6耳、咽、喉、气管、食管

Ear External ear Auricle External acoustic meatus tympanic membrane Middle ear Tympanic cavity Auditory tube Mastoid antrum /cells Internal ear Bony labyrinth骨迷路(*cochlea耳蜗, **vestibule,*** semicircular canals半规管) (lodged perilymph 外淋巴 ) Membranous labyrinth 膜迷路(*cochlear duct蜗管, **utricle 椭圆囊and (lodged endolymph 内淋巴) saccule 球囊, ***semicircular ducts 膜半规管) 1. External ear 1) external acoustic meatus: from external acoustic pore to tympanic membrane; · To run forwards, upwards, and medially; · then, to run forwards, downwards,and medially · There are numerous sebaceous脂腺 and ceruminous glands盯聍腺(secreting cerumen), in skin. · Skin is thin and subcutaneous tissue is scarce缺乏的. 2) . Tympanic membrane · A thin, oval, semitransparent membrane · Formed by the skin, fiber coat and mucosa · Divided into flaccid part (松弛部) upper 1/4 tense part(紧张部)lower 3/4 · External view: umbo 鼓膜脐 cone of light 反射光锥 2. Middle ear 1）Tympanic cavity （1）walls： Ant.(carotid) wall It belongs to posterior wall of carotid canal. It has opening of ： auditory tube and canal for tensor tympani.鼓膜张肌(Ⅴ) Posterior (mastoid ) wall: It is formed by the mastoid process. Mastoid antrum(乳突窦) Mastoid cells 乳突小房 Canal for facial n. lies anteroinferiorly at the mastoid antrum. Pyramidal eminence(锥隆起), stapedius镫骨肌(Ⅶ) in it, is on the inferior to the mastoid antrum pore. Lateral (membranous) wall: *Formed by the tympanic membrane and epitympanic recess *Separating tympanic cavity from external acoustic meatus Medial(labyrinthine)wall: *Formed by internal ear *Separating tympanic cavity from internal ear *Main structures Promontorium(鼓岬) Fenestra vestibui(前庭窗)--Being closed by the base of stapes镫骨 Fenestra cochleae(蜗窗)--Being closed by the 2nd tympanic membrane in life (2) Contents in the tympanic cavity · Chain of auditory ossicles 听小骨链: Malleus(锤骨) Incus(砧骨) Stapes(镫骨) · Muscles: Tensor tympani(鼓膜张肌) (trigeminal n) Stapedius(镫骨肌)(facial n) · Bl. Vessels and nerve: branches from maxillary a.; middle miningeal a. …. · Mucosa: · Lig.: 2) Auditory tube or pharyngotympanic tube *To line the mucosa *To communicate with tympanic cavity and nasopharynx *To regulate air-pressure in tympanic cavity and to balance the pressure on both sides of the tympanic membrane *In childs, it is shorter and leveler水平的. 3) Mastoid antrum and mastoid cells 3. Internal ear 1) bony labyrinth(骨迷路) (1) Cochlea (耳蜗) · A bony canal · To make 2.5 turns around the modiolus(蜗轴) (2) Vestibule (前庭) (3) Semicircular canals(半规管) Anterior Posterior Lateral · Each semicircular canal is semicircle. · They are vertical each other. · Each canal has 2 crura—ampulla and simplex. Anterior and posterior canals open together into the vestibule by crus commune. 2) membranous labyrinth (1) cochlear duct (膜)蜗管 At the section of cochlea, the scala vestibuli (前庭阶), scala tympani(鼓阶) and cochlear duct 膜蜗管 can be observed in the cochlea. Walls: Sup.-vestibular membrane Inf.-basilar membrane Lat.-thicker periosteum Spiral organ-corti’s: on the basilar membrane; auditory receptor(accepting auditory stimulation– endolymph wave); (2) utricle and saccule Macula of utricle (椭圆囊斑) Macula of saccule (球囊斑) They are the organs(receptor) of static balance and receive stimulation of linear movements on acceleration and deceleration (3) 3 semicircular ducts Ampullary crests(壶腹嵴): on the membrane-ampulla, to belong to organs(receptor) of static balance静力平衡 and to receive stimulation of angular acceleration of head Pharynx (P 439-445) It is the muscular and common canal for both digestive system and respiratory system. It extends from the base of the skull to the level of the 6th cervical vertebra where it becomes the esophagus. The pharynx may be divided into 3 parts:nasal part, oral part, and laryngeal part 1. Nasal part (nasopharynx): · Between the base of the skull and the level of the the soft palate Posterior to the nose · Main structures— pharyngeal opening of the auditory tube, tubal torus / elevation (咽鼓管圆枕), pharyngeal recess, tubal tonsil 咽鼓管扁桃体 / pharyngeal tonsil（Post. part of Sup.wall） 2. Oral part (oropharynx) * between the level of soft palate and superior border of the epiglottis; posterior to the oral cavity · * Main structures: · Palate tonsil lies in the tonsil-fossa between the palatoglossal arch and palatopharyngeal arch · Oropharyngeal isthmus is bounded by the uvula, palatoglossal arches and base of the tongue. It is a communication between the oral cavity and oropharynx. 