0:00

你們將要

you we're

0:05

觸診顳骨，所以

gonna be palpating the temporal bone next so

0:08

顳骨一般位於這個區域

temporal bone as a general is right in this area here

0:12

有很多其他與骨骼的連接，我們將要

has quite a few other connections to bones that we're going to

0:15

討論周圍的骨骼，我們不會深入

be discussing kind of what bones are around it we won't go

0:18

過多的縫合線，因為大多數它們

in depth on too many kind of the sutures in this one because most of them

0:21

是不可觸診的，但我們肯定會指出很多

are not palpable but we are definitely pointing out a lot

0:24

骨性地標，當我們通過顳骨時

of bony landmarks as we go through the temporal bone here

0:27

我將從稍微靠後的地方開始

I'm going to start a little bit more towards the back

0:31

並再次嘗試找到一個地標

and try to find again a landmark

0:34

我們之前在顱骨的視頻中看過顳

that we've watched previous videos on the skull the temporal

0:37

窩，所以這是顳骨和顳窩，所以

fossa so this is the temporal bone and the temporal fossa so

0:41

我將快速回顧一下，我不會詳細說明，我們這裡有額骨，這裡有頂骨，然後它開始下降到顳骨上。

a very quick recap I won't go through everything in detail we have a frontal bone here we have parietal bone here and then it starts to drop down onto the temporal bone.

0:53

我想指出顳窩位於耳朵後面，實際上它位於耳朵下方。

I'd like to point out that the temporal fossa goes behind the ear and it actually goes underneath the ear.

1:01

所以如果你在耳朵上方後側觸診，並要求你的身體咬緊牙齒幾次，你會很容易感覺到顳肌在這個位置的顳窩中移動。

So if you're palpating superior posterior to the ear and you ask your body to clench their teeth a few times, you will quite easily feel temporalis moving in the temporal fossa through this location.

1:13

所以顳窩技術上是由四塊骨頭組成的。

So temporal fossa technically is made up of four bones.

1:16

那是第一、第二、第三，然後第四塊是蝶骨，稍微靠前一點。

That was one, two, three, and then the fourth one is going to be the sphenoid bone, a little more anterior.

1:22

但這通常是顳窩的地方

but this is often the temporal fossa gets

1:25

它的名稱來自顳肌，還有那條肌肉

its name for temporalis and again that muscle so

1:29

這將在耳朵上方，我將

that's going to be above the ear here i'm going to

1:32

稍微轉動頭部，並向你展示耳朵後面

turn the head slightly and kind of show you behind the ear

1:35

所以當我們將耳朵向前拉時，這個

so as we pull the ear forward this

1:39

標誌性位置被稱為乳突，所以你很容易抓到，而我現在正在勾勒的肌肉是胸鎖乳突肌

landmark right here is known as the mastoid process so it's quite easy for you to grab and a muscle that i'm kind of outlining right now is sternocleidomastoid

1:50

所以這條肌肉正好上升並插入這個乳突。我們還有另外兩條肌肉利用它作為附著點。

So that's going right up and inserting into this mastoid process. We also have two other muscles utilizing it as an attachment to.

1:57

所以這是你絕對應該了解的東西。當我稍微向後移動時，我將通過拉扯耳朵來指出這一點。

So this is something you should definitely get to know. As I go kind of posterior to it, I'm going to point this out on the ear by pulling on our ear.

2:06

所以這會有點棘手。我們等一下，等攝影機稍微放大一點。

So this is going to get a little bit tricky. And let's see, waiting for the camera to zoom in a little bit.

2:10

但是當我拉近時，我們實際上看到了一些纖維從耳朵的後面出來。

But as I pull in, we're actually seeing a little bit of this fiber coming off the back of the ear.

2:17

我會強調一下。所以這被稱為耳後肌。

I'll stress it a little bit. So this is known as your auricularis posterior.

2:22

這是一塊肌肉，能夠將耳朵向後拉，根據你的資料來源，它起源於一個叫做乳突區域或部位的地方。

It's a muscle that kind of pulls the ear back and it is originating depending on your source on something called the mastoid area or part.

