TheFace

LearningObjiective

1.Knowtheboundaries,partsandlandmarksofthehead.

2.Mastertheorigin,courseanddistributionoffacialartery.

3.Knowtheorigin,branchesanddistributionofmaxillaryartery.Knowtheoriginanddistributionofsuperficialtemporalartery.

4.Masterthefacialveinconnectionswithcavernoussinus.Knowthepositionofthe“Dangertriangleoftheface”.

5.Knowthename,positionandareadrainageofthelymphnodesofthehead.

6.Masterthebranchesanddistributionoffacialnerveinface.

7.Masterthebranchesoftrigeminalnerveinface.

8.Masterthestructuresverticalandtransversalpassingthroughtheparotidgland.

9.Mastertherelationsoftheparotidgland.

Keystone

1.Theorigin,courseanddistributionoffacialartery.

2.Thefacialveinconnectionswithcavernoussinus.

3.Thebranchesanddistributionoffacialnerveinface.

4.Thestructuresverticalandtransversalpassingthroughtheparotidgland.

5.Therelationsoftheparotidgland.

TeachingCourse

QuestionsRequiringShortAnswer

1)Brieflydescribethepositionofparotidglandandthecourseofparotidduct.

2)Writeoutbranchesanddistributionoffacialnerveinface.

3)Describefacialveinconnectionswithcavernoussinus.

4)Writeoutthestructureswhichverticalandtransversalpassingthroughtheparotidgland.

5)Describerelationsoftheparotidgland.

6)Describethebeginnings,courseandendingsofcephalicandbasilicveins.

IntroductionoftheHead

Ⅰ.Boundaries

Inferiorly－alinejoininginferiorborderofmandible,angleofmandible,tipofmastoidprocess,superiornuchallineandexternaloccipitalprotuberance

Ⅱ.Regions

Ⅰ)Cranium

Ⅱ)Face

Ⅲ.Landmarks

1.Superciliaryarch

2.Supraorbitalnotch

3.Infraorbitalforamen

4.Mentalforamen

5.Pterion

6.Zygomaticarch

7.Mastoidprocess

8.Externaloccipitalprotuberance

TheFace

Ⅰ.Skinoftheface

Ⅰ)Verythinandconnectedtothefacialbonesbylooseconnectivetissue.

Ⅱ)Thereisnodeepfascia.Thefacialmuscleslieinthisconnectivetissue.

Ⅱ.Musclesofhead

Ⅰ)Facialmuscles:mostoriginatefrombornandareattachedtotheoverlyingskinormucousmembrane,commonlycalled“musclesoffacialexpression”.

1.Epicranius--consistofparriedoccipitofrontalis

(1)Consistsofpairedfrontalbelliesanteriorlyandoccipitalbelliesposteriorly

(2)Twomusclesjointbygaleaaponeurotica

(3)Function--elevateseyebrowsandwrinklesforehead

2.Orbicularisoculi－closeseyelids

3.Orbicularisoris－closesmouthandpuckerslips

4.Buccinator－compressescheekagainstteeth;accessorymuscleofmastication.

5.Nasalis－constrictorflarenostrils.

Ⅱ)Masticatorymuscles:fourpowerfulmuscles－masseter,temporalis,lateralpterygoid,andmedialpterygoid－actonmandiblethroughtemporomandibularjoint.

1.Masseter

(1)Origin－inferiorborderandmedialsurfaceofzygomaticarch

(2)Insertion－lateralsurfaceoframusofmandibleandangleofmandible

(3)Action－elevatesmandible

2.Temporalis

(1)Origin－temporalfossa

(2)Insertion－coronoidprocessofmandible

(3)Action－elevatesandretractsmandible

3.Lateralpterygoid

4.Medialpterygoid

Ⅲ.Arterialsupplyoftheface

Ⅰ)Facialartery

1.Runsforwardoverdigastricandsubmandibulargland

2.Loopsaroundmandible(whereitispalpable),atanteriorborderofmasseter,toentertheface

3.Followsatortuouscoursetomedialangleofeye

4.Givesoffbranchestosubmandibulargland,palatinetonsilandsuperficialfacialstructuressuchasthelipsandnose

5.Branches

(1)Inferiorlabiala.

