耳鼻咽喉应用解剖肖雪培训课件.ppt

1、The NoseExternal nose 外鼻Nasal cavity 鼻腔Paranasal sinuses 副鼻窦1耳鼻咽喉应用解剖肖雪2022-10-11The External NoseNasal root 鼻根Nasal back 鼻背Nasal apex 鼻尖Alae nasi 鼻翼Nostrils 鼻孔Lateral nasal cartilage鼻外侧软骨2耳鼻咽喉应用解剖肖雪2022-10-11外鼻静脉特点主要经面静脉和内眦静脉回流到颈内静脉。内眦静脉经眼上、眼下静脉与颅内海绵窦相通，该区静脉无瓣膜内眦静脉 面静脉 颈内静脉 眼上/下静脉 海绵窦3耳鼻咽喉应用解剖肖雪202

2、2-10-11Nasal cavity 鼻腔鼻腔 Nasal vestibule 鼻前庭鼻前庭 Nasal vestibule is the anterior and inferior part of nasal cavity.It is lined by skin and contains sebaceous glands,hair follicles and hair.Nasal cavity proper 固有鼻腔固有鼻腔4耳鼻咽喉应用解剖肖雪2022-10-11Nasal cavity proper The roof.Anterior sloping part of the roof

3、is formed by nasal bones;Posterior sloping part by the body of sphenoid bone;The middle horizontal part,by the cribriform plate(筛板).5耳鼻咽喉应用解剖肖雪2022-10-11Nasal cavity proper The floor.formed by the palatal process of the maxilla（上颌骨腭突）and the horizontal process of the palate bones（腭骨水平部）.3/41/46耳鼻咽喉应

4、用解剖肖雪2022-10-11Nasal cavity proper Nasal septum.鼻中隔鼻中隔软骨犁骨筛骨正中板上颌骨腭突7耳鼻咽喉应用解剖肖雪2022-10-11Littles area（plexus）利特尔区利特尔区 (动脉丛动脉丛)Littles area（plexus）利特尔区利特尔区(动脉丛动脉丛)Confluence of:Anterior Ethmoidal a.筛前动脉 Greater Palatine a.腭大动脉 Sphenopalatine a.蝶腭动脉 Sup.Labial a.上唇动脉8耳鼻咽喉应用解剖肖雪2022-10-11Nasal cavity p

5、roper Lateral wall.three scroll-like bone projections called turbinate or conchae（鼻甲）.Below and lateral to each turbinate is the corresponding meatus（鼻道）.9耳鼻咽喉应用解剖肖雪2022-10-11Nasal cavity proper Lateral wall.lNasolacrimal duct(鼻泪管)opens in the anterior part of inferior meatus.鼻泪管开口于下鼻道的前方lThe anteri

6、or group of sinuses (frontal,marxillary and anterior ethmoidal sinuses)open to the infundibulum（筛漏斗）in middle meatus.前组鼻窦（额窦，前组筛窦，上颌窦）开口于中鼻道的筛漏斗。lPosterior ethmoidal sinuses open into superior meatus.后组筛窦开口于上鼻道。lThe openning of sphenoid sinus situate is phenoethmoidal recess（蝶筛隐窝）lies above the supe

7、rior turbinate.蝶窦开口位于上鼻甲上方的蝶筛隐窝10耳鼻咽喉应用解剖肖雪2022-10-11Posterior naris(choanae)后鼻孔Nasal septum鼻中隔 Inferior turbinate下鼻甲 Nasal cavity properNasal cavity proper11耳鼻咽喉应用解剖肖雪2022-10-11Paranasal sinuses 副鼻窦副鼻窦The sinuses are air-filled bony cavities located in the face and skull adjacent to the nose.12耳鼻咽喉

