② Facial muscles 面肌

• Epicranius 颅顶肌 (occipitofrontalis) 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
 Left side of mediastnum

.
 Right side of mediastnum

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“Parotid bed” － internal carotid a., internal jugular v., Ⅸ ～
Ⅻ cranial nerves
 B. Facial vein 面静脉
• Begins at medial angle of eye
(angular vein)
• Runs downward and backward
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
• Connected with cavernous sinus
through the ophthalmic v. and
pteygoid plexus via the deep
facial vein
Frontoparietooccipital region 额顶枕区
Boundaries
• Anterior － supraorbital
margin
• Posterior － external
occipital protuberance and
superior nuchal line
• Lateral － superior temporal
line
Landmarks
– Hyoid bone
– Thyroid cartilage
– Cricoid cartilage
– Carotid tubercle (C6)
– Sternocleidomastoid
– Suprasternal fossa
– Greater supraclaviclar
fossa
Regions
• Anterolatateral Neck 固有颈部

– Anterior region of neck

– Lateral region of neck

– Sternocleidomastoid region

• Posterior Neck (Nape) 项部

– Posterior region of neck

 Anterior region of neck
 Suprahyoid region 舌骨上区
 Submental triangle 颏下三角

 Submandibular triangle

下颌下三角
 Infrahyoid region 舌骨下区
 Carotid triangle 颈动脉三角

 Muscular triangle 肌三角

 Sternocleidomastoid
region
 Lateral region of neck
 Occipital triangle 枕三角
 Supraclavicular triangle
锁骨上三角
(great supraclavicular fossa)
 Anterior region of neck
 Suprahyoid region 舌骨上区
 Submental triangle 颏下三角

 Submandibular triangle

下颌下三角
 Infrahyoid region 舌骨下区
 Carotid triangle 颈动脉三角

 Muscular triangle 肌三角

 Lateral region of neck

 Occipital triangle 枕三角
 Supraclavicular triangle
锁骨上三角
(great supraclavicular fossa)
锁骨上大窝
 Layers of the neck
1. Skin
• The natural line of cleavage of the skin are constant and run
almost horizontally around the neck
2. Superficial fascia
• Consists of fat and loose
connective tissue
• Contents
– Platysma
– Superficial veins
• Anterior jugular v.
• External jugular v.
– Cutaneous nerves
• Lesser occipital n.
• Greet auricular n.
• Transverse nerve of neck
• Supraclavicular n.
– Cervical branch of facial n.
 Carotid sheath 颈动脉鞘
• Formed by components of all three layers of deep cervical fascia
• Contains common and internal carotid arteries, internal jugular vein,
and vagus nerve
• Ansa cervicalis located on its anterior surface
2. Submandibular triangle 下颌下三角
• Bounded by anterior and posterior bellies of digastric and lower
border of the body of the mandible
• Covered by skin, superficial fascia, platysma and investing fascia
• Floor － mylohyoid, hyoglossus and middle constrictor of pharynx
• Contents － submandibular gland, facial a., v., hypoglossal n. and v.,
lingual n., submandibular ganglion and submandibular lymph nodes
 Infrahyoid region 舌骨下区
1. Carotid triangle 颈动脉三角
• Bounded by anterior border of
sternocleidomastoid, superior belly
of omohyoid and posterior belly of
digastic muscles
• Covered by skin, superficial fascia,
platysma and investing fascia
• Floor － prevertebral fascia and
lateral wall of pharynx
• Contents － common carotid a. and
its branches, internal jugular v. and
its tributaries, hypoglossal n. with its
descending branches, the accessory
and vagus nerves, and part of the
chain of deep cervical lymph nodes
2. Muscular triangle 肌三角
• Bounded by midline of the
neck, superior belly of the
omohyoid and anterior border
of the sternocleidomastoid.
• Covered by skin, superficial
fascia, platysma, anterior
jugular v., cutaneous n. and
investing fascia
• Floor － prevertebral fascia
• Contents － sternohyoid,
superior belly of omohyoid,
sternothyroid, thyrohyoid,
thyroid gland, parathyroid
gland, cervical part of trachea
and esophagus
 ☻ Thyroid gland 甲状腺
Shape and position
• H-shape
• Left and right lobes: lie on either side of
inferior part of larynx and superior part of
trachea, extend from middle of thyroid
cartilage to level of sixth trachea cartilage
• Isthmus: overlies 2nd to 4th tracheal
cartilage
• Pyramidal lobe: some times arises from
isthmus
Fibrous capsule:
A sheath of pretracheal fascia which is
attached to arch of cricoid and thyroid
cartilages, hence, the thyroid gland moves
with larynx during swallowing and
oscillates during speaking
• Contents
– Cupula of pleura －
extends up into the neck,
over the apex of lung, 2
～ 3cm above the medial
third of clavicle
– Subclavian v.
– Subclavian a.
– Thoracic duct
– Right lymphatic duct
– Vagus n.
– Phrenic n.
 Lateral region of neck
颈外侧区
• Bounded by posterior
border of
sternocleidomastoid,
anterior border of trapezius
and middle third of clavicle
• Divided by inferior belly of
omohyoid into occipital and
supraclavicular triangles
1. Triangle of the vertebral a. 椎动脉三
角
• Boundaries
– Medially － longus colli
– Laterally － scalenus anterior
– Inferiorly － first part of subclavian a.
– Apex － transverse process of C6
– Posteriorly － Cupula of pleura, transverse
process of C7, anterior rami of C8 spinal
nerves, costal neck of 1st rib
– Anteriorly － carotid sheath, phrenic n. and
arch of thoracic duct (left)
• Contents
– Vertebral a.
– Inferior thyroid a.
– Cervical part of sympathetic trunk
– Cervicothoracic ganglion
3. Supraclavicular triangle
锁骨上三角
• Bounded by posterior border of
sternocleidomastoid, inferior
belly of omohyoid and middle
third of clavicle
• Covered by skin, superficial
fascia, and investing fascia
• Floor － prevertebral fascia and
inferior parts of scalenus
• Contents
– Subclavian v. and venous
angle
– Subclavian a.
– Brachial plexus
 Dissection

Platysma
 Cutaneous nerves and superficial veins

Lesser occipital n.

