复旦大学：《局部解剖学 Regional Anatomy》教学课件（英文）Part 7 – Neck（Part 2）Region of the sternocleidomastoid

Regional Anatomy Part 7- Neck(Part 2 Region of the sternocleidomastoid INTERNATIONAL EDITION Hongqi zhang(张红旗) Dissector Dept of Anatomy, Histoembryology CEmail:zhanghg58@126.com

1 Regional Anatomy Part 7 – Neck (Part 2) Region of the sternocleidomastoid Hongqi Zhang (张红旗 ) Dept. of Anatomy,Histoembryology Email: zhanghq58@126.com

Review the contents last lecture ◆ Platysma ◆ Four cutaneous nn Two ant jugular vv. and two ext jugular vv, lymph node Sternocleadomastoid-med. and lat head at the origin Suprahyoid muscular group Infrahyoid muscular group-important Carotid sheath(common carotid a, vagus n, int jugular v. Thyroid-sup. inf, thyroid a v. mid thyroid v pInt. ext branch of sup. laryngeal n Clear up the boundary of the submental triangle Q Clean up the boundary of the submandibular triangle Identify: Submandibular triangle-facial V, hypoglossal n lingual a & n, duct of submandibular gland, Clear identify related blood vessels& nn. of the thyroid

Review the contents last lecture Platysma Four cutaneous nn. Two ant.jugular vv.and two ext.jugular vv.,lymph node Sternocleadomastoid-med.and lat. head at the origin Suprahyoid muscular group Infrahyoid muscular group- important Carotid sheath (common carotid a.,vagus n.,& int.jugular v.) Thyroid-sup.inf,thyroid a.v. mid.thyroid v. Int.& ext branch of sup.laryngeal n. Clear up the boundary of the submental triangle Clean up the boundary of the submandibular triangle Identify:Submandibular triangle-facial v.,hypoglossal n., lingual a.& n., duct of submandibular gland, Clear & identify related blood vessels & nn. of the thyroid

cervical fascia Pretracheal fascia 2 Thyroid gland Sternohyoid m Platysma m Sternothyroid m. Sternocleidomastoid m Common carotid artery Omohyoid m Intemal jugular vein Sympathetic trunk Vagus ne 2 Carotid sheath neal space Prevertebral fascia Trapezius m. cervical vertebra Superficial fascia Posterior Transverse section of the neck-indicating the fascia of the neck

Transverse section of the neck-indicating the fascia of the neck 1 2 2 3

parotid gland platysma great auricular facial sternocleidomastoid cervical branch of facial external jugular v submandibular gland splenius c laryngeal prominence accessory n」 transverse n, of neck trapezius nterior jugular v lateral supraclavicular n. medial supraclavicular n Intermediate supraclavicular n external jugular v. clavicle muscles, up blood vessels and nerve of the neck(right aspect

muscles,sup.blood vessels and nerve of the neck (right aspect)

Suprahyoid and infrahyoid muscle-8 Identify submental triangle(a) submandibular triangle(b a 2 Suprahyoid mm 1-Digastric m 6 2-Stylohyoid m 3 3-Mylohyoid m 5 6 4-Geniohyoid m Infrahyoid mm 5-Sternohyoid m aaSI 6-Omohyoid m 7-Sternothyroid m 8-Thyrohyoid m Post, view

Suprahyoid mm. 1-Digastric m. 2-Stylohyoid m. 3-Mylohyoid m. 4-Geniohyoid m. Infrahyoid mm. 5-Sternohyoid m. 6-Omohyoid m. 7-Sternothyroid m. 8-Thyrohyoid m. Suprahyoid and infrahyoid muscle ‐ 8 3 4 Post.view 1 2 3 5 7 8 6 6 Iderntify submental triangle (a) & submandibular triangle (b) a b b

Dissect the suprahyoid region Dissect the submental triangle-1 Indentify its boundaries find 1-2 lymph n Dissect the submandibular triangle-2 Boundaries: bellies of digastric, inf border of mandible. removed the fascia of submandibular gland 1. Dissect the facial a -find if between the mandible gland 2. Dissect the mylohyoid m. n-retract the gland superiorly, cut down ant belly close to mandible, reflect it posteriory, clean up mylohyoid and search for mylohyoid n from the surface of the muscle

