Chapter 5, CAPUT

The boundary between the head and neck being on the edge and corner of the lower jaw to the top of the mastoid process, and then - on the upper nuchal line to protuberantia occipitalis externa.

There are cerebral and facial department head, the boundary between

 which runs along the edge of verhneglaznichnomu, zygomatic bone and zygomatic arch to the

external auditory canal (Fig. 5.1). 

Fig. 5.1. The border between the brain and facial (red dotted line) divisions and

the vault and base (yellow dotted line) skull. 

Brain DIVISION

head

In the brain department heads distinguish calvaria, fornix cranii, and the

foundation, basis cranii. Vault and base demarcated from each other nosolobnym suture, supraorbital margin, the upper edge of the zygomatic arch, mastoid process

grounds, hereinafter - the upper nuchal line and protuberantia occipitalis externa. 

Calvaria, FORNIX CRANII

In the cranial vault allocate region: odd - the frontal, parietal, occipital and guys -

temple, ear and mastoid region. The similarity of the anatomical structure of the

first three allows you to combine them into one - the fronto-parietal-occipital. 

L0BN0-TEMENN0-ZATYL0CHNAYA AREA, REGIO FRONTOPARIETOOCCIPITALIS

External benchmarks. Supraorbital edge of the orbit, inion, tragus of ear, external auditory canal.

Boundaries. Front - supraorbital margin, margo supraorbitalis, posterior - superior inion, protuberantia occipitalis externa, and the upper nuchal line, linea nuchae superior, running horizontally on either side of the hill, on the sides - the initial

part of the temporal muscle, m. temporalis, corresponding to the skull superior temporal line.

Projections. Supraorbital vessels and nerves, a., v. et n. supraorbitals, projected on

the supraorbital region on the border of its middle and inner thirds. Nerve lezhmt

medial vessels. Above the block blood vessels and nerves, a., v. et n. supratrochleares, projected in the corner between the upper and inner edges of the orbit.

The main trunk of superficial temporal artery, a. temporalis superficialis, with ushno-temporal nerve, n. auriculotemporalis (III branch of the trigeminal nerve), projected onto the vertical anterior to the tragus (tragus).

Occipital artery, a. occipitalis, and the greater occipital nerve, n. occipitalis major, on the cranial vault are projected at mid-distance between the rear edge of the base and mastoid protuberantia occipitalis externa.

Layer

Leather greater part of the region covered by hair. It is inactive because of the strong connection with the subject of tendon helmet, galea aponeurotica, numerous fibrous strands.

Subcutaneous tissue mesh, gaps between the connective tissue septa are filled with adipose tissue.

Unlike other regions in the areas of the head (cranial vault and face) artery and accompanying veins are located in a layer of subcutaneous tissue, and not under their own fascia.

Vascular adventitia firmly adherent to the connective tissue ridges that divide the tissue into cells. As a result

vessels in the surface layer, if damaged gape. Even small wounds of the skin, subcutaneous been accompanied by heavy bleeding of the gaping vessels. Bleeding in first aid stop pressing of the wounded vessel to the bones of the skull, which is necessary to know the projection of vascular trunks that supply blood to the soft tissue of the cranial vault.

Supraorbital vessels and nerves, a., v. et n. supraorbitals (from the system of internal carotid artery), out of its socket and bend through the supraorbital region

on the border of its middle and inner thirds. The nerve lies medial to the vessels. Upon his release from the same channel (or cutting), they are first under the

frontal belly occipito-frontal muscle, directly to the periosteum. Then their branches reaching in an upward direction, pierced the muscles, tendon helmet and go into the subcutaneous tissue.

Supratrochlear beam: a., v. et n. supratrochleares (also from the system of internal carotid artery) is located medially on the supraorbital neurovascular bundle.

In the subcutaneous tissue of the frontal region 2,0-2,5 cm above the outer third of verhneglaznichnogo edge behind and above is temporal branch of the facial nerve (frontal to occipital-frontal abdomen muscles).

A. temporalis superficialis (one of the two terminal branches of the external carotid artery) comes in the parietal region of the temporal and splits into many branches, anastomosing with the vessels of the frontal and occipital areas, as well as with similar branches of the opposite side.

In the occipital region are distributed branch of occipital artery, a. occipitalis, and the greater occipital nerve, n. occipitalis major. Rear ear vessels and nerves, a.,

v. et n. auriculares posteriores, run parallel to and behind the attachment ear.

Vein areas form a network in which it is difficult to separate the individual

vessels. Most of the veins accompany the arteries with the same name, but there are additional.

Lymph flowing to three groups of lymph nodes: from the frontal region - in the superficial and deep-parotid lymph nodes, nodi parotidei superficiales et profundi; from the parietal region - in the mammillary, nodi mastoidei; of the parietal and occipital areas - in the occipital lymph nodes, nodi occipitales, below the tendon helmet or above.

For the subcutaneous cellular tissue should musculo-aponeurotic

layer consisting of occipito-frontal muscle, sh. occipitofrontalis, from the frontal and occipital bellies and connecting these muscles broad tendon plate:

tendon helmet, galea aponeurotica. As already noted, the skin tendinous helmet connected firmly, but with a deeper layer - periosteum - loosely (Fig. 5.2).

Fig. 5.2. Layers of the cranial vault at the front section A circuit, for Delitsinu, as amended).

1 - tela subcutanea; 2 - galea aponeurotica; 3 - w. diploicae; 4 - podaponev-Rhotic fiber, 5 - pericranium; 6 - subperiosteal fiber, 7, 13 - Pacchionian bodies, 8 - dura mater; 9 - spatium subdurale; 10 - arachnoidea mater; 11 - spatium subarachnoidale; 12 - encephalon; 14 - fak cerebri; 15 - sinus sagittalis; 1916 -

w. cerebri; 17 - v. subcutanea, v. emissaria. 

This explains the fact that the wounds of arch nerepa are often scalped. Triad of tissues - skin, subcutaneous tissue and tendon helmet - the whole peels from the

bones of the cranial vault to greater or lesser extent. Although scalped wounds are severe injuries, with timely assistance provided they are well healed through circulation to the soft tissues.

Tissue under the galea aponeurotica loose. It is called the hearth-ponevroticheskim cellulate space, which is widely distributed in the cranial

vault: anteriorly - to attach the frontal abdominal m. occipitofrontalis to supraorbital edge,backward - to attach the occipital belly of the muscle to the upper nuchal line. On the side leaflets tendon helmet fused with the superficial

fascia of the temporal region. Through the attachment of the temporalis muscle deep sheet of tendon helmet firmly fused with periosteum, limitation, Forex.com podaponevroti-agency space on the sides.

Between the periosteum and the outer plate of bones of the cranial vault is also a loose fiber (subperiosteal). However, along the line of stitches periosteum firmly fused with them and can not be detached.

The features of the anatomical structure of the layers of the cranial vault due to

various forms of hematoma in egoushibah. For example, subcutaneous hematoma vybuhayut in the form of "bumps" due to the fact that blood is not able to spread in the subcutaneous tissue due to fibrotic bridges between skin and tendon helmet; subgaleal hematoma - flat, diffuse, without sharp boundaries; subperiosteal hematomas have sharply defined edges respectively attaching periosteum through the bone joints.

The structure of flat bones of the skull has features. They consist of two plates of compact bone substance: a solid exterior, lamina externa, and less elastic, fragile

domestic, lamina interna («glassy» - lamina vitrea). In the frontal region under the outer plate is lined with mucous membrane auriferous sinus frontal bone, sinus frontalis.

When the internal cranial trauma plate is often damaged more significantly and

over a large area than the outer plate. Often, the inner plate is broken, and the outer remains intact.

Between the plates is spongy substance - diploe in which there are numerous

diploic vein. Diploic veins associated both with the veins sheets that make up the extracranial venous system, and with the venous sinuses of dura mater - the

intracranial venous system. This message comes through so-called graduates (emissarium) - holes in the respective bones, where the emissarnye veins. Of

these, the most constant v. emissaria parietalis, v. emissaria occipitalis,

v.emissaria condilaris and v. emissaria mastoidea. The latter is usually the largest

and most opened in the transverse or sigmoid sinus. V. emissaria parietalis opens

in superior sagittal sinus. Parietal emissary (the origins of the w. emissariae parietales) are located on either side of the sagittal suture anteriorly and posteriorly from biaurikulyarnoy line drawn from the opening of the right ear canal to the left.

Vein soft tissue arch Intraosseous and intracranial veins form a single system in which the direction of blood flow changes due to changes in intracranial pressure.

Relations between extracranial and intracranial venous system makes it possible transition of infection with the skull caps on the meninges (such as boils, carbuncles neck) with the subsequent development of meningitis (inflammation of the meninges), sinustromboza and other serious complications.

Thus, we can note certain characteristics as arterial blood supply and venous drainage from the tissues of the fronto-parietal-occipital region.

Features of the arterial blood supply

1. Arteries of the soft tissues of the cranial vault in contrast to other areas of the arteries are in the subcutaneous tissue.

2. Adventitia of the arteries associated with connective tissue ridges that connect the skin and tendon helmet, so the vessels do not fall off damage,

and gape. This leads to heavy bleeding.

3. The arteries run from the bottom up (radial direction).

4. Blood supply of the soft tissues of the cranial vault by the arteries as the system of the external carotid artery (superficial temporal, occipital), and the system of internal carotid artery (supraorbital, over block).

5. In the soft tissues of the cranial vault has an extensive network of anastomoses between the branches of the arteries, participating in their blood supply, including the arteries of the contralateral side.

Features of venous outflow

I. Vein, like arteries, are in the subcutaneous tissue.

2. Vein, form a wide network of anastomoses.

3. Vein soft tissues of the cranial vault due to both vnutrikost-governmental (diploic) veins, and with intracranial veins (sinuses of the dura mater) through emissarnye vein.

4. Vein soft tissue of the cranial vault do not have valves.

5. Emissarnye veins also have valves so the blood flow can be carried out in the direction of both surface and intracranial veins.

It should be remembered, however, that since there emissarnye vein to align the intracranial pressure, blood flow rate on them is directed to the surface and along

the superficial veins in the system of internal or external jugular vein. Only in cases of thrombosis of superficial venous blood from the surface layers can be released into the sinuses.

6. Relationship between surface and intracranial veins determines the possibility of infection from soft tissues in the cranial cavity with the development of inflammation of the

meninges. 

Temporal region, REGIO TEMPORALIS

External landmarks. Zygomatic arch, the outer edge of the orbit, external auditory canal.

Boundaries. Temporal region is separated from the orbit zygomatic process of frontal and frontal outgrowth of zygomatic bone from the side of the face - zygomatic arch. The upper limit is determined by the contour of the upper edge of the temporalis muscle.

Projections. A. temporalis superficialis is projected on the vertical line passing anterior to the tragus.

At the intersection of this line with the zygomatic arch can palpate the pulsation of the artery or hold her when bleeding.

LAYERS

The skin is thinner than in the fronto-parietal-occipital region; hair remains in the

posterior part of the area. In the anterior part of the skin is thinner and therefore much looseness of the subcutaneous layer can be captured in the fold.

Subcutaneous tissue is loose, layered, so bruising in this area are distributed in width.

Superficial temporal vessels and ushno-temporal nerve, n. auriculotemporalis (III branch of the trigeminal nerve), out of sequence parotid salivary gland in the subcutaneous tissue and to move upward anterior to the tragus (Fig. 5.3).Above

the zygomatic arch from a. temporalis superficialis departs average temporal

artery, a. temporalis media. At the level of supraorbital edge superficial temporal artery is divided into frontal and parietal branches.

Above the front third of the zygomatic arch in the subcutaneous tissue of the

facial nerve to the frontal abdomen m. occipitofrontalis rises, the frontalis, and the circular muscle of the eye -, the zygomaticus.

 Sensitive innervation of the temporal region provide the branches of the trigeminal nerve: n. auriculotemporalis (III Branch) and n.

zygomaticotemporalis (II branch), which comes from the cavity of the orbit through the same hole in the zygomatic bone to the skin of the anterior temporal region.

Fascia of the temporal region, fascia temporalis, looks aponeurosis with fan-oriented bundles of connective fibers. Being attached to bones at the boundaries of the area, the superior temporal line, temporal fascia above the hole closes.At the b-A cm above the zygomatic arches fascia splits into superficial and deep

leaves. The surface sheet is attached to the outside of the zygomatic arch, and deep - to the inside. Between the superficial and deep temporal fascia sheets enclosed mezhfastsialnaya (mezhaponevroticheskaya) fat tissue (Fig. 5.4).

Under the deep leaf of the temporal fascia, between it and the outer surface of the

temporalis muscle is a layer of loose, under- 

Fig. 5.4. Frontal section through the temporal region.

1 - cutis; 2 - tela subcutanea; 3 - fascia superficialis; 4 - fascia temporalis; 5 -

m. temporalis; 6 - spatium interfasciale; 7 - processus zygomaticus; 8 - fascia

parotideo-masseterica; 9 - a. et v. transversae faciei; 10-ductus parotideus; 11 -

gl. parotidea; 12 - m. masseter; 13 - mandibula; 14 - spatium subfasciale; 15 -

a. et v. maxillares; 16 - spatium subtemporale; 17 - ramus frontalis n. facialis.

fascial tissue, continuing downward from the zygomatic arch in mastication-jaw

slit bounded by the inner surface of the m. masseter and the branch of the

mandible. Between the front edge of the temporalis muscle and the outer wall of the orbit goes temporal process of body fat cheeks.