(2)Superiorlabiala.

(3)Angulara.

Ⅱ)Superficialtemporalartery

1.Terminalbranchofexternalcarotid

2.Ascendsinfrontofear(whereitispalpable)tosupplytemporalandanteriorportionofscalp

3.Transversefacialartery－parallelszygomaticarchtosupplythecheek

Ⅲ)Maxillaryartery

1.Passesforward,medialtoneckofmandibletosupplydeepstructuresininfratemporalregion

2.Importantbranch

(1)Middlemeningealarteryenterstheskullthroughforemenspinosum

(2)Posteriorsuperioralveolara.

(3)Inferioralveolara.

Ⅳ.Veinsdrainageoftheface

Ⅰ)Facialvein

1.Beginsatmedialangleofeye(angularvein)

2.Runsdownwardandbackwardthroughtheface,posteriortothefacialartery

3.Belowangleofmandible,joinsanteriorbranchofretromandibularveintoformcommonfacialvein,whichdrainsintointernaljugularvein

4.Connectionswithcavernoussinusthroughtheophthalmicvein,andalsothroughpteygoidveousplexusviathedeepfacialvein

5.“Dangertriangleoftheface”－liesbetweenrootofnoseandtwoanglesofmouth;inthisareathefacialveinhasnovalves

Ⅱ)Retromandibularvein

1.Formedbyunionofsuperficialtemporalandmaxillaryveins

2.Dividesintoananteriorbranchthatuniteswithfacialveinandaposteriorbranchthatjoinsposteriorauricularveintobecomeexternaljugularvein

Ⅲ)Pteygoidvenousplexus

1.Locatedbetweenandaroundmusclesofmastication

2.Receivesbloodfromallregionssuppliedbymaxillarya.

3.Communicateswith

(1)Facev.bydeepfacialveins

(2)Cavernoussinusbyveinsdrainingbaseofskull

(3)Providespossiblepathwayforspreadofinfectiontocranialcavity

Ⅴ.Thelymphaticdrainageofhead

Ⅰ)Lymphnodesofthehead

1.Locatedatjunctionofheadandneck

2.Consistof

(1)Occipitallymphnodes

(2)Mastoidlymphnodes

(3)Parotidlymphnodes

(4)Submandibularlymphnodes:liesnearthesubmandibulargland,receivelymphaticvesselsfromtheface,noseandmouth

(5)Submentallymphnodes

3.Drainintodeepcervicallymphnodes

Ⅵ.Nervesoftheface

Ⅰ)Facialnerve(Ⅶ)

1.Leavesskullthroughinternalacousticmeatus,facialcanalandstylomastoidforamen

2.Dividedthreeparts

(1)Firstpart－betweenstylomastoidforamenandparotidgland

(2)Secondpart－withinparotidgland

(3)Thirdpart－outsideofparotidgland

3.Entersparotidglandanddividesintoitsfiveterminalbranchesformusclesoffacialexpression

4.Branches

(1)Temporal

(2)Zygomatic

(3)Buccal

(4)Marginalmandibular

(5)Cervical

Ⅱ)Sensorycutaneousnerve

1.Supraorbitaln.

(1)Fromtheophthalmicn.oftrigeminaln.

(2)Exittheskullviathesuperaorbitalforamen(ornotch)

2.Infraorbitaln.

(1)Fromthemaxillaryn.oftrigeminaln.

(2)Exittheskullviatheinfraorbitalforamen

3.Mentaln.

(1)Fromthemandibularn.oftrigeminaln.

(2)Exittheskullviathementalforamen

Ⅶ.Parotidgland

Ⅰ)Position:situatedbelowtheexternalauditorymeatusandliesinadeephollowbehindtheramusofmandibularandinfrontofthesternocleidomastoid

1.Superficialpart:triangularinshape,liesbelowandinfrontoftheexternalacousticmeatus,andpartiallycoversthemasseter

2.Deeppart:extendsforwardbetweenthemedialpterygoidm.andramusofmandible

Ⅱ)Capsuleoftheparotidgland

1.Theparotidglandisenclosedwithinawell-definedcapsulewhichextensionoftheinvestingfasciaoftheneck.

