neck ii - home.kku.ac.th · nerves of the neck • cn ix (glossopharyngeal n.) • cn x (vagus n.)...
TRANSCRIPT
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NECK IINECK IIรศรศ..ดรดร..กมลทพยกมลทพย บราวนบราวน
ภาควชากายวภาคศาสตรภาควชากายวภาคศาสตร
คณะแพทยศาสตรคณะแพทยศาสตร มหาวทยาลยขอนแกนมหาวทยาลยขอนแกน
[email protected]@[email protected][email protected]
0808--77--804804--16361636
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OBJECTIVESOBJECTIVES•• เมอสนสดการเรยนการสอนนแลวเมอสนสดการเรยนการสอนนแลว นกศกษาสามารถอธบายหวขอนกศกษาสามารถอธบายหวขอ
ตอไปนไดถกตองตอไปนไดถกตอง
1. Carotid sheath 1. Carotid sheath และและ contentscontents
2. 2. หลอดเลอดบรเวณคอหลอดเลอดบรเวณคอ :: SubclavianSubclavian arteryartery
: : SubclavianSubclavian veinvein
: Common carotid artery,: Common carotid artery, Internal carotid a. Internal carotid a.
& External carotid a.& External carotid a.
: Internal jugular vein: Internal jugular vein
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OBJECTIVESOBJECTIVES3. 3. เสนประสาทบรเวณคอเสนประสาทบรเวณคอ
: Cranial nerves IX, X, XI & XII: Cranial nerves IX, X, XI & XII
: Cervical plexus & : Cervical plexus & PhrenicPhrenic nervenerve
: Brachial plexus : Brachial plexus และแขนงทพบในบรเวณคอและแขนงทพบในบรเวณคอ
: Cervical sympathetic ganglia & trunk: Cervical sympathetic ganglia & trunk
4. Thyroid gland & Parathyroid glands4. Thyroid gland & Parathyroid glands
5. 5. PrevertebralPrevertebral musclesmuscles
6. Lymph nodes & lymphatic vessels of the neck6. Lymph nodes & lymphatic vessels of the neck
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DEEP STRUCTURES OF THE NECKDEEP STRUCTURES OF THE NECK
•• Neurovascular (lateral) compartmentNeurovascular (lateral) compartment•• Visceral (anterior) compartmentVisceral (anterior) compartment•• Musculoskeletal (posterior) compartmentMusculoskeletal (posterior) compartment
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Contents of Carotid SheathContents of Carotid Sheath
•• Common carotid & Internal carotid Common carotid & Internal carotid arteriesarteries
•• VagusVagus nervenerve•• Internal jugular veinInternal jugular vein•• Superior root of Superior root of ansaansa cervicaliscervicalis•• Deep cervical lymph nodesDeep cervical lymph nodes•• (CN IX, CN X & CN XII : base of skull)(CN IX, CN X & CN XII : base of skull)
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Internaljugular
v.
Vagus n.
Common carotid a.
Prevertebralfascia
Carotid sheath
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หลอดเลอดบรเวณคอหลอดเลอดบรเวณคอ (Blood Vessels of the Neck)(Blood Vessels of the Neck)
•• SubclavianSubclavian arteryartery•• SubclavianSubclavian veinvein•• Common carotid arteryCommon carotid artery•• Internal carotid arteryInternal carotid artery•• External carotid arteryExternal carotid artery•• Internal jugular veinInternal jugular vein
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SubclavianSubclavian arteryartery
•• Rt. : from Rt. : from BrachiocephalicBrachiocephalic trunktrunk•• Lt. : from Aortic archLt. : from Aortic arch•• สนสดทสนสดท outer border of 1outer border of 1stst rib rib เปนเปน axillaryaxillary a.a.•• ScalenusScalenus anterior anterior แบงหลอดเลอดนเปนแบงหลอดเลอดนเปน 3 3 สวนสวน
•• 11stst partpart : vertebral a., : vertebral a., thyrocervicalthyrocervical trunk & trunk & internal thoracic a.internal thoracic a.
•• 22ndnd partpart : : costocervicalcostocervical a. ( & dorsal scapular a.)a. ( & dorsal scapular a.)•• 33rdrd partpart : dorsal scapular a.: dorsal scapular a.
