局部解剖学-颈.ppt

Section 4 Lateral Region of Neck 5. Cupula of pleura ( Dome of pleura ) It covers apex of lung and extends through thoracic inlet into root of neck for 2. 5 cm above middle of clavicle. In front of it, there are subclavian a. with its branches, scalenus anterior, phrenic n., vagus n., subclavian v. and cervical part of thoracic duct. Posteriorly, there are sympathetic trunk. Laterally, it is related to scalenus medius and brachial plexus. Medially, there are subclavian a. and brachiocephalic v. on the left side and brachiocephalic a. v., and trachea on the right side. ★ Clinical Notes 1. Supraclavicular approach of brachial plexus block The inserting point of syringe needle is 2 cm above mid-point of clavicle. Because three trunks of plexus are close with each other here, the block is rather complete and suitable for any operation of the upper limb. But it should not insert needle too deep in order to avoid the injury of dome of pleura and apex of lung. 2. Virchow‘s node Malignant cells pass from abdominal cancer via thoracic duct to root of neck. Some tumor cells extend by retrograde permeation into inferior deep lateral cervical lymph nodes ( Supraclavicular lymph nodes, also called Virchows node ). Virchows node lies near biginning of brachiocephalic v. at left side. It may be enlarged by metastatic carcinoma of bronchus, esophagus, stomach, or any other abdominal organs. 3. Scalenus syndrome Spasm of scalenus anterior may lead to circulatory and neurological symptoms in upper limb, such as pale, swelling, numbness, paresthesia or tingling of limb, weakness even loss of the radial pulsation. These symptoms are called scalenus anterior syndrome. It may be the reason that abnormal lowering of shoulder or abnormal elevation of first rib may bring about compression of plexus and of subclavian a. against first rib. THE END Superficial view of the neck showing the platysma muscle (P). You were not required to