Temporalis muscle, m. temporalis, - chewing muscles, lifting the lower jaw. It starts from the periosteum of the temporal bone and from the deep surface of the

temporal fascia. Here it is broad and flat. Lower down its beams converge, it is already taking place behind the zygomatic arch and passes into the powerful tendon that attaches not only to the coronoid process, but also to the front of the branches of the mandible.

Between the deep surface of the temporalis muscle in its lower half and the temporal bone located deep infratemporal fiber associated with the temporo-wing-gap depth of face and front of the fiber with the buccal area. Through this tissue rise from the infratemporal fossa directly to the periosteum anterior and posterior

deep temporal vessels and nerves, a., v. et n. temporales profundi anteriores et posteriores. These arteries diverge in a deep area of the face of the maxillary

artery, a. maxillaris, nerves - on n. mandibularis (W branch of the trigeminal nerve), immediately after its exit from the foramen ovale, and enter into the muscle with its inner surface.

Deep temporal veins empty into the pterygoid venous plexus, plexus pterygoideus.

Lymph flowing in the nodes located in the interior of the parotid salivary gland, - nodi parotideae profundi.

Periostio in the lower part of the area fairly well connected with the subject bone, above its connection with the bone as soft, as in the fronto-parietal-occipital

region. Scales of the temporal bone is very thin, almost does not contain diploe and easily subject to fracture.

Given that the inner surface of the temporal bone adjoins a. meningea media, temporal bone fractures scales may be accompanied by intracranial hemorrhage with the formation of epi-and subduralnyhgematom and sdavleniemmozgovogo substance.

Under the dura within the temporal regions are the frontal, parietal and temporal lobes, separated by a central or Roland [Rolando], and lateral or Sylvian-tion

[Sylvian] furrows. On the projection of these grooves can be judged by a specially prepared scheme craniocerebral topography.

Scheme craniocerebral topography

Projections on the skin of the cranial vault major sulci and gyri of the cerebral

hemispheres, as well as progress a. meningea media and its branching is possible

with the scheme Krenlyayna-Bryusov. First, spend the median sagittal line of the head, connecting intercilium, glabella, with protuberantia occipitalis

externa. Then put the lower horizontal line going through the infraorbital region,

the upper edge of the zygomatic arch and the upper edge of the ear canal. In parallel to her from the upper edge of orbit conducting upper horizontal line (Fig. 5.5).

 Three vertical lines hold up to the median sagittal line from the middle of the zygomatic arch (1-I), from the joint of the mandible (2-I) and from the rear boundary of the base mastoid process (the third).

The projection of the central, sulcus centralis (Roland), the furrows of line drawn from the point of intersection of the posterior vertical midline sagittal line at the top to the point of crossing-over the front of the vertical and horizontal top. The bisector drawn up by the central sulcus and the upper horizontal line is projected

onto the lateral (Sylvian) sulcus , sulcus lateralis. Its projection is a segment bisector between the front and back of the vertical lines.

 Barrel a. meningea media projected on the intersection of the front vertical with the horizontal bottom, ie at the middle of upper edge of the zygomatic arches

(Fig. 5.6). Frontal a branch of a. meningea media projected on the point of intersection of the front vertical with the upper horizontal and the parietal branch - at the intersection of this horizontal with the back vertical.

AREA auricle, REGIO AURICULARIS

On the border of the cerebral and facial parts of the head region is ear. Together with the external auditory meatus, it is part of the outer ear.

The outer ear, auris externa

The outer ear consists of the pinna and ear canal.

Auricle, auricula, commonly called simply the ear, formed an elastic cartilage

covered with skin. This cartilage defines the outer shape of the ear and its projections: the free folded edge - whorl, helix, and parallel to it - pro-tivozavitok, antihelix, as well as the front ledge - tragus, tragus, and lying behind him

antitragus, antitragus. Below auricle ends not containing cartilage ear lobe. Deep

sinks for tragus open hole ear canal. Around him there are remnants of rudimentary muscles, which has no functional significance.

External auditory canal, meatus acusticus externus, consists of cartilage and bone

parts. Cartilaginous portion is about one-third, bone - two thirds of the external

auditory canal. In general, its length is equal to b-A cm, the vertical size - about 1 cm, horizontal - 0,7-0,9 cm passage narrows to the point of transition of cartilage

into bone. The direction of the meatus in the total frontal, but forms a S-shaped

curve of both the horizontal and the vertical plane. To see located in the depth of the eardrum, it is necessary to straighten the ear canal, ear pulling back upwards and outwards.

The front wall of the bony part of the auditory canal is located immediately posterior to the temporomandibular joint, the rear separates it from the mastoid cells, the top - from the cranial cavity, and the lower wall of its borders with the parotid salivary gland.

External auditory canal is separated from the middle ear, eardrum, membrana tympani.

AREA mastoid, REGIO MASTOIDEA

Field of the mastoid process is behind the ear and covered it.

The boundaries correspond to the shape of the mastoid process, which is well detectable. Top border is the line which is a continuation of the posterior zygomatic process of temporal bone.

Intraosseous education are projected onto the surface in four quadrants (Figure 5.7).

To construct the quadrants hold the line on the top of appendages to its base (from bottom to top) and perpendicular to the line at its

middle. At peredneverhnii quadrant projected cave, antrum mastoideum, on anteroinferior - bone of the facial nerve canal, canalis facialis, in caudineural - posterior cranial fossa and lowback quadrant projected sigmoid venous sinus.

Layer

The skin in the anterior region (closer to the ear) is more subtle than in the rear.

In the subcutaneous tissue are rear ear artery and Vein, a. et v. auriculares posteriores, posterior branch of great auricular nerve, n. auricularis magnus (a sensitive branch of the cervical plexus), and posterior auricular nerve, n. auricularis posterior (a branch of the facial nerve).

Fig. 5.7. Mastoid region. Triangle Shipo. Scheme.

1 - the projection of the posterior cranial fossa, 2 - the projection of the sigmoid sinus;

3 - triangle Shipo;

4 - projection of the facial nerve, 5 - external auditory foramen; 6 - projection of the mastoid cave.

Under its own fascia, which is a continuation of fascia sternocleidomastoid muscle, or over it splits

lozheny mammillary lymph nodes, nodi mastoideae. They collect lymph from the fronto-parietal-occipital region, with the back surface of the auricle, from the external auditory canal and eardrum.

Under the fascia and muscles, starting from the mastoid process (m. sternocleidomastoideus, back abdomen so digastricus and so splenitis), in the furrow on the medial side of the process of the occipital artery passes,

a. occipitalis, their way to the soft tissues of the occipital region.

Periostio firmly adherent to the outer surface of the mastoid process, with the exception of a smooth triangular area where the periosteum is easily peels

off. This site is distinguished by the name of the triangle Shiloh (see Fig.

5.7). The boundaries of the triangle are the front rear edge of the ear canal and spina suprameatica, rear - crista mastoidea, and on top - the horizontal line drawn

posteriorly from the zygomatic process of temporal bone. Within the triangle Shipb trepanize mastoid with mastoidites and chronic inflammation of the middle ear at a depth 1,5-2 cm there is a cave mastoid, antrum mastoideum, communicating through aditus ad antrum with the tympanic cavity. Separates the upper wall of the cave, middle cranial

fossa. Front of the cave is the lower part of facial canal. To the rear comes close sigmoid venous sinus.

At the rear boundary of the triangle is Shipo mastoid hole, foramen mastoideum, through which the cavity of the skull passes mastoid эмиссарная Vein, connecting with the superficial veins sigmoid sinus dura

mater. 

INSIDE SKULL BASE, BASIS CRANII INTERNA

The inner surface of the skull base, basis cranii interna, is divided into three pits from which the front and middle is placed a large brain, but in the back - the

cerebellum. The boundary between the anterior and middle holes are the rear edge

of the small wing of sphenoid bone, between the middle and rear - upper bound of the petrosal bone (Fig. 5.8).

Anterior cranial fossa, fossa cranii anterior, is formed by orbital part of frontal bone, ethmoid plate of the ethmoid bone, which lies in the deepening, small wings

and a part of 

Body of sphenoid bone. In the anterior cranial fossa located frontal lobes of the

cerebral hemispheres. On either side of the crista galli are laminae cribrosae,

through which the olfactory nerves, nn. olfactorii (I couple) from the nasal cavity

and a. ethmoidalis anterior (from a. ophthalmica), accompanied by the same name veins and nerve (branch of trigeminal nerve I).

Middle cranial fossa, fossa cranii media, deeper front. It distinguished the middle part, formed by the upper surface of body of sphenoid bone (sella turcica region),

and two lateral. They formed great wings of sphenoid bone, the front faces of the pyramids and some scales of the temporal bone. The central part of the middle fossa is occupied by the pituitary, and the side - temporal lobes of the

hemispheres. Anterior to the sella turcica, the sulcus chiasmatis, is crossing the

optic nerves, chiasma opti-cum. On each side of the sella turcica are important in practical terms, sinuses of dura mater - cavernous, sinus cavernosus, which flow into the upper and lower ophthalmic vein.

 Average fossa communicates with the eye-socket through the optic canal,

canalis opticus, and the superior orbital fissure, fissura orbitalis superior. Through the channel of the optic nerve passes, n. opticus (II couple), and ophthalmic

arteries, a. ophthalmica (from the internal carotid artery) and through the gap -

oculomotor nerve, n. oculomotorius (III pair), block, item trochlearis (IV couple),

outlet, n. abdu-cens (VI pair) and eye, n. ophthalmicus, nerves and ophthalmic veins.

Average fossa communicated through a round hole, foramen rotundum, where is the maxillary nerve, n. maxil-laris (II branch of the trigeminal nerve), with

Pterygopalatine fossa. C infratemporal fossa is linked through the foramen ovale, foramen ovale, which runs mandibular nerve, n. mandibularis (III branch of the

trigeminal nerve), and spinous, foramen spinosum, where is the middle meningeal

artery, a. meningea media. At the top of the pyramid is irregularly shaped hole - foramen lacerum, in which the internal opening of carotid canal, from where it

enters the cranial cavity internal carotid artery, a. carotis interna.

Posterior fossa, fossa cranii posterior, the most profound and separated from the middle upper edges of the pyramids and the back of the Turkish saddle. It is formed almost the whole of the occipital bone, part of the body of sphenoid bone, posterior surfaces of the pyramids and mastoid part of temporal bone and the

posterior inferior angle of parietal bone . In the center of the fossa is situated

foramen magnum, in front of it is scat Blyumenbaha, clivus [Blumenbach]. On the rear surface of each of the pyramids is the internal acoustic opening, poms acusticus internus; travels through the front, n. facialis (VII pair), intermediate, n.

intermedins, and veslibular-cochlear, P. vestibuloco-chlearis (VIII. steam), nerves.

In the petrosal bone and lateral parts of occipital are jugular holes, foramina jugularia, through which the glossopharyngeal, n. glossopharyngeus (GC pair),

vagus, n. vagus (X pair), and extension, n. accessorius (W steam), nerves, and

internal jugular Vein, v. jugularis interna. The central part of the posterior cranial fossa is foramen magnum, foramen occipitale magnum, through which the

medulla oblongata, with its membranes and spinal artery, aa. vertebrales. In the lateral parts of occipital bone are channels sublingual nerves, canalis n. hypoglossi

(XII couple). In the middle and posterior cranial fossa is particularly well represented sulcus sinuses of the dura mater.

In the sigmoid sulcus, or next to it is v. emissaria mastoidea, connecting the occipital vein and veins outside the skull base with the sigmoid sinus.

Shells of the brain, meninges

The next layer after the bones of the cranial vault is the dura mater of the brain,

dura mater cranialis (encephali). It is loosely connected with the bones set and

tightly adherent to the inner base of skull. Normally, no natural space between the

bones and the dura no. However, this cluster of blood (hematoma) revealed the space called the epidural.

Dura mater of the brain goes into a solid shell of the spinal cord.

Dura mater of the brain inside the skull gives three appendages. One of them - sickle cerebrum, falx cerebri, - located in the middle, in the sagittal direction,

and divides the hemisphere. Second - falcula, fak cerebelli. - Shares the cerebellar hemispheres and the third - a gallop cerebellum, tentorium cerebelli, - separating

large brain from the cerebellum. Posterior fak cerebri connected with the snaring

cerebellum. Tentorium cerebelli is attached behind the transverse furrows on the sides - to the upper edges of the rocky parts of the temporal bone.

Dura consists of two sheets. In places its attachment to the bones of the skull sheets diverge and form a triangular-shaped channels lined with endothelium, - sinuses dura of the brain.