8、应用解剖肖雪2022-10-11Maxillary sinus 上颌窦上颌窦 The maxillary sinus is the largest one,present in the maxilla bone.Drains into the nasal cavity through its ostium that is situated in the middle meatus.13耳鼻咽喉应用解剖肖雪2022-10-11Ethmoid sinus 筛窦筛窦 Comprises a group of air cells,which form one of the most complex s

9、tructures in the body.Drains through the middle meatus and above the superior turbinate.14耳鼻咽喉应用解剖肖雪2022-10-11Frontal sinus 额窦额窦 The frontal sinuses are situated beneath the bone of the forehead and just in front of the bone overlying the brain.And drains through the frontal recess（额隐窝）to the middle

10、 meatus.15耳鼻咽喉应用解剖肖雪2022-10-11Sphenoid sinus 蝶窦蝶窦 The sphenoid sinuses open in the upper part of anterior wall and drains into the sphenoethmoidal recess（蝶筛隐窝）（蝶筛隐窝）.16耳鼻咽喉应用解剖肖雪2022-10-11Ostiomeatal complex 窦口鼻道复合体窦口鼻道复合体 The ostiomeatal complex is the sinus hot spot,one of the most important anato

11、mical regions with regard to sinus health and disease.That comprises maxillary sinus ostia,anterior ethmoid cells and their ostia,ethmoid infundibulum,hiatus semilunaris,and middle meatus.筛漏斗及其周围的中鼻甲、钩突、筛泡、半月裂筛漏斗及其周围的中鼻甲、钩突、筛泡、半月裂以及额窦、前组筛窦和上颌窦的自然开口等结以及额窦、前组筛窦和上颌窦的自然开口等结构形成的区域，称为鼻道窦口复合体构形成的区域，称为鼻道窦口复

12、合体(ostiomeatal complex)(ostiomeatal complex)，是内窥镜鼻窦手术以，是内窥镜鼻窦手术以后提出的新概念，对指导手术有重要意义。后提出的新概念，对指导手术有重要意义。17耳鼻咽喉应用解剖肖雪2022-10-11鼻瓣膜区nasal valve area生理性鼻甲周期 physiological turbinal cycle/鼻周期nasal cycle鼻肺反射 nasopulmonary reflex喷嚏反射sneeze reflex18耳鼻咽喉应用解剖肖雪2022-10-11The Ear19耳鼻咽喉应用解剖肖雪2022-10-11 External,Mi

13、ddle,and Inner ear.Each serves different aspects of the auditory sensation.集音 传音 感音 20耳鼻咽喉应用解剖肖雪2022-10-11The External Ear 外耳外耳 The auricle 耳廓 The external acoustic meatus 外耳道 略呈略呈S S状弯曲，长约状弯曲，长约2.52.53.5cm3.5cm。外外1 13 3为软骨部，内为软骨部，内2 23 3为骨部，外耳道有两处较狭窄，一为骨部与软骨部交界为骨部，外耳道有两处较狭窄，一为骨部与软骨部交界处，另一处为骨部距鼓膜处，另

14、一处为骨部距鼓膜0.5cm0.5cm处较狭窄处，称为外耳道狭部。处较狭窄处，称为外耳道狭部。软骨部是耳疖的好发部位。软骨部是耳疖的好发部位。The external Ear 外耳21耳鼻咽喉应用解剖肖雪2022-10-11The Middle Ear 中耳Tympanic cavityMastoid Process 乳突乳突Auditory tube咽鼓管咽鼓管Consists of the tympanic cavity(鼓室),auditory tube(咽鼓管),tympanic antrum(鼓窦)and mastoid process(乳突).22耳鼻咽喉应用解剖肖雪2022-10-

