Thyroid gland & Root of neck. L o g o
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1 Thyroid gland & Root of neck Dept. of Human Anatomy Zhou Hong Ying L o g o
2 Thyroid gland Outline Location & superficial feature Blood supply & Venous drainage Relationship of its vessels and related nerves Nerves
3 its isthmus lies on the 2 nd to 4 th tracheal rings Surface Anatomy of Thyroid Gland
4 Thyroid ---capsules False & True capsule
5 False & True capsule Thyroid ---capsules
6 The Relations of Thyroid Gland anteriorly - infrahyoid muscles & SCM posterolaterally - carotid sheath & its contents medially - larynx, trachea, pharynx, esophagus, external & recurrent laryngeal nerves posteriorly - parathyroid gland
7 Important Relationship of Thyroid Gland
8 Thyroid external feature left & right lobes isthmus pyramidal lobe
9 Thyroid external feature Upper pole of its lobe extends upward to oblique line of thyroid cartilage Lower one downward to level of 6th tracheal ring Isthmus lies in front 2 to 4 tracheal rings Pyramid lobe is usually to left of median plane
10 Pyramidal Lobe & Accessory Thyroid Gland
11 Parathyroid glands superior parathyroid glands inferior parathyroid glands
12 Parathyroid glands & thyroid gland
13 superior thyroid artery inferior thyroid artery Arterial Supply of the Thyroid Gland
14 across recurrent laryngeal nerve. Thyroid arteries Superior thyroid a. arises from ECA & reaches gland at its upper pole. On its way to gland, STA runs accompanied with external laryngeal nerve. Inferior thyroid artery : branch of the thyrocervical trunk, posterior to the carotid sheath to reach the posterior aspect of the gland. Before arrived to gland it runs
15 Thyroid Ima Artery
16 Superior, middle, & inferior thyroid v. form a plexus between its two capsules drained by three pairs of veins. Superior & middle thyroid veins empty into IJV inferior one into brachiocephalic vein.
17 Superior, middle, & inferior thyroid v.
18 Related nerves superior laryngeal nerve - internal branch - external branch recurrent laryngeal nerve
19 Root of the neck The area between the thorax and neck. It opens into the superior thoracic aperture. The jugular notch opposite posteriorly to disc between the T1 & T2 L o g o
20 OUTLINE Relationship with other Regions NeuroVascular Structures Lymphatic Drainage of Neck
21 Skeleton of root of neck laterally by the first pair of ribs and their costal cartilages Anteriorly by manubrium Posteriorly by the body of T1 & T2 vertebrae
22 The Transition between Root of Neck & Mediastinum What structures in the root of the neck
23 Structures in the root of the neck viscera organs of digestive system and respiratory system: the trachea and esophagus. carotid sheath and its contents. Brachial plexus and subclavian vessels phrenic nerve structures in triangle of the vertebral artery: vertebral a Sympathetic trunk of neck apex of lungs, cervical pleura and sibson fascia
24 Apex of lungs
25 Prevertebral Muscles
26 Scalene originate from transverse process of cervical vertebrae & run downward & laterally (obliquely) Scalenus anterior inserts onto upper surface of 1st rib. It is used as a key structure in root of neck. Scalenus space
27 Scalenus space Scalenus space is bounded by the scalenus anterior and medius and 1st rib. The brachial plexus and subclavian a. pass through the space.
28 Structures on the anterior aspect of scalenus anterior Structures vertically running: carotid sheath & contents in the sheath phrenic nerve (most lateral) sympathetic trunk of cervical part (medial)
29 Structures on the anterior aspect of scalenus anterior Structures transversely: subclavian v transverse cervical a suprascapular a
30 Subclavian vein Direct continuation of axillary vein at outer border of 1st rib. Usually it has only one tributary: external jugular vein
31 Termination of lymphatic trunks Venous Angle
32 Structures on the posterior aspect of scalenus anterior subclavian artery lies inferiorly to the brachial plexus The subclavian artery is divided into three parts by the scalenus anterior. At outer border of 1st rib, it continue as axillary artery. brachial plexus : upper, middle, lower trunks lie superior to subclavian artery
33 Branches of the subclavian artery
34 Branches of subclavian artery Vertebral a., internal thoracic a., & thyrocervical trunk Costocervical trunk Dorsal scapular artery
35
36 Vertebral triangle boundary: Base is the 1 st part of subclavian a Content: vertebaral a.
37 Brachial plexus
38 Structures in the root of the neck
39 L o g o lymphatic drainage of the neck
40 Deep cervical lymph nodes jugular trunks thoracic duct right lymphatic duct Superficial lymph nodes
41
42 lymphatic drainage of the neck
43 lymphatic drainage of the neck
44 Dissection Guide
45 Dissection Guide
46 Dissection Guide
47 Dissection Guide
48 Dissection Guide
49 Typical cases 患者, 女性,36 岁, 颈部前方有一包块, 主诉体重下降且精神紧张 家人抱怨该患者易急躁 激动和哭泣 查体 : 颈部两侧各检查到一个肿块, 位于喉下方 从后方触诊可感觉肿大的甲状腺, 可随吞咽上下移动 其他体征 : 眼球突出 脉搏加快 手指震颤 手掌潮湿 诊断 : 甲状腺功能亢进 治疗 : 药物治疗无效, 对患者进行了部分甲状腺切除 术后患者出现声音嘶哑 问题 :1. 肿大的甲状腺虽吞咽上 下移动的解剖学基础是? 2. 由于患者甲状腺肿大, 可能受压迫的神经为? 3. 为什么要进行部分甲状腺切除? 4. 患者出现声音嘶哑的原因可能是什么?
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