3 курс / Топографическая анатомия и оперативная хирургия / ТАиОХ голова

Ɋɢɫ 4.14. ȼɟɧɵ ɥɢɰɚ ɢ ɫɢɧɭɫɵ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɢ

1 ² sinus sagittalis superior;

2 ² sinus sagittalis inferior; 3 ² v. cerebri magna (Galeni); 4 ² sinus transversus;

5 ² sinus rectus; 6 ² sinus petrosus superior et inferior; 7 ² v. jugularis interna;

8 ² v. retromandibularis;

9 ² m. sternocleidomastoideus;

10 ² plexus venosus pterygoideus;

11 ² v. facialis; 12 ² a. ophthalmica inferior; 13 ² a. ophthalmica superior; 14 ² sinus intercavernosus;

15 ² sinus cavernosus;

16 ² sinus sphenoparietalis;

17 ² v. emissaria parietalis.

Ɂɚ ɩɨɞɤɨɠɧɨɣ ɤɥɟɬɱɚɬɤɨɣ ɪɚɫɩɨɥɨɠɟɧɚ ɳɟɱɧɨ-ɝɥɨɬɨɱɧɚɹ ɮɚɫɰɢɹ fascia buccopharyngea Ɉɧɚ ɩɨɤɪɵɜɚɟɬ ɳɟɱɧɭɸ ɦɵɲɰɭ ɫɧɚɪɭɠɢ ɢ ɭ ɟɟ ɡɚɞɧɟɝɨ ɤɪɚɹ ɨɛɪɚɡɭ ɟɬ ɭɩɥɨɬɧɟɧɢɟ ɜ ɜɢɞɟ ɫɜɹɡɤɢ ɤɪɵɥɨɜɢɞɧɨ-ɧɢɠɧɟɱɟɥɸɫɬɧɨɣ ɲɨɜ ± raphe pterygomandibularis) ɧɚɬɹɧɭɬɨɣ ɦɟɠɞɭ ɤɪɸɱɤɨɦ ɤɪɵɥɨɜɢɞɧɨɝɨ ɨɬɪɨɫɬɤɚ ɢ ɳɟɱɧɨɣ ɥɢ ɧɢɟɣ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ ȼ ɞɚɥɶɧɟɣɲɟɦ ɮɚɫɰɢɹ ɩɟɪɟɯɨɞɢɬ ɜ ɡɚɞɧɟɦ ɨɬɞɟɥɟ ɧɚ ɝɥɨɬ ɤɭ ɝɞɟ ɩɨɤɪɵɜɚɟɬ ɟɟ ɜɟɪɯɧɢɣ ɤɨɧɫɬɪɢɤɬɨɪ.

ɉɨɞ ɭɤɚɡɚɧɧɨɣ ɮɚɫɰɢɟɣ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɳɟɱɧɚɹ ɦɵɲɰɚ m. buccinator ɤɨɬɨɪɚɹ ɧɚɱɢɧɚɟɬɫɹ ɨɬ ɤɪɵɥɨɜɢɞɧɨ-ɧɢɠɧɟɱɟɥɸɫɬɧɨɝɨ ɲɜɚ ɬɚɤɠɟ ɨɬ ɜɟɪɯɧɟɣ ɢ ɧɢɠɧɟɣ ɱɟ ɥɸɫɬɢ ɢ ɜɩɥɟɬɚɟɬɫɹ ɫɩɟɪɟɞɢ ɜ ɤɪɭɝɨɜɭɸ ɦɵɲɰɭ ɪɬɚ ɢ ɞɪɭɝɢɟ ɦɵɲɰɵ ɪɚɫɩɨɥɨ ɠɟɧɧɵɟ ɜɨɤɪɭɝ ɪɨɬɨɜɨɝɨ ɨɬɜɟɪɫɬɢɹ ɓɟɱɧɚɹ ɦɵɲɰɚ ɫ ɜɧɭɬɪɟɧɧɟɣ ɫɬɨɪɨɧɵ ɩɨɤɪɵ ɬɚ ɫɥɢɡɢɫɬɨɣ ɨɛɨɥɨɱɤɨɣ ɢɧɬɢɦɧɨ ɫɜɹɡɚɧɚ ɫ ɧɟɣ ɇɚ ɭɪɨɜɧɟ ɩɟɪɜɵɯ ɜɟɪɯɧɢɯ ɦɨɥɹ ɪɨɜ ɨɧɚ ɩɪɨɛɨɞɚɟɬɫɹ ɜɵɜɨɞɧɵɦ ɩɪɨɬɨɤɨɦ ɨɤɨɥɨɭɲɧɨɣ ɠɟɥɟɡɵ

Ɉɤɨɥɨɭɲɧɨ-ɠɟɜɚɬɟɥɶɧɚɹ ɨɛɥɚɫɬɶ (regio parotideomasseterica)

Ƚɪɚɧɢɰɵ

ȼɟɪɯɧɹɹ ² ɫɤɭɥɨɜɚɹ ɞɭɝɚ; ɧɢɠɧɹɹ ² ɧɢɠɧɢɣ ɤɪɚɣ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ;

ɩɟɪɟɞɧɹɹ ² ɩɟɪɟɞɧɢɣ ɤɪɚɣ ɠɟɜɚɬɟɥɶɧɨɣ ɦɵɲɰɵ; ɡɚɞɧɹɹ ² ɥɢɧɢɹ ɩɪɨɜɟɞɟɧɧɚɹ ɨɬ ɧɚɪɭɠɧɨɝɨ ɫɥɭɯɨɜɨɝɨ ɩɪɨɯɨɞɚ ɞɨ ɜɟɪɯɭɲɤɢ ɫɨɫɰɟɜɢɞɧɨɝɨ ɨɬɪɨɫɬɤɚ ɪɢɫ .

