Chapter 5, CAPUT L0BN0-TEMENN0-ZATYL0CHNAYA AREA, REGIO
FRONTOPARIETOOCCIPITALIS
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).  medial vessels. Above the block blood vessels and nerves, a., v. et n.
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. 
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
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  Above the front third of the zygomatic arch in the subcutaneous tissue of the
tissues in the cranial cavity with the development of inflammation of the
meninges.  circular muscle of the eye -, the zygomaticus.
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.
facial nerve to the frontal abdomen m. occipitofrontalis rises, the frontalis, and the
 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  v. cerebri magna [Galen], which collects blood from the substance of the
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,
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 Fig. 5.14. The back wall of
bone leave channel openings are located on the same vertical line: foramen (or orbit. Optical channel (on
incisura) supraorbital for items from supraorbitalis I branch trigeminal nerve, Shpalteholtsu, as amended).
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
1 - n. lacrimalis; 2 - P. frontalis; 3 - n. trochlearis; 4, 15 - P. x-axis lomotorius; 5, 22
nerve (Figure 5.13).
- ala parva ossis

 Mimic muscles innervate the branches of the facial nerve, n. facialis (VII 9. sphenoidalis (dissected), 6 - ca-
pair), chewing - III branch of the trigeminal nerve, n. mandibularis.
10. nal is opticus (open top), 7, 18 - n. opticus; 8 - anulus ten-dineus
AREA Orbit, REGIOORBITALIS communis; 9 - m. leva-

Orbit, orbita, - paired symmetrical hole in the skull, which is located in the eyeball 11
 tor palpebrae superior; 10 - m. 
with its subsidiary apparatus. obliquus superior; 11 - m. rec- 
tus medialis; 12 - pars me-
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 13 dialis orbitae; 1913 - m. rectus
surface. Axis orbital pyramids converge (converge) and diverge posteriorly
(divergiruyut) front. Average size of the orbit: the depth of an adult ranges from 4 14 inferior; 14 - v. ophthalmica 
to 5 cm wide at the entrance to it is about 4 cm and the height is typically less than
inferior; 16 - m. rectus lateralis; 
3,5-3,75 cm
17 - a. ophthalmica; 19 - n. na- 
The walls are formed by different thickness of bone slices and separate the orbit: sociliaris; 1920 - m. rectus superior; 
the top - from the anterior cranial fossa and frontal sinus, the lower - of maxillary 21 - v. ophthalmica superior.
sinuses, sinus maxillaris (maxillary sinus) medial - from the nasal cavity
and lateral - from the temporal fossa.
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
Almost at the very top of their sockets situated round hole about 4 mm in diameter orbitalis superior, connecting the cavity of the eye socket with a cavity of the
- 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 skull (middle cranial fossa). It held:
well. ophthalmica, in the cavity skull (Fig. 5.14)
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,   The thin subcutaneous muscle is a part of mimic muscles of the eye,
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  The rear surface of the cartilage and orbital wall is lined with mucous membranes
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.).
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.
- 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.
 and horizontal plate of palatine bone that make up the hard palate, palatum
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
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 brush rr. temporales match I finger; vols. zygomatici - And, rr. buccales - III, PM
small facial lymph nodes. marginalis mandibularis - IV and the city of colli - V finger.

The inner (deep) surface of the buccal muscle covers the mucous membrane of Excretory duct of parotid gland or duct stenonov [Stenon (Stensen)], projected on
the mouth. a line running parallel to the zygomatic arch and below it on 1,5-2,5 cm in the
direction of the outward-
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 Fig. 5.31. The projections of the branches of the facial nerve
division (deep facial area), which lie pterygoid muscle, blood vessels and nerves.
1 - rr. temporales; 2 - rr. zygomatici; 3 - rr. buccales; 4 - PM marginalis
Surface Front parotid-masticatory area, pars superficialis regio mandibularis; 5 - PM colli.
parotideomasseterica
tion meatus to the middle distance between the wing of the nose and corner of his
In the surface layers of the external reference is the angle and the lower edge of mouth. Anterior to the tragus palpable, particularly when movements in the joints,
the mandible, zygomatic arch, external auditory canal and palpable front edge of articular process of the mandible and temporomandibular joint.Further anteriorly,
chewing muscles. downward from the middle of zygomatic arches, projecting coronoid process of
mandible.
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
Layer
the external auditory meatus to the tip of the mastoid process.

Projections. Motional branch of the facial nerve innervating the mimic muscles, The skin is thin, men covered with hair.
projected along lines diverging fan from a point downwards and anterior to the
tragus (Figure 5.31). Subcutaneous tissue permeated by connective cords that connect the skin with its
own fascia.
Remember the direction of the branches of the facial nerve better as
Superficial fascia is expressed only in the anteroinferior part of the region where
follows. Brush with diluted fingers should be attached to the side of the face so
a lower jaw spreads and is attached to the skin, platysma.
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
On the outer surface of the chewing muscles, covered by fascia
mandible, and V finger was directed vertically downward neck. In such a situation 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  and remove the pus drained.
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
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.