1. Head

2. 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.

3. 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

4. Pterion
Epidural hemorrhage

5. 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

7. 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.

8. 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

9. 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

10. 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

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

12. 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

13. 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

14. 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

15. “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

16. 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

17. 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

18. 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

19. 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

20. 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

22. 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

23. 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 .

24. 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

25. 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.

26. 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.

27. 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

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

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

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

31. Dissection
Skin incisions

34. The cranial part

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

36. 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

37. 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.

38. 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

39. 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

40. 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.

41. 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

42. 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

43. 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

44. 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

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

46. Temporal fascia 颞筋膜

47. Temporalis

48. Periosteum

49. 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

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

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

52. Transverse sinus
Sigmoid sinus
Superior petrosal sinuses
inferior petrosal sinuses

53. Thank You!