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5/11/2018 Anatomie ORL IRM - slidepdf.com
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Anatomia topografica a
regiunii cervicale
Aspecte imagistice in
patologia O.R.L.
5/11/2018 Anatomie ORL IRM - slidepdf.com
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Anatomia topografica a
capului si gatului
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ANATOMIA SI SPATIILE
GATULUI cu utilitate practica • Regiunile supra- si infrahioidiana.
• Clinicienii si anatomistii impart anatomia
de suprafata a gatului in zone triunghiulare.
• M. SCM: traiect oblic \ din regiunea
occipitala pana la “furculita’’sternala ;
divide gatul in: triunghiul anterior si posterior.
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TRIUNGHIUL ANTERIOR
• Superior - mandibula
• Posterior- sternocleidomastoidian• Anterior-intre simfiza menton
si “furculita” sternala
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TRIUNGHIUL POSTERIOR
• Superior - occiput
• Posterior - trapez• Anterior - sternocleidomastoidian
• Inferior - clavicula
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1-SCM
2-M. Trapez
3-M. Milohioid
4-M. Digastric5-M. Gl. Parotida
6-A. Carotida
7-V. Jugulara
8-Triunghi Anterior
9-Triunghi Posterior
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SPATIILE
SUPRAHIOIDIENE 1.Spatiul parafaringian
2.Spatiul mucoasei faringiene
3.Spatiul parotidian 8.Sp. perivertebral4.Spatiul carotidian 9.Sp. submandibular
5.Spatiul masticator 10.Sp. sublingual
6.Fosa pterigopalatina 11.Sp. post. cerv.
7.Spatiul retrofaringian
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1-Sp.muc parafaringiene
2-Sp. Parafaringian
3-Sp. Submandib.
4-Sp. Sublingual5-Sp. Cevical post.
6-Sp.Carotidian
7-Sp. Retrofaringian
8-Sp.Perivertebral
9-M. Genioglos10-M. Hioglos
11-M. Trapez
12-M. SCM
13-Proc. Stiloid
14-Sp. Parotidian15-N. Facial
16-Gl. Submandibulara
17-Gl. Parotida
18-V. Retromandib.
19-M. milohioid
20-Mandibula
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SPATIILE
INFRAHIOIDIENE • 1.Spatiul visceral
• 2.Spatiul carotidian
• 3.Spatiul cervical posterior
• 4.Spatiul cervical anterior
• 5.Spatiul retrofaringian• 6.Spatiul perivertebral
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1,2 Sp.cervic.AsiP
3-Sp. Carotitian
4-Sp.visceral
5-Sp.retrofaringian6-Sp.perivertebral
7-V.jugulara anterioara
8-V. jugulara posterioara
9-Gl.Tiroida
10-Paratiroida
11-V.jugulara interna
12-A. Carotida
13-N. Vag
14-Lant simpatic
15-M. lung gat
16-A. Vert.17-Esofag
20-Trahee
21-Vase tiroidiene
23-M.Trapez
24-M. SCM
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SPATII COMUNE SUPRA- SI
INFRAHIOIDIENE • 1.Spatiul carotidian
• 2.Spatiul retrofaringian
• 3.Spatiul perivertebral
• 4.Spatiul cervical posterior
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FASCIA CERVICALA A
GATULUI • Nu este vizibila prin CT si IRM.
• Fascia cervicala superficiala inveleste m.
platisma si nodulii limfatici superficiali.
• Fascia cervicala profunda este formata din
3 straturi: superficial, mijlociu si profund.
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Linia rosie-fascia cervicala superficiala
Linia verde-fascia cervicala profunda
Linia albastra- fascia profunda
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COMPARTIMENTELE
SUPRAHIOIDIENE
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1.SPATIUL
PARAFARINGIAN
• Este dispus intre faringe si m. faringieniconstrictori.
• Contine: grasime, rr. ale a. carotide ext.,plexuri faringiene venoase.
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1- Masa parafaringiana
2-Grasime3-Sp. Muc parafaringiene
4-Mandibula
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2.SPATIUL MUCOASEI
FARINGIENE • Reprezinta nasofaringele traditional.
• Contine: mucoasa, tesut limfatic, m.
constrictori, “torus tubaris”, m . levator veli
palatini, m . salpingofaringian, fascia farin-
gobazilara ,glandele salivare minore si ca-patul cartilaginos al trompei Eustachio.
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1. Cai aeriene deplasate
2. Sp. Faringian3.M. prevertebrali
4. V. jug.A. Carotida
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3.SPATIUL PAROTIDIAN
• Se gaseste intre straturile superficiale ale
fasciei cervicale profunde.
• Contine : glanda parotida, nervul facial,artera carotida externa , vena
retromandibulara , ganglioni limfatici.
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1.Sp. Parafarigian
2.Mandibula
3. M.maseter4. Masa parotidiana
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4.SPATIUL CAROTIDIAN
• Se extinde de la baza craniului pana la arcul
aortic si este inconjurat de fascia carotidi-
ana formata din cele 3 straturi ale facieicervicale.
• Contine : a.carotida interna , vena jugulara
interna, nervii IX, X ,XI, XII, plexulsimpatic, ganglioni limatici.
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1.Faringe
2. Sp carotidian3. M. pterigoidian
4. Masa dev. din sp.
Carotidian
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5.SPATIUL MASTICATOR
• Este dispus in interiorul stratului
superficial al fasciei cervicale profunde.