2.Thesuperficialcapsuleisthickandunyieldingandtightlyaffixedtotheunderlyingglandulartissuebynumerousfibroussepta.

3.Thedeepcapsuleisquitethinandeasilydisrupted.

Ⅲ)Parotidduct

1.Arisesfrontanteriorborderofgland

2.Lies1.5cmbelowandparalleltozygomaticarch

3.Passesforwardovermasseter,piercesthebuccinatorandoralmucosatoopenoppositeseconduppermolartooth

Ⅳ)Structuresverticalpassingthroughtheparotidgland

1.Externalcarotida.

2.Superficialtemporala.

3.Superficialtemporalv.

4.Retromandibularvein

5.Auriculotemporaln.

Ⅴ)Structurestransversalpassingthroughtheparotidgland

1.Maxillarya.&v.

2.Tranversefaciala.&v.

3.Branchesoffacialn.

Ⅵ)Relationsofparotidgland1.Superiorly

(1)Externalacosticmeatus

(2)Poteriormarginoftemporomandibularjoint

2.Anteromedially

(1)Masseter

(2)Ramusofmandible

(3)Posteriorpartofmedialpterygoid

3.Posteromedially

(1)Mastoidprocess

(2)Sternocleidomastoid

(3)Posteriorbellyofdigastric

(4)Styloidprocess

(5)Internalcarotida.

(6)Internaljugularv.

(7)Ⅸ～Ⅻcranialnerves

4.“Parotidbed”

(1)Internalcarotida.

(2)Internaljugularv.

(3)Ⅸ～Ⅻcranialnerves

Ⅷ.Spacesofface

Ⅰ)Masseterspace－liesbetweenthemasseter,andramusofmandible

Ⅱ)Pterygomandibualspace

1.Liesbetweenramusofmandibleandmedialpterygoid

2.Contents:

(1)Lingualn.

(2)Inferioralveolarn.,a.,v.

Ⅲ)Sublingualspace

1.Position:betweenmucousmembraneoffloorofmouthandmylohyoidandhyoglossus

2.Contents

(1)Sublingualgland

(2)Deeppartofsubmandibularglandandduct

(3)Submandibularganglion

(4)Linguialn.

(5)Hypoglossaln.andvessels

TheCranium

LearningObjiective

1.Mastertheboundariesandlayersofthefrontoparietooccipitalregion.

2.Knowtheboundariesandlayersofthetemporalregion.

3.Knowthevesselsandnervessuppliedthefrontoparietooccipitalregionandthetemporalregion.

4.Masterthepositionandrelationsofthehypophysis.

5.Masterthepositionandrelationsoftheopticchiasma.

6.Masterthestructurespassingthroughcavernoussinus.

Keystone

1.Thelayersofthefrontoparietooccipitalregion.

2.Thepositionandrelationsofthehypophysis.

3.Thepositionandrelationsoftheopticchiasma.

4.Thestructurespassingthroughcavernoussinus.

QuestionsRequiringShortAnswer

1.Describethelayersofthefrontoparietooccipitalregion.

2.Writeoutthepositionandrelationsofthehypophysis.

3.Writeoutthepositionandrelationsoftheopticchiasma.

4.Brieflydescribethestructurespassingthroughcavernoussinus.

ReadingandComprehension

Ⅰ.Frontoparietooccipitalregion

Ⅰ)Boundaries

1.Anteriorly－supraorbitalmargin

2.Posteriorly－externaloccipitalprotuberanceandsuperiornuchalline

3.Laterally－superiortemporalline

Ⅱ)Layersoffrontoparietooccipitalregion:consistsoffivelayers

1.Skinthickandhairbearingandcontainsnumeroussebaceousglands

2.Superficialfascia

(1)Denseconnectivetissuethatbindstheskintotheunderlyingepicranialaponeurosis

(2)Vesiclesandnervesinsuperficialfascia:Thevasculatureofthescalprunsprimarilyinthislayer.Itisrichandwidelyanastomosis.Woundsofthescalpbleedprofuselybuthealwell.

1)Anteriorgroup

①Supratrochleara.v.n.

