Fig. one. The basis of the cartilaginous department of the outer nose - lateral cartilage, the top edge of which borders with the nasal bone of the same side and partly with a frontal overhead jaw process. The upper edges of the lateral cartilage constitute the continuation of the back of the nose, adjacent in this department to the cartilage part of the upper sepairs of the nasal partition. The lower edge of the lateral cartilage borders with a large cartilage of the wing, which is also pair. Large wing cartilage has a medial and lateral legs. Connecting in the middle, the medial legs form the tip of the nose, and the lower departments of the lateral legs are the edge of the nasal holes (nostrils). Between the lateral and large cartilages of the nose wing in the thickness of the connective tissue can be located seismine cartilages, different shapes and magnitude.
The wing of the nose, except for large cartilage, includes connective tissue formations, of which the posterior deposits of the nasal holes are formed. The inner departments of the nostrils are formed by the movable part of the nasal partition.
Outdoor nose is covered with the same skin as a face. The outer nose has muscles that are intended for compressing the nasal holes and pulling out the book wings of the nose.
The blood supply to the outer nose provides the eye artery (a. Ophtalmi), dorsal nose (a. Dorsalis NASI) and facial (a. Facialis) artery. The venous outflow is carried out through the facial, angular and partially eyelas, which contributes to the spread of infection in inflammatory diseases of the outer nasal on the sinus of a solid cerebral shell. Lymphotok from the outer nose occurs in the submandibular and the upper elevative lymph nodes. The outdoor nose motor innerware provides facial nerve sensitive - triple (I and II branches).
Nose cavity anatomy is more complicated. The nasal cavity is located between the front cranial fossa (from above), the sockets (laterally) and the oral cavity (bottom). The front of the nose cavity through the nostrils is reported to the external environment, from behind with the help of Hoan - with the nasophaling area.
There are four nasal cavity walls: lateral (lateral), internal (media), upper and lower. The most complex structure has a side wall of the nose formed by several bones and carrying nasal shells. From bone formations, it is the nasal bones, the upper jaw, the tear bone, the lattice bone, the lower nose sink, the vertical plate of the sky bone and the wonderful process of wedge-shaped bone. On the side wall there are three longitudinal protrusions formed by shells. The larger is the lower nose sink, this is an independent bone, the average and the upper sinks are grilled bone grid.
The bottom wall of the nasal cavity (bottom of the nasal cavity) is actually hard heaven, it is formed by the sky of the upper jaw (in the front sections) and the horizontal plate of the sky bone. The front end of the bottom of the nose has a canal, which serves to pass the nastural nerve (N. Nasopalatinus) from the cavity of the nose into the oral cavity. The horizontal plate of the sky bone limits the lower departments of Hoan.
The inner (medial) wall of the nasal cavity is a nasal partition (Fig. 2). In the lower and rear sections, it is represented by bone formations (the nasal crest of the sky alert of the upper jaw, perpendicular to the lattice bone plate and self-bone - with a soul). In the front departments, this bone formation is adjacent to the quadrangular shape cartilage of the nasal partition (Cartilage Septi NASI), the top edge of which forms the front of the back of the nose back. The rear edge of the coulter limits the Hoans medially. In the leading department, the chiffs of the nasal partition is adjacent to the medial process of large cartilage of the nose wing, which, together with the skin, the nasal partition is made up of its rolling part.
Fig. 2. Nasal partition 1. Lamina Cribrosa 2. Crista Sphenoidalis 3. Apertura Sinus Sphenoidalis 4. SINUS Sphenoidalis 5. Ala vomeris 6. Clivus 7. Pars Ossea 8. Pars Cartilaginea 9. Septum Nasi 10. Lamina Medialis Processus Pterygoidei 11. Processus Palatineus Crista nasalis maxillae 12. 13. Canalis incisivus 14. Spina nasalis anterior Cartilago alaris major 15. 16. 17. Cartilago vomeronasalis Cartilago septi nasi 18. Cartilago lateralis nasi Vomer 19. 20. 21. Processus posterior Os nasale 22. Lamina perpendicularis ossis ethmoidalis 23. Crista Gali 24. Sinus Frontalis
Fig. 2. The upper wall of the nasal cavity (roof) in the front departments is formed by the nose bones, frontal overflow of the upper jaw and partially perpendicular to the lattice bone plate. In the middle departments, the upper wall forms a lattice (dended) plate (Lamina Cribrosa) of the lattice bone, in the rear - wedge-shaped bone (the front wall of the wedge-shaped sinus). Wedge-shaped bone forms the top wall of the Hoan. The lattice plate is permeated with a large number (25-30) of the holes through which the branches of the front lattice nerve and vein accompanying the front lattice artery and connecting the nasal cavity with the front cranial pocket.