Ʉɨɠɚ ɬɨɧɤɚɹ ɷɥɚɫɬɢɱɧɚɹ ɫɨɞɟɪɠɢɬ ɛɨɥɶɲɨɟ ɤɨɥɢɱɟɫɬɜɨ ɩɨɬɨɜɵɯ ɢ ɫɚɥɶɧɵɯ ɠɟɥɟɡ ɉɨɞɤɨɠɧɚɹ ɠɢɪɨɜɚɹ ɤɥɟɬɱɚɬɤɚ ɬɨɧɤɨɣ ɩɨɜɟɪɯɧɨɫɬɧɨɣ ɮɚɫɰɢɟɣ ɪɚɡɞɟɥɹɟɬɫɹ ɧɚ ɞɜɚ ɫɥɨɹ ɩɨɜɟɪɯɧɨɫɬɧɵɣ ɢ ɝɥɭɛɨɤɢɣ

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ɉɨɞɤɨɠɧɚɹ ɤɥɟɬɱɚɬɤɚ ɩɪɨɧɢɡɚɧɚ ɫɨɟɞɢɧɢɬɟɥɶɧɧɨ-ɬɤɚɧɧɵɦɢ ɬɹɠɚɦɢ ɫɜɹɡɵɜɚɸɳɢɦɢ ɤɨɠɭ ɫ ɫɨɛɫɬɜɟɧɧɨɣ ɮɚɫɰɢɟɣ

ȼ ɝɥɭɛɨɤɨɦ ɫɥɨɟ ɩɨɞɤɨɠɧɨɣ ɠɢɪɨɜɨɣ ɤɥɟɬɱɚɬɤɢ ɩɪɨɯɨɞɹɬ ɜɟɬɜɢ ɧɢɠɧɟɱɟɥɸɫɬɧɨɝɨ ɧɟɪɜɚ ɢ ɱɚɫɬɢɱɧɨ ɛɨɥɶɲɨɣ ɭɲɧɨɣ ɧɟɪɜ ɢɡ ɲɟɣɧɨɝɨ ɫɩɥɟɬɟɧɢɹ ɢɧɧɟɪɜɢɪɭɸɳɢɟ ɤɨɠɭ ɷɬɨɣ ɨɛɥɚɫɬɢ ɬɚɤɠɟ ɜɟɬɜɢ ɥɢɰɟɜɨɝɨ ɧɟɪɜɚ ɢɧɧɟɪɜɢɪɭɸɳɢɟ ɦɢɦɢɱɟɫɤɢɟ ɦɵɲɰɵ ɥɢɰɚ