15、11The tympanic Cavity 鼓室鼓室The epitympanumThe mesotympanumThe hypotympana23耳鼻咽喉应用解剖肖雪2022-10-11鼓室六壁 上壁 为鼓室盖，与中颅窝大脑颞叶相隔。下壁 以薄骨板与颈静脉球相隔。内壁 即内耳外壁。有“一岬两窗两凸”，鼓岬、前庭窗、圆窗、面神经管隆凸、外半规管隆凸24耳鼻咽喉应用解剖肖雪2022-10-11外壁 大部分为鼓膜所封闭。前壁 上有鼓膜张肌半管，下有咽鼓管鼓室口。前壁下部借一薄骨板与颈内动脉管相隔。后壁 即乳突前壁，乃骨部外听道的延续，上部有鼓窦入口通鼓窦，后壁有面神经的垂直段通过25耳鼻咽喉应用解

16、剖肖雪2022-10-11Tympanic Membrane 鼓膜鼓膜光锥光锥Cone of lightCone of light紧张部紧张部Pars tensePars tense松弛部松弛部Pars flaccidPars flaccid锤纹锤纹 Malleolar striaMalleolar stria锤骨短突锤骨短突Short process Short process of malleusof malleus外耳道皮肤外耳道皮肤26耳鼻咽喉应用解剖肖雪2022-10-11Lateral&Anterior WallsAnterior wall面神经面神经颈内动脉颈内动脉咽鼓管咽鼓管鼓

17、膜张肌鼓膜张肌鼓索神经鼓索神经27耳鼻咽喉应用解剖肖雪2022-10-11Medial WallMedial Wall鼓岬鼓岬圆窗圆窗鼓窦鼓窦28耳鼻咽喉应用解剖肖雪2022-10-11malleus incusstapes Tympanic vestibular Membrane windowMalleus 锤骨锤骨Incus砧骨砧骨 Stapes 镫骨镫骨Auditory ossicles and Ossicular chainAuditory ossicles and Ossicular chain听骨&听骨链29耳鼻咽喉应用解剖肖雪2022-10-11The Auditory Tube

18、(Eustachian tube)咽鼓管 Two parts:bony&cartiliginous parts（外（外1/31/3为骨部，内为骨部，内2/32/3为软骨部）为软骨部）Two openings:the pharyngeal&the tympanic orifices Variety with anatomy between infant and adult30耳鼻咽喉应用解剖肖雪2022-10-11The Inner Ear 内耳内耳/Labyrinth 迷路迷路 The inner ear osseous labyrinth（骨迷路）（骨迷路）contains the vest

19、ibule（前庭）（前庭）,semicircular canals（半规管）（半规管）and cochlea（耳蜗）（耳蜗）membranous labyrinth（膜迷路）（膜迷路）.utricle(椭圆囊椭圆囊),saccule(球囊球囊),membranous semicircular canals(膜半规管膜半规管),membranous cochlea duct(膜蜗管膜蜗管),内淋巴管内淋巴管囊囊(endolymphatic duct)Vestibule前庭前庭Cochlea耳蜗耳蜗Semicircular canals半规管半规管31耳鼻咽喉应用解剖肖雪2022-10-11Oss

20、eous labyrinth 骨迷路Lateral semicircular canal水平半规管水平半规管Posterior semicircular canal后半规管后半规管Superior semicircular Canal上半规管上半规管Vestibule window前庭窗前庭窗Cochlea window蜗蜗 窗窗Cochlea耳蜗耳蜗Osseous labyrinth（骨迷路）vestibule（前庭）semicircular canals（半规管）cochlea（耳蜗）32耳鼻咽喉应用解剖肖雪2022-10-11semicircular canals半规管Lateral s

21、emicircular canal外（水平）半规管外（水平）半规管Posterior semicircular canal后半规管后半规管Superior semicircular Canal上半规管上半规管位于前庭后方，为上、后、外三个弓形互相垂直的骨管，5孔开口于前庭，膨大端为壶腹，另一端为单脚。上半规管与后半规管单脚合并为总角。33耳鼻咽喉应用解剖肖雪2022-10-11Vestibule 前庭前庭lateral wallthe vestibular window，the cochlear window 为鼓室内壁的一部分，有前庭窗及蜗窗，分别为镫骨底板及圆窗为鼓室内壁的一部分，有前庭窗