3. Laryngeal part (laryngopharynx) (1) It lies posterior to the larynx, and between the level of the epiglottis and level of the 6th cervical vertebra. (2) Main structures: *Piriform fossa (recess)梨状隐窝 lies on the each side of the laryngeal orifice. * fold for laryngeal n. *It is communicats antrainferiorly with laryngeal cavity through the laryngeal orifice, and continuous inferiorly with esophagus. Pharyngeal nerves： 1) motor fibers: · Accessory n. carried by the vagus n. · Glossopharyngea n. to the stylopharyngeaus · Mandibular n.(V3) supplied tensor veli palatini 2) sensory fibers: · Glossopharyngea n. · Maxillary n.(V2) Communication of the pharynx It is continuous with anteriorly *nasal cavity through the posterior nasal aperture **oral cavity through the pharyngeal isthmus ***laryngeal cavity through the laryngeal opening Laterally ****tympanic cavity through opening of auditory tube and auditory tube Inferiorly *****esophagus Larynx (P 430-438) 1..The larynx is a part of respiratory passage as well as the organ of phonation. It lies in the neck region in front of the C3-C6 vertebrae and the laryngopharynx. It consists of the laryngeal cartilages, joints, mucosa and muscles. 2. The joints of laryngeal cartilages: · (1)cricothyroid joints · (2)cricoarytenoid joints · (3)thyrohyoid membrane · (4) conus elasticus (known as cricothyroid lig.) It extends from cricoid cartilage to the thyroid cartilage and arytenoid cartilages. *Its superior border is free and forms vocal lig.(声韧带). *Its anterior part is called as median cricothyroid lig.. (5) quadrangular membrane (方形膜) It extends from lateral border of the epiglottic cartilage to the arytenoids cartilage and thyroid cartilage. Its inferior border is free and forms vestibular lig.(室韧带/前庭韧带). 3.laryngeal mm. *Thy are skeletal mm.. These mm.can open and close the rima glottis(声门); tense and relax vocal fold(声带). **divided into the extrinsic and intrinsic groups ***supplied by recurrent laryngeal n. (cricothyroid m. by the external laryngeal n. or external br .) superior laryngeal n. vagus nerve recurrent laryngeal n. 4. Laryngeal cavity: *1) vestibular fold and rima vestibuli:(前庭襞和前庭裂) The fold—vestibular lig.+ mucosa The rima—between the both vestibular folds *2) vocal fold and rima glottidis: (声带和声门裂) The fold—vocal lig.+ muscle in the vocal fold+ mucosa The rima–-a narrowest space in the laryngeal cavity between the both vocal folds, and between both arytenoid cartilages; *3) division of the laryngeal cavity (1) vestibule of larynx: it lies between the laryngeal inlet and vestibular fold (2) intermediate cavity of the larynx and ventricle of larynx intermediate cavity: between the rima vestibuli and rima glottidis ventricle of larynx: between vestibular fold and vocal fold of each sides (3) infraglottic cavity: between the rima glottidis and laryngeal outlet (at the 6th cervical vertebra) feature: submucosa tissue is relaxed. So, the region is easy to be oedema (水肿) for inflammation and high hot. 5. Nerves Superior laryngeal n. divided into the internal laryngeal br. ( accompanying with superior laryngeal a.-from superior thyroid a., n. piercing thyrohyoid membrane, supplying laryngeal mucosa superior to vocal fold) external laryngeal br. (accompanying with superior thyroid a., then, a. and n. dividing above the superior pole about 1 cm., supplying cricothyroid m.) recurrent laryngeal n. *From vagus nerves in the thorax *crossing around the the arch of the aorta (left) and right subclavian a.(right) *crossing with inferior thyroid a. *Coursing through the posterior to the inferior horn of thyroid cartilage Supplying others laryngeal mm.and mucosa of inferior to vocal fold Trachea (cervical part) Superiorly: connects with larynx Inferiorly: bifercates the left and right bronchus Formation: it is formed by the cartilages, smooth muscle, and connectiv tissue. the cartilage of the trachea show the “C”—shaped, and posterior wall of cartilage is lack. Nunbor of trachea in neck:6-8 Position of cut the trachea: 3rd-4th;or 4th-5th tracheal cartilages Relationship: posteiorly—esophagus; lateriorly—tharoid lobes; postlateriorly—caroted sheath, laryngeal recurrent n. Esophagus 3 parts: 3 strictures *origin part of esophagus， 15 cm from the incisor **where it is crossed by the left bronchus, 25cm ***where it passes through the diaphragm, 40cm Arteries arise from inferior thyroid a; arch of aorta, thoracic aorta; posterior intercostal a; abdorminal aorta;