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SUBCLAVIAN A.
Aortic arch
Brachiocephalic trunk
Right subclavian a.Left subclavian a.
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Scalenusanterior
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InternalThoracic a.
First part of subclavian a.
Vertebral a.
Thyrocervical trunk
Inferior thyroid a.
Transverse cervical a.
Suprascapular a.
Ascending cervical a.
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SubclavianSubclavian veinvein
•• ตอมาจากตอมาจาก axillaryaxillary veinvein•• เรมจากขอบนอกของเรมจากขอบนอกของ 11stst ribrib•• ทอดอยลางและหนาตอทอดอยลางและหนาตอ subclaviansubclavian arteryartery•• ScalenusScalenus anterior & anterior & phrenicphrenic n. n. แทรกอยระหวางแทรกอยระหวาง
a. & v.a. & v.•• รวมกบรวมกบ internal jugular vein internal jugular vein เทเขาเทเขา
brachiocephalicbrachiocephalic v. v. หลงตอหลงตอ sternoclavicularsternoclavicular jtjt..
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Common Carotid ArteryCommon Carotid Artery
•• ไมมแขนงทคอไมมแขนงทคอ
•• ใหให terminal branches terminal branches โดยโดย bifurcation bifurcation เปนเปน ::•• External carotid artery External carotid artery เลยงบรเวณคอและหนาเลยงบรเวณคอและหนา
•• Internal carotid artery Internal carotid artery เขาในกะโหลกศรษะเลยงสมองเขาในกะโหลกศรษะเลยงสมอง
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Carotid SinusCarotid Sinus
•• กระเปาะทตาแหนงเรมตนของกระเปาะทตาแหนงเรมตนของ internal carotid a. internal carotid a. •• เปนเปน baroreceptorbaroreceptor ((ตวรบเมอมการเปลยนแปลงความดนเลอดตวรบเมอมการเปลยนแปลงความดนเลอด
•• เชนเชน hypotension : carotid sinus hypotension : carotid sinus ถกกระตนถกกระตน สญญาณสญญาณ
ประสาทสงไปตามประสาทสงไปตาม CN IX CN IX เขาสเขาส cardiovascular cardiovascular centre centre ทกานสมองทกานสมอง (medulla) (medulla) ทาใหเพมการทางานของทาใหเพมการทางานของ sympathetic sympathetic
•• เพมอตราการเตนของหวใจเพมอตราการเตนของหวใจ ความแรงการบบตวกลามเนอหวใจความแรงการบบตวกลามเนอหวใจ ทาใหทาให BP BP เพมเพม
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Carotid BodyCarotid Body
•• At the bifurcation between internal & At the bifurcation between internal & external carotid external carotid aaaa..
•• N. supply : N. supply : GlossopharyngealGlossopharyngeal N, (CN IX)N, (CN IX)•• Act as a chemoreceptor : Act as a chemoreceptor : รบรการเปลยนความดนยอยรบรการเปลยนความดนยอย
ของออกซเจนของออกซเจน (pO2), (pO2), ความดนยอยของคารบอนไดออกไซดความดนยอยของคารบอนไดออกไซด pCO2, pCO2, ความเปนกรดและดางในเลอดความเปนกรดและดางในเลอด (blood pH)(blood pH)
•• Hypoxia : carotid bodyHypoxia : carotid body
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External carotid arteryExternal carotid artery
•• Superior Thyroid a.Superior Thyroid a.•• Lingual a.Lingual a.•• Facial a.Facial a.•• Ascending pharyngeal a.Ascending pharyngeal a.•• Occipital a.Occipital a.•• Posterior auricular a.Posterior auricular a.•• Maxillary a.Maxillary a.•• Superficial temporal a.Superficial temporal a.