Arteries of the dura. Most of the dura of the brain supplies the middle meningeal

artery as well. meningea media, - a branch of a. maxillaris. It penetrates into the

cranial cavity through spinous foramen, foramen spinosum. In the cranial artery

divided into frontal and parietal branches. The trunk of the middle meningeal artery and its branches rather tightly connected to the dura mater, and on the bones

form a notch - sulci meningei. In connection with this artery is often damaged at

the turn of the temporal bone. The frontal branch of a. meningea media often takes place over a short distance in the bone canal - is observed at the site of

convergence of four bones: frontal, parietal, temporal, and sphenoid. Artery

escorted two w. meningeae mediae, passing in contrast to the artery in the thickness of the dura mater.

Anterior meningeal artery, a. meningea anterior, a branch of the anterior ethmoid

artery, a. ethmoidalis anterior (from the ophthalmic artery of the internal carotid

artery). Posterior meningeal artery, a. meningea posterior, departs from the

ascending pharyngeal artery, a. pharyngea ascendens (from the external carotid

artery). Both of them form numerous anastomoses with a. meningea media.

The nerves of the dura mater, rr. meningei, away from the branches of the trigeminal nerve: ophthalmic, maxillary, and mandibular nerves.

The next layer is the arachnoid of the brain, arachnoidea

mater cranialis, passing over the furrows of the brain. Hematomas formed between the solid and the arachnoid, called subdural (see Fig. 5.2).

Between the arachnoid and the next, the pia mater of the brain, pia mater cranialis (encephali), is Subfolde-duck (subarachnoid space), along with shells

passing on the spinal cord. And in the cranial cavity, and around the spinal

subarachnoid space contains cerebrospinal fluid, liquor cerebrospinalis. This fluid fills the ventricles and the brain.

Subarachnoid (subarachnoid space) is particularly well expressed on the basal

surface of the brain. Extended areas of space called the subarachnoid cisterns. The largest of the ten tanks - posterior cerebellar-brain-curve cistern, cisterna cerebellomedullaris posterior, or a large tank, based in the deep fissure between

cerebellum and medulla oblongata. It communicates with the cavity PG ventricle, then through the brain, or Sylvia [Sylvius] water supply - with the IIIventricle,

with a message from the lateral ventricles of the brain. A large tank also

communicates with subarachnoid space of the spinal cord. At the level of the upper edge of atlantoza-tylochnoy membrane, this tank has a depth of 1.5 cm Here is her puncture for diagnostic or therapeutic purposes - suboktsipitalnaya puncture (Fig. 5.9).

Anterior to the optic chiasma is located chiasm cistern, cisterna

chiasmatica. Developing this inflammatory process (optohiazmalny arachnoiditis) is often accompanied by loss of sight.

Soft Shell brain, pia mater cranialis (encephali), closely adjoins to the brain and

comes in all grooves. It is rich in vessels feeding the brain. Penetrating into the cavity III and PG ventricles forms of vascular plexuses that produce cerebrospinal fluid.

Cerebral circulation

The brain artery supplying the four - two internal carotid system of obshey carotid and two vertebral system of the subclavian artery.

A. carotis interna, having passed through his neck part peripharyngeal space, suitable to the outer base of the skull and enters the outer aperture of the carotid

canal, apertura externa canalis carotici. She goes into the cranial cavity through the internal carotid canal at the aperture of the top of the pyramid of the temporal

bone and goes up the sulcus caroticus sphenoid bone. Parasellar internal carotid artery is directed anteriorly, passes through the thickness of cavernous sinus and

on leaving it pays well. ophthalmica, guided by the visual channel in the cavity of

the orbit. Then a. carotis interna pierced firm and arachnoid of the brain and gives the posterior communicating artery, a.communicans posterior, which anastomose

with the posterior cerebral artery, a. cerebri posterior, departing from

a. basilaris. Terminal branches of internal carotid artery are the anterior and middle cerebral artery, aa. Cerebri anterior et media. At the front edge of the Turkish saddle left and right anterior cerebral arteries converge and connect with each other via the anterior communicating artery, a. communicans

anterior. Anterior cerebral artery supplies the medial surface of the frontal,

parietal and occipital lobes partially cerebral hemispheres. The larger a. cerebri media, or Sylvian [Sylvian], krovosnab-ues lateral surface of the same lobes.

Vertebral artery, a. vertebralis, steam room, passing around the neck through the hole in the transverse processes of cervical vertebrae through the foramen

magnum is included in the cranial cavity. At the base of the skull, both vertebral

arteries merge to form the basilar artery, a. basilaris. which runs in the furrow at

the bottom of the brain of the bridge. From a. basilaris depart two aa. cerebri

posteriores. which are connected via the posterior communicating artery with

middle cerebral artery. Thus arises Willis (Willis) arterial circle - circulus arteriosus cerebri (Willissii [Willis]), which is located in the subarachnoid space at the base of the brain and the skull surrounding the sella turcica (Figure 5.10).

Again components Willis circle. A. communicans anterior, connecting the anterior cerebral arteries, thus connecting the right and left internal carotid artery. posterior communicating artery branching off from the internal carotid arteries,

linking them with the posterior cerebral artery, extending from a. basilaris, formed by the confluence of the right and left vertebral arteries.

Willis arterial Croot played a vital role in blood supply to the brain, because due to its constituent anastomosis power cord blood preserved at the termination of any of the four arteries, his image.

Venous outflow from the brain

Vein's brain do not normally accompany the artery. Superficial veins are located

on the surface of the cerebral convolutions, deep - deep in the brain. Deep veins

merge to form 

large vein in the brain, v. cerebri magna, or vein of Galen [Galen], - a short trunk,

which runs into direct sinus dura mater. All other veins of the brain also fall into one or other sinus.

Dural venous sinuses

Dural venous sinuses that collect venous blood from the veins of the brain are formed in places of attachment of the dura mater to the bones of the skull due to

the splitting of its leaves. Sine the blood flowing from the brain into the internal

jugular vein (Figure 5.11). Valves were sinuses are not.

 

Figure 5.11. Sinuses of the dura mater (by Netgeru, as amended). 1 - fak cerebri; 2, 15 - sinus sagittalis superior; 3 - sinus sagittalis inferior; April - sinus sphenoparietalis; 5 - sinus intercavernosi; 6 - sinus petrosus inferior; 7 - sinus occipitalis; 8 - sinus sigmoideus; 9 - sinus transversus; 1910 - confluens sinuum;

11 - sinus rectus; 12 - sinus petrosus superior; 13 - v. magna cerebri (Galeni); 14 - tentorium cerebelli.

Superior sagittal sinus dural, sinus sagittalis superior, located in the upper edge of falx cerebri, are fastened to the same name furrow of the cranial vault, and

extends from the crista galli to protuberantia occipitalis interna. In the anterior parts of the sinus has anastomoses with the veins of nasal cavity. Through parietal emissarnye vein it is linked to diploic veins and superficial veins of the cranial

vault. The rear end of the sinus empties into the sinus passages Gerofilusa [Herophilus], confluens sinuum.

Lower sagittal sinus, sinus sagittalis inferior, is located in the lower margin of falx cerebri and moves in a straight sinus.

Live sine, sinus rectus, located at the junction of falx cerebri and gallop

cerebellum and is in the sagittal direction. It also runs a large brain Vein,

v. cerebri magna [Galen], which collects blood from the substance of the

brain. Straight sinus, as well as superior sagittal, empties into the sinus passages.

The occipital sinus, sinus occipitalis, is the base of the sickle cerebellum, falx

cerebelli. His top end runs into the sinus passages, and the inferior end of a large foramen is divided into two branches, the envelopes of the hole edge and the flow

in the left and right sigmoid sinuses. The occipital sinus via emissary-WIDE veins associated with superficial veins of the cranial vault.

Thus, in the sinus venous blood comes from the superior sagittal sinus, a direct (and through him from the bottom of the sagittal sinus) and occipital sinuses. Confluens sinuum blood from flowing in the transverse sinuses.

Transverse sinus, sinus transversus, lies at the basis of a gallop of the

cerebellum. The inner surface of the occipital bone scales, it corresponds to a broad and well visible furrow transverse sinus. The right and left transverse sinus sigmoid sinus continues to relevant parties.

Cribriform sine, sinus sigmoideus, takes venous blood from the cross and sent to the front of the jugular holes, where goes to the upper bulb of the internal jugular

vein, bulbus superior v. jugularis internae. Proceedings sinus corresponds to the same name furrow on the inner surface of the base mastoid temporal and occipital bones. A mammillary emissarnye veins sigmoid sinus is also related to the surface veins of the cranial vault.

In doubles cavernous sinus, sinus cavernosus, located on either side of the Turkish saddle, blood flowing from the small sinuses anterior cranial fossa and

veins of orbit. In his fall ophthalmic vein, w. ophthalmicae, anastomoziruyushie

with veins of face and deep venous plexus wing-person, plexus

pterygoideus. Latest related to the cavernous sinus also through emissaries. The right and left sinuses are interconnected mezhpescheristymi sinuses - sinus

intercavernosus anterior et posterior. From the cavernous sinus blood flowing through the upper and inferior petrosal sinus to the sigmoid sinus and then into the internal jugular vein.

Contact cavernous sinus to the surface and deep veins and with a solid shell of the brain is of great importance in the spread of inflammatory processes and explains the development of such severe complications as Meningitis.

A cavernous sinus are the internal carotid artery, a. carotis interna, and a lead-nerve, n. abducens (VI pair), through its outer wall - oculomotor nerve, n. oculomotorius (III pair), block nerve, n. trochlearis (IV couple) and I branch of the trigeminal nerve - ophthalmic nerve, n. ophthalmicus (Figure 5.12).

By the posterior cavernous sinus adjoins Gasser's ganglion of the trigeminal nerve

- ganglion trigeminal [Gasserian]. By the anterior cavernous sinus approaches are sometimes fat tissue Pterygopalatine fossa, which is a continuation of the fat body cheek.

 Thus, venous blood from all parts of the brain through the cerebral veins

falls into one or other sinus dural and further into the internal jugular vein. With an increase in intracranial pressure blood from the cranial cavity can be further

released into the system of superficial veins via emissarnye vein. The reverse movement of blood is possible only by developing for one reason or another

superficial vein thrombosis associated with emissarnoy. 

FACIAL HEAD

On the surface of the facial department head in front of the orbit distinguished, regio orbitalis, nose, regio nasalis, mouth, regio oralis, adjacent to her chin

region, regio mentalis. On either side are suborbital, regio infraorbitalis, buccal,regio buccalis, and parotid chewing. Regio

parotideomasseterica, area. In the latter distinguish superficial and deep parts.

The blood supply to the person mainly by the external carotid artery, a. carotis

externa, through its branches: a. facialis, a. temporalis superficialis and the

a. maxillaris. In addition, the blood supply to the person involved and

a.ophthalmica of a. carotis interna. In the arteries of systems of internal and external carotid artery anastomoses exist in orbit.

Receptacles shall constitute an abundant network of well-developed anastomosis,

resulting in injury have been hard bleeding. However, due to good circulation in soft tissue wounds of a person, usually heals quickly, and plastic surgery on the

face end favorably. As in the vault of the skull, face artery located in the subcutaneous fatty tissue, in contrast to other areas.

Vein's face, like an artery, widely anastomose with each other. From the surface

layers of the venous blood flowing to the front of the vein, v. facialis, and partly

pozadichelyustnoy, v. retromandibu-laris, from the deep - on the maxillary vein,

v. maxillaris. Ultimately, all these veins the blood flowing into the internal

jugular vein. Importantly, the vein is anastomosed as a person with the veins, flowing into the cavernous sinus dura mater (via v. ophthalmica, as well as through emissarnye veins on the outer base of the skull), resulting in suppurative processes in the face (TSS) along the veins may extend to lining of the brain with the development of severe complications (meningitis, phlebitis sinus, etc.).

Sensitive innervation of the face is provided by branches of the trigeminal nerve

(n. trigeminus, V couple): p. ophthalmicus (I branch), P. maxillaris (II Branch), n.

mandibularis (III branch). The branches of the trigeminal nerve to the skin from bone leave channel openings are located on the same vertical line: foramen (or incisura) supraorbital for items from supraorbitalis I branch trigeminal nerve, foramen infraorbitale for ae infraorbitalis from II branch of the trigeminal nerve and the foramen mentale for Section III of the mentalis branches of the trigeminal nerve (Figure 5.13).

 Mimic muscles innervate the branches of the facial nerve, n. facialis (VII pair), chewing - III branch of the trigeminal nerve, n. mandibularis.

AREA Orbit, REGIOORBITALIS

Orbit, orbita, - paired symmetrical hole in the skull, which is located in the eyeball with its subsidiary apparatus.

Orbit in humans are in the shape of square pyramids, truncated tops of which are turned back, sellar in the cranial cavity, and the broad base - anteriorly, its outer

surface. Axis orbital pyramids converge (converge) and diverge posteriorly

(divergiruyut) front. Average size of the orbit: the depth of an adult ranges from 4 to 5 cm wide at the entrance to it is about 4 cm and the height is typically less than 3,5-3,75 cm

The walls are formed by different thickness of bone slices and separate the orbit: the top - from the anterior cranial fossa and frontal sinus, the lower - of maxillary sinuses, sinus maxillaris (maxillary sinus) medial - from the nasal cavity and lateral - from the temporal fossa.