ɋɨɛɫɬɜɟɧɧɚɹ ɮɚɫɰɢɹ ɨɤɨɥɨɭɲɧɨ-ɠɟɜɚɬɟɥɶɧɨɣ ɨɛɥɚɫɬɢ ɜɤɥɸɱɚɟɬ ɠɟɜɚɬɟɥɶɧɭɸ ɮɚɫɰɢɸ fascia masseterica ɢ ɮɚɫɰɢɸ ɨɤɨɥɨɭɲɧɨɣ ɠɟɥɟɡɵ fascia parotidea) ɹɜɥɹɹɫɶ ɩɪɨɞɨɥɠɟɧɢɟɦ ɫɨɛɫɬɜɟɧɧɨɣ ɮɚɫɰɢɢ ɲɟɢ ɩɟɪɟɯɨɞɹ ɧɚ ɥɢɰɨ ɜ ɧɢɠɧɢɯ ɨɬɞɟɥɚɯ ɩɪɢɤɪɟɩɥɹɟɬɫɹ ɩɨ ɧɢɠɧɟɦɭ ɤɪɚɸ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ ɢ ɟɟ ɭɝɥɭ ɚ ɜɜɟɪɯɭ ± ɤ ɧɚɞɤɨɫɬɧɢɰɟ ɫɤɭɥɨɜɨɣ ɞɭɝɢ ɗɬɚ ɮɚɫɰɢɹ ɩɨɤɪɵɜɚɟɬ ɠɟɜɚɬɟɥɶɧɭɸ ɦɵɲ ɰɭ m. masseter) ɢ ɪɚɫɳɟɩɥɹɹɫɶ ɨɛɪɚɡɭɟɬ ɤɚɩɫɭɥɭ ɞɥɹ ɨɤɨɥɨɭɲɧɨɣ ɠɟɥɟɡɵ ɇɚɪɭɠɧɵɣ ɥɢɫɬɨɤ ɮɚɫɰɢɢ ɞɨɜɨɥɶɧɨ ɩɥɨɬɧɵɣ Ɉɬ ɧɟɝɨ ɜ ɬɨɥɳɭ ɠɟɥɟɡɵ ɦɟɠɞɭ ɟɟ ɞɨɥɶɤɚɦɢ ɨɬɯɨɞɹɬ ɩɟɪɟɝɨɪɨɞɤɢ ȼɧɭɬɪɟɧɧɢɣ ɥɢɫɬɨɤ ɛɨɥɟɟ ɬɨɧɤɢɣ ɢ ɢɦɟɟɬ ɪɹɞ ɞɟɮɟɤɬɨɜ Ɉɞɢɧ ɢɡ ɧɢɯ ɪɚɫɩɨɥɨɠɟɧ ɜɜɟɪɯɭ ɜ ɦɟɫɬɟ ɩɪɢɥɟɝɚɧɢɹ ɠɟɥɟɡɵ ɤ ɯɪɹɳɟɜɨɣ ɱɚɫɬɢ ɧɚɪɭɠɧɨɝɨ ɫɥɭɯɨɜɨɝɨ ɩɪɨɯɨɞɚ Ɂɞɟɫɶ ɢɦɟɸɬɫɹ ɳɟɥɢ ɤɨɬɨɪɵɟ ɩɪɨɯɨɞɹɬ ɥɢɦɮɚɬɢɱɟɫɤɢɟ ɫɨɫɭɞɵ ɇɚɝɧɨɢɬɟɥɶɧɵɟ ɩɪɨɰɟɫɫɵ ɠɟɥɟɡɵ ɱɟɪɟɡ ɷɬɢ ɳɟɥɢ ɦɨɝɭɬ ɩɪɨɪɵɜɚɬɶɫɹ ɜ ɧɚɪɭɠɧɵɣ ɫɥɭɯɨɜɨɣ ɩɪɨɯɨɞ Ⱦɪɭɝɨɣ ɞɟɮɟɤɬ ɤɚɩɫɭɥɵ ɪɚɫɩɨɥɨɠɟɧ ɜ ɨɛɥɚɫɬɢ ɜɵɩɹɱɢɜɚɧɢɹ ɝɥɨɬɨɱɧɨɝɨ ɨɬɪɨɫɬɤɚ ɨɤɨɥɨɭɲɧɨɣ ɠɟɥɟɡɵ ɤɨɬɨɪɵɣ ɧɟ ɩɨɤɪɵɬ ɤɚɩɫɭɥɨɣ Ɉɬɪɨɫɬɨɤ ɜɵɩɨɥɧɹɟɬ ɩɪɨɦɟɠɭɬɨɤ ɦɟɠɞɭ ɲɢɥɨɜɢɞɧɵɦ ɨɬɪɨɫɬɤɨɦ ɢ ɜɧɭɬɪɟɧɧɟɣ ɤɪɵɥɨɜɢɞɧɨɣ ɦɵɲɰɟɣ ± ɷɬɢɦ ɩɭɬɟɦ ɜɨɫɩɚɥɢɬɟɥɶɧɵɟ ɩɪɨɰɟɫɫɵ ɦɨɝɭɬ ɩɪɨɧɢɤɚɬɶ ɢɡ ɤɚɩɫɭɥɵ ɨɤɨɥɨɭɲɧɨɣ ɠɟɥɟɡɵ ɜ ɨɤɨɥɨɝɥɨɬɨɱɧɨɟ ɩɪɨɫɬɪɚɧɫɬɜɨ

Ɉɤɨɥɨɭɲɧɚɹ ɠɟɥɟɡɚ glandula parotidea) ɹɜɥɹɟɬɫɹ ɫɚɦɨɣ ɤɪɭɩɧɨɣ ɫɥɸɧɧɨɣ ɠɟɥɟɡɨɣ ɫɟɪɨɡɧɨɝɨ ɬɢɩɚ ɢɦɟɟɬ ɞɨɥɶɱɚɬɨɟ ɫɬɪɨɟɧɢɟ ɪɢɫ ȼɵɜɨɞɧɨɣ ɩɪɨɬɨɤ ɠɟɥɟɡɵ ductus parotideus ɞɥɢɧɨɣ ɨɤɨɥɨ ɫɦ ɨɬɯɨɞɢɬ ɨɬ ɟɟ ɩɟɪɟɞɧɟɝɨ ɤɪɚɹ ȼɧɚ ɱɚɥɟ ɨɧ ɥɟɠɢɬ ɧɚ ɩɟɪɟɞɧɟɣ ɩɨɜɟɪɯɧɨɫɬɢ ɠɟɜɚɬɟɥɶɧɨɣ ɦɵɲɰɵ ɡɚɬɟɦ ɨɝɢɛɚɟɬ ɟɟ ɩɟɪɟɞɧɢɣ ɤɪɚɣ ɩɪɨɯɨɞɢɬ ɱɟɪɟɡ ɬɨɥɳɭ ɠɢɪɨɜɨɝɨ ɬɟɥɚ ɳɟɤɢ ɢ ɩɪɨɛɨɞɚɟɬ ɳɟɱɧɭɸ ɦɵɲɰɭ ɉɪɨɣɞɹ ɡɚɬɟɦ ɩɨɞ ɫɥɢɡɢɫɬɨɣ ɨɛɨɥɨɱɤɨɣ - ɫɦ ɨɧ ɨɬɤɪɵɜɚɟɬɫɹ ɜ ɩɪɟɞ ɞɜɟɪɢɟ ɪɬɚ ɧɚ ɭɪɨɜɧɟ ɦɟɠɞɭ ɩɟɪɜɵɦɢ ɢ ɜɬɨɪɵɦɢ ɜɟɪɯɧɢɦɢ ɤɨɪɟɧɧɵɦɢ ɡɭɛɚɦɢ ɉɪɨɟɰɢɪɭɟɬɫɹ ɩɪɨɬɨɤ ɩɨ ɥɢɧɢɢ ɫɨɟɞɢɧɹɸɳɟɣ ɨɫɧɨɜɚɧɢɟ ɦɨɱɤɢ ɭɯɚ ɫ ɤɪɵɥɨɦ ɧɨ ɫɚ