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Internal jugular veinInternal jugular vein
•• Inferior Inferior petrosalpetrosal sinussinus•• Pharyngeal veinsPharyngeal veins•• Facial vein (common facial vein)Facial vein (common facial vein)•• Lingual veinLingual vein•• Superior thyroid veinSuperior thyroid vein•• Middle thyroid veinMiddle thyroid vein
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Nerves of the NeckNerves of the Neck
•• CN IX (CN IX (GlossopharyngealGlossopharyngeal N.)N.)•• CN X (CN X (VagusVagus N.)N.)•• CN XI (Accessory N.)CN XI (Accessory N.)•• CN XII (Hypoglossal N.)CN XII (Hypoglossal N.)•• Cervical Plexus & Cervical Plexus & PhrenicPhrenic n.n.•• Brachial plexusBrachial plexus•• Cervical sympathetic trunk (chain) & gangliaCervical sympathetic trunk (chain) & ganglia
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Cranial nervesCranial nerves
•• O, O, O, Ta, Tee, O, O, O, Ta, Tee, AbAb, Fung, Ah, Gung, , Fung, Ah, Gung, VaVa, , AaAa, , HeaHea
•• Olfactory, Optic, Olfactory, Optic, OculomotorOculomotor, , TrochlearTrochlear, , Trigeminal, Trigeminal, AbducensAbducens, Facial, Auditory, , Facial, Auditory, GlossopharyngealGlossopharyngeal, , VagusVagus, Accessory, , Accessory, Hypoglossal nervesHypoglossal nerves
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GlossopharyngealGlossopharyngeal N. (CN IX)N. (CN IX)
•• ออกจากกานสมองสวนออกจากกานสมองสวน medullamedulla
•• Mixed nerve : motor & sensory Mixed nerve : motor & sensory fibresfibres•• Motor : Motor : StylopharyngeusStylopharyngeus & Mm. of pharynx& Mm. of pharynx•• Parasympathetic : Parotid glandParasympathetic : Parotid gland•• Sensory : Posterior 1/3 of tongue, general & Sensory : Posterior 1/3 of tongue, general &
taste, carotid body & sinustaste, carotid body & sinus•• Swallowing, saliva secretion & sense of taste of Swallowing, saliva secretion & sense of taste of
postrpostr 1/3 of tongue & pharynx1/3 of tongue & pharynx
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VagusVagus Nerve (CN X)Nerve (CN X)
•• เรมตนทเรมตนท medulla oblongatamedulla oblongata
•• Mixed nerve : motor & sensory Mixed nerve : motor & sensory fibresfibres•• Branches: Branches: meningealmeningeal branchbranch
: auricular branch: auricular branch: pharyngeal branch: pharyngeal branch: superior laryngeal nerve: superior laryngeal nerve: Cardiac branches: Cardiac branches: Recurrent laryngeal nerve: Recurrent laryngeal nerve
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Accessory Nerve (CN XI)Accessory Nerve (CN XI)
•• Motor nerve : cranial roots & spinal rootsMotor nerve : cranial roots & spinal roots
•• Cranial roots : Cranial roots : ออกจากกานสมองสวนออกจากกานสมองสวน medullamedulla
•• Spinal roots : Spinal roots : ออกจากออกจาก C1C1--C5 spinal cord C5 spinal cord segmentssegments
•• Supply : Supply : SternocleidomastoidSternocleidomastoid & & TrapeziusTrapezius
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Hypoglossal Nerve (CN XII)Hypoglossal Nerve (CN XII)
•• ออกจากกานสมองสวนออกจากกานสมองสวน medulla medulla
•• Hypoglossal canal of occipital boneHypoglossal canal of occipital bone•• Motor nerve : muscles of tongueMotor nerve : muscles of tongue•• Branches : Branches : meningealmeningeal
: superior root (descending) : superior root (descending) brbr. Of . Of ansaansacervicaliscervicalis ((omohyoid,sternohyoidomohyoid,sternohyoid & & sternothyroidsternothyroid))
: n. to : n. to thyrohyoidthyrohyoid: muscular: muscular--hyoglossushyoglossus, , genioglossusgenioglossus, ,