22、及蜗窗，分别为镫骨底板及圆窗膜所封闭；膜所封闭；posterior wall-5 orifices of semicircular canals Anterior wall-an opening communicates with scala vestibuli（前庭阶）Vestibular window前庭窗Cochlear window蜗窗34耳鼻咽喉应用解剖肖雪2022-10-11bony canals of cochlea winding for 2.2-2.75 around central modiolus.The Cochlea Scala tympani 鼓阶Scala ves

23、tibuli 前庭阶Cochlear duct 蜗管 前庭膜于前庭的前下方，为螺旋形骨管，绕蜗轴旋转两圈半，形似蜗牛。骨蜗管由骨螺旋板、基底膜和前庭膜将蜗管分为前庭阶、中阶和鼓阶三个管腔。中阶(膜蜗管)内储内淋巴，系膜迷路，为一封闭的盲管。35耳鼻咽喉应用解剖肖雪2022-10-11SemicircularcanalsCochlearDuct蜗管蜗管Utricle椭圆囊椭圆囊Saccule球囊球囊The Membranous Labyrinth 膜迷路膜迷路亦分前庭、半规管及耳蜗三部（内有听觉和位觉感受器）36耳鼻咽喉应用解剖肖雪2022-10-11Outer Hair CellsInner

24、Hair CellsSupporting cells.stereociliaThe organ of Corti （Corti器）位于耳蜗基底膜上，为耳蜗神经的末梢感受器37耳鼻咽喉应用解剖肖雪2022-10-11Utricle&Saccule 椭圆囊和球囊椭圆囊和球囊-位于前庭，感受直线加速度运动的刺激38耳鼻咽喉应用解剖肖雪2022-10-11Ampulla 壶腹Cupula 壶腹嵴Membranous semicircular canals 膜半规管膜半规管Cupula 壶腹嵴壶腹嵴（位于半规管壶（位于半规管壶腹端腹端 ，主要感受正负角加速度的刺激），主要感受正负角加速度的刺激）39耳鼻

25、咽喉应用解剖肖雪2022-10-11耳蜗神经核上橄榄核外侧丘系核下丘听觉皮层耳蜗40耳鼻咽喉应用解剖肖雪2022-10-11The Pharynx41耳鼻咽喉应用解剖肖雪2022-10-1142耳鼻咽喉应用解剖肖雪2022-10-11Nasopharynx 鼻咽43耳鼻咽喉应用解剖肖雪2022-10-11后鼻孔后鼻孔下鼻甲下鼻甲中鼻甲中鼻甲上鼻甲上鼻甲咽隐窝咽隐窝咽鼓管圆枕咽鼓管圆枕l 腺样体（Adenoid）：顶部与后壁交界处的丰富淋巴组织团块，过分肥大可引起耳鼻咽喉等处的症状，10岁以后逐渐萎缩。l 咽鼓管咽口（The orifice of Eustachian tube）：下鼻甲后端后方

26、约1-1.5cm处l 咽鼓管圆枕（Torus tubalis）：咽口上方隆起的部分l 咽隐窝（Pharyngeal recess）：咽鼓管圆枕后上方的凹陷区，为鼻咽癌的好发部位。该处接近颅底破裂孔，鼻咽癌可循此自然孔道侵入颅内。Posterior naris(choanae)44耳鼻咽喉应用解剖肖雪2022-10-11The Oropharynx 口咽口咽Palatopharyngeal arch 腭咽弓腭咽弓Palatoglossal arch 腭舌弓腭舌弓45耳鼻咽喉应用解剖肖雪2022-10-11口咽口咽 (oropharynx)l 咽峡：上-悬雍垂(uvula)、软腭游离缘(soft