②Supraorbitala.v.n.

2)Posteriorgroup

①Occipitala.v.

②Greateroccipitaln.

3.Epicranialaponeurosisandoccipitofrontalis

(1)Itisinterposedbetweenthefrontalisandoccipitalisportionsoftheoccipitofrontalismuscle.

(2)Thesemusclesplacetheaponeurosisundertensionsothatdeeptransverselacerationsofthescalpgapewidely

4.Subaponeuroticspace(looseconnectivetissue)

(1)Extracranialhematoma,theresultofbleedinginthesubaponeuroticspace,canextendoverthecranium.ltcanextendposteriorly,tothesuperiornuchalline;anteriorly,intotheeyelidstoproducethe“blackeye”;andlaterally,tothetemporalline.

(2)Thelooseconnectivetissuelayerprovidestheplaneofseparationinanyinjurythattearsthescalpfromthecalvariaorforthesurgeonelevatingthescalpfromtheperiosteum.

(3)Containsarichnetworkofdeeparteriesandveins.Therefore,thislayerhasbeencalledthe“dangerousarea”.Infectionmayspreadtothesubstanceofthebones,tovenouschannelswithinthecranialcavity,ortothebrain.

5.Pericranium:fusesfirmlywithboneatthesuturesandwiththeperiosteumoftheadjacentbone,thuslimitingthesubperiostealspace.

Ⅱ.Temporalregion

Ⅰ)Boundaries

1.Superiorly－superiortemporalline

2.Inferiorly－superiorborderofzygomaticarch

3.Anteriorly－thejunctionoffrontalandzygomaticbones

4.Posteriorly－posteriorportionofsuperiortemporalline

Ⅱ)layersoftemporalregion:consistsoffivelayers

1.Skin

2.Superficialfascia－vesiclesandnervesinsuperficialfascia:

(1)Anteriorauriculargroup

1)Superficialtemporala.&v.

2)Auriculotemporaln.

(2)Posteriorauriculargroup

1)Posteriorauriculara.&v.

2)Lesseroccipitaln.

3.Temporalfascia:

(1)Attachedabovetothesuperiortemporallineandbelowtothesuperiorborderoftheaygomaticarch

(2)Twolayers

1)Temporalis

2)Periosteum:thinandstronglyadherenttothetemporalbone

TheAnteriorRegionofNeck

LearningObjiective

1.Knowthelandmarksoftheneck.Knowtheparts,regionsandtrianglesoftheneck.

2.Masterthefasciallayersoftheneck.

3.Knowtheboundariesandcontentsofsubmandibulartriangle.

4.Mastertheboundariesandcontentsofcarotidtriangleandmusculartriangle.

5.Mastertherelationshipbetweentheexternalbranchofsuperiorlaryngealnerveandsuperiorthyroidartery.

6.Mastertherelationshipbetweentherecurrentlaryngealnerveandinferiorthyroidartery.

7.Masterthepositionandrelationsofthethyroidgland.

8.Mastertherelationsofcervicalpartoftrachea.

Keystone

1.Thefasciallayersoftheneck

2.Therelationshipbetweentheexternalbranchofsuperiorlaryngealnerveandsuperiorthyroidartery.

3.Therelationshipbetweentherecurrentlaryngealnerveandinferiorthyroidartery.

4.Thepositionandrelationsofthethyroidgland.

QuestionsRequiringShortAnswer

1.Brieflydescribethefasciallayersoftheneck.

2.Brieflydescribetherelationshipbetweentheexternalbranchofsuperiorlaryngealnerveandsuperiorthyroidartery.

3.Brieflydescriberelationshipbetweentherecurrentlaryngealnerveandinferiorthyroidartery.

4.Brieflydescriberelationsofthethyroidgland.

5.Brieflydescriberelationsofthecervicalpartoftrachea.