2:32

所以我只是指出這是這個過程，稍微更靠近後頭骨的地方是乳突區域或部位。

So I'm just pointing that out that this is the process and a little bit more superior towards the occipital bone in here is the mastoid area or part.

2:42

所以這與耳後肌直接對齊。

So that's kind of directly in line this posterior auricularis muscle.

2:47

所以有時候需要提到這一點。

So sometimes that needs to be mentioned in reference.

2:51

好的，我只是要稍微抬起你的耳朵，如果我在這個前面。

okay I'm just going to lift up your ear a little bit if I go in front of this

2:56

乳突突起正好在下面。

mastoid process directly below the

2:59

耳朵，我會花一些時間，我不會太用力，但在這個位置下面。

ear I'm going to take some time I'm not going

3:02

在這個位置下推得太用力

to push too hard but underneath and in this location

3:05

被稱為你的茎突，所以你有這個小的骨性突起，這是為了你的茎突舌肌，如果你想確認這一點

is known as your styloid process so you have this small bony projection that's sticking down this is for your stylohyloid muscle so if you're wanting to confirm this one

3:17

你會要求你的對象吞嚥，這是舌骨作為一個群體的主要功能之一，因為它們幫助操控

You'd ask your person to swallow which is one of the main functions of the hyoids as a group as they help maneuver

3:24

在吞嚥過程中的舌骨。所以茎突就藏在這裡下面

The hyoid bone during swallowing So the styloid process tucked up underneath here

3:29

我們現在要把頭部帶回中立位置，我們不

We're going to bring the head back to the neutral now We're not

3:32

會把手指伸進人們的耳朵裡，儘管你可能想這樣做，但我們要做的是找到這片小皮膚

sticking our fingers inside people's ears as much as you might like to But instead what we're going to do is we're going to find this little flap of skin

3:39

有些人會稱這為耳屏，你可能聽說過耳屏穿孔，我將把這片皮膚蓋在她的耳洞上。

Some people will call this the tragus you might hear of a tragus piercing and I'm going to take that skin and I'm going to cover over top of her ear hole.

3:48

所以耳屏，我們蓋住它和外耳

So the tragus and we cover it and the outer ear

3:52

耳洞有兩個名稱，稱為外耳道或外聽道，

hole has two names known as the external acoustic meatus or mitus or the external auditory,

4:01

AU聽道，所以再次強調，我們不是把

AU auditory meatus so again instead of sticking

4:04

手指伸進去堵住它，而是把這片皮膚

your finger inside and plugging it we're just taking this flap of skin and

4:07

蓋在上面，所以這顯然是

covering over top of it so that's going to be again obviously

4:10

封閉耳洞，對我來說這是一個簡單的確認方式，

closing the ear hole for me that's an easy way to confirm

4:14

而不是把物體放進去，只是在這個耳屏前面，皮膚將

it instead of sticking an object inside just anterior to this tragus and the skin is going

4:21

是這個顴骨弓的開始，周圍還有幾個骨性標誌。

to be the beginning of this zygomatic arch and there's a few more bony landmarks around this.

4:28

所以我們會回來逐一解釋這些，但我會先從弓開始。

So again we'll come back and explain them kind of one by one but I'm going to start with the arch.

4:33

所以顴骨，也就是這裡的

So the zygomatic bone which is the

4:36

顴骨將向後突出，朝向顳骨，然後顳骨會向前推進，兩者在

cheekbone here is going to be projecting posteriorly towards the temporal and then the temporal is going to be kind of pushing forward and they kind of meet

4:46

這個位置的中間某處相遇，

somewhat in the middle right around this location at

4:49

在它們自己的縫合點，但整個

their own suture point but this whole

4:52

區域稱為顴弓，所以

area is called the zygomatic arch so

4:56

顳骨有一個稱為顴骨的

the temporal bone has what's known as a zygomatic

4:59

部分向前延伸，然後

portion going forward and then the

5:02

顴骨有一個分支向後延伸到顳骨。

zygomatic bone has a branch going back towards the temporal

5:06

所以你可能會看到並聽到這兩者，或者你可能會稱整個結構為顴弓，但請知道後面的部分主要由顳骨組成。

so you might see and hear those two or you might just call the whole thing zygomatic arch but please know the posterior your part is mainly made up of the temporal.