• Contine : m. temporal, m. maseter, m.pterigoid ,medial si lateral, ramul
mandibulei, ramul mandibular al n.
trigemen, a. maxilara , a. si vena alveolarainf. , grasime.
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1. Masa in Sp.Masticator
2. Sp. parafaringian
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6.FOSA PTERIGOPALATINA
• Are forma de piramida este plin cu grasime
si situat intre platourile pterigoide si
peretele posterior al sinusului maxilar.• Contine: n. maxilar, ggl. sfenopalatin,
portiunea terminala a arterei maxilare, gra-
sime.
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1.Masa in fosa pterigopalatina
2. Sp. Masticator
3. Sinus maxilar
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7.SPATIUL RETRO-
FARINGIAN suprahioidian
• Situat intre straturile mijlociu si superficial
ale fasciei cervicale profunde , se extinde
de la baza craniului pana in mediastinul sup.
• Contine : ganglioni limfatici si grasime.
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1.Sp. Retrofaringian
2. M. lung la gatului
3.SCM
4.A. carotida interna
5. V. jugulara int.
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8.SPATIUL PERI-
VERTEBRAL suprahioidian • Situat intre fascia prevertebrala si stratul
profund al fasciei cervicale profunde.
• Contine: anterior- m.prevertebral, m.scalen, plexul brahial, n. frenic, a. si v.
vertebrala corpul si pediculul vertebral.
posterior-procesul spinos si lamavertebrala, m .paraspinali.
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1. Sp. Carotidian
2. Masa perivertebrala
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9. SPATIUL
SUBMANDIBULAR • Comunica liber cu spatiul sublingual prin-
tr-o zona situata intre marginea libera a m.
milohioidian si m. hipoglos.• Contine: grasime , portiunea ant. a m. di-
gastric, portiunea superficiala a glandei
submandibulare, ggl. lmfatici, portiunea int.a n. hipoglos, a. si v. faciale.
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1. Sp. Submandibular
2. Glanda submandib.3.SCM
4.V. jugulara int.
5. A. Carotida int.
6. A. Carotida ext.
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10. SPATIUL SUBLINGUAL
• Se localizeaza superomedial de m. milohi-
oidian.
• Contine :glande si ducte sublinguale , a. siv. sublinguala , nervul lingual, n. hipoglos,
n. glosofaringian, lobul profund al gl. sub-
mandibulare , port. ante. a m. hipoglos.
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1. Masa sublinguala
2. Gl. Submandib.
3.Musc. limbii
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11.SPATIUL CERVICAL
POSTERIOR
• Apartine compartimentului infrahioidian.
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COMPARTIMENTELEINFRAHIOIDIENE
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1.SPATIUL VISCERAL
• Se gaseste intre stratul mijlociu al fasciei
cervicale profunde si se extinde de la baza
craniului pana la mediastin.• Contine : hipofaringele , esofagul, laringele
traheea, nervul laringeu recurent, glanda
tiroida glandele paratiroide si ganglionilimfatici.
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1. Masa din Sp. Visceral
2. Cai aerien comprimate
3. A.Carotida
4. V. jugulara int.
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2. SPATIUL CAROTIDIAN -
infrahioidian • Contine: a. carotida comuna, vena jugulara
interna, nervul vag, plexul simpatic , ggl.
limfatici ai lantului cervical profund.
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3. SPATIUL POSTERIOR
CERVICAL • Este in principal acelasi spatiu ca si spatiul
triunghiular posterior.
• Contine : grasime, ggl. limfatici accesorispinali , vase si nervi spinali accesori, plex
brahial preaxilar , nerv scapular dorsal.
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1. Masa din Sp. Cervic
posterior
2. Sp. Parafaringiandeplasat
3. A. Carotida int.
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4. SPATIUL CERVICAL
ANTERIOR • Este un spatiu plin cu grasime si cuprins
intre cele 3 capete ale fasciei cervicale
profunde .• Contine :grasime si ggl. limfatici.
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1. Masa din sp. Cervic ante.
2.Cai aeriene
3. A. Carotida
4. V. jugulara int.
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5 . SPATIUL RETRO-
FARINGIAN -infrahioidian • Este dispus intre straturile mijlociu si
profund ale fasciei cervicale profunde.
• Contine :grasime .
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6. SPATIUL
PERIVERTEBRAL • Descris la spatiile suprahioidiene.
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Pricipalele tumori maligne
cervicale• Metastaze
• Carcinoame
• Adenocarcinoame
• Limfoame
• Liposarcoame
• Neurofibrosarcoame
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Alte tumori cervicale
• Tumori vasculare
• Tumori de origine embrionara
• Pseudotumori
• Abcese
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T.carcinamatoasa laringe
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T. carcinomatoasa laringe
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Carcinom cu celule scuamoase
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Carcinom cu celule scuamoase
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Carcinom cu celule scuamoase
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Adenocarcinom chistic
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Adenocarcinom chistic
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Adenocarcinom chistic
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Adenocarcinom chistic
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Anevrism carotida externa
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Anevrism carotida externa
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Anevrism carotida externa
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Anevrism + t. tiroidiana
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Glomus jugulara
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Glomus jugulara
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Glomus jugulara
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Carcinom cu celule scuamoase
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Liposarcom
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Liposarcom
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Maladia Castelmann
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Maladie Castelmann
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CONCLUZII
• Anatomia – indispenabila in studiul
imagistic al afectiunilor O.R.L.
• Regiunea cuprinde elemente anatomicenumeroase intr-un volum redus.
• Patologia prezinta elemente intricate.
• Investigatiile imagistice au valoarecomplementara.