The space between the nasal partition and the nasal sinks is called a common nose. In the lateral departments of the nasal cavity, according to three nose sinks there are three nasal strokes (Fig. 3). The bottom nose (Meatus Nasi Inferior) is limited to the bottom nasal sink, the bottom of the nasal cavity. In the front third of the lower nasal stroke, at a distance of 10 mm from the front end of the sink, there is a hole of the rosal canal. The lateral wall of the lower nasal stroke in the lower departments is thick (it has a spongy structure), closer to the place of attachment of the bottom nasal shell is significantly thinned, and therefore the puncture of the maxillary sinus (nose partition correction) produce precisely on this site: to retreat 2 cm from the front end of the lower Sinks
Fig. 3. Nasal cavity 1. Bulla Ethmoidalis 2. Concha Nasalis Inferior 3. Concha Nasalis Media 4. Concha Nasalis Superior 5. Apertura Sinus Sphenoidalis 6. Sinus Sphenoidalis 7. MEATUS NASI INFERIOR 8. MEATUS NASI MEDIUS 9. BURSA PHARYNGEALIS 10. MEATUS NASI Inferior 11. Tonsilla Pharyngealis 12. Torus Tubarius Auditivae 13. Ostium Pharyngeum Tubae 14. Palatum Molle 15. Meatus Nasopharyngeus 16. Palatum Durum 17. Plaica Lacrimalis 18. Ductus Nasolacrimalis 19. Labium Superius 20. Vestibulum NASI 21. Apex Nasi 22. Limen NASI 23. AGGER NASI 24. DORSUM NASI 25. PROSESSUS UNCINATUS 26. HIATUS SEMILUNARIS 27. RADIX NASI 28. APERTURA SINUS FRONTALIS 29. SINUS FRONTALIS
Fig. 3. Middle nose (Meatus Nasi Medius) is located between the lower and medium nose sinks. Its lateral wall is represented not only by bone tissue, but also the dupicurate mucous membrane, which is called "Fontanela" (Spring). If partially remove the middle noveline sink, it will open a semi-lunar cleft (HIATUS semilunaris), in front of the bone-plate-bounded departments, in the hook-bubble bubble (Bulla etmoidalis). In the front sections of the seated gap, the mouth of the frontal sinus opens, in the middle sections - the front and medium cells of the sinus sinuses, and in the rear sections there is a deepening formed by the duplicatory mucous membrane and called the funnel (infundibulum), which ends with a hole leading to the maxillary sinus.
The top nose (Meatus Nasi Superior) is located between the upper and medium nose sinks. It opens the rear cells of the lattice bone. The wedge-shaped sinus opens into the clin-shaped-lattice depression (Recessus spheno-ethmoidalis).
The nasal cavity is lined with a mucous membrane, which covers all bone walls of the walls, and therefore the contours of the bone department are saved. The exception is the eve of the nasal cavity, which is covered with skin and has hairs (Vibrisae). In this area of \u200b\u200bthe epithelium remains a multi-layer flat, as in the exterior nose area. The mucous membrane of the nasal cavity is covered with a multi-row cylindrical fiscal epithelium.
Depending on the characteristics of the structure of the mucous membrane of the nose cavity, respiratory and olfactory departments are distinguished. The respiratory department occupies an area from the bottom of the nasal cavity to the middle of the middle nasal shell. Above this boundary, flickering cylindrical epithelium is replaced by a specific olfactory. For the respiratory department of the nasal cavity, a large thickness of the mucous membrane is characteristic. In its subepitheral department, numerous alveolar-tubular glands are contained, which in the nature of the secret are divided into mucous membranes, serous and mixed. For the respiratory part of the mucous membrane, the presence in its thickness of the cavernous plexuses - varicose-extended venous vagina having a muscular wall, which can be reduced in volume. The cavernous plexuses (cavernous bodies) provide the regulation of air temperature passing through the nasal cavity. The cavernous fabric is contained in the thickness of the mucous membrane of the lower nasal shells, located along the lower edge of the middle nasal sink, in the rear sections of the middle and upper nose shells.
In the olfactory department, except for a specific olfactory epithelium, there are support cells that are cylindrical, but devoid of cilia. The glands, which are in this nasal cavity department, highlight a more liquid secret than glands in the respiratory part.
The blood supply to the nasal cavity is carried out from the external system (a. Carotis Externa) and internal (a. Carotis Interim) of the carotid arteries. From the first artery originates the mainly-sky arterier (a. Sphenopalatina); Passing through the main-pacific hole (formen sphenopalatinum) in the nose cavity, it gives two branches - rear nasal lateral and partition arteries (AA. Nasales Posteriores Laterales ET Septi), providing blood supply in the rear sections of the nasal cavity, both lateral and medial walls. From the inner carotid artery takes the beginning of the eye artery, from which the branches of the front and rear lattice arteries (AA Ethmoidales Anterior et Posterior) depart. The front ethmoidal arterys are in the nose through the lattice plate, the rear - through the rear lattice hole (Formen Ethmoidale POST.). They provide power to the area of \u200b\u200bthe lattice labyrinth and the front sections of the nasal cavity.
Blood outflow is carried out on the front facial and eye veins. The features of blood outlet often determine the development of eye and intracranial rhinogenic complications. In the nasal cavity, especially pronounced venous plexuses are available in the front sections of the nasal partition (Locus Kilsselbachii).
Lymphatic vessels form two networks - superficial and deep. The olfactory and respiratory area, despite the relative independence, have anastomose. The lymphotok occurs in the same lymph nodes: from the front sections of the nose into the submandibular, from the rear - in deep cervical.
The sensitive innervation of the nasal cavity is provided by the first and second branches of the trigeminal nerve. The front department of the nasal cavity is innervated by the first trigeminal nerve branch (front grilted nerve - n. Ethmoidalis anterior-branch of the rheorest nerve - N. Nasociliaris). The nasal nerve from the nasal cavity penetrates through the rosantic hole (Foramen Nasociliaris) into the cavity of the skull, and from there - through a lattice plate into the nasal cavity, where it is branched in the area of \u200b\u200bthe nose partition and the front sections of the nose. The outer nasal branch (Ramus Nasalis Ext.) Between the nasal bone and the side cartilage comes on the back of the nose, innervating the skin of the outer nose.
The hinds of the nasal cavity can be innervated by the second branch of the trigeminal nerve penetrating the nasal cavity through the rear-lattice hole and branched in the mucous membrane of the rear cells of the lattice bone and the sinuses of the wedge-shaped bone. From the second branch of the trigeminal nerve, nodal branches and a porzniknyh nerve are depressed. The nodal branches are part of the storage unit, but most of them passes directly into the nasal cavity and innerves the ass in the side wall of the nasal cavity in the region of the middle, and the upper nasal shells, the rear cells of the lattice bone and the sinuses of the wedge-shaped bone in the form of RR. Nasales.
