Vessels and nerves of the neck

1. Vessels and nerves of the neck 陳建榮 http://web.nchu.edu.tw/~chenjr/index.htm

2. Fascia筋膜 • Superficial fascia淺筋膜 • Deep fascia深筋膜

3. 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.

5. 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)

7. x x

10. Area innervated by spinal n. Lateral br. Ventral br. Dorsal br.

11. Dermatomes皮節 Refer pain

12. Refer pain反射痛 phantom pain幻肢痛

14. Nerves in cervical region • C1~C5 spinal nerves • Accessory nerve (CN XI) • Vagus nerve (CN X)

15. 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.

16. 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 (C1C2) Occi C1 C2

18. Ansa cervicalis頸環 C1 - No cutaneous br. of dorsal and ventral branches

19. 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

21. Innervation of C2 spinal n.

22. Spinal n. of C2

23. C3 – C5

26. 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.)

27. Brachiocephalicus肱頭肌 • Cleidobrachialis • Cleidomastoideus • Cleidocervialis Human: Sternocleidomastoid m. Dog: Sternocephalicus - sternooccipitalis - sternomastoideus Cleidomastoideus Cleidocervicalis

28. Vagus n. (CN X)迷走神經 • Vagosympathetic trunk • Carotid sheath • Cranial laryngeal n. • Recurrent laryngeal n. (caudal laryngeal n.)

29. Recurrent laryngeal n. (caudal laryngeal n.) -Left recurrent laryngeal n. -Right recurrent laryngeal n.

31. 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

32. Branches of Subclavian a. • Internal thoracic a. • Vertebral a. • Costocervical a. • Superficial cervical a. • Axillary a.

34. Common carotid a.總頸動脈 • Caudal thyroid a. • Cranial thyroid a. • External carotid a. • Internal carrotid a.

35. Blood supply of cervical vertebrae • Vertebral a. (subclavian a.) • Blood supply of brain: • Veterbral a. • Internal carotid a.

36. 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

37. Costocervical trunk肋頸動脈幹 • Costocervical trunk • Deep cervical a. • Thoracic vertebral a. • Dorsal scapular a.

38. 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.

41. Thyroid gland Parathyroid gland Medial retropharyngeal lymph node內咽後淋巴結

42. Blood supply of thyroid gland • Cranial thyroid a. • Caudal thyroid a.

43. 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

45. 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。

46. 在肱頭肌表面可找到肩肱靜脈。

47. 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。

48. 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

50. 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