ȼ ɬɨɥɳɟ ɨɤɨɥɨɭɲɧɨɣ ɠɟɥɟɡɵ ɪɚɫɩɨɥɚɝɚɸɬɫɹ ɫɨɫɭɞɢɫɬɨ-ɧɟɪɜɧɵɟ ɨɛɪɚɡɨɜɚɧɢɹ ɧɚɪɭɠɧɚɹ ɫɨɧɧɚɹ ɚɪɬɟɪɢɹ ɩɨɡɚɞɢɱɟɥɸɫɬɧɚɹ ɜɟɧɚ ɥɢɰɟɜɨɣ ɢ ɭɲɧɨ-ɜɢɫɨɱɧɵɣ ɧɟ ɪɜɵ Ɉɧɢ ɩɪɨɧɢɡɵɜɚɸɬ ɟɟ ɜ ɬɪɟɯ ɧɚɩɪɚɜɥɟɧɢɹɯ

ȼ ɜɟɪɬɢɤɚɥɶɧɨɦ ɧɚɩɪɚɜɥɟɧɢɢ ɫɧɢɡɭ ɜɜɟɪɯ ɩɪɨɯɨɞɢɬ ɧɚɪɭɠɧɚɹ ɫɨɧɧɚɹ ɚɪɬɟ

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ɪɢɹ ɫ ɟɟ ɤɨɧɟɱɧɵɦɢ ɜɟɬɜɹɦɢ ɩɨɜɟɪɯɧɨɫɬɧɨɣ ɜɢɫɨɱɧɨɣ ɚɪɬɟɪɢɟɣ ɢɞɭɳɟɣ ɜ ɫɨɩɪɨ ɜɨɠɞɟɧɢɢ ɭɲɧɨ-ɜɢɫɨɱɧɨɝɨ ɧɟɪɜɚ n. auriculotemporalis ɢ ɨɬɞɚɸɳɟɣ ɩɨɩɟɪɟɱɧɭɸ ɚɪɬɟɪɢɸ ɥɢɰɚ a. transversa faciei ɢ ɜɟɪɯɧɟɱɟɥɸɫɬɧɨɣ ɚɪɬɟɪɢɟɣ ɩɟɪɟɯɨɞɹɳɟɣ ɜ ɝɥɭɛɨɤɭɸ ɨɛɥɚɫɬɶ ɥɢɰɚ ɢ ɩɨɡɚɞɢɱɟɥɸɫɬɧɨɣ ɜɟɧɨɣ v. retromandibularis).

ɋɡɚɞɢ ɧɚɩɟɪɟɞ ɩɪɨɯɨɞɹɬ ɜɟɬɜɢ ɥɢɰɟɜɨɝɨ ɧɟɪɜɚ ɉɨɫɥɟɞɧɢɣ ɩɨ ɜɵɯɨɞɟ ɢɡ ɥɢɰɟɜɨɝɨ ɤɚɧɚɥɚ canalis facialis ɱɟɪɟɡ ɲɢɥɨ-ɫɨɫɰɟɜɢɞɧɨɟ ɨɬɜɟɪɫɬɢɟ for. stylomastoideum ɜɫɬɭɩɚɟɬ ɜ ɬɨɥɳɭ ɨɤɨɥɨɭɲɧɨɣ ɠɟɥɟɡɵ Ɂɞɟɫɶ ɨɧ ɪɚɫɫɵɩɚɟɬɫɹ ɧɚ ɦɧɨ ɝɨɱɢɫɥɟɧɧɵɟ ɜɟɬɜɢ ɨɛɪɚɡɭɸɳɢɟ ɨɤɨɥɨɭɲɧɨɟ ɫɩɥɟɬɟɧɢɟ plexus parotideus ȼɟɬɜɢ ɥɢɰɟɜɨɝɨ ɧɟɪɜɚ ɪɚɡɜɟɬɜɥɹɸɬɫɹ ɧɚ ɛɨɤɨɜɨɣ ɩɨɜɟɪɯɧɨɫɬɢ ɥɢɰɚ ɜ ɪɚɞɢɚɥɶɧɨɦ

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ɧɚɩɪɚɜɥɟɧɢɢ ɜ ɜɢɞɟ ɝɭɫɢɧɨɣ ɥɚɩɤɢ ɱɬɨ ɫɥɟɞɭɟɬ ɭɱɢɬɵɜɚɬɶ ɩɪɢ ɪɚɡɪɟɡɚɯ ɜ ɷɬɨɣ ɨɛ ɥɚɫɬɢ

Ɋɢɫ Ɉɤɨɥɨɭɲɧɚɹ ɫɥɸɧɧɚɹ ɠɟɥɟɡɚ

Ɉɛɵɱɧɨ ɧɚ ɥɢɰɟ ɪɚɡɥɢɱɚɸɬ ɩɹɬɶ ɨɫɧɨɜɧɵɯ ɜɟɬɜɟɣ ɥɢɰɟɜɨɝɨ ɧɟɪɜɚ ɜɢɫɨɱɧɵɟ (rr. temporales ɫɤɭɥɨɜɵɟ rr. zygomatici ɳɟɱɧɵɟ rr. buccales ɤɪɚɟɜɚɹ ɧɢɠɧɟɱɟ ɥɸɫɬɧɚɹ r. marginalis mandibulae ɢ ɲɟɣɧɚɹ r. coli Ʉɪɨɦɟ ɬɨɝɨ ɢɦɟɟɬɫɹ ɡɚɞɧɢɣ ɭɲɧɨɣ ɧɟɪɜ n. auricularis posterior) ȼɟɬɜɢ ɥɢɰɟɜɨɝɨ ɧɟɪɜɚ ɫɧɚɛɠɚɸɬ ɦɢɦɢɱɟɫɤɢɟ ɦɵɲɰɵ ɥɢɰɚ ɥɨɛɧɭɸ ɢ ɡɚɬɵɥɨɱɧɭɸ ɦɵɲɰɵ ɩɨɞɤɨɠɧɭɸ ɦɵɲɰɭ ɲɟɢ m. platysma ɲɢɥɨɩɨɞɴɹɡɵɱɧɭɸ ɦɵɲɰɭ m. stylohyoideus ɢ ɡɚɞɧɟɟ ɛɪɸɲɤɨ ɞɜɭɛɪɸɲɧɨɣ ɦɵɲɰɵ m. digastricus) ɪɢɫ 15-4.16).