Almost at the very top of their sockets situated round hole about 4 mm in diameter - the beginning of the bone of the optic canal, canalis opticus, 5-6 mm in length, which serves for passage of the optic nerve, n. opticus, and ophthalmic artery as

well. ophthalmica, in the cavity skull (Fig. 5.14)

Fig. 5.14. The back wall of

orbit. Optical channel (on Shpalteholtsu, as amended).

1 - n. lacrimalis; 2 - P. frontalis; 3 - n. trochlearis; 4, 15 - P. x-axis lomotorius; 5, 22 - ala parva ossis

9. sphenoidalis (dissected), 6 - ca-

10.nal is opticus (open top), 7, 18 - n. opticus; 8 - anulus ten-dineus

communis; 9 - m. leva-

11 tor palpebrae superior; 10 - m. obliquus superior; 11 - m. rec- tus medialis; 12 - pars me-

13 dialis orbitae; 1913 - m. rectus

14 inferior; 14 - v. ophthalmica inferior; 16 - m. rectus lateralis; 17 - a. ophthalmica; 19 - n. na- sociliaris; 1920 - m. rectus superior; 21 - v. ophthalmica superior.

In the depths of the orbit, on the border between the upper and outside its walls, next to the canalis opticus, there is a large superior orbital fissure, fissura orbitalis superior, connecting the cavity of the eye socket with a cavity of the

skull (middle cranial fossa). It held:

1. optic nerve, n. ophthalmicus;

2. oculomotor nerve, n. oculomotorius;

3. abducens, n. abducens;

4. nerve block, n. trochlearis;

5) upper and lower eye veins, w. ophthalmicae superior et inferior.

At the boundary between the outer and lower walls of the orbit is inferior orbital fissure, fissura orbitalis inferior, leading from the cavity of the orbit in Pterygopalatine and nizhnevisochnuyu hole. A superior orbital fissure are:

1) the infraorbital nerve, n. infraorbitaUs, together with the same name, governmental artery and vein;

2. skulovisochny nerve, n. zygomaticotemporal;

3. skulolitsevoy nerve, n. zygomaticofacialis;

4) venous anastomoses between the veins of the eye sockets and venous Plexus Pterygopalatine fossa.

The inner wall of the eye sockets are located front and rear mesh openings serving for passage of like nerves, arteries and veins of the eye sockets in the labyrinths of ethmoid bone and nasal cavity.

In the thicker lower wall sockets runs through the infraorbital fissure, sulcus infraorbitaUs, passing anterior to the eponymous canal opening on the front surface of the respective hole, foramen infraorbitale. This channel is used for passage of the infraorbital nerve with similar artery and vein.

Log in orbit, aditus orbitae, limited bone edges and closed orbital septum, septum orbitale, that divides the century and the actual orbit.

Eyelids, palpebrae

This is curved to form the anterior segment of the eyeball cutaneous cartilaginous plates that protect the eye.

Layer

The skin is thin, movable.

Subcutaneous tissue is loose, there were anastomoses of vessels eyeball to vessels

individual. As a consequence, it is easy as there is swelling in the local inflammatory processes (such as barley), and in general (angioneurotic Quincke's edema, kidney disease, etc.).

The thin subcutaneous muscle is a part of mimic muscles of the eye,

m. orbicularis oculi, and, like other facial muscles of the face, innervated by the facial nerve.

Underneath a layer consisting of cartilage century and is attached to it orbital wall, which is the other edge is fixed to the supra-and infraorbital margins.

The rear surface of the cartilage and orbital wall is lined with mucous membranes - conjunctivitis, conjunctiva palpebrarum, passing on the sclera of the eyeball,

conjunctiva bulbi. Places the transition from life on the conjunctiva sclera form

the upper and lower arches of the conjunctiva - fornix conjunctivae superior et

inferior. Lower set can be viewed by pulling the eyelid down. For inspection of the upper body of the conjunctiva should unscrew the upper eyelid.

The front edge of the century has eyelashes, which are located at the base of the sebaceous glands. Purulent inflammation of these glands is known as barley -

cholasion. Closer to the rear edge of Century visible holes peculiar sebaceous, or meybomievyh [Meibom] glands, embedded in the thickness of cartilage age (Figure 5.15).

   1 - cornea; 2 - sclera et tunica conjunctiva bulbi; 3 - plica semilunaris conjunctivae; 4 - papilla lacrimalis et punctum lacrimale; 5 - lacus lacrimalis; 6 - carun-cula lacrimalis; 7 - angulus oculi medialis; 8 - papilla lacrimalis et punctum lacrimale; 9 - limbus palpebralis posterior; 10 - limbus palpebralis anterior; 11 - glandu-lae tarsales (Meibomi); 12 - fornix conjunctivae inferior.

Open the lid margin at the lateral and medial angles of the palpebral fissure form the corners, fixed to the bones of orbit bundles.

Lacrimal gland, glandula iacrimalis

Lacrimal gland located in the lacrimal fossa in verhnelateralnoy part of orbit.

Medial part of century, devoid of eyelashes, limit tearful lake, lacus

Iacrimalis. Beginning at this point lacrimal ducts empty into the lacrimal

sac, saccus Iacrimalis. The contents of the lacrimal sac nasolacrimal assigned duct, ductus nasolac-rimalis, in the lower nasal passage.

Eyeball, bulbus oculi

Eyeball placed in the cavity of the orbit, taking it only partially. It is surrounded

by fascia, sheath of eyeball, vagina bulbi, or Tenon capsule [Tenon]. Tenon capsule dressing eyeball almost its entire length, except the part corresponding to the cornea (front) and the place you are, going from the eyes of the optic nerve (back), hangs like an eyeball in the orbit among adipose tissue, itself fixed fascial bands, reaching the walls of their sockets and its edge.The walls of the capsule

pierced the tendons of muscles of the eyeball. Tenon capsule is not fused tightly with the eyeball: between it and the surface of the eye is slit, spatium episclerale, which allows eyeball to move in this space.

Behind the Tenon capsule is postbulbar Front (Fig. 5.16).

Postbulbar department busy adipose tissue, ligaments, muscles, blood vessels, nerves.

Muscular system includes 6 sockets muscles of the eyeball (4 direct and 2 oblique muscles) and muscle lifts the upper eyelid (m. levator palpebrae

superior). Outside rectus muscle in-unnerving n. abducens, the upper trailing - n. trochlearis, others, including the muscles, my upper eyelid - n. oculomotorius.

Optic nerve, n. opticus (II vapor), is covered by continuing to him (up to the

sclera) firm, the arachnoid and pia. In the fatty tissue surrounding the optic nerve with its shells are ophthalmic arteries and the neurovascular bundle of muscles of the eyeball.

   10 inferior, 4 - tunica shgdshkpUa bulbi; 5 - fornix ranjmietive in-

u ferior, 6 - m. obliquus inferior, 7 - situs muscle fascia, 8, 15 - vagina bulbi

(Tenoni); 9 - n. opticus; 10 - corpus adiposum orbitae;

^ 11 - m. rectus superior, 12 - m. levator palpebrae superior, 13 - fasciae

musculares; 14 - bulbils oculi (sclera); 16 - spatium interfasciale (Tenoni). 

All tissues of the orbit, including eyeball, are powered from the main arterial trunk

- ophthalmic artery as well. ophthalmica. It is a branch of the internal carotid artery, which runs in the cavity of the skull via the optic canal, this vessel enters the orbit, giving branches to the muscles and the eyeball, and divided into terminal branches, out of its socket on the front surface (Figure 5.17).

Eye vein, w. ophthalmicae superior et inferior, going from the upper and lower walls of the orbit, the back wall of the lower falls at the top, which through the superior orbital fissure is in the cranial cavity, and flows into cavernous sinus.Ocular veins anastomose with the veins of face and nasal cavity, as well as

venous plexus Pterygopalatine fossa. In the veins of the eye sockets are no

valves. 

The nose, REGIO NASALIS

The upper boundary of the area corresponds to the horizontal line connecting the medial ends of the eyebrows (the root of the nose), bottom - line drawn through the attachment of the nasal septum and lateral boundaries are defined

nososchechnymi and nasolabial folds. The nose is divided into the external nose and nasal cavity.

 Fig. 5 .17. The cavity of the orbit from above (on Shpalteholtsu, as

amended). 1 - m. rectus medialis; 2 - v. ophthalmica superior; 3 - ramus frontalis

n. frontalis; 4 - n. su-praorbitalis; 5 - m. levator pal-pebrae superior; 6 - m. rectus

superior; 7 - n. opticus; 8 - gl. Iacrimalis; 9 - n. Iacrimalis; 10

bulbus oculi; 11 - m. rectus lateralis; 12 - n. nasociliaris; 13

n. abducens; 14 - n. troch-learis; 15 - a. ophthalmica; 16

v. ophthalmica superior; 17 - mm. levator palpebrae superioris et rectus superior (unfolded), 18

a. ophthalmica; 19 - ganglion semilunare (Gasseri); 20 -

n. trochlearis;. 21 - n. oculomoto-rius; 22 - n. abducens; 1923 - a carotis

interna; 24 - n. opticus; 25 - chiasma opticum.

External nose, nasus externus, formed at the top of the nasal bones, at the side -

the frontal processes of the upper jaw and cartilage. The upper narrow end of the back of the nose from the forehead called the root, radix nasi; above it there are

several in-depth market intersuperciliary - intercilium, glabella. The side of the nose downward convex, delimited expressly nasolabial furrow, sulcus

nasolabialis, mobile and make the wings of the nose, alae nasi. Between the lower free edges of the wings of the nose is formed movable part septum, pars mobilis septi nasi.

The skin at the root of the nose is thin and mobile. At the tip of the nose and the wings of the skin is thick, rich with large sebaceous glands and firmly adherent to

the cartilage of the external nose. In nostrils, she goes to the inner surface of the

cartilage, forming the vestibule of the nasal cavity. The skin is a sebaceous gland

and the thick hairs (vibrissae); they can reach a considerable length. Next, the skin goes into the nasal mucosa.

Blood supply of the external nose by a. dorsalis nasi (terminal branch a.

ophthalmica) and branches of the facial artery. Vein, linked to the facial veins and the origins of the ophthalmic veins.

Sensitive innervation by I branch of the trigeminal nerve.

Nasal cavity, cavum nasi, is the initial respiratory tract and contains the organ of

smell. In front it is apertura piriformis nasi, the rear pair of holes, hoany, report it

to the nasopharynx. Through the bone of the nasal septum, septum nasi osseum,

the nasal cavity is divided into two not quite symmetrical halves. Each half of the nasal cavity has five walls: top, bottom, back, medial and lateral.

The upper wall forms a small part of the frontal bone, lamina cribrosa of ethmoid bone and part of sphenoid bone.

The structure of the lower wall or bottom, consists of palatine process of maxilla and horizontal plate of palatine bone that make up the hard palate, palatum

osseum. The bottom of the nasal cavity is the "roof of oral cavity.

Medial wall of nasal septum.

The back wall is only a short distance in the upper section, as below are hoany. It is formed by nasal surface of body of sphenoid bone with what you have on it a pair hole - apertura sinus sphenoidalis.

In the formation of the lateral wall of the nasal cavity are involved lacrimal bone, os lacrimale, and the lamina orbitalis ethmoid bone separating the nasal cavity of the eye sockets, nasal surface of the frontal process of the maxilla and the thin bone plate, A decline in the nasal cavity from the maxillary sinus, sinus maxillaris.

On the lateral wall of the nasal cavity hanging inside the three nasal shells, which are separated by three of the nose: upper, middle and bottom (Figure 5.18).

The upper nasal passage, meatus nasi superior, located between the upper and middle shells ethmoid bone, and he half as long as the average speed and is only in the posterior part of the nasal cavity, with reported sinus sphenoidalis, foramen sphenopalatinum and opened the rear cells of ethmoid bone.

Middle nasal meatus, meatus nasi medius, is between the middle and lower

shells. In his opening cellulae ethmoidales anteriores et mediae and sinus maxillaris.

 

Fig. 5.18. Nasal passages (to Shpalteholtsu, as amended). 1 - sinus frontalis; 2 - spina frontalis; 3 - os nasale; 4 - concha nasalis media; 5 - atrium meatus medii; 6 - vestibulum nasi; 7 - labium superius; 8 - palatum durum; 9 - concha nasalis inferior; 10 - meatus nasi inferior; 11 - meatus nasi medius; 12 - palatus molle; 13 - ostium pharyngeum tubae auditivae; 14 - fornix pharyngis; 15 - meatus nasopharyngeus; 16 - sinus sphenoidalis; 17 - recessus sphenoethmoidalis; 18 - apertura sinus sphenoidalis; 19 - concha nasalis superior; 20 - meatus nasi superior; 21 - crista galli.

The lower nasal passage, meatus nasi inferior, passes between the bottom of the

sink and the bottom of the nasal cavity. In its anterior open nasolacrimal canal.

The space between the turbinate and nasal septum is designated as the common nasal passage.

On the side wall of the nasopharynx is opening of auditory tube connecting the

pharyngeal cavity with the cavity of the middle ear (tympanic cavity). It is located at the rear end of the lower shell at a distance of about 1 cm posterior to it.