ReadingandComprehension

RegionalAnatomyofNeck

Section1PartsandRegionsoftheNeck

Ⅰ.Boundaries

Ⅰ)Superior－alinejoininginferiorborderofmandible,angleofmandible,tipofmastoidprocess,superiornuchallineandexternaloccipitalprotuberance

Ⅱ)Inferior－alinejoiningjugularnotch,sternoclavicularjoint,superiorborderofclavicle,acromionandspinousprocessesofC7

Ⅱ.Regionsofneck

Ⅰ)Neck

1.Anteriorregionofneck

2.Sternocleidomastoidregion

3.Lateralregionofneck

Ⅱ)Nape

Ⅲ.Trianglesofneck

Ⅰ)Trianglesofanteriorregionofneck

1.Suprahyoidregion

(1)Submentaltriangle

(2)Submandibulartriangle

2.Infrahyoidregion

(1)Carotidtriangle

(2)Musculartriangle

Ⅱ)Trianglesoflateralregionofneck

1.Occipitaltriangle

2.Supraclaviculartriangle(greatersupraclavicularfossa)

Ⅳ.Landmarksoftheneck

1.Hyoidbone

2.Thyroidcartilage

3.Cricoidcartilage

4.Catotidtubercle

5.Sternocleidomastoid

6.Suprasternalfossa

7.Greatersupraclaviclarfossa

Section2LayersoftheNeck

Ⅰ.Skinoftheneck

Thenaturallineofcleavageoftheskinareconstantandrunalmosthorizontallyaroundtheneck

Ⅱ.Superficialfascia

Ⅰ)Platysma

Ⅱ)Superficialveins

1.Anteriorjugularv.

2.Externaljugularv.

Ⅲ)Cutaneousnerves

1.Lesseroccipitaln.

2.Greetauricularn.

3.Transversenerveofneck

4.Supraclavicularn.

5.Cervicalbranchoffacialn.

Ⅲ.Cervicalfascia

Ⅰ)Superficiallayerofcervicalfascia(investingfascia)

1.Enclosestrapezius,sternocleidomastoid,posteriorbellyofdigastricandparotidandsubmandibularglands

2.Attachedtobonylandmarksofupperandlowerboundariesofneckandzygomaticarchofface

Ⅱ)Pretracheallayer

1.Liesdeeptotheinfrahyoidmuscle

2.Enclosesvisceraofneck:pharynx,larynx,trachea,esophagus,thyroidglandandparathyroidglands

3.Completelysurroundsthyroidgland,formingasheathforit,andbindtheglandtolarynxtoformsuspensoryligamentofthyroidgland

4.Extendsfromarchofcricoidcartilage,thyroidcartilageandhyoidbonetofibrouspericardiumofsuperiormediastinum

Ⅲ)Prevertebrallayer

1.Liesanteriortobodiesofcervicalvertebraeandprevertebralmuscles;extendsfrombaseofskulldownwardintothesuperiormediastinum,continuouswithanteriorlongitudinallig.andendothoracicfascia

2.Coverssubclavianvesselsandrootsofbrachialplexus

3.Extendsintoupperlimbasaxillarysheath

Ⅳ)Carotidsheath

1.Formedbycomponentsofallthreelayersofdeepcervicalfascia

2.Containscommonandinternalcarotidarteries,internaljugularvein,andvagusnerve

Ⅳ.Fasciaspaces

Ⅰ)Suprasternalspace

1.3－４cmabovemanubriumofsternitheinvestingfasciasplitsintotwolayers,whichareattachedtotheanteriorandposteriormarginsoftheupperborderofthemanubrium,betweenthesetwolayersisaslit-likespace,calledthesuprasternalspace

2.Containsconnectivetissue,andsometimesalymphnode

Ⅱ)Pretrachealspace

1.Liesbetweenpretracheallayerandcervicalpartoftrachea

2.Containsarteriathyroideaima,inferiorthyroidv.,unpairedthyroidvenousplexus,brachiocephalictrunkandleftbrachiocephalicv.