ɂɡɧɭɬɪɢ ɤɧɚɪɭɠɢ ɜ ɬɨɥɳɟ ɠɟɥɟɡɵ ɩɪɨɯɨɞɢɬ ɭɲɧɨ-ɜɢɫɨɱɧɵɣ ɧɟɪɜ ɢɡ III ɜɟɬɜɢ ɬɪɨɣɧɢɱɧɨɝɨ=ɧɟɪɜɚ Ɉɧ ɢɞɟɬ ɜɦɟɫɬɟ ɫ ɩɨɜɟɪɯɧɨɫɬɧɨɣ ɜɢɫɨɱɧɨɣ ɚɪɬɟɪɢɟɣ ɢ ɜɟɧɨɣ ɢ ɪɚɡɜɟɬɜɥɹɟɬɫɹ ɜ ɜɢɫɨɱɧɨɣ ɨɛɥɚɫɬɢ ɉɨ ɫɧɹɬɢɸ ɨɤɨɥɨɭɲɧɨ-ɠɟɜɚɬɟɥɶɧɨɣ ɮɚɫɰɢɢ ɜɦɟɫɬɟ ɫ ɨɤɨɥɨɭɲɧɨɣ ɠɟɥɟɡɨɣ ɨɛɧɚɪɭɠɢɜɚɟɦ ɠɟɜɚɬɟɥɶɧɭɸ ɦɵɲɰɭ ɤɨɬɨ ɪɚɹ ɧɚɱɢɧɚɟɬɫɹ ɨɬ ɫɤɭɥɨɜɨɣ ɞɭɝɢ ɢ ɩɪɢɤɪɟɩɥɹɟɬɫɹ ɤ ɭɝɥɭ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ

ɇɟɩɨɫɪɟɞɫɬɜɟɧɧɨ ɡɚ ɠɟɜɚɬɟɥɶɧɨɣ ɦɵɲɰɨɣ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɜɟɬɜɶ ɧɢɠɧɟɣ ɱɟɥɸ ɫɬɢ r. mandibulae) ɍɞɚɥɢɜ ɩɨɫɥɟɞɧɸɸ ɩɨɩɚɞɚɟɦ ɜ ɝɥɭɛɨɤɢɣ ɨɬɞɟɥ ɛɨɤɨɜɨɣ ɨɛɥɚ ɫɬɢ ɥɢɰɚ

ȼ ɨɛɥɚɫɬɢ ɨɤɨɥɨɭɲɧɨɣ ɠɟɥɟɡɵ ɢɦɟɸɬɫɹ ɩɨɜɟɪɯɧɨɫɬɧɵɟ ɢ ɝɥɭɛɨɤɢɟ ɨɤɨɥɨɭɲɧɵɟ ɥɢɦɮɚɬɢɱɟɫɤɢɟ ɭɡɥɵ nodi lymphatici parotide superficiales et profundi). Ƚɥɭɛɨɤɢɟ ɨɤɨɥɨɭɲɧɵɟ ɥɢɦɮɚɬɢɱɟɫɤɢɟ ɭɡɥɵ ɜɤɥɸɱɚɸɬ ɬɪɢ ɝɪɭɩɩɵ ɨɞɧɚ ɢɡ ɧɢɯ ± ɩɪɟɞɭɲɧɵɟ ɥɢɦɮɚɬɢɱɟɫɤɢɟ ɭɡɥɵ nodi lymphatici preauriculares ɪɚɫɩɨɥɚ ɝɚɸɬɫɹ ɜɩɟɪɟɞɢ ɤɨɡɟɥɤɚ ɭɲɧɨɣ ɪɚɤɨɜɢɧɵ ɜɧɟ ɤɚɩɫɭɥɵ ɠɟɥɟɡɵ ɞɪɭɝɚɹ ± ɧɢɠɧɟ ɭɲɧɵɟ nodi lymphatici infraauriculares) ± ɧɢɠɟ ɭɲɧɨɣ ɪɚɤɨɜɢɧɵ ɜɛɥɢɡɢ ɡɚɞɧɟɝɨ ɤɪɚɹ ɧɢɠɧɟɝɨ ɨɬɪɟɡɤɚ ɨɤɨɥɨɭɲɧɨɣ ɠɟɥɟɡɵ ɬɪɟɬɶɹ ɝɪɭɩɩɚ ± ɜɧɭɬɪɢɠɟɥɟɡɢɫɬɵɟ (nodi lymphatici intraglandulares) ɪɚɫɩɨɥɚɝɚɸɬɫɹ ɜ ɬɨɥɳɟ ɠɟɥɟɡɵ ɩɪɟɢɦɭɳɟɫɬɜɟɧ