Along the nasal partition in the direction of the back, a large branch is a nastural nerve (nasopalatinus). In the front sections of the nose, it penetrates through the cutting channel into the mucous membrane of the solid sky, where he anastomoses with the nose branches of the alveolar and sky nerves.
Secretor and vascular innervation is carried out from the upper cervical sympathetic assembly, the postgangylionic fibers of which penetrate the nasal cavity in the second branch of the triangistic nerve; Parasympathetic innervation is carried out through the Cutting Node (Gang. Pterigopalatinum) due to the nerve of the walled canal. The latter is formed by a sympathetic nerve that departs from the upper cervical sympathetic node, and a parasympathetic nerve, originating from the knee node of the face nerve.
Specific olfactory innervation is carried out by an olfactory nerve (N. Olfactorius). Sensitive bipolar cells of the olfactory nerve (I neuron) are located in the olfactory area of \u200b\u200bthe nasal cavity. The olfactory threads (Filae Olfactoriae), separated from these cells, penetrate the skull's cavity through a lattice plate, where, connecting, form an olfactory bulb (Bulbus Olfactorius) concluded in the vagina formed by a solid cerebral shell. Metic fibers of sensitive cells of the olfactory bulbs form an olfactory tract (TRACTUS Olfactorius - II neuron). Next, olfactory ways go to the olfactory triangle and end in the cortical centers (Gyrus Hippocampi, Gyrus Dentatus, Sulcus Olfactorius).
Outdoor nosenasus. externus, includes root, back, top and nose wings.
Anatomy of outdoor nose
Nose root,radix. nasi., separated from the forehead with a removal - we move.
The side sides of the outer nose are connected by the median line and form nasal backdorsum nasi., and the lower parts of the sides are wings of the nose,alae. nasi..
Book the back of an external nose goes into top of the nose,apex nasi..
Wings of the nose with their lower edges limit nostrilsnares.. According to the middle line, the nostrils are separated from each other mobile (webbed) part of the nasal partition.
The outer nose has a bone and cartilaginous skeleton formed by the nose bones, frontal overpoints of the upper jaws and several guialic cartilage. The nose root, the upper part of the back and side of the outer nose have a bone skeleton, and the middle and lower parts of the back and side sides - cartilage.
Counties nose
Counties nose: Lateral nose cartilage, cartilago. nasi. laterdlis, big cartilage nose wing, cartilargo. alaris major., small wing cartilage, cartilagines. aldres. minores., additional nasal cartilage, cartilagines. nASDLES. accessoriae., winged nose partitions, cartilargo. septi. nDSI.
Mucous membrane of nose
tunica. mucosa. nasi., tightly smashed with the periosteum and the superior wall of the nose cavity walls. In the mucous membrane of the cavity of the nose, the olfactory region is distinguished, regio. olfactoria, and respiratory area regio. respiratoria.. The olfactory area includes part of the nose mucous membrane, covering the right and left upper nasal sinks and part of the average, as well as the appropriate surface of the nasal partition. The rest of the nose mucosa refers to the respiratory area.
Vesselsand nasal oral mucosa nerves
The mucous membrane of the nasal cavity is hydrocated by the branches of the wedge-palate artery from the maxillary artery, steaming front and rear lattice arteries from the eye artery. The venous blood from the mucous membrane crowds along a wedge-hair vein flowing into the walled plexus. The lymphatic vessels from the nasal oral mucosa are directed to the subband and chifferent lymphatic nodes. Sensitive innervation of the mucous membrane of the nasal cavity (front part) is carried out by branches of the front lattice nerve from the rosantic nerve. The back of the lateral wall and the nasal cavity partition is innervated by the branches of the naseless nerve and the rear nose branches of the topless nerve. The glands of the mucous membrane of the nasal cavity is innervated from the rolling node, the rear nose branches and the nastow nerve from the vegetative nucleus of the intermediate nerve (pieces of the face nerve).
Blood supply The nasal cavity is carried out from the external system (a. Carotis Externa) and internal (a. Carotis Interna) of the carotid arteries. From the first artery originates the wedge-sky arterier (a. Sphenopalatina); Passing through a wedge-packer (formen sphenopalatinum) in the nose cavity, it gives two branches - rear nasal lateral and partition arteries (AA. Nasales Posteriores Laterales ET Septi), providing blood supply in the rear sections of the nasal cavity, both lateral and medial walls. From the inner carotid artery takes the beginning of the eye artery, from which the branches of the front and rear lattice arteries (AA Ethmoidales Anterior et Posterior) depart. The front grate arteries are in the nose through the front lattice hole (Foramen Ethmoidale Anterior), the rear - through the rear grid hole (Foramen Ethmoidale Posterior). They provide power to the area of \u200b\u200bthe lattice labyrinth and the front sections of the nasal cavity. In the field of the medial angle of the eye, anastomosis is formed between a. Dorsalis NASI (from a. Ophthalmica from a. CAROTIS INTERNA) and a. Angularis (branch a. Facialis from a. Carotis Externa).
Foundation of blood It is carried out on the front facial and eye veins. In the nasal cavity, especially pronounced venous plexuses are available in the front sections of the nasal partition (Locus Kilsselbachii).
Lymphatic vessels Forming two networks - superficial and deep. The lymphotok comes from the front sections of the nose into the submandibular, from the rear - in deep cervical lymph nodes.
Sensitive (general) innervation Nose cavities provide the first and second branches of the trigeminal nerve. The front department of the nasal cavity is innervated by the first trigeminal nerve branch (front grilted nerve - n. Ethmoidalis anterior-branch of the rheorest nerve - N. Nasociliaris). The nasal nerve from the nasal cavity penetrates through the rosantic hole (Foramen Nasociliaris) into the cavity of the skull, and from there - through a lattice plate into the nasal cavity, where it is branched in the area of \u200b\u200bthe nose partition and the front sections of the nose. The outer nasal branch (r. Nasalis Ext.) Between the nasal bone and side cartilage comes on the back of the nose, innervating the skin of the outer nose.