27、palate)，侧-舌腭弓(palatoglossal arch)、扁桃体(tonsil)、咽腭弓(palatopharyngeal arch)，下-舌背。l 腭扁桃体：l 咽侧索：每侧咽腭弓的后方的纵行条索状淋巴组织46耳鼻咽喉应用解剖肖雪2022-10-11Laryngopharynx 喉咽喉咽Post-cricoid region 环后区Pyriform sinuses 梨状窝梨状窝47耳鼻咽喉应用解剖肖雪2022-10-11Waldeyers Ring 咽淋巴环咽淋巴环 Adenoid 腺样体腺样体 Tubal Tonsils.咽鼓管扁桃体咽鼓管扁桃体 Palatine Tonsils

28、.腭扁桃体腭扁桃体 Lingual Tonsils.舌扁桃体舌扁桃体 Lat.Pharyngeal bands.咽侧索咽侧索Definition:Ring of Lymphoid tissue guarding entrance to the digestive&respiratory tracts.48耳鼻咽喉应用解剖肖雪2022-10-11咽旁间隙咽后间隙Parapharyngeal and retroparyngeal spaceParapharyngeal and retroparyngeal space 咽旁隙和咽后隙Parapharyngeal space 咽旁隙咽旁隙intern

29、al carotid a.颈内动脉颈内动脉jugular v.颈内静脉颈内静脉cranial nerves sympathetic chain 交感干交感干cervical lymphnodes 颈淋巴结颈淋巴结49耳鼻咽喉应用解剖肖雪2022-10-11咽后隙 retropharyngeal space 上界：起于颅底。下界：止于第一、二胸椎平面。前界：颊咽筋膜、咽后壁。后界：椎前筋膜。外界：以薄层筋膜与咽旁隙相隔。内界：为咽缝将其分为左右两部分。内容：疏松结缔组织和淋巴结，易形成咽后壁脓肿，小儿多见。50耳鼻咽喉应用解剖肖雪2022-10-11The Larynxl 喉部位于颈前正中，舌骨

30、之下；l 上接喉咽部，下连气管；l 是呼吸的重要通道，下呼吸道的门户；l 由软骨组成支架，附以肌肉、韧带、粘膜等；为呼吸和发音器官。51耳鼻咽喉应用解剖肖雪2022-10-11Epiglottic cartilage 会厌软骨 52耳鼻咽喉应用解剖肖雪2022-10-11Thyroid cartilage 甲状软骨 The largest cartilage of larynx53耳鼻咽喉应用解剖肖雪2022-10-11Cricoid cartilage 环状软骨The only complete cartilaginous ring54耳鼻咽喉应用解剖肖雪2022-10-11Arytenoi

31、d cartilage 杓状软骨杓状软骨paired,pyramidal shapedl声带突：声带附着处l肌突：环杓后肌及环杓侧肌附着55耳鼻咽喉应用解剖肖雪2022-10-11喉的韧带与膜 喉软骨之间有纤维状韧带相连接，有甲状舌骨膜、舌骨会厌韧带、舌会厌韧带、甲状会厌韧带、喉弹性膜、环甲膜等，环甲膜正位于声门下，是紧急气管切开的部位环甲膜穿刺或切开术56耳鼻咽喉应用解剖肖雪2022-10-11Muscles of larynx extrinsic laryngeal muscles喉外肌 intrinsic laryngeal muscles喉内肌 57耳鼻咽喉应用解剖肖雪2022-10-

32、11Intrinsic laryngeal muscles 喉内肌喉内肌 Abductor 外展外展 Posterior cricoarytenoid 环杓后肌环杓后肌 Adductors 内收内收 Lateral cricoarytenoid 环杓侧肌环杓侧肌 Transverse arytenoid 杓横肌杓横肌 Adjust tension of the vocal cord:Cricothyroid 环甲肌环甲肌 Thyroarytenoid 甲杓肌甲杓肌 Move the epiglottic:Thyreo-epiglotticus 甲状会厌肌甲状会厌肌58耳鼻咽喉应用解剖肖雪202

