1. Head
山东大学医学院 解剖教研室
李振华

2. Regions and landmarks of head
Cranium 颅部
Face 面部

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

4. Landmarks of head
Pterion

5. Face 面部

6. 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.

7. 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

8. Facial muscles 面肌

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

10. ★ 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

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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. Facial nerve (Ⅶ) 面神经

24. 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

25. 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

26. 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.

27. 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

28. ★ 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

29. ★ 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

30. 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

31. 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

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

33. 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.

34. 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.

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

36. 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

37. Cranium 颅部

38. Calvaria 颅顶
Frontoparietooccipital region 额顶枕区
Temporal region 颞区

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

40. ★ 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

41. ★ 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

42. ★ 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.

43. ★ 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

44. ★ 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

45. ★ 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.

46. ★ 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

47. ★ 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

48. 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

49. 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

50. 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

51. 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 .

52. Skin incisions

53. ★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