The hinds of the nasal cavity can be innervated by the second branch of the trigeminal nerve penetrating the nasal cavity through the rear-lattice hole and branched in the mucous membrane of the rear cells of the lattice bone and the sinuses of the wedge-shaped bone. From the second branch of the trigeminal nerve, nodal branches and a porzniknyh nerve are depressed. The nodal branches are part of the storage unit, but most of them passes directly into the nasal cavity and innerves the ass in the side wall of the nasal cavity in the region of the middle, and the upper nasal shells, the rear cells of the lattice bone and the sinuses of the wedge-shaped bone in the form of RR. Nasales.
Along the nasal partition in the direction of the back, a large branch is a nastural nerve (nasopalatinus). In the front sections of the nose, it penetrates through the cutting channel into the mucous membrane of the solid sky, where he anastomoses with the nose branches of the alveolar and sky nerves.
Sympathetic innervation is carried out from the upper cervical sympathetic assembly, the postganglyonic fibers of which penetrate the nasal cavity along the vessels. Parasympathetic innervation is carried out through the row (Gang. Pterigopalatinum) due to the nerve of the wilfish channel (visive nerve). The latter is formed by a sympathetic nerve that departs from the upper cervical sympathetic node, and a parasympathetic nerve, originating from the knee node of the face nerve.
Specific olfactory innervation is carried out by an olfactory nerve (N. Olfactorius). Sensitive bipolar cells of the olfactory nerve (I neuron) are located in the olfactory area of \u200b\u200bthe nasal cavity. The olfactory threads (Filae Olfactoriae), separated from these cells, penetrate the skull's cavity through a lattice plate, where, connecting, form an olfactory bulb (Bulbus Olfactorius) concluded in the vagina formed by a solid cerebral shell. Metic fibers of sensitive cells of the olfactory bulbs form an olfactory tract (TRACTUS Olfactorius - II neuron). Next, olfactory ways go to the olfactory triangle and end in the cortical centers (Gyrus Hippocampi, Gyrus Dentatus, Sulcus Olfactorius).
Blood supply eyes Provided from an internal carotid artery system through a. ophthalmica. Through the visual channel, the eye artery penetrates the cavity of the orphanage and, at first under the optic nerve, then rises from the outside and crosses it, forming an arc. All the main branches of the eye artery are departed from it.
Central retinal artery (a. Centralis Retinae) is a small-diameter vessel, which comes from the initial part of the eye artery arc. In addition to the central artery, the retina, which bloodsput the retina, almost all the blood supply to the eye occurs due to scalest vessels. There are also two long rear eye artery, one enters the scler from the nasal side and one temporary along the horizontal meridian about n. Opticus. These two artery are divided into 3 - 5 branches in the area of \u200b\u200bOra Serrata.
The output of the eye from the eye is carried out through the rear clearance after the form of the ampoule near the inner sclera.
Flow of venous blood Directly from the eyeball takes place mainly on the inner (retinal) and outer (wilderness) vascular eyes. The first is represented by the central veloy of the retina, the second - four revili veins. V. Centralis Retinae accompanies the appropriate artery and has the same as it distribution. Sinus Cavernosus (V. Ophtalmica Superior) falls directly into the sinus cavernosus (v. Ophtalmica superior).
Rotary veins (VV. Vorticosae) Divide blood from choroids, ciliary processes and most of the muscles of the ciliary body, as well as iris. They learn the scleer in the oblique direction in each of the quadrants of the eyeball at the level of its equator. The upper pair of uniform veins falls into the upper eye vein, the bottom - to the bottom.
Flow of venous blood From the auxiliary bodies of the eye and the eyeballs occurs through a vascular system, which has a complex structure and is characterized by a number of features very important in clinical terms. All veins of this system are deprived of valves, as a result of which the outflow of blood can occur both towards the cavernous sinus, i.e. In the cavity of the skull, and in the vein system, the persons who are associated with venous plexuses of the head area, the wonder outright, the stalls, a mysterious trafficking of the lower jaw. In addition, the venous challenge of the socket anastomoses with the veins of the grids and the nasal cavity. All these features determine the possibility of the dangerous propagation of purulent infection with the skin of the face (furuncular, abscesses, grinding inflammation) or from the incomplete sinuses in the cavernous sine.
Motor innervation The human body is implemented using the III, IV, VI and VII pairs of cranial nerves, sensitive - by the first (N. Ophthalmicus) and partly the second (n. maxillaris) branches of the trigeminal nerve (V pair of cranial nerves).
The Oculomotorius III (N. Oculomotorius III pair of cranial nerves) begins on the kernels lying on the bottom of the Silviev of the water pipe at the level of the front bugs of Quadrahmia. Fibers for three straight lines (upper, internal and lower) and lower muscles, as well as for two portions of the muscle, raising the upper eyelid, are departed from the somatic motor core. The fibers departing from the parasympathetic core, through the eyeling unit innervate the muscle of the pupil sphincter (m. Sphincter Pupillae), and departing from the unpaired core - the ciliac muscle. M. Dilatator Pupillae gets sympathetic innervation from the top cervical sympathetic assembly, the postganglyonic fibers of which penetrate the eye on the way a. Ophtalmica, and not interrupting pass through the eyeling knot.
Block nerve (n. Trochlearis, IV pair of cranial nerves) begins from the moving nucleus located at the bottom of the Silviev of the water pipes immediately behind the core of the glasses of the o'clock nerve. Penetrates the eye across the top basic slit laterally muscular funnel. Innervates the upper oblique muscle.
Violent nerve (n. Abducens, Vi pair of cranial nerves) begins on the kernel located in the Varolisk Bridge. Leaving the cavity of the skull through the upper eye gland, located inside the muscular funnel between the two branches of the glasses. Innervates the outdoor straight muscle of the eye.