25

ɧɨ ɩɨ ɯɨɞɭ ɧɚɪɭɠɧɨɣ ɫɨɧɧɨɣ ɚɪɬɟɪɢɢ ȼ ɩɨɫɥɟɞɧɟɣ ɝɪɭɩɩɟ ɜɫɬɪɟɱɚɸɬɫɹ ɭɡɥɵ ɥɟ ɠɚɳɢɟ ɧɚ ɩɨɜɟɪɯɧɨɫɬɢ ɠɟɥɟɡɵ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨ ɩɨɞ ɟɟ ɤɚɩɫɭɥɨɣ

Ɋɢɫ 4.16 ɉɪɨɟɤɰɢɢ ɜɟɬɜɟɣ ɥɢɰɟɜɨɝɨ ɧɟɪɜɚ

1 ² rr. temporales;

2 ² rr. zygomatici;

3 ² rr. buccales;

4 ² ɝ. marginalis mandibularis;

5 ² ɝ. colli.

Ƚɥɭɛɨɤɚɹ ɨɛɥɚɫɬɶ ɥɢɰɚ (regio facialis profunda)

Ɉɝɪɚɧɢɱɟɧɚ ɩɪɟɞɟɥɚɦɢ ɩɨɞɜɢɫɨɱɧɨɣ ɢ ɤɪɵɥɨɜɢɞɧɨ-ɧɟɛɧɨɣ ɹɦɨɤ ɢ ɫɬɚɧɨɜɢɬɶ ɫɹ ɞɨɫɬɭɩɧɨɣ ɞɥɹ ɢɡɭɱɟɧɢɹ ɩɨɫɥɟ ɭɞɚɥɟɧɢɹ ɠɟɜɚɬɟɥɶɧɨɣ ɦɵɲɰɵ ɜɟɬɜɢ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ ɢ ɫɤɭɥɨɜɨɣ ɞɭɝɢ ɋɭɳɟɫɬɜɭɟɬ ɢ ɞɪɭɝɨɟ ɧɚɡɜɚɧɢɟ ² ɦɟɠɱɟɥɸɫɬɧɚɹ ɨɛɥɚɫɬɶ

Ƚɪɚɧɢɰɵ

ɫɧɚɪɭɠɢ ² ɜɟɬɜɶ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ ɢ ɜɧɭɬɪɟɧɧɹɹ ɩɨɜɟɪɯɧɨɫɬɶ ɜɢɫɨɱɧɨɣ ɦɵɲɰɵ; ɫɩɟɪɟɞɢ ² ɛɭɝɨɪ ɜɟɪɯɧɟɣ ɱɟɥɸɫɬɢ; ɦɟɞɢɚɥɶɧɨ ² ɛɨɤɨɜɚɹ ɩɨɜɟɪɯɧɨɫɬɶ ɝɥɨɬɤɢ;

ɫɜɟɪɯɭ ² ɬɚ ɱɚɫɬɶ ɧɚɪɭɠɧɨɝɨ ɨɫɧɨɜɚɧɢɹ ɱɟɪɟɩɚ ɤɨɬɨɪɚɹ ɫɨɨɬɜɟɬɫɬɜɭɟɬ ɫɪɟɞ ɧɟɣ ɱɟɪɟɩɧɨɣ ɹɦɤɟ

ɉɨɞɜɢɫɨɱɧɚɹ ɹɦɤɚ fossa infratemporalis) ɹɜɥɹɟɬɫɹ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɵɦ ɩɪɨ ɞɨɥɠɟɧɢɟɦ ɜɢɫɨɱɧɨɣ ɹɦɤɢ ɢ ɨɬɞɟɥɹɟɬɫɹ ɨɬ ɩɨɫɥɟɞɧɟɣ ɩɨɞɜɢɫɨɱɧɵɦ ɝɪɟɛɧɟɦ crista infratemporalis ɛɨɥɶɲɨɝɨ ɤɪɵɥɚ ɤɪɵɥɨɜɢɞɧɨɣ ɤɨɫɬɢ

Ƚɪɚɧɢɰɵ

əɦɤɚ ɨɝɪɚɧɢɱɟɧɚ

ɢɡɧɭɬɪɢ ɥɚɬɟɪɚɥɶɧɨɣ ɩɥɚɫɬɢɧɤɨɣ ɤɪɵɥɨɜɢɞɧɨɝɨ ɨɬɪɨɫɬɤɚ lamina lateralis processus pterygoidei);

26

ɫɧɚɪɭɠɢ ± ɜɟɬɜɶɸ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ ɢ ɜɧɭɬɪɟɧɧɟɣ ɩɨɜɟɪɯɧɨɫɬɶɸ ɠɟɜɚɬɟɥɶɧɨɣ ɦɵɲɰɵ

ɉɟɪɟɞɧɟɣ ɫɬɟɧɤɨɣ ɫɥɭɠɢɬ ɧɢɠɧɹɹ ɜɢɫɨɱɧɚɹ ɩɨɜɟɪɯɧɨɫɬɶ ɢɥɢ ɛɭɝɨɪ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ tuber maxillae ɢ ɧɢɠɧɹɹ ɱɚɫɬɶ ɫɤɭɥɨɜɨɣ ɤɨɫɬɢ;

ɜɟɪɯɧɟɣ ɫɬɟɧɤɨɣ ± ɧɢɠɧɹɹ ɩɨɜɟɪɯɧɨɫɬɶ ɛɨɥɶɲɨɝɨ ɤɪɵɥɚ ɤɥɢɧɨɜɢɞɧɨɣ ɤɨɫɬɢ ɢ ɧɟɛɨɥɶɲɚɹ ɱɚɫɬɶ ɱɟɲɭɢ ɜɢɫɨɱɧɨɣ ɤɨɫɬɢ ɚ ɬɚɤɠɟ ɧɢɠɧɹɹ ɝɥɚɡɧɢɱɧɚɹ ɳɟɥɶ