5:17

就在那下面，我開始感覺到一個圓球狀的結構，這實際上是下頜骨的頭部。

Just below that I'm starting to feel kind of a round ball-like structure and this is actually the head of the mandible.

5:25

它還有幾個其他名稱，所以你可能會聽到它被稱為髁或髁突，而在它前面的是冠狀突。

It has a couple other names as well so you might hear this as the condyle or condylar process versus in front of it this is the coronoid process.

5:33

所以為了確認我在下頜骨的頭部，我實際上會讓她張開嘴。

So to confirm that I am on the head of this mandible I'm actually going to get her to open her mouth.

5:38

當她張開嘴時，我可以輕易感覺到那塊骨頭移動，當她閉上嘴時，它又回到原位。讓我們再慢慢來一次。

So she opens her mouth I can easily feel that bone move and as you close it goes back up in place. Let's do that nice and slow again.

5:45

你會感覺到它正好經過我的手指，它稍微晃動，然後再次，當它經過時閉上嘴。

You'll feel it go right past my fingers, it's wiggling a little bit, and then again, close as it goes past.

5:51

所以那是頭部回到這個凹槽裡。

So that is the head going back up into the fossa of this.

5:56

這是顳骨的下頜凹槽。當這個下頜骨的頭部回到裡面時。

So this is the mandibular fossa of the temporal bone. As this mandible, the head of it, is going back inside.

6:02

所以你實際上無法感覺到顳骨的下頜凹槽，因為裡面有髁，但那會在這個位置的深處。

So you can't really feel the mandibular fossa of the temporal bone because it has the condyle inside of it, but that would be deep to this location.

6:12

接下來，在這個弓的沿線上，會有一個叫做關節小結節的東西。

Next, along this arch, there's going to be something called the articular tubercle.

6:18

所以我需要找到那個髁的

So I need to find that condyle of the

6:22

頭部，然後我會下降到

head and I'm going to drop to the inferior

6:26

顴弓的下表面，就在它前面，會有一個基本上突出的骨頭小隆起，一個小結節。

surface of the zygomatic arch just in front of it and there's going to be just basically a bump on the bone that's sticking inferior, a tubercle.

6:36

當一個人張開嘴時，頭部會向下移動並向前移動，經過這個關節小結節。

As a person opens their mouth, the head is going to drop inferior and translate forward as it goes past this articular tubercle.

6:46

當他們閉上嘴時，它會經過然後再回到裡面。

As they close them up, it goes past and then goes back up and in.

6:51

如果你深入研究過顳下頜關節的關節結構，

If you've looked indepthly at the joint structure of the TMJ,

6:54

顳下頜關節中有一個圓盤，也就是關節圓盤，這有助於在你張嘴和閉嘴時，頭部和圓盤前後移動。

temporal mandibular joint, you will know there's a disc in there as well, an articular disc, and this is what's helping move the head and that disc back and forth as you open and close.

7:04

所以這可能是你想進一步研究的內容，但目前這是位於下頜窩前方的關節結節。

So that might be something you want to further look into, but for now, this is the articular tubercle just in front of that mandibular fossa.

7:13

再次沿著這個顴骨弓前進。

working our way again along this zygomatic arch

7:17

現在弓本身對你來說有點難以看清。

now the arch itself is kind of hard for you to see

7:20

只是這樣感覺，但你看不到的是，

just to feel it this way but what you're not seeing is

7:24

如果我的手指是弓，那麼顳肌實際上是

if my finger was the arch then the temporalis muscle is actually

7:27

在它下面，所以這個弓在視覺上更容易

going underneath it so the arch is more visually

7:30

從上往下看時看到，顳肌在這個弓的下面，所以這將是顳骨的一部分。

seen from looking up and down on it as the temporalis goes underneath this arch so again that's going to be part of the temporal bone.

7:40

所以顳骨有很多事情發生。確保你仔細看一到兩次，並記住所有的地標。

So quite a bit going on with the temporal bone. Make sure you go through this once or twice and get all of those landmarks down.

Bony Landmark Palpation - Temporal Bone (Skull)