人体解剖学甲状腺和颈根部thyroid gland and root of the neck

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On its way to gland, STA runs accompanied with,external laryngeal nerve.,Thyroid arteries,Inferior thyroid artery,: branch of the thyrocervical trunk, posterior to the carotid sheath to reach the posterior aspect of the gland.,ITA divides into several branches that pierce the false capsule, supply the inferior pole of the gland,Before arrived to gland it runs across,recurrent laryngeal nerve,.,Thyroid arteries,Thyroid Ima Artery,Veins of thyroid gland connect to form a plexus between its two capsules & finally are drained by three pairs of veins.,Superior & middle thyroid veins empty into IJV,but inferior one into brachiocephalic vein.,Superior, middle, & inferior thyroid v.,Superior, middle, & inferior thyroid v.,Nerves & arteries,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,laterally by the first pair of ribs and their costal cartilages,Anteriorly by manubrium,Posteriorly by the body of T1 & T2 vertebrae,Skeleton of root of neck,What structures in the root of the neck,All structures going,from the head to the thorax;,from the thorax to the upper limb;,from the neck to upper limb and through the superior thoracic aperture.,Structures in the root of the neck,viscera organs,of digestive system and respiratory system: the trachea and esophagus are located in anterior median line .,carotid sheath,and structures located in this sheath .,Brachial plexus,and,subclavian vessels,phrenic nerve,structures in,triangle of the vertebral artery,: vertebral a, thyrocervical trunk,Sympathetic trunk of neck,apex of lungs, cervical pleura and sibson fascia,Apex of lungs,Prevertebral Muscles,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.,Scaleni medius & posterior can be separated only at their insertions. The former into 1st rib, the latter 2nd rib.,Scalenus space,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),Structures on the anterior aspect of scalenus anterior,Structures transversely:,subclavian v,transverse cervical a,suprascapular a,Subclavian vein,Direct continuation of,axillary,vein,at outer border of 1st rib.,Usually it has only one,tributary: external jugular vein,Termination of lymphatic trunks,Lower limb R/L lumbar trunks,Abdomen intestinal trunks,L subclavian,L bronchomediastinal,L jugular,R subclavian,R bronchomediastinal right lymphatic duct,R jugular,Thoracic duct,Aortic foramen,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. 1st part is medial to this muscle,2,nd,part is behind to it, 3,rd,located laterally to it .,At outer border of 1st rib, it continue as,axillary,artery.,brachial plexus,: upper, middle, lower trunks lie superior to,subclavian,artery,B,ranches of the subclavian artery,The right subclavian artery originates from the brachiocephalic trunk posterior to the sternoclavicular joint,the left originates from the arch of aorta.,Branches of subclavian artery,Vertebral a., internal thoracic a., &,thyrocervical,trunk,Costocervical,trunk,Dorsal scapular artery,Vertebral ,boundary:,Base is the 1,st,part of subclavian a,Content:,vertebaral,a.,Brachial plexus,Structures in the root of the neck,lymphatic drainage of the neck,Deep cervical lymph nodes,jugular trunks,thoracic duct,right lymphatic duct,Superficial lymph nodes,lymphatic drainage of the neck,lymphatic drainage of the neck,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？,Detach,sternothyroid,from its insertion & reflect it downward.,Identify & expose right & left lobes of thyroid gland, which are connected by an isthmus. Note whether a pyramid lobe extends upward from isthmus.,Cut isthmus & turn right lobe laterally.,Find recurrent laryngeal nerve which ascends posterior to gland & lies in groove between esophagus and trachea.,Find inferior thyroid artery.,Dissection of Thyroid Gland,人有了知识，就会具备各种分析能力，,明辨是非的能力。,所以我们要勤恳读书，广泛阅读，,古人说“书中自有黄金屋。,”通过阅读科技书籍，我们能丰富知识，,培养逻辑思维能力；,通过阅读文学作品，我们能提高文学鉴赏水平，,培养文学情趣；,通过阅读报刊，我们能增长见识，扩大自己的知识面。,有许多书籍还能培养我们的道德情操，,给我们巨大的精神力量，,鼓舞我们前进,。,