ɫɧɢɡɭ ɝɪɚɧɢɱɢɬ ɫ ɪɨɬɨɜɨɣ ɩɨɥɨɫɬɶɸ cavitas oris);

ɫɡɚɞɢ - ɲɢɥɨɜɢɞɧɵɦ ɨɬɪɨɫɬɤɨɦ ɫ ɦɵɲɰɚɦɢ ©ɚɧɚɬɨɦɢɱɟɫɤɨɝɨ ɛɭɤɟɬɚª Ʉɧɭɬɪɢ ɩɨɞɜɢɫɨɱɧɚɹ ɹɦɤɚ ɩɟɪɟɯɨɞɢɬ ɜ ɤɪɵɥɨɜɢɞɧɨ-ɧɟɛɧɭɸ fossa ptery-

gopalatina). ɉɨɫɥɟɞɧɹɹ ɢɦɟɟɬ ɳɟɥɟɜɢɞɧɭɸ ɮɨɪɦɭ ɢ ɪɚɫɩɨɥɨɠɟɧɚ ɦɟɠɞɭ ɤɪɵɥɨ ɜɢɞɧɵɦɢ ɨɬɪɨɫɬɤɚɦɢ ɫɡɚɞɢ ɢ ɛɭɝɪɨɦ ɜɟɪɯɧɟɣ ɱɟɥɸɫɬɢ ɫɩɟɪɟɞɢ Ɇɟɞɢɚɥɶɧɨɣ ɫɬɟɧ ɤɨɣ ɫɥɭɠɢɬ ɩɟɪɩɟɧɞɢɤɭɥɹɪɧɚɹ ɩɥɚɫɬɢɧɤɚ ɧɟɛɧɨɣ ɤɨɫɬɢ ɤɨɬɨɪɚɹ ɨɬɞɟɥɹɟɬ ɟɟ ɨɬ ɩɨɥɨɫɬɢ ɧɨɫɚ ɜɟɪɯɧɟɣ ɫɬɟɧɤɨɣ ± ɛɨɥɶɲɨɟ ɤɪɵɥɨ ɨɫɧɨɜɧɨɣ ɤɨɫɬɢ Ʉɪɵɥɨɜɢɞɧɨɧɟɛɧɚɹ ɹɦɤɚ ɩɪɢ ɩɨɦɨɳɢ ɨɬɜɟɪɫɬɢɣ ɫɨɨɛɳɚɟɬɫɹ ɫ ɞɪɭɝɢɦɢ ɨɬɞɟɥɚɦɢ ɥɢɰɚ ɧɨɫɨ ɜɨɣ ɩɨɥɨɫɬɶɸ ɱɟɪɟɡ ɤɪɵɥɨɜɢɞɧɨ-ɧɟɛɧɨɟ ɨɬɜɟɪɫɬɢɟ for. sphenopalatinum ɝɞɟ ɩɪɨ ɯɨɞɢɬ ɨɞɧɨɢɦɟɧɧɚɹ ɚɪɬɟɪɢɹ ɜɟɧɚ ɢ nn. nasales posteriores ɩɨɥɨɫɬɶɸ ɫɪɟɞɧɟɣ ɱɟ ɪɟɩɧɨɣ ɹɦɤɢ ɱɟɪɟɡ ɤɪɭɝɥɨɟ ɨɬɜɟɪɫɬɢɟ ɝɞɟ ɩɪɨɯɨɞɢɬ II ɜɟɬɜɶ ɬɪɨɣɧɢɱɧɨɝɨ ɧɟɪɜɚ ɩɨɥɨɫɬɶɸ ɝɥɚɡɧɢɰɵ ɱɟɪɟɡ ɧɢɠɧɟɝɥɚɡɧɢɱɧɭɸ ɳɟɥɶ fissura orbitalis inferior ɩɨɥɨ ɫɬɶɸ ɪɬɚ ɱɟɪɟɡ ɤɪɵɥɨɜɢɞɧɨ-ɧɟɛɧɵɣ ɤɚɧɚɥ canalis pterygopalatinus ɜ ɤɨɬɨɪɨɦ ɩɪɨɯɨɞɹɬ ɧɟɛɧɵɟ ɧɟɪɜɵ ɢ ɫɨɫɭɞɵ ɫ ɨɫɧɨɜɚɧɢɟɦ ɱɟɪɟɩɚ ɱɟɪɟɡ ɤɪɵɥɨɜɢɞɧɵɣ ɤɚɧɚɥ (canalis pterygoideus ɝɞɟ ɩɪɨɯɨɞɢɬ ɨɞɧɨɢɦɟɧɧɵɣ ɧɟɪɜ

ɍɤɚɡɚɧɧɵɟ ɹɦɤɢ ɫɨɫɬɚɜɥɹɸɳɢɟ ɝɥɭɛɨɤɭɸ ɨɛɥɚɫɬɶ ɥɢɰɚ ɡɚɩɨɥɧɟɧɵ ɤɥɟɬɱɚɬ ɤɨɣ ɫ ɪɚɫɩɨɥɨɠɟɧɧɵɦɢ ɜ ɧɟɣ ɦɧɨɝɨɱɢɫɥɟɧɧɵɦɢ ɫɨɫɭɞɚɦɢ ɢ ɧɟɪɜɚɦɢ Ɂɞɟɫɶ ɪɚɫ ɩɨɥɚɝɚɸɬɫɹ ɬɚɤɠɟ ɦɟɞɢɚɥɶɧɚɹ ɢ ɥɚɬɟɪɚɥɶɧɚɹ ɤɪɵɥɨɜɢɞɧɵɟ ɦɵɲɰɵ ɢ ɩɪɨɯɨɞɢɬ ɫɭ ɯɨɠɢɥɢɟ ɜɢɫɨɱɧɨɣ ɦɵɲɰɵ