The vessels of the nasal cavity form anastomotic network arising from multiple

systems. Arteries are branches of the a. ophthalmica (aa ethmoidales anterior and

posterior), a. maxillaris (A.

sphenopalatina) and a. facialis (rr. septi nasi). Vein, form a network that are

located more superficially. Particularly dense venous plexus, having a form cavernous formations are concentrated in a mucosal tissue of lower and middle

nasal turbinate. From these plexuses are most nosebleeds. Vein nasal anastomose with veins nasopharynx, orbit and meninges.

Sensitive innervation of the nasal mucosa by I and II of the branches of the

trigeminal nerve, ie, ocular and maxillary nerve. Specific innervation by olfactory nerve.

Paranasa sinus, sinus paranasales

On each side of the nasal cavity adjacent maxillary and frontal sinuses, ethmoidal labyrinth and sphenoid sinus in part.

Maxillary or maxillary [High more], sinus, sinus maxillaris, located in the thickness of the maxillary bone (Fig. 5.19).

This is the largest of all the paranasal sinuses, and its capacity in the adult - an

average of 10-12 cm 3. The form of sinus recalls four-sided pyramid whose base is on the side of the nasal cavity, and the tip - from the zygomatic process of maxilla. Obverse side facing anteriorly, the upper, or orbital, the wall separates the sinus from the orbit, back turned toward the infratemporal and Pterygopalatine palatal pits. bottom wall of maxillary sinus forms the alveolar process of maxilla, separating the bosom of the oral cavity.

Internal, or nasal, sinus wall with a clinical standpoint, the most important, it

meets most of the lower and middle nasal passages. This wall, except for its lower

part, fairly thin, and gradually becomes thinner from bottom to top. The hole through which the sinus communicates with the nasal cavity, hiatus maxillaris, is high just under the bottom of the orbit, which contributes to stagnation in the secretion of inflammatory sinus. To the front of the inner wall of the sinus maxillaris adjoins nasolacrimal duct and to caudineural parts - mesh cells.

The upper, or orbital, the wall of the maxillary sinus the most subtle, especially in

the posterior part. When inflammation verhnechelyust 

tion sinuses (sinusitis), the process may spread to the region of orbit. In the thick wall of the ophthalmic passes canal infraorbital nerve, sometimes nerve and blood vessels directly to the mucous membrane prilezhat sinus.

The front, or front, wall section of the upper jaw is formed between the

infraorbital margin and the alveolar processes. This is the most fat of all the walls of the maxillary sinus, it is covered with soft tissues of the cheeks, accessible

feeling. Flat depression in the center of the front surface of the front wall, called

"Klykova fovea, corresponds to the most delicate part of the wall. At the top of the "Klykova pits" located hole for exit infraorbital nerve, foramen

infraorbital. Through the wall pass rr. alveolares superiores anteriores et medius

(Branches of the n. infraorbitalis II branch of the trigeminal nerve), forming a

plexus dentalis superior, as well as aa. alveolares superiores anteriores from the infraorbital artery (from the a. maxillaris).

The bottom wall or bottom of the maxillary sinuses, located near the rear of the alveolar process of maxilla and usually corresponds lune four rear of the upper teeth. This makes it possible if necessary to open the maxillary sinus through the

respective tooth socket. With an average sinus its bottom is at about the bottom of the nasal cavity, but are often located and below.

Frontal sinus, sinus frontalis, is located between the plates and scales of the orbital

frontal bone. Its dimensions vary considerably. It distinguished the lower, or the ophthalmic, anterior, or front, rear, or brain, and the median wall.When inflammation of the frontal sinuses (sinusitis), through its wall istonchennye process may spread to the orbit, as well as in the anterior cranial fossa.

Frontal sinus communicates with the nasal cavity through the aperture of the frontal sinus, apertura sinus frontalis, which opens in front of the middle nasal passage.

Sphenoid sinus, sinus sphenoidalis, located in the body of sphenoid bone directly

behind the ethmoid labyrinth of choanal vault and nasopharynx. Sagittal sinus

wall is located is divided into two mostly unequal parts by volume. On the front, the most subtle, the wall in each half of the sinus is a hole, apertura sinus

sphenoidalis. The shape and size of sphenoid sinus is highly variable. Its upper wall facing the anterior and middle cranial pits (Fig. 5.20).

Middle Division of the upper wall of sinus consistent with sellar located in his pituitary fossa, and anterior to them - optic chiasma.

Outside, on the side of the sphenoid sinuses are the internal carotid artery and the

cavernous venous sinus. In addition, the sides of the sinus are the oculomotor, abducens and block, perforating the outside wall of the pesheristogo sinus, as well as I branch of the trigeminal nerve.

The bottom wall of sphenoid sinus forms a set of nasal cavities.

Ethmoid labyrinth, labyrinthus ethmoidalis, consists of 2-5 or more different in

size and form of lattice cells, cellulae 

ethmoidales, which are separated from the anterior cranial fossa, the orbital part of frontal bone and ethmoid bone, and from orbit - orbital plate, lamina

orbitalis. Behind cells ethmoid labyrinth is sometimes reaches the front wall of

sphenoid sinus. Wedge-shaped plate ethmoid labyrinth, the free end of which the nasal cavity is the backbone of the middle shell, divides the pneumatic cells in the front and rear, front-cells open into the middle nasal passage, and the rear - to the top.

Through istonchennye wall ethmoid labyrinth inflammation may spread into the cranial cavity, orbit and optic nerve, the channel is under strong development of the cells ethmoid labyrinth is in close proximity with him.

The mucous membrane of the paranasal sinuses on the structure differs little from the nasal mucosa, but it is much thinner and relatively poorer vessels and glands than the mucosa nasal cavity.

Blood supply of paranasal sinuses are the branches of the internal and external

carotid arteries, mainly through the eye and the maxillary artery. Vein sinus anastomose with the veins and pterygoid plexus person, and the veins of the frontal sinus - with the veins of the dura mater, with the longitudinal sinus and

cavernous sinus. In these ways, sometimes penetrates infection in orbit or cranial cavity.

Innervation of the paranasal sinuses is carried out from I and II of the branches of

the trigeminal nerve, as well as from Pterygopalatine site. 

The mouth, REGIO ORALIS

The mouth is situated between the area at the top of his nose and chin area at the bottom. The upper boundary of the region runs along the horizontal line drawn through the base of the nasal septum, lower - by the chin-labial sulcus region is

bounded on the sides nasolabial furrows. By the mouth include the lips and mouth.

His lips form a front wall of the oral cavity, their free edges are fringed oral cleft, rima oris, and form the corners of his mouth.

Leather Lip contains sebaceous and sweat glands, men have hair, for women -

fluff. On the red fringe leather goes into the inner surfaces of the mucosa lips.

Subcutaneous tissue is practically not visible, so as to attach skin facial

muscles. The most pronounced circular muscle of mouth, m. orbicularis oris, but her in this area are the muscles to lift and lower corner of his mouth and all her lip as a whole. The muscles of the mouth, like all the facial muscles innervated by branches of the facial nerve, suitable to the back (deep) muscle surface:

rr. buccales and G. marginalis mandibu-laris. Mimic muscles covered surface fascia.

Sensitive innervation is provided by nerve branches of the trigeminal nerve system.

Loose submucosa fiber is followed by a muscular layer. There are vessels: the upper and lower labial artery from the facial artery with their accompanying veins.

The mucous membrane in the middle forms the upper and lower bridles. In the lateral part of it goes into the mucous membrane of the cheeks, the top and bottom - on the gums, forming the upper and lower arches.

Lymphatic vessels in the lips divert lymph podnizhnechelyus-tnye and, in addition, buccal, parotid, superficial and deep cervical lymph nodes. Vessels from

the middle part of the lower lip to chin are lymph nodes. Lymphatic vessels of both sides lips widely anastomose with each other, so the disease process can cause a reaction of lymph nodes on the other hand.

Oral cavity, cavitas oris, topographically divided into two sections - the front, or a prelude to his mouth, vestibulum oris,, and rear, or oral cavity proper, cavitas oris propria, widely communicating with each other with open mouth (Fig. 5.21).

When closed jaws threshold is reported with the oral cavity through the interdental space and openings at the ends of alveolar

 

Figure 5 .21. Oral cavity, sagittal slice.

1 - palatum durum; 2 - dentes; 3 - labium superior, 4 - rima oris; 5 - labium

inferior, 6 - vestibulum oris; 7 - mandibula; 8 - m. mylohyoideus; 9 -

m. geniohyoideus; 10 - gl. sublingualis; 11 - m. genioglossus; 12 - os hyoideum; 13 - isthmus faucium; 14 - lingua; 15 - palatum molle; 16 - cavum oris pro-prium.

processes behind the last molars of both jaws. Grounds for branches of the lower jaw covered pterygo-jaw fold.

Vulval mouth in the form of a narrow horseshoe that mimic the shape of alveolar arches gap extends from front to back.

Boundaries (walls) are in the front vestibule of mouth, the sides from the outside - the cheeks, inside - labio-buccal surface of teeth and alveolar processes of jaws (Figure 5.22).

 In advance of the oral cavity open ducts of parotid glands. Duct openings are located on the right and left side of the mucous membrane of the cheek in the form of papilliform elevation at the crown of the first or second molars of the

upper jaw. Under the mucosa in the center of the front surface of the lower jaw is

chin hole, from which come a., v. P. et mentales.

Oral cavity proper (see Fig. 5.21, 5.22) with a closed mouth appears as a narrow horizontal slit, formed by a set of hard palate and the tongue of the side edge of language in this densely touch to the jaw and lingual surfaces of teeth.Anterolateral wall of the oral cavity before the alveolar process with teeth and a body part and the inner surface of the branches of the mandible and medial pterygoid muscles. Behind the mouth called the pharynx isthmus, isthmus

faucium, in the middle part pharynx, pars oralis pharyngis. At the top of this department is connected via the nasal part of pharynx and opening choanae, choanae, with the nasal cavity at the bottom - a glottal part of pharynx, pars laryngea pharyngis, with the cavity of the larynx and esophagus (Figure 5.23).

The upper wall of the oral cavity is formed by the hard palate. At the front end of the longitudinal palatal suture, almost directly from the necks of the central incisors, located incisive canal, foramen incisivum, leading to the eponymous

canal. Through it passes n. nasopalatine II branch of the trigeminal nerve.

In the posterolateral corners of the sky symmetrically arranged large and small palatine foramen, foramina palatina majores et minores, Pterygopalatine channel,

canalis palatinus major. Combining Pterygopalatine hole with oral

Pterygopalatine channel is used for passing the palatine nerves, nn. palatini

anterior, medialis and posterior, and descending palatine artery, a. palatina descendens.

The back wall of oral cavity of soft air, palatum molle. It consists of a

symmetrical muscles of the soft palate and muscles of the tongue. With the reduction of the soft palate muscles between its edge, front temples and back of the tongue a hole throat.

Posterior margin of the soft palate goes into the side wall of the pharynx in the form of two folds, anterior and posterior palatine arches. In the front is

palatoglossus, m. palatoglossus, in the back - velopharyngeal,

m. palatopharyngeus.

Between the temples formed tonsillar fossa, fossa tonsillaris, which placed tonsils,

tonsilla palatinae. It is separated from the pharyngeal wall of loose fiber. Tonsils has its own capsule, capsula tonsillae, and covered with mucous

membrane. Blood supply is provided by the ascending pharyngeal 

and facial arteries (branches of the external carotid artery) and descending palatine

artery (from a. maxillaris). Nerves of the palatine tonsils are branches glossopharyngeal (IX couple), vagus (X pair), lingual nerve (a branch of the

trigeminal nerve III), as well as Pterygopalatine site. These are suitable to the amygdala from the outside.

Tonsils with pharyngeal (posterior wall of the nasopharynx), lingual (behind the root language) and two tube tonsils (pharyngeal openings auditory (Eustachian) tubes) form pharyngeal lymphoid ring, anulus lymphoideus phar-yngis, first documented by NI Pirogov, and then Valdeyerom [WaldeyerJ.

Pathologically enlarged pharyngeal tonsil is called adenoids (Fig. 5.24). Adenoids difficult nasal breathing, so quite often they should be removed surgically.

Innervation of the mucous membrane of hard and soft palate by 11 branch of the trigeminal nerve through a ganglion pterygopalatinum, which runs palatine

nerves, nn. palatini. The muscles of the soft palate innervated by the way: muscle,

strained soft palate, m. tensor veli palatini, equipped with a W branch of the trigeminal nerve, and the remaining muscles are innervated by branches of the pharyngeal plexus.

The bottom wall or bottom, oral cavity, the share of the soft tissues located

between the tongue and skin nadpod-speaking part of the front of the neck. The

basis of the bottom of the oral cavity is a jaw-hyoid muscle, m. mylohyoideus,

located in over her muscles (rm. genioglossus, geniohyoideus, hyoglossus, styloglossus).

By the bottom of the oral cavity is fixed root of the tongue, lingua. Language - the muscular organ, which on the sides align muscles running from the chin, the

sublingual gland and spine-antrum. At m. mylohyoideus, in the interval between

 Figure 5 .24. Increased pharyngeal tonsil 

- Adenoids.

lower jaw and mm. geniohyoideus and genioglossus, is steam sublingual salivary gland, or iron Rivinusa [Rivinus] (Fig. 5.25).