Facial nerve (n. Facialis, VII pair of cranial nerves) has a mixed composition, i.e. Includes not only motor, but also sensitive, taste and secretory fibers, which belong to the intermediate nerve (N. Intermedius Wrisbergi). Intermediate nerve contains secretory fibers for tear glands. They move away from the upper salivary nucleus located in the stem portion of the brain and through the knee node (Gangl. Geniculi) fall into a large rocky nerve (N. Petrosus Major). The afferent path for the tear glands begins with the conjugal and nasal branches of the trigeminal nerve. There are other zones of reflex stimulation of tear-products - retina, front frontal brain fraction, basal gangliya, thalamus, hypothalamus and cervical sympathetic gangli.
Triple nerve (N. Trigeminus, V pair of cranial nerves) is mixed, i.e. Contains sensitive, motor fibers.
The first branch of the trigeminal nerve (N. Ophtalmicus) is a source of sensitive (cornea, iris, a ciliary body), vasomotor and trophic innervation. Linny nerve (n. Frontalis) provides sensitive innervation of the middle part of the upper eyelid, including the conjunctival, and the skin of the forehead.
The second branch of a trigeminal nerve (N. Maxillaris) takes part in sensitive innervation of only the auxiliary bodies of the eye through the two branches - n. infraorBitalis and N. Zygomaticus. Podpgradial nerve (N. InfraorBitalis) innervates the central part of the lower century (RR. Palpebreles Inferiores). Zylogo nerve (n. Zygomaticus) in the cavity of the orcuit is divided into two twigs - n. zygomaticotemporalis and n. zygomaticofacialis. Having passed through the appropriate channels in the zick bone, they innervate the skin of the side of the forehead and a small zone of the zick region.
Auxiliary eye apparatus.
Top and lower eyelid Palpebrae Superior et Inferior)
Blood supply : a. Palpebreles Laterales (from a. Lacrimalis), AA. Palpebreles Mediales AA. Conjunctivales Anteriores Et Posteriores (from a. Ophthalmica).
Venous outflow : vv. Palpebreles (in VV. Ophthalmicae, v. Facialis, V. Temporalis superficialis.
Lymphatic outflow :
Innervation : palpebra Superior - N. Frontalis, n. lacrimalis; Palpebra Inferior - n. infraorBitalis
Muscles eye apple (musculi Bulbi Oculi. ).
Blood supply : rR. Musculares a. Ophthalmicae.
Venous outflow : vv. Ophthalmicae.
Lymphatic outflow : lNN. Parotidei, Submentales, submandibulares.
Innervation : n. Oculomotorius (MM. Recti Superior, Medialis et Inferior, m. Obliquus Inferior, M. Levator Palpebrae Superioris), n. Trochlearis (m. Obliquus Superior), N. abducens (m. Rectus Lateralis)
Temaful apparatustooth gland (glandula Lacrimalis)
Blood supply: a. Lacrimalis (from a. Ophthalmica).
Venous outflow : v. Lacrimalis (in v. Ophthalmica Superior).
Lymphatic outflow : lNN. Parotidei.
Innervation : sensitive: n. lacrimalis (from n. Frontalis); fromimpathing: plexus Caroticus Internus; parasimpatic: n. Petrosus Major (from N. Facialis)
An ear
Outdoor an ear Auris Externa. ) and adjacent areas suppliersblood From the sprigs of the outer carotid artery: surface temporal (RR. Auriculares Anteriores AA. Temporalis superficialis), occipital (RR. Auriculares AA. Occipitalis) and the rear ear (a. Auricularis Posterior), as well as a deep ear artery (a. Auricularis Profunda) - A twig of the maxillary artery (a. maxillaris).
Vienna This area fell into the surface temporal (v. Temporaalis superficialis), in the outer jugular (v. jugularis externa) and in the trimmed veins (v. Retromandibularis).
Lymph From the structure of the outer ear, it is subject to LNN. Mastoidei, Parotidei, Cervicales Laterales Profundi.
Innervation The outer ear is carried out by the sensitive branches of the earnest (n. Auriculotemporalis - the third branch of the trigeminal nerve - N. Trigeminus) and the big ear (n. Auricularis Magnus - the branch of the cervical plexus) of the nerves, as well as the ear branch (R. Auricularis) of the wandering nerve (N . Vagus). In this regard, some people have mechanical irritation of the rear and lower walls of the outer auditory passage, innervated by a wandering nerve causes a reflex cough. Motor nerve for rudimentary muscles of ear sink is the rear ear nerve (N. Auricularis Posterior - branch n. Facialis).
Blood supplymiddle Ear It is carried out of the pools of external and partially internal carotid arteries: front drum artery (a. Tympanica Anterior from a. Maxillaris); a. Tympanica Superior (from a. Meningea Media); rear drum artery a. Tympanica Posterior et a. Stylomastoidea (from a. Auricularis Posterior); a. TYMPANICA INFERIOR (from a. Pharyngea Ascendens),. From the inner carotid artery, branches to the front departments of the AA drum cavity are departed. CAROTICOTYMPANICAE.
Venous outflow From the middle ear, there is mainly in the veins of the same name, in the outer jugular vein.
Lymphotok From the middle ear, in the course of the mucous membrane of the auditory pipe into pattering lymph nodes, LNN. Retropharyngei, as well as lnn. Mastoidei, Parotidei, Cervicales Laterals Profundi.
Innervation(afferent) of the middle ear occurs due to the drum nerve (N. Tympanicus) from the IX pair (N. Glossopharyngeus) of the cranial nerves. Having entered into the drum cavity, the drum nerve and its twigs are anastomosed on the inner wall with sprigs of the facial nerve, triple and sympathetic plexus of the inner carotid artery, forming a drum plexus (Plexus Tympanicus s. Jacobsoni).