Ⅲ)Retropharyngealspace

Liesbetweenprevertebrallayerandbuccopharyngealfascia

Ⅲ)Prevertebralspace

Liesbetweenprevertebralmuscles,cervicalpartofvertebralcolumnandprevertebrallayer

Section3AnteriorRegionofNeck

Ⅰ.Suprahyoidregion

Ⅱ)Submentaltriangle

1.Liesbelowthechin

2.Boundaries

(1)Laterallybyanteriorbelliesofdigastric

(2)Inferiorlybythebodyofhyoidbone

3.Coveredbyskin,superficialfasciaandinvestingfascia

4.Floor－mylohyoidmuscles

5.Contents－submentallymphnodes

Ⅱ)Submandibulartriangle

1.Boundedbyanteriorandposteriorbelliesofdigastricandlowerborderofthebodyofthemandible

2.Coveredbyskin,superficialfascia,platysmaandinvestingfascia

3.Floor－mylohyoid,hyoglossusandmiddleconstrictorofpharynx

4.Contents－submandibulargland,faciala.,v.,hypoglossaln.linguala.v.andn.,submandibularganglionandsubmandibularlymphnodes

Ⅱ.Infrahyoidregion

Ⅰ)Carotidtriangle

1.Boundedbyanteriorborderofsternocleidomastoid,superiorbellyofomohyoidandposteriorbellyofdigasticmuscles

2.Coveredbyskin,superficialfascia,platysmaandinvestingfascia

3.Deep－prevertebralfascia

4.Medial－lateralwallofpharynx

5.Contents

(1)Commoncarotida.anditsbranches

1)Externalcarotida.

2)Internalcarotida.

(2)Internaljugularv.anditstributaries

(3)Hypoglossaln.withitsdescendingbranches

(4)Vagusnerve

(5)Accessorynerve

(6)Partofthechainofdeepcervicallymphnodes

Ⅱ)Ralationsofposteriorbellyofdigastic

1.Superficial

(1)greatauricularn.

(2)retromandibularv.

(3)cervicalbranchoffacialn.

2.Deep

(1)internalandexternalcarotida.

(2)internaljugularv.

(3)Ⅹ～Ⅻcranialn.

(4)cervicalpartofsympathetictrunk

3.Superiorly

(1)posteriorauriculara.

(2)faciala.

(3)glossopharyngealn.

4.Infeiorly

(1)occipitala.

(2)hypoglossaln.

Ⅲ)Musculartriangle

1.Boundedbymidlineoftheneck,superiorbellyoftheomohyoidandanteriorborderofthesternocleidomastoid.

2.Coveredbyskin,superficialfascia,platysma,anteriorjugularv.,coutaneousn.andinvestingfascia

3.Deep－prevertebralfascia

4.Contents

(1)Superiorbellyofomohyoid

(2)Sternohyoid

(3)Sternothyroid

(4)Thyrohyoid

(5)Thyroidgland

(6)Parathyroidgland

(7)Cervicalpartoftracheaandesophagus

Ⅳ)Thyroidgland

1.Shapeandposition

(1)H-shape

(2)Leftandrightlobes:lieoneithersideofinferiorpartoflarynxandsuperiorpartoftrachea,extendfrommiddleofthyroidcartilagetolevelofsixthtracheacartilage

(3)Isthmus:overlies2ndto4thtrachealcartilage

(4)Pyramidallobe:sometimesarisesfromisthmus

2.Coveringsofthethyroidgland

(1)Falsecapsule:asheathofpretrachealfasciawhichisattachedtoarchofcricoidandthyroidcartilagestoformthesuspensoryligamentofthyroidgland,hence,thethyroidglandmoveswithlarynxduringswallowingandoscillatesduringspeaking

(2)Truecapsule:fibrouscapsule

(3)Spacebetweensheathandcapsuleofthyroidgland:therearelooseconnectivetissue,vessels,nervesandparathyroidglands

3.Relationsofthethyroidgland

(1)Anteriorly:

1)skin

2)superficialfascia

3)investingfascia

4)infrahyoidmusclesandpretrachealfascia

(2)Posteromedially:

1)Larynxandtrachea

2)Pharynxandesophagus

3)Recurrentlaryngealnerve

(3)Posterolaterally

1)Carotidsheathwiththecommoncarotida.,theinternaljugularv.,andthevagusn.

2)Cervicalsympathetictrunk

4.Arteriesofthyroidgland

(1)Superiorthyroida.

1)Branchofexternalcarotida.

