Head

Ⅰ. Boundaries :lower border of mandible—the angle of mandible—the mastoid process—the superior nuchal line—the external occipital protuberance

Ⅱ. Divisions:• the face• the cranium

— supra-orbital margin—zygomatic arch— superior margin of external acoustic meatus— mastoid process.

Ⅰ. Boundaries :lower border of mandible—the angle of mandible—the mastoid process—the superior nuchal line—the external occipital protuberance

Ⅱ. Divisions:• the face• the cranium

— supra-orbital margin—zygomatic arch— superior margin of external acoustic meatus— mastoid process.

Region and parts Cranium 颅部 Face 面部

Landmaeks Superciliary Supraorbital notch Infraorbital foramen Mental foramen Pterion Zygomatic arch Mastoid process External occipital protubera

nce

Epidural hemorrhage

Pterion

Muscles of head Facial muscles 面肌 Epicranius 颅顶肌 (oddi

pitofrontalis) 枕额肌 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Platysma 颈阔肌

The skin of face is 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.

Masticatory muscles 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

Temporalis 颞肌 Origin － temporal fossa Insertion － coronoid proce

ss of mandible Action － elevates and retr

acts mandible lateral pterygoid 翼外肌 Medial pterygoid 翼内肌

Arteries of headFacial a. 面动脉 Branch of external caroteid a. Runs forward over digastric a

nd submandibular gland Loops around mandible (whe

re 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

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

Maxillary artery 上颌动脉 Branch of external caroti

d a. Entrance to infratempora

l 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 f

oremen spinosum Supplies cranium and du

ra mater Posterior superior alveola

r a. 上牙槽后动脉

Veins of head Facial vein 面静脉 Begins at medial angle of ey

e (angular vein) Runs downward and backw

ard through the face, posterior to the facial artery

Below angle of mandible, joins anterior branch of retromandibular vein to form common facial vein, which drains into internal jugular vein

Connections with cavernous sinus 海绵窦 through the ophthalmic vein 眼静脉 , and also through pteygoid plexus 翼静脉丛 via the deep facial vein 面深静脉

“Danger area” 危险三角－ lies between root of nose and two angles of mouth; in this area the facial vein has no valves

Retromandibular vein 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

Pteygoid plexus 翼静脉丛

Located between and around muscles of mastication

Receives blood from all regions supplied by maxillary a.

Communicates with Face by deep facial veins Cavernous sinus by veins d

raining base of skull Provides possible pathwa

y for spread of infection to cranial cavity

The lymphatic drainage of head Lymph nodes of head Located at junction of head an

d neck Consist of occipital, mastoid, p

arotid, submandibular, submental lymph nodes

Drain into deep cervical lymph nodes

Submandibular lymph node 下颌下淋巴结 lies near the submandibular gland, receive lymphatic vessels from the face, nose and mouth

Nerves of head Facial nerve ( ) Ⅶ 面神

经 Leaves skull through intern

al acoustic meatus, facial canal and stylomastoid foramen

Divided three parts First part － between stylo

mastoid foramen and parotid gland

Second part － within parotid gland

Third part － outside of parotid gland

Enters parotid gland and divides into its five terminal branches for muscles of facial expression Temporal 颞支 Zygomatic 颧支 Buccal 颊支 Marginal mandibular

下颌缘支 Cervical 颈支

Trigeminal nerve (Ⅴ) 三叉神经

Ophthalmic nerve 眼神经 ( 1) → supraorⅤbital n. 眶上神经

Maxillary nerve 上颌神经 ( 2) → infraorⅤbital n. 眶下神经

Mandibular nerve 下颌神经 ( 3) →mental Ⅴn. 颏神经

Parotid gland 腮腺 Position: situated below th

e 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: lies deep to medial pterygoid .

Parotid duct 腮腺管 Arises front anterior

border of gland Lies 1.5 cm below an

d parallel to zygomatic arch

Passes forward over masseter, pierces the buccinator and oral mucosa to open opposite second upper molar tooth

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 id quite thin and easily disrupted.

Structures passing through the parotid gland Vertical

External carotid a. Retromandibular vein Superficial temporal a. &

v. Auriculotemporal n.

Transversal Maxillary a. & v. Tranverse facial a. & v. Branches of facial n.

Relationships of parotid gland Superior － external acostic

meatus, poterior margin of temporomandibular joint

Anteromedialy － masseter, ramus of mandible, posterior part of medial pterygoid

Poateromedial － mastoid process, sternocleidomastoid, posterior belly of digastric, styloid process, internal carotid a., internal jugular v., Ⅸ ～Ⅻ cranial nerves

“Parotid bed” － internal carotid a., internal jugular v., Ⅸ ～Ⅻ cranial nerves

Masseter space 咬肌间隙

Lies between the masseter, and ramus of mandible

Pterygomandibual space 翼下颌间隙 Lies between ramus of

mandible and medial pterygoid

Sublingual space 舌下间隙 Between mucous membrane of floor of mouth and m

ylohyoid and hyoglossus

Dissection

Skin incisions

The cranial part

Frontal parietal occipital region额顶枕区

Boundaries Anterior － supraorbital

margin Posterior － external oc

cipital protuberance and superior nuchal line

Lateral － superior temporal line

Layers consists of five layers:

Skin 皮肤 Superficial fascia 浅筋膜 Galea aponeurotica and

occipitofrontalis 帽状腱膜和枕额肌

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

The skin has the greatest concentration of hair and sebaceous glands

皮厚、腺多、血运丰富 The superficial fascia is de

nse connective tissue that binds the skin strongly to the underlying galea aponeurotica The vasculature of the sc

alp runs primarily in the. lt is richand widely anastornotic-

Wounds of the scalp bleed profusely but heal well.

Arteries, veins and nerves Anterior group

Supratrochlear a. v. n. Supraorbital a. v. n.

Posterior group Occipital a. v. Greater occipital n.

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

Galea aponeurotica It is interposed between t

he 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

Subaponeurotic space (loose connective tissue) Extracranial hematoma, the resul

t 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 lateraliy, 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 thescalp from the periosteum.

Contains a rich network of deep arteries and veins. Therefore, this layer has been called the “dangerous area”.

Infaction 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

Pericranium

Fuses firmly with bone at the sutures and with the periosteum of theadjacent bone, thus limiting the subperiosteal space.

薄而致密，易于颅骨分离，如有血肿，与骨一致

Temporal region Boundaries Superior － superior te

mporal line Inferior － superior bord

er of zygomatic arch Anterior － the junction

of frontal and zygomatic bones

Posterior － posterior portion of superior temporal line

Layers consists of five layers:

Skin 皮肤 Superficial fascia 浅筋

膜 Temporal fascia 颞筋

膜 Temporalis 颞肌 Periosteum 骨膜

Superficial fascia 浅筋膜 Anterior auricular group

Superficial temporal a. & v.

Auriculotemporal n. Posterior auricular group

Posterior auricular a. & v. Lesser occipital n.

Temporal fascia 颞筋膜

Temporalis

Periosteum

Cerebral dural materCharacters A thick and dense inelast

ic membrane that composed of two layers, an inner or meningeal and outer or endosteal

It is in loose contact with calvaria, and most strongly adherent to base of skull

Four septa Cerebral falx Tentorium of cerebellum － in front there is a gap, the tento

rial incisure, for passage of midbrain Cerebellar falx Diaphragma sellae

Sinuses of duramater Superior sagittal sinus Inferior sagittal sinus

Straight sinus Confluence of sinus

Transverse sinus

Sigmoid sinus

Superior petrosal sinuse

s

inferior petrosal sinuses