Efferent innervation is provided by n. Facialis (Musculus Stapedius), n. Musculi Tensoris Tympani (from N. MandiBularis).
Interior Ear (Auris Interna) gets cROSNABLE From the labyrinth artery (a. Labyrinthi), in most cases from the main arteries (a. basilaris). Inner ear microcirculation is characterized by segmental, a high degree of damping adaptive mechanisms provide noiseless flow, and the absence of a vascular anastomosis system of middle ear.
Venous outflow The labyrinth is carried out through the labyrinth veins (VV. Labyrinthi) v. Canaliculi cochleae, v. aqueducti vestibule (in sinus petrosus superior) in the lower sinuses (sinus petrosus inferior), and further in the sigmoid (sinus sigmoideus).
Innervationthe inner ear is provided by n. vestibulocochlearis
Nose physiology and spicy sinuses
The nose performs the following functions: respiratory, olfactory, protective and resonator.
The main function is respiratory. Finding into the nasal cavity, the air flow passes through the most narrow place - the nasal valve is twisted into the spiral (turbulent movement), then its movement becomes straight, laminar. Next, the main part of the air flow comes along a general nose along the middle nasal shell. When inhaling, a part of the air is inhaling, which contributes to warming and moisturizing inhaled air, as well as partial diffusion of it into the olfactory region. When exhaling, the main part of the air goes on a general nose, partially - by the rest of the nasal stroke and goes into the incomplete sinuses.
The protective function of the nasal cavity is manifested in purification, warming and humidification. Air warming is provided by the reflex extension and filling in the blood of the cavernous vessels and the contact of the air with the mucous membrane. Air moisturizing occurs due to the secret of the mucous gland gland, glassoid cells, lymphs and tear fluid.
The purification of air is carried out by hairs of the anticipation of the nose, the mucous secret, which has a bactericidal action, as well as cilia of fiscal epithelium.
In the olfactory region of the nose cavity there are peripheral receptors of the olfactory analyzer, adequate irritant of which are molecules of odorous substances. Praching substances along with air fall on the breath into an olfactory area, which is upward from the lower edge of the middle nasal shell. There are various smell theories: chemical (dissolution of fragile substances molecules in a lipoid substance), physical - excitation of olfactory cells by oscillations by fragile substances molecules, physico-chemical - excitation of cells of electrochemical energy of odorous substances.
The separator sinuses perform a resonator and protective function. Small sinuses (lattice, wedge-shaped) resonate high sounds, and large - low (maximum, frontal).
Mucous membrane of the nasal cavity and the incomparatory sinuses,
Mucous membrane cavity The nose is tightly soldered with a periosteum, directly moves into the mucous membrane of the incomplete sinuses, does not have a submembrance layer. The epithelium of the mucous membrane is multi-row, cylindrical, flickering, contains glazing and basal cells. The oscillations of the cilia of the fiscal epithelium are directed towards the nasopharynx.
The cavernous fabric is located on the medial surface of the bottom of the nasal shell, the free edge and the rear ends of the middle and top nose sinks. It consists of a club of veins, the walls of which are rich in smooth muscles and elastic fibers. The cavernous fabric under the influence of various factors instantly can expand and shrink.
The epithelium of the olfactory region consists of olfactory, basal supporting and tubular-alveolar (bowmen) cells (figures 1. ** - 1. **).
The mucous membrane of the incomplete sinuses in the structure is practically no different from the mucous membrane of the nasal cavity, the outflow of the mucus from the sinuses is directed to the outlet openings.
Blood supply of nose cavity Very plentiful and carried out at the expense of the branches of the outer and internal carotid arteries (Figure 1.10).
Vienna of the nasal cavity accompany the arterial vessels, have numerous anastomoses with veins of the outer nose and face, nasopharynx, the stalls, through the lattice veins - with the veins of the socket, cavernous.
The vascular network of the mucous membrane of the nasal cavity in the head-bottom of the nasal partition is called the "bleeding zone" or "kiselbach". Here there are accumulations of the end branches of the arteries of the nasal partition of A.Nasalis Septi, Palatini Major, Ethmoidalis Anterior, Labalis Superior and venous capillaries. The covering epithelium zone of Kiselbach thin and with increasing blood circulating vessels, it is easy to rush.
Innervation of the mucous membrane of the nasal cavity. The olfactory, sensitive and vegetative innervation of the mucous membrane of the cavity is distinguished.
Sensitive innervation is carried out at the expense of the branches of the trigeminal nerve. The forefront of the nasal cavity is mainly innervated by the branches of the eyelet nerve, and the rear-branches of the top-jaw nerve. Sympathetic innervation is carried out of the sleeping plexus, which is associated with the upper sympathetic node. Parasympathetic innervation goes through the vision of the nerve from the crankshaft of the facial nerve. All nerves of the nose cavity are closely linked and anastomosed with dental, eye and nerves of a solid cerebral shell.
Lymphatic nasal cavity system. The outflow of lymphs from the front sections of the nose cavity is carried out in the submandibular lymph nodes, from the middle and rear - in the deep cervical lymph nodes.
Research outdoor nose. The outer inspection, the palpation of the nose and the incomplete sinuses is carried out to detect pathological changes: inflammatory, deformation of bone walls, attitudes and pathological mobility, pain observed in the fractures of the nose bones or the walls of the incomplete sinuses. First examines the outer nose, the projection of the incomplete sinuses on the face, then the back of the nose, the root area, rope is painted with stipoping fingers. The front and bottom walls of the frontal sinuses are palpable with large fingers of both hands. At the outlet points of the trigeminal nerve branches, a slight pressure is made. Nose in the norm in the palpation of the nose and the walls of the frontal sinuses is absent.
To determine the attitudes and pathological mobility, the bone of the outdoor nose is fixed between the large and index finger of the right brush, and an attempt is made to shift the nose bones to the parties. When attachments, crunch bones are heard. With pathological mobility, bones are easily shifted to the sides. The front walls of the maxillary sinuses are also palipped with a thumb of the right brush with pressure on the Dog Piece area (outlet of the trigeminal nerve branches). Normally, soreness when pressed in a dog is not defined.