styloglossusstyloglossus & intrinsic mm of tongue& intrinsic mm of tongue
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Cervical PlexusCervical Plexus
•• Anterior Anterior ramirami of C1of C1--C4 (C5)C4 (C5)•• Sensory part : Sensory part : lessorlessor occipital (C2occipital (C2--3)3)
: great auricular (C2: great auricular (C2--3)3): transverse cervical (C2: transverse cervical (C2--3)3): : supraclavicularsupraclavicular (C3(C3--4)4): : proprioceptiveproprioceptive sensation of sensation of
StmatoidStmatoid (C2(C2--3)3): : proprioceptiveproprioceptive sensation of sensation of
TrapeziusTrapezius (C3(C3--4) & roots C34) & roots C3--4 to Lev scapulae4 to Lev scapulae
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PhrenicPhrenic nervenerve
•• Ventral Ventral ramirami of C3,4,5of C3,4,5•• ทอดดงหนาตอทอดดงหนาตอ scalenusscalenus anterioranterior
•• Supplies diaphragmSupplies diaphragm•• ProprioceptiveProprioceptive sensation sensation จากกะบงลมจากกะบงลม เยอหมเยอหม
ปอดปอด เยอบชองทองเยอบชองทอง สวนทบกะบงลมสวนทบกะบงลม
•• Sensory Sensory fibresfibres จากจาก mediastinalmediastinal pleura & pleura & pericardiumpericardium
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Brachial PlexusBrachial Plexus
•• Ventral Ventral ramirami of C5,6,7,8, T1of C5,6,7,8, T1•• Roots,TrunksRoots,Trunks, Divisions, (Cords, Main , Divisions, (Cords, Main BrsBrs.).)•• Posterior triangle (Posterior triangle (AxillaAxilla))
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Cervical Sympathetic Ganglia & TrunkCervical Sympathetic Ganglia & Trunk
•• Superior cervical Superior cervical gggg..•• Middle cervical Middle cervical gggg..•• Inferior cervical Inferior cervical gggg. + 1. + 1stst thth. . GgGg.=.=stellatestellate
gggg..
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Viscera of the NeckViscera of the Neck
•• LarynxLarynx•• TracheaTrachea•• ThyroidThyroid•• ParathyroidParathyroid•• EsophagusEsophagus
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Thyroid GlandThyroid Gland
•• Two lateral lobes & isthmusTwo lateral lobes & isthmus•• Isthmus : tracheal rings 2,3,4Isthmus : tracheal rings 2,3,4•• ขอบบนขอบบน :: oblique line of thyroid cartilageoblique line of thyroid cartilage•• ขอบลางขอบลาง :: tracheal rings 4,5tracheal rings 4,5•• อาจพบอาจพบ pyramidal lobepyramidal lobe
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Deep Lymphatic DrainageDeep Lymphatic Drainage
•• Along internal jugular veinsAlong internal jugular veins•• Superior deep cervical nodesSuperior deep cervical nodes•• Inferior deep cervical nodesInferior deep cervical nodes•• Jugular lymphatic trunkJugular lymphatic trunk•• RtRt lymphatic ductlymphatic duct•• Thoracic ductThoracic duct
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ฝากใหคดฝากใหคด จาจา และนาไปปฏบตดวยตลอดไปและนาไปปฏบตดวยตลอดไป
••ตรงตอเวลาตรงตอเวลา
••กตญรคณพอแมกตญรคณพอแม ครอาจารยครอาจารย และผมและผม
พระคณพระคณ
••เอาใจเขามาใสใจเราเอาใจเขามาใสใจเรา
••รกและภมใจในคณะแพทยรกและภมใจในคณะแพทยมขมข..ของเราของเรา
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ใหเขยนชอใหเขยนชอ--สกลสกล && Sec Sec ลงในกระดาษเปลาลงในกระดาษเปลา
•• เขยนวาทผานมาจนถงวนนเขยนวาทผานมาจนถงวนน
•• คณมแตละขอคณมแตละขอ (4(4 ขอขอ) ) มากนอยเพยงใดมากนอยเพยงใด
•• ยกตวอยางททาในแตละขอยกตวอยางททาในแตละขอ
•• เขยนจรยธรรมและคณธรรมทคณเขยนจรยธรรมและคณธรรมทคณ//เพอนเพอน มมากทสดมามมากทสดมา 10 10 ขอขอ
•• เขยนจรยธรรมและคณธรรมทคณเขยนจรยธรรมและคณธรรมทคณ//เพอนเพอน มนอยทสดมามนอยทสดมา 10 10 ขอขอ
•• สงไมเกนสปดาหหนาสงไมเกนสปดาหหนา
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