External jugular vein

Greet auricular n.
Transverse nerve of neck
Supraclavicular n.
Anterior jugular vein
Submendibular gland

Digastric Accessory n.

Hypoglossal n.

Superior thyroid a.
Ansa cervicalis Cervical plexus

Sternothyroid Phrenic n.
Sternohyoid
Omohyoid
Vagus n.
 Hypoglossal n.

Vagus n.
Internal branch

Superior thyroid a.
External branch
Vertebral a.

Inferior thyroid a.
Inferior thyroid a. Vagus n.

Recurrent laryngeal n. Thoracic duct

 Inferior thyroid a.
Vertebral a.

Transverse cervical a. Thyrocervical trunk

Costocervical Suprascapular a.
trunk
Internal thoracic a.
Subclavian vein
• It is an continuation of axillary
vein at the lateral border of
first rib
• Joins internal jugular vein to
form the brachiocephalic vein.
Angle of union is termed
venous angle 静脉角
 Anterior branches of thoracic nerves
• Intercostal nerves 肋间神经 (anterior rami of T1- T11): runs forward
inferiorly to intercostals vessels in costal groove of corresponding rib,
between intercostals externi and intercostals interni; first six nerves are
distributed within their intercostals space, lower five intercostals nerves
leave anterior ends of their intercostals spaces to enter abdominal wall
• Subcostal nerve 肋下神经 (anterior ramus of T12): follows inferior border
of T12 rib and passes into abdominal wall
• Distribution: distributed to intercostales and anterolateral abdominal
muscles, skin of thoracic and abdominal wall, parietal pleura and
peritoneum
 The Mediastinum 纵隔
Concept － all of organs
between the left and right
mediastinal pleurae is
called mediastinum. It
extends from the sternum
in front to the vertebral
column behind, and from
the thoracic inlet above
to the diaphragm below.
 Subdivisions of mediastinum
• Superior mediastinum 上纵隔
• Inferior mediastinum 下纵隔
– Anterior mediastinum 前纵隔
– Middle mediastinum 中纵隔
– Posterior mediastinum 后纵隔
 Left side of mediastnum
Left subclavian a.
Thoracic duct
Left vagus n. Aortic arch
Left recurrent n. Thoracic aorta
Phrenic n. &
pericardiacophrenic a.
Sympathetic trunk
Root of lung

Pericardium

Esophagus

Greater splanchnic n
 Right side of mediastnum
Trachea
Left vagus n. Superior vena cava
Arch of azygos v. Phrenic n. &
pericardiacophrenic
Azygos v.
a.
Root of lung
Sympathetic trunk

Esophagus Pericardium

Inferior vena cava

 Superior mediastinum 上纵隔
Locating － from inlet of thorax
to plane extending from level
of sternal angle anteriorly to
lower border of T4 vertebra
posteriorly
Contents
• Superficial layer
– Thymus
– Three veins
• Left brachiocephelic v.
• Right brachiocephelic v.
• Superior vena cava
Triangule of ductus arteriosus 动脉
导管三角
• Bounded by phrenic n., left vagus n. and
left pulmonary a.
• Contents － arterial ligament , left
recurrent n. and superficial cardiac
plexuses
Posterior mediastinum 后纵隔
• Location － posterior to heart and pericardium, anterior to
vertebrae T5 － T12
• Contents: esophagus, vagus n., thoracic aorta, azygos system of
veins, thoracic duct, thoracic sympathetic trunk, posterior
mediastinal lymph nodes
 Lymphatic drainage of breast
• Into pectoral ln. from lateral and
central parts of breast
• Into apical and supraclavicular ln.
from superior part of breast
• Into parasternal ln. from medial part
of breast
• Into interpectoral ln. from deep part
of breast
• The lymphatic capillaries of breast
form an anastomosing network which
is continuous across the midline with
that of the opposite side and with
that of the abdominal wall
 Veins of thorax
Brachiocephalic veins
• Formed by union of internal jugular and
subclavian veins posterior to the
sternoclavicular joint
• Angle of union is termed venous angle
Superior vena cava
• Formed by union of right and left
brachiocephalic veins behind the right
sternocostal synchondrosis of first rib
• Runs vertically down on right of ascending
aorta
• Joined by azygos vein at level of sternal angle
• Enters right atrium at lever of lower border of
third right sternocostal joint
• Collects blood from veins of upper half of body
Thoracic duct 胸导管
• Begins in front of L1 as a dilated sac, the
cisterna chyli 乳糜池 , which formed by
joining of left and right lumbar trunks and
intestinal trunk
• Enter thoracic cavity by passing through the
aortic hiatus of the diaphragm and ascends
along on the front of the vertebral column,
between thoracic aorta and azygos vein
• Travels upward, veering to the left at the level
of T5
• At the roof of the neck, it turns laterally and
arches forwards and descends to enter the
left venous angle