33、2-10-11Extrinsic laryngeal muscles 喉外肌喉外肌Suprahyoid Muscles 舌骨上肌群舌骨上肌群 Mylohyoid 下颌舌骨肌下颌舌骨肌 Digastric 二腹肌二腹肌 Geniohyoid 颏舌骨肌颏舌骨肌 Stylohyoid 茎突舌骨茎突舌骨 Genioglossus 颏舌肌颏舌肌 Styloglossus 茎突舌肌茎突舌肌Infrahyoid Muscles 舌骨下肌群舌骨下肌群 Thyrohyoid 甲状舌骨肌甲状舌骨肌 Omohyoid 肩胛舌骨肌肩胛舌骨肌 Sternohyoid 胸骨舌骨肌胸骨舌骨肌 Sternothyroid 胸

34、骨甲状肌胸骨甲状肌59耳鼻咽喉应用解剖肖雪2022-10-11Intrinsic laryngeal muscles 喉内肌喉内肌 环甲肌Cricothyroid环杓侧肌Lateral crico-arytenoid 环杓后肌Posterior crico-arytenoid杓肌Arytenoid甲杓肌Thyroarytenoid60耳鼻咽喉应用解剖肖雪2022-10-11Laryngeal nerves Superior laryngeal nerve 喉上神经喉上神经 （支配声门以上喉内感觉及环甲肌的运动）（支配声门以上喉内感觉及环甲肌的运动）Recurrent laryngeal ner

35、ve 喉返神经喉返神经 （支配除环甲肌以外的喉内诸肌的运动，（支配除环甲肌以外的喉内诸肌的运动，声门下区的声门下区的感觉感觉,左侧绕主动脉弓上行，右侧绕锁骨下动脉上行左侧绕主动脉弓上行，右侧绕锁骨下动脉上行。）。）61耳鼻咽喉应用解剖肖雪2022-10-11Superior&Recurrent laryngeal nerve喉上和喉返神经喉上和喉返神经Superior laryngeal n.Recurrent laryngeal n.Superior laryngeal n.62耳鼻咽喉应用解剖肖雪2022-10-11Supraglottics 声门上区声门上区Glottics 声门区声门区

36、 Subglottics 声门下区声门下区 Epiglottis 会厌 False vocal cords 室带Laryngeal ventricle 喉室Fissure of glottic 声门裂 Rigion of Larynx Rigion of Larynx 63耳鼻咽喉应用解剖肖雪2022-10-11False vocal cord室带室带Laryngeal vestibule喉前庭喉前庭Laryngeal ventricle喉室喉室Vocal cord声带声带Fissure of glottis声门裂声门裂Infraglottic cavity声门下腔声门下腔Tracheal c

37、avity气管腔气管腔Laryngeal cavity 喉腔64耳鼻咽喉应用解剖肖雪2022-10-11Laryngeal cavity 喉腔l 声带：由粘膜、声韧带、肌肉（甲杓肌）组成。l 声门裂：两侧声带外展时声门区出现的等腰三角形裂隙，其前端为前联合，后端为后联合。Vocal cord声带False vocal cord室带Epiglottis会厌Aryepiglottic fold杓会厌襞Anterior commisure前联合Fissure of glottis声门裂65耳鼻咽喉应用解剖肖雪2022-10-11气管、支气管 由马蹄形软骨、结缔组织、平滑肌和黏膜构成 气管与食道的关系密切 左右支气管的大小及与中线的角度不同66耳鼻咽喉应用解剖肖雪2022-10-11食道 与气管、丛膈和主动脉弓的关系密切 存在四个生理狭窄67耳鼻咽喉应用解剖肖雪2022-10-11The end!68耳鼻咽喉应用解剖肖雪2022-10-11