At the bottom of the oral mucosa, passing on the lower surface of the tip of the

tongue, forming the center line of the bridle, frenulum linguae. On either side of it, in the middle of the body of mandible, located papillae, carunculae sublinguals, which opens the duct submandibular salivary gland duct large hyoid. Along the bottom of the tongue, under the mucous membrane, in the place where she goes from your gums to the lateral surface of tongue extends the neurovascular bundle (v. lingualis, P. lingualis, a. profunda linguae, and behind - n. hypoglossus).

The arterial supply of the language is mainly lingual artery, a. lingualis - branch outside of the carotid artery.

Figure 5.25. Mpptsy bottom of the oral cavity, blood vessels and nerves of the

language; top view and front. Removed mucosa and sublingual gland on the left,

in addition, removed genioglossal mptscha and lingual nerve. 1, 5 -

m.genioglossus; 2 - n. lingualis; 3 - gl. sublingualis; 4 - ductus subniandibuJaris; 6

- so mylohyoideus; 7 - a. sublingualis; 8 - v. lingualis; 9 - n. hypoglossus; 10 -

m. hyoglossus; 11 - a. lingualis; 12 - m. longitudinalis inferior.

Vein oral artery was escorted with the same name, and form anastomoses with the venous plexus: wing-and pharyngeal.

The motor innervation of the tongue by subsection hypoglossus (XII couple).

Innervation of the mucous membrane of the tongue by

lingual and glossopharyngeal (GC pair) nerves. Sensitive fibers (except taste) to anterior two-thirds of the language are composed of subsection lingualis (III branch of the trigeminal nerve), and gustatory volokna go to compose a string, chorda tympani, which is at the exit from the tympanic cavity is connected to the lingual nerve. To the rear third of the tongue taste fibers pass in the forth hypoglossus, remaining sensitive fibers - in the same nerve and the internal branch of superior laryngeal.

Lymph from the tip of the tongue and on the front of the floor of the mouth flowing into podpodborodochnye nodes, and then - in podnizhnechelyus-tnye and deep cervical lymph nodes. From the side of the body language of lymph flowing directly into podnizhne-jaw, and from the pharyngeal surface of the root of the tongue and lingual tonsils - in the upper deep cervical lymph nodes.

Teeth

The teeth are arranged in the form of two arcs that are one above the other, arcus

dentalis superior et inferior, and free pro crowns in the mouth. With a maximum lifting the lower jaw arch merge the two crowns. Teeth are separated from the actual threshold of mouth cavity.

In the tooth, dens, distinguished crown, corona dentis, cervix, cervix dentis, and

root, radix dentis. Dentin, which is their foundation in the area is covered with

enamel crowns, and root - cement. Inside each tooth is, cavitas dentis, continuing in the root (or roots) in a canal, canalis radicis dentis. Latest on the tips of the

roots of a tooth ends hole, foramen apicis dentis. Polosg tooth filled pulp, pulpa dentis, in which a hole through the apical root penetrate from the jaws of blood vessels and nerves.

Connecting tooth root with a wall lune is the type vkolachivaniya (gomphosis). Ligament restraint in lune tooth root, is called periodontal, periodontium.

The front teeth are called incisors, dentes incisivi. On each side of the incisors, in the largest segment of bending the dental arch, are the teeth with sharp conical crowns - teeth, denies canini. Posteriorly from them are dvuhbugorkovye small

molars or premolars, dentes premolares. Most rear, mnogobugorkovye teeth, called large molars - molars, dentes molares.

The blood supply to the teeth occurs mainly at the expense of

a. maxillaris. From her depart upper alveolar artery, aa. alveolares superiores, and

inferior alveolar artery, a. alveolaris inferior. The upper jaw molars receive blood from the back of the upper alveolar artery and the front - from the front upper

alveolar arteries, the waste from one of the terminal branches as well. maxillaris -

infraorbital artery, a. infraorbitalis, which takes place in the same channel.

A. alveolaris inferior, passing in the mandibular canal, gives branches to the teeth of the mandible.

From alveolar arteries depart aa. Dentales, penetrating into the pulp through the apical hole.

Venous outflow occurs in the veins accompanying the artery pterygoid plexus,

plexus pterygoideus. Vein's upper jaw teeth are also associated with eye veins and

through them - with the venous sinuses of skull. A facial and zanizhnechelyustnye vein blood from the teeth enters the system jugular veins.

Lymph drainage is carried out in the submandibular lymph nodes and

chin. Hence the lymph flow goes to the superficial and deep cervical nodes.

The upper teeth are innervated by n. maxillaris, 11 branches of the trigeminal nerve, which gives the upper alveolar nerve accompanying artery of the same

name. Rear upper front, middle and rear alveolar nerves, connecting with each other arcades form a superior dental plexus, plexus dentalis superior. This wreath can be partially and directly under the mucous membrane of the maxillary sinus (Figure 5.26).

The lower teeth innervates III branch of the trigeminal nerve, n.

mandibularis. From it departs n. alveolaris inferior, which passed in the mandibular canal, usually split up on the trunk forming a lower dental plexus,

plexus dentalis inferior. From the latter through the apical hole of the root come into pulp dental branches, rami dentales (Figure 5.27).

Autonomic innervation of the teeth is carried out from the head of the sympathetic and parasympathetic nervous system.

Chin AREA, REGIO MENTALIS

Unpaired region located between the mouth and chin projection.

External benchmarks. Chin protrusion, genial tubercles, lower lip, chin-lip groove.

Boundaries. Top - chin-lip sulcus, below - the base (lower edge) mandible, on each side - the vertical line running down from the corners of his mouth.

Projections. The intersection of the vertical line running down from a point on the boundary of the inner and middle third of the orbit, with the middle distance between the alveolar and the lower edge of the lower jaw projecting chin opening

through which goes the chin of the neurovascular bundle. This point is located at 1 cm above and lateral chin protuberance.

Layer

Skin rather thick, covered with hair in men.

Subcutaneous tissue is weak. In the subcutaneous tissue located facial muscles: mentomeckelian drop down corner of his mouth and lowered his lower

lip. They are covered with superficial fascia. Like other facial muscles, they innervate-Xia facial nerve, its marginal branch, city marginalis mandibularis.

Own fascia in this area no.

Chin neurovascular bundle comes from the same hole of the lower jaw and is

located on the periosteum. N. mentalis - terminal branch n. alveolaris inferior (from the branches of the trigeminal nerve III) innervates the skin and mucous

membrane of lower lip. A. mentalis - a branch of a. alveolaris inferior, departing

from a. maxillaris. Vein is the source of the same name v. alveolaris inferior,

going into a deep area of the face. 

Infraorbital area, REGIO INFRAORBITALS

External benchmarks. Infraorbital margin of orbit - acute in the outer part and

smoothed the transition to the back of the nose. Lower down from this region in thin people visible to the eye Klykova fossa, fossa canina, passing downward into the alveolar process of maxilla, the lateral edge of the external nose, cheekbone.

Boundaries. Upper - lower edge of the orbit, the bottom - the horizontal line drawn through the skin of the nasal septum, medial - the outer edge of the nose, lateral - vertical line drawn from the inferior lateral angle of the orbit to its intersection with the lower limit.

Projections. The vertical line drawn through the point on the border between the inner and middle third of the supraorbital region, projected onto the origins of the

sensory branches I, II and III branches of the trigeminal nerve. In the infraorbital area is infraorbital nerve, n. infraorbitalis (from n. maxillaris, II branch of the n. trigeminus), on 0,5-0,8 cm below the infraorbital region (see Fig. 5.13).

Layer

The skin has many sebaceous glands and sweat glands, slender.

Subcutaneous fat is loose. There are facial muscles and the neurovascular education. Facial muscles, starting with facial bones, in the infraorbital area are

located in several layers. Surface is the lower part of the circular muscles of the

eye, m. orbicularis oculi, under it - small and large

zygomatic muscle, Vols. zygomatici minor et major, covering, in turn, muscles, my

upper lip, so levator labii superioris. The muscles are separated by layers of

subcutaneous fat and surrounded by a superficial fascia. Own fascia in this area

no. Underneath infraorbital area, in the bottom of fossa canina, goes from the infraorbital foramen and divides into branches of the infraorbital neurovascular bundle.

Infraorbital artery, a. infraorbitalis, - branch of a. maxillaris, penetrates through the superior orbital fissure into the cavity of the orbit, then the infraorbital canal is

sent to the fossa canina. Vein of the same name flows into the lower eye or wing vein venous plexus. Infraorbital vessels anastomose with branches Facial. Infraorbital nerve, n. infraorbitalis, is the ultimate branch n.

maxillaris. Upon emerging from the same canal infraorbital nerve innervates the skin area, skin and mucous membranes of the upper lip.

Facial artery and Vein are in the subcutaneous tissue along the diagonal from the lower lateral angle of the upper medial (medial angle of orbit).

A. facialis (from the system of the external carotid artery), giving branches to his nose, anastomose with the infraorbital (from an internal carotid artery). At the

medial angle of the eye she called a. angularis, passing between the layers of

facial muscles and anastomose with the ophthalmic artery, a. ophthalmica.

V. facialis forms such as anastomosis, the most important of which are anastomoses with the upper and lower eye veins carrying blood in the cavernous

sinus dura of the brain. Under normal conditions, the outflow of venous blood

from the person going down, toward the internal jugular vein. In suppurative processes in the upper lip, the nasolabial folds, on the wings of his nose facial

Vein or its tributaries can be thrombosed or compressed edematous fluid. In such cases, the flow of blood has a different direction (retrograde) - upward, and septic

embolus can reach the cavernous sinus, which leads to the development of phlebitis sinus sinustromboza, meningitis, or Pius.

The motor nerves of facial muscles - he was. zygomatices et buccales - branches of the n. facialis - go in the direction of the outer corner of the eye and midway

between the wing of the nose and corner of his mouth. They are in a deep layer of subcutaneous fat and facial muscles are part of their deep surfaces.

The next layer is the periosteum anterior surface of the upper jaw. 

Cheek AREA, REGIO BUCCALIS

External benchmarks. Zygomatic bone and zygomatic arch, the lower edge of the

lower jaw, nasolabial furrow, cutting edge m. masseter.

Boundaries. Upper - zygomatic arch, the lower - the lower edge of the lower jaw, front - a vertical line drawn from the outer corner of the eye, rear - the front edge palpable chewing muscles.

Projections. Facial artery and Vein are projected from the place of crossing the front edge of the chewing muscle with the lower edge of the lower jaw in the

diagonal direction to the inner corner of eye. On this line at about the level of the wing of the nose is determined by one of the major anastomotic veins with wing-facial venous plexus.

Layer

The skin is thin, contains a large amount of sweat and sebaceous glands, strongly adherent to the well-developed layer of subcutaneous fat.

In the loose subcutaneous tissue are the facial artery and Vein. A. facialis lowback appears in the corner of the field, the front edge of the chewing muscles on the bottom edge of the mandible. At this stage it can easily palpate the pulsation or pressed against the bone to stop the bleeding (Figure 5.28).

 Skirting the edge of the jaw artery enters the buccal region of the

submandibular triangle neck. Then its projection, respectively, it goes in a diagonal direction to the infraorbital area. Facial artery severely kinked, forming bends inwards in the field of deviation from it the lower and the upper labial

artery, aa. Labiates inferior et superior. Branches a. facialis anastomose with the

transverse artery of face, a. transversa faciei (from the superficial temporal), and

with a. buccalis (from maxillary) artery.

Facial Vein comes in the buccal region of the infraorbital area on the same diagonal line as the facial artery, located posterior to it (Fig. 5.29).

At the level of the wing of the nose, above or below it, it anastomosed with the deep venous plexus wing-face, which, in turn, is associated with cavernous sinus dura mater (Figure 5.30).

The branches of the n. facialis are in a deep layer of subcutaneous tissue.

 Practically important education, are also located in the subcutaneous tissue is sucking pad Bichat [Bichat],

 

Figure 5.30. Vein face and sinuses of the dura mater. 1 - sinus sagjttalis superior;

2 - sinus sagittalis inferior; 3 - v. cerebri magna (Ga-leni); 4 - sinus transversus; 5

- sinus rectus; 6 - sinus petrosus superior et inferior; 7 - v. jugularis interna; 8 -

v. retromandibularis; 9 - m. sternocleidomastoideus; 10 - plexus venosus

pterygoideus; 11 - v. facialis; 1912 - a ophtiialmica inferior; 1913 - a ophtlialmica superior; 14 - sinus intercavernosus; 15 - sinus cavernosus; 16 - sinus

sphenoparietalis; 17 - v. emissaria parietalis. 

corpus adiposum buccae. It is located at the rear boundary of the region adjoining

the front edge of the chewing muscles. Sucking pad enclosed in a fairly dense fastsialnuto capsule, which separates it from the subcutaneous tissue, as well as

from the buccal muscles located deeper. Part of the fat body located in the

neighboring, parotid-masticatory areas between the deep surface of the

m. masseter, and so buccinator. From this part of the fat body depart processes: temporal, ophthalmic and wings offensively palatine, penetrating into the appropriate field.