2)Runssuperficialandparalleltotheexternalbranchofsuperiorlaryngealn.toreachtheupperpoleofthyroidgland

3)Givesoffsuperiorlaryngeala.incompanywithinternalbranchofsuperiorlaryngealn.

(2)Inferiorthyroidartery

1)Branchofthyrocervicaltrunkofsubclaviana.

2)Turnsmediallyanddownward,reachestheposteriorborderofthethyroidgland,whereitiscloselyrelatedtotherecurrentlaryngealn.

3)Suppliesinferiorpoleofthyroidgland

(3)Arteriathyroideaima

Mayarise(4%)fromthebrachiocephalica.oraorticarch

5.Nervesoflarynx

(1)Superiorlaryngealn.

1)Internalbranch：whichpiercesthyrohyoidmembranetoinnervatesmucousmembraneoflarynxabovefissureofglottis

2)Externalbranch：isfinen.,whichdescendsincompanywiththesuperiorthyroida.andsuppliescricothyroid

(2)Recurrentlaryngealnerves

1)Ascendintracheo-esophagealgroove

2)Passdeeptothelobeofthethyroidglandandcomeintocloserelationshipwiththeinferiorthyroida.

3)Crosseitherinfrontoforbehindthearteryofmaypassbetweenitsbranches

4)Nervesenterlarynxposteriortocricothyroidjoint,thenerveisnowcalledinferiorlaryngealnerve

5)Innervations:laryngealmucosabelowfissureofglottis,alllaryngeallaryngealmusclesexceptcricothyroid

6.Venousdrainage

(1)Superiorthyroidveinsdrainintointernaljugularvein

(2)Middlethyroidveinsdrainintointernaljugularvein

(3)Inferiorthyroidveinsoftwosidesanastomosewithoneanotherastheydescendinfrontofthetracheatoformunpairedthyroidvenousplexus.Theydrainintobrachiocephalicveins.

Ⅴ)Parathyroidgland－Yellowish-brown,ovoidbodies

1.Position

(1)Twosuperiorparathyroidglands:lieatjunctionofsuperiorandmiddlethirdofposteriorborderofthyroidgland

(2)Twoinferiorparathyroidglands:lieneartheinferiorthyroidartery,closetotheinferiorpolesofthyroidgland

2.Function:regulatecalciumandphosphatebalanceandisthereforeessentialforlife

Ⅵ)Cervicalpartoftrachea

1.Beginsatlowerendoflarynx－levelofC6vertebra

2.Consistsofaseriesofincompletecartilagerings

3.Extendsintothorax

4.Relationsofcervicalpartoftrachea

(1)Anteriorly

1)Skin

2)Superficialfascia

3)Investingfascia

4)Suprasternalspaceandjugulararch

5)Infrahyoidmusclesandpretrachealfascia

6)Isthmusofthyroidgland(infrontofthe2ndto4thtrachealcartilage)

7)Inferiorthyroidv.andunpairedthyroidvenousplexus

8)Arteriathyroidima(ifpresent)

9)Thymus,leftbrachiocephalicv.andaorticarchinchild

(2)Superolaterally－lobesofthethyroidgland(downasfarasthesixthring)

(3)Posteriorly

1)Esophagus

2)R.&L.recurrentlaryngealnerves

(4)Posterlaterally

1)Cervicalsympathetictrunk

2)Carotidsheath

Ⅶ)Cervicalpartofesophagus

1.ExtendingfrompharynxatlevelofC6vertebra

2.Descendsthroughtheneck,itinclinestotheleftside

3.Relationsofthecervicalpartofesophagus

(1)Anteriorly

1)Trachea

2)Recurrentlaryngealnervesascend,oneoneachside,inthegroovebetweenthetracheaandesophagus

(2)Posteriorly

1)prevertebrallayerofcerviclfascia

2)longuscolli

3)vertebralcolumn

(3)Laterally

1)lobeofthethyroidgland

2)carotidsheathwiththecommoncarotida.,theinternaljugularv.,andthevagusn.

SternocleidomastoidRegionandLateralRegionofNeck

LearningObjiective

1.Knowtheboundariesandcontentsofsternocleidomastoidregion.

2.Masterthecontentsofcarotidsheath.

3.Knowtheboundariesandcontentsofthe