: Lingual n. Inferior alveolar n., a., v.

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

Sublingual space 舌下间隙 Contents Sublingual gland 舌下腺 Deep part of submandibular gland and duct 下颌下腺深部及腺管 Submandibular ganglion 下颌下神经节 Linguial n.舌神经 Hypoglossal n. and vessels 舌下神经及血管

Cranium 颅部

Calvaria 颅顶 Frontoparietooccipital region 额顶枕区 Temporal region 颞区

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

★ Layers of frontoparietooccipital region Consists of five layers Skin 皮肤 Superficial fascia 浅筋膜 Epicranial aponeurosis and occipitofrontalis 帽状腱膜及枕额肌 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

★ Layers of frontoparietooccipital region Skin 皮肤 Superficial fascia 浅筋膜 Epicranial aponeurosis and occipitofrontalis 帽状腱膜和枕额肌 Subaponeurotic space 腱膜下隙 Pericranium 颅骨外膜

★ Layers of frontoparietooccipital region 1. Skin 皮肤 thick and hair bearing and contains numerous sebaceous glands 皮厚、腺多、血运丰富 2. The superficial fascia 浅筋膜 Dense connective tissue that binds the skin to the underlying epicranial aponeurosis The vasculature of the scalp runs primarily in this layer. It is rich and widely anastomosis. Wounds of the scalp bleed profusely but heal well.

★ Layers of frontoparietooccipital region A. v. and n. in superficial fascia Anterior group Supratrochlear a. v. n. 滑车上动、静脉和神经 Supraorbital a. v. n. 眶上动、静脉和神经 Posterior group Occipital a. v. 枕动、静脉 Greater occipital n. 枕大神经 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

★ Layers of frontoparietooccipital region 3. Epicranial aponeurosis and occipitofrontalis 帽状腱膜和枕额肌 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

★ Layers of frontoparietooccipital region 4. Subaponeurotic space 腱膜下隙 (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 laterally, 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 the scalp from the periosteum.

★ Layers of frontoparietooccipital region 4. Subaponeurotic space 腱膜下隙 Contains a rich network of deep arteries and veins. Therefore, this layer has been called the “dangerous area”. Infection 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

★ Layers of frontoparietooccipital region 5. Pericranium 颅骨外膜 Fuses firmly with bone at the sutures and with the periosteum of the adjacent 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 颞区 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 of temporal region 颞区 Consists of five layers: Skin 皮肤 Superficial fascia 浅筋膜 Temporal fascia 颞筋膜 Temporalis 颞肌 Periosteum 骨膜

Layers of temporal region Superficial fascia 浅筋膜 Anterior auricular group Superficial temporal a. & v. 颞浅动、静脉 Auriculotemporal n. 耳颞神经 Posterior auricular group Posterior auricular a. & v. 耳后动、静脉 Lesser occipital n. 枕小神经

Layers of temporal region 颞区 Temporal fascia 颞筋膜 Two layers Attached above to the superior temporal line and below to the superior border of the aygomatic arch Temporalis 颞肌 Periosteum 骨膜 thin and strongly adherent to the temporal bone .

Skin incisions

★You must identify follow structures！ Facial a. & v. Branches of trigeminal n. Supratrochlear a. v. n. Supraorbital a. v. n. Mental n. Auriculotemporal n. Parotid duct Branches of facial n. Temporal branches Zygomatic branches Buccal branches Marginal mandibular branch Cervical branch