Dissect the submental triangle-1: Indentify its boundaries & find 1-2 lymph n. Dissect the submandibular triangle-2 Boundaries: bellies of digastric, inf.border of mandible.removed the fascia of submandibular gland, 1. Dissect the facial a.- find if between the mandible & gland; 2. Dissect the mylohyoid m.& n.- retract the gland superiorly, cut down ant .belly close to mandible, reflect it posteriory, clean up mylohyoid and search for mylohyoid n.from the surface of the muscle. Dissect the suprahyoid region 1 2 2

Dissect the suprahyoid region Dissect the structures superficial to geniohyoid: cut the geniohyoid close to hyoid bone, reflect it anteriorly and expose the geniohyoid msearch for submandiburar duct and lingual n, from the ant border of deep part of submandibualr gland find the hypoglossal n close to inf border of post belly of digastric m 茎突舌肌 sus 茎突咽肌N stylopharyng glossopharyngeal n nrnsubmandibul submandibular submandibular 颏舌肌 genioglossus hyoglossus lingual a 颏舌骨肌 geniohyoid middle/ constrictor of ph

Dissect the structures superficial to geniohyoid: cut the geniohyoid close to hyoid bone, reflect it anteriorly and expose the geniohyoid m.search for submandiburar duct and lingual n,from the ant.border of deep part of submandibualr gland.find the hypoglossal n.close to inf.border of post.belly of digastric m. Dissect the suprahyoid region

Dissect infrahyoid region and SCM region Clean the sup layer of deep cervical fascia expose the mm Dissect the sternocleidomastoid(SCM) muscle Cut the SCM from its origin, and reflect superiorly, serach for the accessory n. close to the mid. point of post border of SCM Dissect pretracheal fascia and ansa cervicalis Clean up infrahyoid mm, search for the branches of ansa cervicalis from the lat border of the infrahyoid mm, and trace along the branches to ansa cervicalis. Cut down sternohyoid m close to the sup. border of sternum, and reflect it superioly, expose sternothyroid and thyrohyoid. Cut down sternothyroid m from its lower end reflect it superiorly expose the thyroid, larynx and trachea

Clean the sup.layer of deep cervical fascia & expose the mm. Dissect the sternocleidomastoid(SCM) muscle Cut the SCM from its origin,and reflect superiorly ,serach for the accessory n. close to the mid. point of post.border of SCM. Dissect pretracheal fascia and ansa cervicalis Clean up infrahyoid mm, search for the branches of ansa cervicalis from the lat.border of the infrahyoid mm,and trace along the branches to ansa cervicalis. Cut down sternohyoid m.close to the sup.border of sternum,and reflect it superioly,expose sternothyroid and thyrohyoid.Cut down sternothyroid m.from its lower end.reflect it superiorly expose the thyroid, larynx and trachea. Dissect infrahyoid region and SCM region

Dissect the carotid sheath Cut open carotid sheath longitudinally, identify the common carotid a,int and ext carotid aa and vagus n search for sup Hypoglossal nerve (xl) laryngeal n. at both sides of the larynx Dissect the deep ext jugular lymph nodes erve to thyrohyoid m Search for lymph n. along int jugular v. accesory Dissect the carotid triangle Identify its bourdary Superior root of ansa cervicalis C3 Common carotid a cervicalis Int carotid a Carotid Sternohyoid m triangle Ext card a cervicalis Carotid sinus gus n Deep cervical lymph n Internal jugular vein NsT- wmy Sternothyroid m

Dissect the carotid sheath: Cut open carotid sheath longitudinally, identify the common carotid a,int.and ext.carotid aa.and vagus n. search for sup. laryngeal n. at both sides of the larynx. Dissect the deep.ext.jugular lymph nodes Search for lymph n. along int.jugular v. Dissect the carotid triangle: Identify its bourdary. Carotid triangle Common carotid a. Int.carotid a. Ext.carod a. Carotid sinus. Vagus n. Deep cervical lymph n

Hypoglossal nerve (Xll) Contents of carotid triangle Int jugular v& its tributaries /rve to uyoyo. Common carotid a. its branches Hypoglossal n. descending branch Hyoid bone Vagus n. its branches Accessory n Superior root of ansa Deep cervical lymph nodes Superior belly of cervical Internal jugular vein Ansa cervicalis ①④① Carotid sheath and contents

Ansa cervicalis Contents of carotid triangle: Int.jugular v & its tributaries Common carotid a.& its branches Hypoglossal n.& descending branch Vagus n. & its branches Accessory n. Deep cervical lymph nodes 3 1 2 Carotid sheath and contents