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Vessels and nerves of the neck. 陳建榮. http://web.nchu.edu.tw/~chenjr/index.htm. Fascia 筋膜 Superficial fascia 淺筋膜 Deep fascia 深筋膜. Fascia of cervical: Superficial fascia Deep fascia Superficial lamina Prevertebral lamina Pretracheal lamina Common carotid sheath 總頸動脈鞘 Vagosympathetic n.
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Vessels and nerves of the neck 陳建榮 http://web.nchu.edu.tw/~chenjr/index.htm
Fascia筋膜 • Superficial fascia淺筋膜 • Deep fascia深筋膜
Fascia of cervical: • Superficial fascia • Deep fascia • Superficial lamina • Prevertebral lamina • Pretracheal lamina • Common carotid sheath總頸動脈鞘 • Vagosympathetic n. • Common carotid a. • Internal jugular v.
Spinal nerve脊神經 • Root segment • Dorsal root背根 • Dorsal root ganglion背根神經節 (spinal ganglion脊神經節) • Ventral root腹根 • Meningeal branch脊膜支 • Communicating branch交通支 • Dorsal ramus背支 (dorsal branch) • Ventral ramus腹支 (ventral branch)
x x
Area innervated by spinal n. Lateral br. Ventral br. Dorsal br.
Dermatomes皮節 Refer pain
Refer pain反射痛 phantom pain幻肢痛
Nerves in cervical region • C1~C5 spinal nerves • Accessory nerve (CN XI) • Vagus nerve (CN X)
C1 (lateral vertebral foramen) • Dorsal ramus suboccipital n.枕骨下神經 m. of suboccipital area • Ventral ramus ansa cervicalis頸環 sternothyroideus, sternohyoideus, thyrohyoideus m.
Suboccipital region: • Rectus capitis dorsalis major背大頭直肌 (C2 occipital) • Rectus capitis dorsalis intermedius背小頭直肌 (C1 occipital) • Obliquus capitis cranialis前頭斜肌 (occipital C1) • Obliquus capitis caudalis後頭斜肌 (C1C2) Occi C1 C2
Ansa cervicalis頸環 C1 - No cutaneous br. of dorsal and ventral branches
C2 (first intervertebral forament) • Dorsal ramus • greater occipital n.大枕骨神經 • Ventral ramus • great auricular n.大耳殼神經 • transverse cervical n.橫頸神經
Accessory n. (CN XI) 副神經 • CN XI: • Sternocephalicus m.胸骨頭肌 • Sternomastoideus m.胸骨乳突肌 • Sternooccipitalis m.胸骨枕骨肌 • Cleidomastoideus m.鎖骨乳突肌 • Cleidocervicalis m.鎖骨頸肌 • Trapezius m.斜方肌 Cleidobrachialis m.鎖骨肱肌 -(brachiocephalicus n.)
Brachiocephalicus肱頭肌 • Cleidobrachialis • Cleidomastoideus • Cleidocervialis Human: Sternocleidomastoid m. Dog: Sternocephalicus - sternooccipitalis - sternomastoideus Cleidomastoideus Cleidocervicalis
Vagus n. (CN X)迷走神經 • Vagosympathetic trunk • Carotid sheath • Cranial laryngeal n. • Recurrent laryngeal n. (caudal laryngeal n.)
Recurrent laryngeal n. (caudal laryngeal n.) -Left recurrent laryngeal n. -Right recurrent laryngeal n.
Vessels in cervical region • Common carotid a.總頸動脈 ( brachiocephalic a.) • Subclavian a.鎖骨下動脈 • Vertebral a.脊椎動脈 • Costocervical a.肋頸動脈 • Superficial cervical a.淺頸動脈 • Axillary a.腋動脈 • Internal thoracic a.內胸動脈 • Internal jugular v.內頸靜脈 • External jugular v.外頸靜脈
Branches of Subclavian a. • Internal thoracic a. • Vertebral a. • Costocervical a. • Superficial cervical a. • Axillary a.
Common carotid a.總頸動脈 • Caudal thyroid a. • Cranial thyroid a. • External carotid a. • Internal carrotid a.
Blood supply of cervical vertebrae • Vertebral a. (subclavian a.) • Blood supply of brain: • Veterbral a. • Internal carotid a.
Superficial cervical a.淺頸動脈 • Superficial cervical a. • Deltoideus br. • Suprascapular a. • Prescapular br. • Ascending br. Superficial cervical lymph nodes 淺頸淋巴結
Costocervical trunk肋頸動脈幹 • Costocervical trunk • Deep cervical a. • Thoracic vertebral a. • Dorsal scapular a.
External jugular v.外頸靜脈 • Linguofacial v.舌顏靜脈 • Maxillary v.上頜靜脈 • Omobrachial v.肩肱靜脈 • Superficial cervical v.淺頸靜脈 • Cephalic v.頭靜脈 • Internal jugular v. • Caudal thyroid v. • Brachiocephalic v.
Thyroid gland Parathyroid gland Medial retropharyngeal lymph node內咽後淋巴結
Blood supply of thyroid gland • Cranial thyroid a. • Caudal thyroid a.
將右側頸部及肩胛上方之皮膚掀開。 • 2. 注意以下幾個構造: • 1. C2、C3及C4的背側枝及腹側枝。 • 2. 外頸靜脈
3. 將闊頸肌移除,清理以下幾個構造: • 1. C2的腹側枝(great auricular n. and transverse cervical n.) • 2. 清理肱頭肌及斜方肌間的空隙,找出淺頸淋巴結、(副神經)及(淺頸動脈) • 3. 找出跨過肱頭肌的肩肱靜脈及其頭端的分枝舌顏靜脈及上頜靜脈。 • 4. 辨認出下頜腺。
4. 將鎖骨頸肌及胸骨枕骨肌於中段剪開,找出副神經,並確認其支配之肌肉有那些。 1. 認出匯入外頸靜脈的頭靜脈、淺頸靜脈。 2. 清理淺頸動脈的分枝。
5. 剪開鎖骨乳突肌及胸骨乳突肌,找出頸環之構造及其支配肌肉。 找出咽後淋巴節
6. 清理總頸動脈鞘,找出總頸動脈、迷走交感神經鏈、內頸靜脈。 1. 找出甲狀腺及其周圍的動靜脈。 2. 清理氣管及食道,注意喉返神經。 Splenius m. 夾肌