Study of nasal functions. The respiratory function of the nose (is determined separately on both sides with the help of a sample with a vat (proba of warhead). One wing of the nose with the index finger of the left hand is pressed against the nasal partition, the hand is brought by a piece of watts to another anticipation and asking for a patient to make a short breath and exhalation. The degree of breathing is determined.
Olfactory nose functiondetermined by a set of fragile substances or a special device with an Olifactometer. The set includes odorous substances located by increasing intensity: soap, wine alcohol, valerian tincture, vinegar. The paint substance is alternately driven to each nostril (with the second closed), they ask for a substance. If the patient distinguishes the smells of all the odorous substances of the set, the smell is normal. If the patient distinguishes only sharp smells - Valerian, vinegar, it means that a patient has a decrease in the smell - hyposimia, and in the absence of ability to distinguish the smells - anosmia. Sometimes the sick feels the smell, but cannot differentiate it - coconium.
Front rosicopia It is carried out to assess the state of the anticipation, nasal moves, the mucous membrane of the nasal shell, the nasal partition, the contents of the nose cavity. For inspection of the anticipation of the nose with a thumb of his right hand rises the tip of the nose. Then the other parts of the nasal cavity are alternately inside with the help of the nasal mirror. To do this, on the revealed palm of the left hand, the nose mirror lies with the beak, the finger is pressed against the screw of the mirror, II and III lay on the Branches, IV and V are between the branches. The elbow of the left hand is descended, the right hand of the doctor falls on the themes of the patient to change the position of the head during rhinoscopy. The beak of the mirror in a closer form is introduced on the eve of the nose: the right half of the beak should be located at the bottom-inner corner of the anticipation of the nose, left - in the upper-outer corner. II and III fingers nazh-mold branches, the beak is revealed. First, they look at the nasal cavity, with the right position of the head: the color of the mucous membrane is pink, the surface is smooth, the nasal partition in the midline, the nasal sinks are not increased, the overall nasal stroke is free. For the inspection of the bottom of the nasal cavity, the patient's head tilted down, the middle nasal stroke - the stop and to the side, the rear departments are a few kice and up. Remove the nasal mirror with incomplete closure of the branches (so as not to infringe the hairs). The tip of the beak nasal mirror should not be introduced deeper on the beginning of the nasal mucosa in order to avoid injury of the Kisselbach zone. Also inspect the left half of the nose.
Rear Rososcopy. . To perform it, it is necessary: \u200b\u200ba spatula, a nose-pharyngeal mirror, reinforced in the handle and heated to the body temperature. The spatula is taken with her left and administered to the oral cavity from the right angle of the patient's mouth. The distal end of the spatula give the book the front ⅔ language. Nasopharyngeal mirror taking a right hand as a pen for writing, and administered mirror surface upward through the left corner of the open mouth of the patient in the oropharynx, of the soft palate without touching the root of the tongue and the posterior pharyngeal wall, the light from the reflector is incident on the surface of nasopharyngeal mirror and being reflected, Lights the nasopharynx and rear nasal cavity departments. The patient should try to breathe nose. In the mirror seen from the rear ends choanae turbinates and the coulter on the middle set of nasopharynx, pharyngeal side walls with the mouths of the auditory tubes (at the rear ends of the lower turbinate) pharyngeal tonsil on posterolateral upper wall nasopharynx.
Optical Rososcopy. . The technique of optical rhinoscopy is to examine all departments of the nasal cavity using optical rhinoscopes. The inspection begins with the introduction of a rososcope into the nasal cavity without anesthesia or with surface anesthesia with a solution of 10% lidocaine: a general nose-to-nasal stroke, a lower nose sink, a nasal partition, a nasopharynx, then the average nasal sink is inspected, the middle nose with the osteiathel complex, the top nose and Top nose sink with sfenhetmoid pocket.
Optical sinusoscopy - This is a study of the incomplete sinuses using optics. It is performed for inspecting the maxillary sinuses as the most susceptible to the inflammatory process and accessible to the study. The essence of the technique lies in the puncture of the maxillary sinus through its front wall or the bottom nose, followed by the inspection of the sinus telescope of Hopkins and the possible taking of the mucous membrane for histological examination or removal of the cyst.
Sounding and puncture. The probing of the anatomical structures of the nasal cavity is carried out in order to determine their consistency, mobility, prevalence. To perform this manipulation, use the butt or probe with cutting and chantering.
Sensing of the incomplete sinuses is carried out by special cannulas more often with therapeutic purposes: washing, injection of medicinal substances. This study can only be performed by an experienced specialist and therefore did not receive wide use in practice.
The puncture of the incomplete sinuses is used quite widely, both with diagnostic and therapeutic purposes. The most common puncture in diseases of the maxillary sinus is carried out, less often - with frontitles, phothenoids, etmoidites. The puncture of the maxillary sinus is carried out under the local anesthesia with a 10% solution of lidocaine through the lower nose course of the needle of Kulikovsky, retreat 2 cm from the front end of the lower nose-sink. The content is then aspirated and washed with saline, an antibiotic or antiseptic is introduced. Through the puncture needle, a drainage can be carried out in a maxillary sinus and conduct long-term treatment. With a properly performed puncture of the maxillary sinus, there is no complication.
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In children, usually up to 5 years, the nasal septum is not curved, and further, due to the uneven growth of bone and cartilage of the nasal septum occurs in varying degrees expressed its rejection. In adults, more often in men, the curvature of the nasal partition is observed in 95% of cases.
