Neck頸部丁兆習山東大學醫學院人體解剖教研室Office:1205dingzhaoxi@DissectionoftheAnteriorNeck

Step1

SkintheneckStep2DissectthesuperficialfasciaCleantheplatysmaSearchfortheexternaljugularvein,andtheunderlyingcutaneousn.ofthecervicalplexus.Trytofindcervicalbranchoffacialn.Preservethesuperficalveinsandcutaneousnerves,thenremovethesuperficialfasciaStep3

Reflectthefirstlayerofdeepfascia(investingfascia)Step4Identifythemusclesandtriangles

oftheneckCleanandIdentifythemuscles:sternocleidomastoid,omohyoid,digastrics,infra-andsuprahyroidmusclesIdentifythevarioustrianglesintheregionformedbymuscles,includingthecarotidtriangle,submandibulartriangle,musculartraingle.Step5

Dissectthesubmandibulartriangle

RemovetheroofofsubmandibulartriangleCleanandidentifythesubmandibularglandCleanandidentifyfaciala.andv,linguala.andv,lingualn.hypoglossaln.passingthetrianglesStep6

DissectthecarotidtriangleIdentifythecarotidsheathTrytofindtheansa

cervicalisonthesurfaceofcarotidsheathSeparatethecommoncarotida,internalandexternalcarotida.

internaljugularv.andvagusn.

Tracethebranchesofexternalcarotida.suchassuperiorthyroida.,linguala.andfaciala.Searchforsuperiorlaryngealnerve,hypoglossaln.,accessoryn.DissectionofSternocleidomastoidregionStep1

Dissectthesternocleidomastoid：Reflectthesternocleidomastoidupwardsfromitssternalend,takecareoftheaccessoryn.piercingtheupendofsternoclidomastoidandthentothetrapeziusStep2

Dissecttheansa

cervicalis：lookfortheansa

cervicalisrelatedanteriorlytothesheathcarotidsheath

Step3

ExposethecontentsofthecarotidsheathNOTE:lookfortheterminalendofthoracicductbehindthecarotidsheathandendtotheleftvenousangleattherootofneckStep4

Dissectthecervicalplexusandphrenicnerve

Identifythecervicalplexusonthescalenus

mediusandlevatorscapulae.SearchforphrenicnerveonthescalenusanteriorandtraceitdownwardtooutletofthoraxStep6

Searchforcervicalsympathetictrunk

beneaththeprevertebralfasciaandbesidethevertebralcolumnStep6Dissectthescalenefissure

Identifythe

scaleni,scalenefissure

Cleanthepassingsubclaviana.andbrachialplexusStep7Lookforthesubclaviana.and

itsbranches

suchas

thyrocervicaltrunk,thevertebralartery,internalthoracicartery.Dissectionofmusculartriangle（thyroidglandandlarynx）Step1

Cleanandidentifytheinfrahyoidmuscles,musculartriangle

Step2

DissectthethyroidglandReflectthesternohyoidandsternothyroidupwardtoexposethethyroidglandIdentifythethyroidgland（laterallobeandisthmus）Dissectionofmusculartriangle（thyroidglandandlarynx）Step3Dissectthesuperiorthyroida.

Tracethesuperiorthyroida.runningwiththeexternalbranchoflaryngealn.tothesuperiorpoleofthyroidglandTracethe

superiorlaryngeala.runningwiththeinternalbranchofthesuperiorlaryngealn.intothyrohyoid

membranceStep4Dissectthesuperiorlaryngealn.

Tracetheinternalbranch

intolaryngealcavityTracetheexternalbranch

tocricothyroidmuscleDissectionofmusculartriangle（thyroidglandandlarynx）Step5

Dissecttheinferiorthyroida.

Searchfortheinferiorthyroida.loopedbehindtheinferiorpoleofthyroidgland,andtraceittothethyrocervicaltrunkStep6

Dissecttherecurrentlaryngealn.

Searchforandidentifytherecurrentlaryngealn.inesophago-trachialgrooveTracethenerveupwardbehindtheinferiorpoleofthyroidglandandcrossingtheinferiorthyroida.（tobeinferiorlaryngealnerve)TracethenervesdownwardtotheiroriginDissectionofmusculartriangle（tracheaandesophagus）Step1CuttheisthmusandseparatetherightandleftlobeofthyroidglandlaterallyStep2IdentifythetracheaanditsneighborhoodStep3IdentifytheesophagusanditsneighborhoodDissectionof

scalenefissureStep1Identifytheboundariesofscalenefissurescalenusanteriorandmedius,firstribStep2Identifythestructuresinthescalenefissurebrachialplexus,subclaviana.Step3Identifystructuresonthescalenusanteriortransversecervicala.,suprascapulara.subclavianv.thoracicduct(left)phrenicn.Dissectionof

Triangleofthevertebrala.Step1IdentifytheboundariesofTriangleofthevertebralascalenusanteriorSubclaviana.Vertebal

colum（longuscoli）Step2IdentifythestrucutresinthescaleneVertebrala.Inferiorthyroida.CervicalpartofsympathetictrunkCervicothoracicganglion★Youmustidentifyfollowstructures！MusclesSternocleidomastoidSternohyoidSternothyroidThyrohyoidOmohyoidScalenusanteriorScalenus

mediusScalenusposteriorArteriesCommoncarotida.InternalexternalcarotidarteryExternalcarotidarterySuperiorthyroida.Subclaviana.Vertebrala.Internalthoracica.ThyrocervicaltrunkInferiorthyroida.★Youmustidentifyfollowstructures！VeinsExternaljugularveinInternaljugularv.

Subclavianv.LymphductThoracicductRightlymphaticductNervesLesseroccipitaln.Greatauricularn.TransversenerveofneckSupraclavicularn.Phrenicn.Ansa

cervicalisAccesoryn.Vagusn.Internalbranchofsuperiorlaryngealn.Externalbranchofsuperiorlaryngealn.RecurrentlaryngealnervesHypoglossaln.CervicalpartofsympathetictrunkOrgansSubmandibularg