Temporal process rises under the zygoma along the outer wall of the orbit, located in mastication-jaw space, and reaches the front edge of the temporalis

muscle. Here it is associated with podfastsialnym temporal space and the deep temporal space (between the bone and the deep surface of the temporal muscles).

Orbital process of the body fat cheeks, located in the infratemporal fossa, adjoins to the inferior orbital fissure.

Pterygopalatine process penetrates further into the outer base of the skull between

the rear edges of the upper and lower jaw and the base of pterygoid. Often Pterygopalatine process the fat body cheeks reaches nizhnemedialnoy of superior orbital fissure, and through it penetrates into the cavity of the skull, which adjoins the wall mezhpescheristogo sinus dura mater.

In this regard, pyo-inflammatory diseases of the face may spread to the cranial cavity, even if the venous anastomosis is not involved in the process. Often the source of infection, spreading along the body processes fatty cheeks were suppurative inflammatory diseases of the upper and lower jaws.

The next layer - dense gingivo-pharyngeal (own) buccal muscle fascia.

Buccinator, m. buccinator, starting from the upper and lower jaws, and weaves in

front of the muscles surrounding the mouth slit. On the outer surface of the buccal muscles are n. buccalis (from section mandibularis), buccal and blood vessels are small facial lymph nodes.

The inner (deep) surface of the buccal muscle covers the mucous membrane of the mouth.

At the level of first upper molars buccinator pierced excretory duct parotid salivary gland.

Parotid BUBBLE AREA, REGIO PAROTIDEOMASSETERICA

Field is located between the front edge of the chewing muscles and ear canal. In

her distinguished superficial division, busy branch of mandible with m. masseter and parotid gland. inwards from the branches of the lower jaw is deep division (deep facial area), which lie pterygoid muscle, blood vessels and nerves.

Surface Front parotid-masticatory area, pars superficialis regio parotideomasseterica

In the surface layers of the external reference is the angle and the lower edge of the mandible, zygomatic arch, external auditory canal and palpable front edge of chewing muscles.

Boundaries. Erhnyaya - zygomatic arch, the lower - the lower edge of the lower jaw, front - the front edge of the chewing muscles, the back - a line drawn from the external auditory meatus to the tip of the mastoid process.

Projections. Motional branch of the facial nerve innervating the mimic muscles, projected along lines diverging fan from a point downwards and anterior to the tragus (Figure 5.31).

Remember the direction of the branches of the facial nerve better as

follows. Brush with diluted fingers should be attached to the side of the face so that I crossed the finger straight up the middle of the zygomatic arch, II finger went to the outer corner of the eye, III - on the upper lip, IV - the edge of the

mandible, and V finger was directed vertically downward neck. In such a situation

brush rr. temporales match I finger; vols. zygomatici - And, rr. buccales - III, PM marginalis mandibularis - IV and the city of colli - V finger.

Excretory duct of parotid gland or duct stenonov [Stenon (Stensen)], projected on a line running parallel to the zygomatic arch and below it on 1,5-2,5 cm in the direction of the outward-

 

Fig. 5.31. The projections of the branches of the facial nerve

1 - rr. temporales; 2 - rr. zygomatici; 3 - rr. buccales; 4 - PM marginalis mandibularis; 5 - PM colli.

tion meatus to the middle distance between the wing of the nose and corner of his

mouth. Anterior to the tragus palpable, particularly when movements in the joints, articular process of the mandible and temporomandibular joint.Further anteriorly, downward from the middle of zygomatic arches, projecting coronoid process of mandible.

Layer

The skin is thin, men covered with hair.

Subcutaneous tissue permeated by connective cords that connect the skin with its own fascia.

Superficial fascia is expressed only in the anteroinferior part of the region where a lower jaw spreads and is attached to the skin, platysma.

On the outer surface of the chewing muscles, covered by fascia parotideomasseterica, a transverse direction in accordance with the above

projections are ductus parotideus, a. et v. and transversa faciei buccal branches of the facial nerve, which at first lie in the splitting of fascia parotideomasseterica, and then in the subcutaneous tissue.

Own fascia area, fascia parotideomasseterica, fairly dense, forms a pouch of

chewing muscles, rolling in the anterior fascial capsule body fat cheeks. Behind the fascia itself splits apart, forming a capsule of parotid salivary gland.

Masseter, m. masseter, starts from the zygomatic process of maxilla and zygomatic arch, attached to the corresponding tuberosity of the mandible.

Between m. masseter and the lateral branch of the surface of the coronoid process of the mandible, which is attached to the tendon of the temporalis muscle, is mastication-jaw space filled with loose fiber. It continues under the zygomatic arch up to the outer surface of the temporalis muscle to the point of its fixation to the inner surface of the temporal fascia (the aponeurosis) that is, until

podfastsialnogo (subgaleal th) space of the temporal region. For this gap burrowing pus penetrate from one region to another.

On the deep surface of the branches of the mandible, in its center, is opening the lower jaw, foramen mandibulae, through which the channel enters the lower jaw inferior alveolar neurovascular bundle.

The parotid gland, glandula parotidea, fills in zadinizhnechelyustnuyu hole bounded by the front edge of the posterior branch of the lower jaw from above - the outer ear canal, behind - the mastoid process and the beginning of a sternocleidomastoid muscle, at the bottom - strong fascial spur connecting the case sternocleidomastoid muscle with the angle of mandible and divides the bed of parotid and submandibular glands, from the inside - the side wall of the pharynx.

The surface of the parotid salivary gland located on the outer side of the chewing muscles. She often continues to run ductless gland to anterior edge of the chewing muscles.

The deep part (pharyngeal process) reaches medially to the fatty tissue located at the lateral wall of the pharynx in the anterior lateral peripharyngeal space. Nizhni process parotid gland down to the inner surface of the angle of the mandible.

Fascial capsule of the parotid gland developed differently: on the outer surface of

the gland, at its front, bottom and rear sides of it thickened. Fascial capsule gland has two "weak points": one on the top surface of iron adjacent to the external auditory canal; second - on the inner side of pars profunda parotid gland, facing the front peripharyngeal space between subulate process and the internal pterygoid.

When purulent inflammation of the parotid salivary glands (mumps) pus in 4 times more often crop up in this space, the wall of the pharynx than in the external auditory canal.

In the depth of the parotid salivary glands are important neurovascular education.

Facial nerve, n. facialis. After leaving the foramen stylomastoideum, it permeates through the capsule in the box gland, where divided into upper and the lower

branch. From the upper branches diverging rr. temporales, zygomatici et

buccalles, from the bottom - PM marginalis mandibularis and the city colli. Upon leaving the cancer branch of the facial nerve pierced fascia parotideo-masseterica and sent to the facial muscles in the subcutaneous tissue.

External carotid artery, a. carotis externa, is obliquely upwards behind the branches of the mandible. In cervical articular process mandible is divided into

a. temporalis superficialis and the a. maxillaris.

From the start of a. temporalis superficialis artery departs transverse face,

a. transversa faciei, accompanying the excretory duct cancer and anastomosing in

the buccal area of the facial artery. A. maxillaris sent to the deep parts of the area.

Ushno-temporal nerve, n. auriculotemporalis, departs from subsection tap-dibularis immediately upon its exit from the foramen ovale and enters the parotid

gland. Along with a. temporalis superficialis, located medially of it, n. auriculotemporalis goes through the back surface of the capsule gland and rises

vertically in front of the ear canal, in the temporal region. In iron

n. auriculotemporalis gives branches to the gland tissue, the outer ear canal, eardrum and connecting branches to the facial nerve.

Zanizhnechelyustnaya Vein, v. retromandibularis, in the box parotid gland is the

most superficial. It is formed from the veins of the parotid gland, v. maxillaris, as

well as from v. transversa faciei. In the downward direction it goes from cancer and in a sleepy triangle neck flows into the front of the vein, the guide to the

internal jugular vein. V. retromandibularis anastomose with the wing-venous plexus in the deep parts of the area, as well as with external jugular vein.

The purulent exudate in the inflammatory process (mumps) can compress the branches of the facial nerve, which leads to paresis or paralysis of facial muscles

and the subsequent facial asymmetry. Severe purulent process or swelling of the parotid gland can lead to erosion of (arrosion) vessel walls, passing in the box cancer, and severe bleeding.

The deep portion of the parotid-masticatory areas (deep facial area), pars profunda regio parotideomasseterica (regio facialis profunda)

Deep Front parotid-masticatory area, which is often called deep facial area, located between the rear surface of upper jaw and the inner surface branch of the

mandible. There is also another name - intermaxillary region. It is limited:outside - a branch of the lower jaw and the inner surface of the temporal muscle in front - a mound of maxilla, medial - lateral surface of the pharynx, the top - the part outside the skull base, which corresponds to the middle cranial fossa.In the hole is most holes, connecting the outer and inner base of the skull:

oval, spinous, torn anterior, inferior orbital fissure and round. The back wall of a parotid gland with its capsule.

In the deep parts of the field are two spaces: temporo-wing, spatium temporopterygoideum, located between the inner surface of the lower half of the temporalis muscle and lateral pterygoid; mezhkrytovidnoe, spatium in-terpterygoideum, concluded between

the two pterygoid (mm. pterygoideus lateralis et medialis). In both spaces, communicating with each other, are blood vessels and nerves, surrounded by

fiber: a. maxillaris and its branches, the branches of n. mandibularis, pterygoid

venous plexus, plexus pterygoideus. Fiber temporo-pterygoid and mezhkrylovidnogo spaces directly and in the course of vessels and nerves reach the holes in the skull base, Pterygopalatine fossa, orbit and floor of the mouth.

In the temporal-wing-space located a. maxillaris and venous plexus wing, plexus

pterygoideus. To better remember we can assume that in this space are located in the main blood vessels.

Pterygoid venous plexus is located mainly on the outer surface of the lateral pterygoid muscle, although their small branches, and passes on the medial

pterygoid muscle, and the mouth of the auditory tube. Pterygopalatine plexus presented or in the form of petlistoy network, or in the form of several large

venous trunks, surrounded by small veins. Larger branches of pterygoid plexus prilezhat to the lateral pterygoid muscle.

Plexus pterygoideus takes blood from v. alveolaris inferior, v. meningea media,

w. parotidei, v. temporalis profunda. From a practical standpoint, it is important that the pterygoid plexus is connected with the cavernous sinus dura the brain

through the w. emissarii foraminis laceri anterioris et rete foraminis

ovalis. Through the superior orbital fissure is associated with v. ophthalmica

inferior. With superficial veins person pterygoid plexus is connected by branches

of deep vein person. Described venous connections have important clinical implications, as are ways of transfer of infection (Figure 5.32).

Outflow of blood from the pterygoid plexus via v. retromandibularis, which takes

place in a box at the parotid 

and neck merges with facial vein. There is also a bypass connecting this vein with the external jugular vein.

We emphasize once more that the normal outflow of venous blood is carried downwards, that is blood in the pterygoid plexus comes from the cavernous sinus, but not vice versa.

Maxillary artery, a. maxillaris, located on the surface of the lateral pterygoid muscle, is among the venous branches in the lateral direction and further directed

inwards and upwards to several Pterygopalatine fossa. In the initial division after being released from the parotid gland is located near the capsule of temporo-mandibular joint.

A. maxillaris gives numerous branches (16), which are blood-vosnabzhayut formation of deep facial area, as well as the dura mater. A. meningea media depart immediately anterior to the articular process of the mandible and goes between the branches ushno-temporal nerve up to the spinous foramen . A. alveolaris inferior branches off at the mandibular notch and goes vertically down to the

mandibular canal. Apart from them as well. Maxillaris depart upper alveolar branch, temporal, palatine, infraorbital, etc.

Mezhkrylovidnoe space located between lateral and medial pterygoid. Both of them start pterygoid sphenoid bone, and attached differently: medial - to the inner surface of the angle of the mandible, and lateral - to the front surface of the neck

of the mandible and the articular capsule. The outside surface of the medial pterygoid fascia covers mezhkrylovidnaya beyond which are predominantly nerves.

Mandibular nerve, P. mandibularis (III branch of the trigeminal nerve), out of the oval hole and covered with a lateral pterygoid muscle, is divided into

branches. This nerve, in contrast to I and II of the branches of the trigeminal nerve

is mixed, has a motor and sensory branches. The motor branches (n. massetericus, pp. Temporales profundi, pp. Pterygoidei lateralis et medialis, n. musculi tensor veli palatini) almost immediately go to the appropriate masticatory muscles.

Sensitive to the different branches during the pass through mezhkrylovidnoe space (Figure 5.33).

Buccal nerve, P. buccalis, passes between the two portions of lateral pterygoid

muscle and on the way to buccal area is more anterior and medial position. Other nerves lie on the outer surface of the medial pterygoid muscle.

Inferior alveolar nerve, n. alveolaris inferior, is in the interval between the branches of the mandible and medial pterygoid, and together with like artery and vein

 down to the opening of the channel of the lower jaw, butting

mezhkrylovidnuyu fascia. Before assuming this channel the inferior alveolar nerve gives motor mandibulohyoid nerve, n. mylohyoideus, walking on the inner surface of the lower jaw to the muscle of the same name through the region of Wharton th triangle.

