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首页 甲状腺解剖

甲状腺解剖.ppt

甲状腺解剖

我是谁
2011-11-12 0人阅读 举报 0 0 0 暂无简介

简介:本文档为《甲状腺解剖ppt》,可适用于自然科学领域

ThyroidAnatomyThyroidAnatomy#ThyroidAnatomyThyroidAnatomyThyroidAnatomyThyroidAnatomyMostoftheanterolateralsurfaceoftheneckiscoveredbythethinplatysmamuscles,remnantsofthepanniculuscarnosusofmammals(watchadogshakeitscoat)ThismuscleisatthelevelofthesuperficialfasciaanditsundersideprovidesanexcellentplaneofdissectionexposingthedeepfasciaoftheneckBecauseoftheinvertedVshapedgapinthislayeranteriorly,dissectionofflapsinacollarincisionshouldbeginlaterallyThyroidAnatomyThyroidAnatomyThesternocleidomastoidmusclesflankthestrapsandcovertheinternaljugularsandcarotidsheathsTheyareenclosedinanencirclinggirdleofdeepcervicalfasciacalledtheinvestinglayerThislayercontinuesposteriorlytoenclosethetrapeziusmuscles(seeneckclinicalfolio)TheexternaljugularveinsdescendacrosstheposteriorportionsofthesternocleidomastoidsandanteriorjugularveinsdescendalongthestrapsanteriorlyThyroidAnatomyThyroidAnatomyThethyroidiscoveredbythesternohyoidandsternothyroid(strap)musclesTheseareenclosedinanintermediatelayerofdeepcervicalfascia(seeThryoidAnatomy:)withthesternohyoidsbeingapposedinthemidlineandtheunderlyingsternothyroidsbeingslightlymorelateralWhenmobilizingthestrapsitisimportanttostayintheplanedeeptobothmusclesTheomohyoidmusclesascenddiagonallyacrosstheupperpartofthestrapsandareautomaticallymobilizedwiththosemusclesThyroidAnatomyThyroidAnatomyVenousdrainageofthethyroidrunswiththesuperiorlaryngealarteriesabove,passeslaterally(middlethyroidveins)directlyintotheinternaljugularveins,anddrainsinferiorlyintothebrachiocephalicveinsThedominantlymphaticdrainageaccompaniesthevesselswithinthelooseareolarcarotidsheathsTheveinsformaplexusonthesurfaceoftheglandwithintheareolarthyroid(visceral)fasciaRemainingexternaltothiscapsuleprovidesarelativelybloodlessdissectionEntryintothecapsuleisabloodymessThyroidAnatomyThyroidAnatomyTwocommonvariantsarethepresenceofapyramidallobeextendingupwardfromtheisthmusandathyroidimaarteryascendingfrombelowThepyramidallobeisaremnantofthetrackthethyroidfollowedinembryologiclifefromtheforamencecumatthebaseofthetongue,throughthesiteofthefuturehyoidbonetoitsfinallocationIncompletedescentofthethyroidcanbemistakenforatumorInthefaceofahighmidlineneckmass,itisimperativetodocumentthyroidtissueinthenormallocationbyscanbeforeexcisionThethyroidimaarteryarisesfromanyofthegreatvesselsofthechestandneckThyroidAnatomyThyroidAnatomyThearterialsupplytothethyroidcomesprincipallyfromthesuperiorandinferiorthyroidarteriesTheformerarisefromtheexternalcarotidandthelatterareusuallyabranchofthethyrocervicaltrunkoffthesubclavianarteriesTheinferiorthyroidarteriespassbehindthecommoncarotidstoreachthelowerthirdofthethyroidglandoneachsideNotethepositionsofthevagusandrecurrentlaryngealnerves(detailsinsubsequentimagesThyroidAnatomyThyroidAnatomyThethyroidglandisthmussaddlesoneortwooftheuppermosttrachealringsandusuallyblocksthesiteofanoptimaltracheostomyItisroutinelydividedinsuchcasesThelobesoftheglandwrapposteriorlytoembracetheuppertracheaandlowerlarynxTheposteriorfaceofeachlobeliesonthecarotidsheath(seealsoneckanatomy)ThyroidAnatomyThyroidAnatomyThethyroidglandisenclosedinathinlayerofpretrachealorvisceralfasciawhichalsoincludesthetracheaandesophagusThevisceralcompartmentoftheneckisdeeptotheintermediatefasciasurroundingthestrapmusclesandtheinvestingfasciaenclosingthesternocleidomastoidandtrapeziusmuscles(seeneckanatomyimages)Behindthevisceralcompartmentistheprevertebralfasciaoverlyingthecervicalvertebrae(seebrachialplexusanatomy)ThespacebetweentheesophagusandprevertebralfasciaextendsdownintothemediastinumTherecurrentlaryngealnerveisinthetracheoesophagealgrooveoranteriortoitinthemajorityofindividuals(detailsinsubsequentimages)ThyroidAnatomyThyroidAnatomyThelarynxisinnervatedbybranchesofthevagusnerve(cranialnerveX)Allthemusclesofthelarynxexceptthecricothyroid(seelarynx)aresuppliedbytherecurrentlaryngealnervesTheterminalportionofthisnervepassesbeneaththeinferiorpharyngealconstrictortoenterthelarynxbehindthearticulationoftheinferiorcornuofthethyroidcartilagewiththecricoidcartilageRecurrentlaryngealnerveinjuryresultsinparalysisofthevocalcordinarelativelyadductedpositionBilateralrecurrentnerveinjuryduringtotalthyroidectomymayresultinacutepostoperativeairwayobstructionItisimportanttodopreandpostoperativelaryngoscopytodocumentvocalcordfunctionThesuperiorlaryngealnervearisesfromthenodoseganglionofthevagusjustoutsidethejugularforamenatthebaseoftheskullandpassesdiagonallydownwardclosetothesidesofthelarynxItsendsasensorybranchthroughthethyrohyoidmembraneandcontinuesasamotorbranchtothecricothyroidmuscleandinferiorconstrictorThecricothyroidmusclemaintainstensiononthevocalcordsInjurytothesuperiorlaryngealnerveresultsinlossoftimbre,enduranceandhighrangesingingcapabilityThyroidAnatomyThyroidAnatomyTherecurrentlaryngealnerveontherightarisesfromthevagusatthelevelofthesubclavianartery,passesbeneaththearteryandascendsnearthetracheaesophagealgroove(seebelow)TheleftrecurrentlaryngealarisesattheleveloftheaorticarchandpassesbeneaththeaortajustdistaltotheligamentumarteriosumandalsoascendsneartheleftTEgrooveThyroidAnatomyThyroidAnatomyRarely,oneofthelaryngealnervesisnotrecurrentbuttakesastraightcoursetothelarynxfromaboveThishappenswhenanaorticarchdevelopmentalanomalyresultsinaberranttakeoffofasubclavianarteryfromthedistalarchTheconditionisrareandusuallyinvolvesanaberrantrightsubclavianartery(lessthanofthepopulation)passingposteriortotheesophagusInthatcasetherightnerveisnonrecurrentCompressionoftheesophagusiscalleddysphagialusoriaVeryrarely(in),thereisarightsidedaorticarchwithamirrorimageanomalyresultinginanonrecurrentleftnerveThyroidAnatomyThyroidAnatomyTheterminalportionoftherecurrentnerveliesintheTEgrooveabouthalfthetimeWhennotinthegroove,itismostoftenmoreanteriorandmaybeinthesuspensoryligament(ofBerry)orevenintheglanditselfMostoften(,Skandalakis)thenerveisposteriortotheinferiorthyroidartery

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