The upper wall of the nasal cavity in the front departments is formed by the nose bones, in the middle department - the lattice plate of the lattice bone (Lamina Cribrosa Ossis Ethmoidals). This is the narrowest roof area of \u200b\u200bthe nasal cavity - the width of only a few millimeters. The upper wall is very thin, and with careless operational interventions in the nasal cavity, damage to this thin plate with the occurrence of nasal lycvoreans is possible. With an acceding infection, the inflammation of brain shells is possible. The top wall is permeated by a large number (25-30) of small holes which pass into the nasal cavity of the olfactory nerve fibers (fila olphactoria) and vein, artery accompanying lattice (a ethmoidals.), - a source of possible heavy nosebleeds.
The bottom wall of the nasal cavity is degrading the nasal cavity from the oral cavity. It is formed by a chicken outfit of the upper jaw and a horizontal plate of a sky bone. The width of the nasal cavity in an adult is 12-15 mm, in a newborn - 7 mm.
Behind the nasal cavity is reported through the homans with the nasal part of the pharynx, in the newborn hanana have a triangular or rounded form of 6x6 mm2, and the age of 10 is doubled. In early age, the nasal moves are narrowed by nasal sinks. Inferior turbinate tight to the bottom of the nasal cavity, so in young children, even a slight inflammation of the nasal mucosa leads to a complete shutdown of nasal breathing, upset the act of sucking.
The mucous membrane of the nasal cavity sweeps two conditionally secreted zones - olfactory and respiratory. The respiratory area (Regio Respiratoria) captures the lower departments of the nasal cavity (from the bottom of the nose to the upper sections of the middle shell and is located opposite the lower part of the nasal partition). The mucous membrane of the respiratory zone is firmly associated with subject to bone and cartilage formations.
The thickness of the mucous membrane of the respiratory zone is about 1 mm. Opt mental base is absent. The mucous membrane of the nasal cavity is formed by cellular epithelium cells, as well as a large number of glassworm and basal cells. On the surface of each cell of the focusing epithelium there is 200-300 cilias, which make 160-250 oscillations per minute. These cilias fluctuate in the direction of the hindstores of the nasal cavity, to the Hanam. With inflammatory processes, metaplasia cells of focusing epithelium in walkers are possible. Basal cells contribute to the regeneration of the mucous membrane of the nasal cavity.
In the norm, the mucous membrane of the nasal cavity over the course of day allocates about 500 ml of fluid, which is necessary for the normal functioning of the nasal cavity. With inflammatory processes, the extractive ability of the mucous membrane of the nasal cavity increases many times. Under the cover of the mucous membrane of the nasal shells there is a fabric consisting of a plexusion of small and large blood vessels - "tangle" of extended veins, resembling a cavernous tissue. The walls of the veins are richly equipped with smooth muscle cells, which are innervated by the fibers of the trigeminal nerve and under the influence of irritation of its receptors can contribute to the filling or emptying of the cavernous tissue, mainly lower nose shells.
In the post-section of the nasal partition, it is possible to highlight a special area of \u200b\u200babout 1 cm2, where there is a large accumulation of arterial and especially venous vessels. This bleeding zone of the nasal partition is called "Kiselbakhovo Place", it is from this area most often nasal bleeding.
The olfactory area (Regio Olphactoria) captures the top sections of the middle shell, the entire upper sink and the top of the nasal partition surface. Axons (chattering nerve fibers) of olfactory cells in the form of 15-20 thin nervous yarns pass through the holes of the lattice plate into the cavity of the skull and enter the olfactory bulb. The dendrites of the second neuron are suitable for nerve cells of an olfactory triangle and reach subcortical centers. Further, the fibers of the third neuron begin, reaching the pyramidal neurons of the cortex - the central departments of the olfactory analyzer near the paraterial mulware.
Blood supply of nose cavity
The blood supply to the nasal cavity is carried out by the branches of the maxillary artery (A. Ta-Xilaris). From it, a wedge-shaped chicken artery departs (a. Sphenopalatina), which is in the nasal cavity through the hole of the same name at about the rear end level of the middle shell. It gives branches for the side wall of the nose and the nasal partition, anatomizes with a large palate artery (a. Palatina Major) and the artery of the upper lip (a. Labia sup.). In addition, the front and rear grate arteries (AA Etmoidalia) penetrate the nose cavity (A. Ophtalmica sup.), Which is the branch of the inner carotid artery (a. CAROTIS INT.).
1 - Kisselbachovo
Thus, the blood supply to the nasal cavity is carried out from the system of internal and outer carotid arteries, therefore, not always the interference of the outer carotid artery leads to a stop of persistent nose bleeding.
The veins of the nose cavity are superficially relative to the arteries and form in the mucous membrane of the nasal shells and nasal partitions several plexuses, one of which is Kiselbach. In the rear sections of the nasal partition also there is a cluster of venous vessels of larger diameter.
The outflow of venous blood from the nasal cavity goes in several directions. From the rear sections of the nose cavity, the venous blood enters the walled plexus associated with the cavernous sine (Sinus Cavernosus), located in the middle cranial fossa, so if the infectious process occurs in the nasal cavity and the nose of the pharynx, the infection in the skull cavity is possible.
From the front sections of the nose cavity, the venous blood enters the veins of the upper lip (w. Labiales), the corner veins (w. Angulares), which through the upper eye vein also penetrate the cavernous sine. That is why, with a furuncule, located in the entrance to the nose, it is also possible to spread infection to the cavity of the skull, the average cranial fossa.
The presence of the front and rear veins of the lattice labyrinth with the elephants of the orphanage can cause the transition of the inflammatory process from the lattice maze on the contents of the soccer. In addition, one of the branches of the front venture of the lattice labyrinth, passing through the lattice plate, penetrates into the front cranial fossa, an anatoming with a mild cerebral vein. Due to the thick venous network with numerous anastomoses in the border areas, such severe complications are possible, such as thrombophlebitis of the maxillofacial region, the veins of the society, the sinus thrombosis, the development of sepsis.
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