Lingual nerve, n. lingualis, located on the outer surface of the medial pterygoid

and anterior medial n. alveolaris inferior. Outside the top down to it chorda tym-pani, masked barrel inferior alveolar nerve.

Ushno-temporal nerve, n. auriculotemporalis, departs from the mandibular nerve

near the foramen ovale by two beams, which cover a. meningea media. Next comes the nerve to the medial surface of the articular process of mandible and penetrates into the bed of the parotid gland, through which passes upwards in the temporal region.

Pterygopalatine fossa, fossa pterygopalatina, located in the anteromedial area of

the department. She bounded back pterygoid, front - a mound of the upper jaw, from the inside - Perpendicular plate of palatine bone. From the middle cranial fossa through a round opening the skull, foramen rotundum, it includes

maxillary nerve, n. maxillaris (II branch of the trigeminal nerve). It is a direct continuation of the paragraph infraorbitalis, which is included in the infraorbital canal (in the bottom wall of the orbit, formed by the maxillary bone) and before its release in the infraorbital area gives higher alveolar and gingival branches innervating the upper teeth and gums.

The self-titled process of body fat cheeks rises in Pterygopalatine hole of the buccal region.

The deepest division of a swallow with the surrounding peripharyngeal space, spatium peripharyngeum.

It consists of the retropharyngeal space, spatium retropharyn-geum, and two lateral, spatium lateropharyngeum.

Retropharyngeal space is located between the pharynx (with its fascia) and prespinal fascia and extends from the base of the skull to the level VI cervical vertebra, which goes into spatium retroviscerale neck.

Directly to the deep division adjoins the side face peripharyngeal space. Above it reaches the base of the skull, and below - the hyoid bone. Outhouse lateral space is limited to the medial pterygoid muscle and its overlying fascia and parotid gland, behind - the transverse processes of cervical vertebrae, from the inside - the side wall of the pharynx and coming from the pharynx to the bottom of the transverse processes and lateral pharynx, fascial vertebrates ridges that separate side peripharyngeal space from the retropharyngeal.

Each side peripharyngeal space is divided, in turn, on the front and back with the aid of a beam of muscles and fascia, starting from subulate appendages (shilodiafragma).

By the anterior lateral peripharyngeal space adjacent the inside - the tonsils, the outside (in the interval between the medial pterygoid and subulate outgrowth) - pharyngeal process of the parotid gland (Figure 5.34).

In the posterior part of lateral peripharyngeal space behind "shilodiafragmy" pass

internal jugular Vein, v. jugularis interna (outside), internal carotid artery,

a. carotis interna (from inside), and 4 of the cranial nerves: glossopharyngeal, P.

glossopharyngeus (LX pair), wandering, n. vagus (Hpara), extension, c.

accessorius (XI couple), and hypoglossal, P. hypoglossus (XII couple). The first three nerve-you

Figure 5.34. Peripharyngeal space on the cross-section. 1 - m. pterygoideus medialis; 2 - pfedny Front parafaringealnogo space, 3 - pharyngeal process of the parotid gland, 4 - aponeurosis stylopliaringeus; 5 - vertebro-pharyngeal process, 6

- spatium retropha-ryngeum et nodi retropliaryngei; 7 - a. carotis interna; 8 -

mm. prevertebrales; 9 - v. jugularis interna; 10 - cauda parafaringealnogo space,

11 - m. digastricus; 12 - m. stemocleidomastoideus; 13 - gl.parotidea; 14 -

n. facialis; 15 - ductus parotideus; 16 - m. masseter, 17 - mandibula walk from the cranial cavity through the jugular hole, and hypoglossal - through canalis n. hypoglossi of the occipital condyle.

Along the internal jugular veins are located deep cervical lymph nodes, nodi lymphoidei cervicales profundi.

Fiber side peripharyngeal and retropharyngeal spaces plays a significant role in the development of deep phlegmon face and neck.

Injection peripharyngeal space is frequently observed in suppurative parotitis in inflammation tissue mezhkrylovidnogo gap in inflamed gums of the mandible, lesions 7 th and 8 th tooth of the mandible. Inflammation of the tissue lateral

peripharyngeal space can lead to difficulty swallowing and breathing. In passing the infection from anterior lateral peripharyngeal space in the rear (destruction "shilodiafragmy") may cause symptoms of cranial nerves.There is also the danger of necrosis of wall of the internal carotid artery and subsequent arrozivnogo bleeding, most often fatal. A further complication may be septic thrombosis of the internal jugular vein.

Hiking fascial sheath carotid neurovascular bundle infection can spread to the upper mediastinum. In the case of infection in the retropharyngeal space to further its spread along the posterior pharyngeal wall and then along the

esophagus can lead to the development of posterior mediastinal Nita. 

OPERATIONS HEAD

Closed head injuries are often accompanied by internal bleeding with the

formation of epi-and subdural hematomas. At diagnosis may delete izlivsheysya blood with one trepanations.

Hole impose over the place determined by the highest accumulation of

blood. This usually occurs in the temporal or parietal region, where the branches

of the middle meningeal artery. By a small (3-4 cm) vertical (radial) section of skin with subcutaneous tissue and aponeurotic helmet.

The bleeding usually stops coagulation. Periostio longitudinally dissected and set

aside raspatory. Using the first spear and then spherical cutters scutching doing a

hole in the bone. Bleeding from the bone stops bone wax. With subdural hemorrhage dura becomes dark blue color, it is tense, convex and not

pulsating. Producing cross-section of a pointed scalpel. In the space between the solid and the pia mater introduce a catheter through which suck blood.Subdural cavity is washed with warm isotonic sodium chloride solution, removing blood clots.

Primary surgical treatment of penetrating wounds of the cranial vault. Penetrating wounds of the cranial vault called the wounds of soft tissues,

bones and dura mater. If the mater is not damaged, even extensive wounds of the other layers are non-penetrative.

The purpose of the operation - stop bleeding, remove foreign bodies, and bone fragments, the prevention of infection in soft tissues, bones, and in the cranial cavity, as well as preventing damage to the brain, prolaboring the wound in traumatic edema.

The hair around the wound carefully shaved off in the direction of the wound edges to the periphery. The skin is treated with tincture of iodine. Sparingly excised with a scalpel crushed wound edges, stepping back from the edges of the

wound on 0,5-1 cm Incisions spend so that the form of wounds was close to linear or elliptical, and the wound had a radial direction. In this case, the wound is easier to reduce without tension, and their blood supply is disturbed minimally.

To pause (or decrease) bleeding fingers pressed against the wound to the bone, and then successively relaxing finger pressure, a bleeding vessel is compressed hemostat or Billroth type "Mosquito", followed by coagulation or Flashing catling.

Studs or small retractor stretch the edges of the wound of soft tissues. Remove freely lying bone fragments, and associated with the periosteum intact sections of

bone remain, after processing to put them in place. Vascularized soft tissues and

bones of the cranial vault ensures their subsequent engraftment. If the hole of the

bone wound is small and does not allow a firm to inspect wound 

mater to the limits of the intact tissue, then tipped rongeur skusyvayut edge of the

bone. First skusyvayut outer plate, and then inside. After trepanation defects removed fragments of internal records, which may be under the edge of the trephine hole (Figure 5.35).

This extension of opening a wound or bone trial freon zevogo hole called

resection trepanation of the skull. After her skull is defective, which subsequently

must be closed. This suggested many ways to cranioplasty.

Stopping bleeding from veins diploic produced in several ways. To do this, or rubbing in the spongy bone of a special bone wax, or with a pair of nippers tipped compress the outer and inner plate of bone, thus breaking the trabeculae. The cut of the bone is put gauze swabs soaked in warm isotonic sodium chloride

solution. Bleeding from the damaged veins emissarnyh stop rubbing the wax in the bone hole, to detect which detaches periost.

After stopping the bleeding hole gradually extend to the intact dura mater. If the

dura is not damaged and well pulsates, it must not be cut. Tense, not pulsating

dura dark blue indicates a subdural hematoma. Dura dissected crosswise.Blood sucked out, destroyed brain tissue, superficially located bone fragments and remnants of blood gently washed with a jet of warm isotonic sodium chloride, which is then sucked out.

Seek out the source of bleeding (most often the middle meningeal vessels or

damaged sinus dura mater). Bleeding from the artery and its branches stopped, proshivaya artery together with the dura. The same process of the middle meningeal veins.

Damage to the walls of the sinus of the dura mater - is a very serious and dangerous complication. The best solution is a linear vascular suture the wound sinus or plastic walls of its outer layer of the dura mater with the fixation of the

vascular suture. However, technically it is difficult to do. A simple but less reliable methods of artificial trombirova-tion sine piece of muscle or bundles of collagen fibers with the expectation of subsequent recanalization. More often, however, the clot blocks blood flow, as in the case of suturing sinus ligation,

which leads to more or less edema of the brain . The closer to confluens sinuum made dressings, the worse the prognosis.

After stopping the bleeding and thorough cleaning of the wound edge slit the dura mater is placed on the wound surface of the brain, but do not sew it for decompression in the case of brain edema and increased intracranial pressure.On the soft tissues cranial vault impose frequent seams to prevent cerebrospinal fluid.

Coast no-seam and Cesky cephalotrypesis performed in order to access the cranial

cavity. The indications for it are operations for tumors of the brain and stroke,

vascular injuries of the dura mater, depressed fractures. The difference osteoplastic trepanation of resection is that access to the cranial cavity is created by cutting out a large bone flap, which after the surgical technique is laid in

place. After a trepanation is not required re-operation to eliminate the bone defect, as in resection trepanation (Fig. 5.36).

Semicircular incision of soft tissues produce in such a way that the base of the flap

was at the bottom. Then do not cross running radially from the bottom up blood vessels and blood supply of the flap of soft tissue is not disturbed.Length of the flap is not less than 6-7 cm after stopping bleeding skin and we are muscular-aponeurotic flap giving way down on the gauze swabs and the top cover with gauze soaked in isotonic sodium chloride or 3% hydrogen peroxide solution.

Shearing subperiosteal bone-graft begin with arched dissection periosteum with a

scalpel, departing at] cm inwards from the edges of the skin incision. Periostio detaches from the cut in both sides of the width equal to the diameter cutter, which is then applied depending on the value created by the lesion 5-7 hole with a

manual or electric talk. First, use spear cutter, and with the appearance of bone chips, blood-stained, indicating that gets cutters in diploic layer of bone spear blade or replace the cone-spherical cutter, so as not to "fall" into the cranial

cavity. Land between these holes saw through a wire saw Gigli. From one hole to

another spend a saw with a thin steel plate - Conductor Polenova. Any form are at

an angle of 45 ° to the plane of the operative field. This outer surface of the bone

graft is more internal: when return 

schenii flap in place it does not falls into the defect created in trepanation. Since being cut all connection between the holes, except one, lying at the side or bottom

with respect to the base of the flap of soft tissue. This jumper is breaking in bringing the entire bone flap is associated with intact bone section only periosteum. Subperiosteal bone flap on the leg, after which ensured its blood

supply, is giving way. Next, perform scheduled operational techniques.In concluding the operation, first sew the dura mater. The bone graft is placed on the place and fix catgut sutures drawn through the periosteum, muscle and tendon

helmet. The wound was sewn up in layers of soft tissue.

Trephine resection is sometimes used for decompression - reducing elevated

intracranial pressure. This operation is also known as decompression interdiction vnoy trepanation. This palliative operation: it produces an increase in pressure in cases of inoperable brain tumors or progressive swelling of the brain

of another etiology. The purpose of the operation - the creation of a certain section of a set of permanent defect in the bones of the skull and dura

mater.Decompression trephine conduct, usually in the temporal region. This

makes it possible to hide the hole created by the temporalis muscle to prevent the injury of the brain through a hole.

After dissection of soft tissues and periosteum large spherical cutter creates a hole in the bone, which is further expanded with the help of cutting pliers, tipped

toward the zygomatic arch. Before opening the highly tense dura produce lumbar

puncture. Cerebrospinal fluid is extracted in small portions (10-30 ml) to avoid

the wedging of the brain stem in the foramen magnum. Dura is opened, giving the outflow of cerebrospinal fluid, after which the wound is sutured in layers, with the exception of the dura mater.

Operation for acute purulent parotitis. The operation was performed under

general anesthesia. The purpose of the operation - opening of pyo-necrotic core, drainage of the wound until oggorzheniya necrotic tissue.

The skin incision length of approximately 2 cm above the produce fluctuations in

the light of the topography of the facial nerve. After opening the abscess cavity and remove the pus drained.

With extensive lesions gland makes two cuts first, horizontal, 2-2,5 cm long, starting at the I cm anterior to the base earlobe and hold the bottom edge parallel

to the zygomatic arch. After dissecting the skin, subcutaneous tissue, and fastsial-

term capsule gland removed pus. The cavity is not examined by the probe, and a finger to avoid damage to neurovascular structures that pass in the box of the

parotid gland. The second section starting from the base of the ear lobe, retreating 1-1,5 cm posterior to the wet

VI of the mandible, and lead him down parallel to the anterior edge of the

sternocleidomastoid muscle. After dissection of the skin, subcutaneous tissue and

the capsule gland removed pus. Finger or blunt instrument connects both sections

and carry out drainage pipes protruding free ends of both sections.