Ʌɚɬɟɪɚɥɶɧɚɹ ɤɪɵɥɨɜɢɞɧɚɹ ɦɵɲɰɚ m. pterygoideus lateralis) ɧɚɱɢɧɚɟɬɫɹ ɨɬ ɧɢɠɧɟɣ ɩɨɜɟɪɯɧɨɫɬɢ ɛɨɥɶɲɨɝɨ ɤɪɵɥɚ ɤɥɢɧɨɜɢɞɧɨɣ ɤɨɫɬɢ ɢ ɧɚɪɭɠɧɨɣ ɩɥɚɫɬɢɧɤɢ ɤɪɵɥɨɜɢɞɧɨɝɨ ɨɬɪɨɫɬɤɚ ɂɞɟɬ ɩɨɱɬɢ ɝɨɪɢɡɨɧɬɚɥɶɧɨ ɜ ɥɚɬɟɪɚɥɶɧɭɸ ɫɬɨɪɨɧɭ ɢ ɤɡɚ ɞɢ ɢ ɩɪɢɤɪɟɩɥɹɟɬɫɹ ɤ ɲɟɣɤɟ ɫɭɫɬɚɜɧɨɝɨ ɨɬɪɨɫɬɤɚ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ ɢ ɤɚɩɫɭɥɟ ɧɢɠ ɧɟɱɟɥɸɫɬɧɨɝɨ ɫɭɫɬɚɜɚ

Ɇɟɞɢɚɥɶɧɚɹ ɤɪɵɥɨɜɢɞɧɚɹ ɦɵɲɰɚ m. pterygoideus medialis) ɧɚɱɢɧɚɟɬɫɹ ɨɬ ɹɦɤɢ ɤɪɵɥɨɜɢɞɧɨɝɨ ɨɬɪɨɫɬɤɚ ɢɞɟɬ ɜɧɢɡ ɢ ɥɚɬɟɪɚɥɶɧɨ ɢ ɩɪɢɤɪɟɩɥɹɟɬɫɹ ɧɚ ɦɟɞɢ ɚɥɶɧɨɣ ɩɨɜɟɪɯɧɨɫɬɢ ɭɝɥɚ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ

ȼ ɝɥɭɛɨɤɢɯ ɨɬɞɟɥɚɯ ɥɢɰɚ ɜ ɬɚɤ ɧɚɡɵɜɚɟɦɨɣ ɦɟɠɱɟɥɸɫɬɧɨɣ ɨɛɥɚɫɬɢ ɢɦɟɸɬɫɹ ɤɥɟɬɱɚɬɨɱɧɵɟ ɩɪɨɫɬɪɚɧɫɬɜɚ ɢɥɢ ɦɟɠɦɵɲɟɱɧɵɟ ɳɟɥɢ ɪɚɫɩɨɥɨɠɟɧɧɵɟ ɦɟɠɞɭ ɜɟɬɜɶɸ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ ɢ ɛɭɝɪɨɦ ɜɟɪɯɧɟɣ ɱɟɥɸɫɬɢ

Ɋɚɡɥɢɱɚɸɬ ɩɨ ɇ ɂ ɉɢɪɨɝɨɜɭ ɞɜɚ ɩɪɨɫɬɪɚɧɫɬɜɚ: ɜɢɫɨɱɧɨ-ɤɪɵɥɨɜɢɞɧɨɟ (interstitium temporopterygoideum), ɡɚɤɥɸɱɟɧɧɨɟ ɦɟɠɞɭ ɤɨɧɟɱɧɵɦ ɨɬɞɟɥɨɦ ɜɢɫɨɱɧɨɣ ɦɵɲɰɵ ɩɪɢɤɪɟɩɥɹɸɳɟɣɫɹ ɤ ɜɟɧɟɱɧɨɦɭ ɨɬɪɨɫɬɤɭ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ ɢ ɧɚɪɭɠɧɨɣ ɤɪɵɥɨɜɢɞɧɨɣ ɦɵɲɰɟɣ ɦɟɠɤɪɵɥɨɜɢɞɧɨɟ (interstitium interpterygoideum) ɡɚɤɥɸ ɱɟɧɧɨɟ ɦɟɠɞɭ ɨɛɟɢɦɢ ɤɪɵɥɨɜɢɞɧɵɦɢ ɦɵɲɰɚɦɢ ± ɧɚɪɭɠɧɨɣ ɢ ɜɧɭɬɪɟɧɧɟɣ. ɇɚɪɭɠɧɵɣ ɨɬɞɟɥ ɷɬɨɝɨ ɩɪɨɫɬɪɚɧɫɬɜɚ ɜ ɫɬɨɦɚɬɨɥɨɝɢɢ ɧɚɡɵɜɚɟɬɫɹ ɤɪɵɥɨɜɢɞɧɨ-

ɧɢɠɧɟɱɟɥɸɫɬɧɵɦ spatium pterygomandibulare).

ȼ ɨɛɨɢɯ ɩɪɨɫɬɪɚɧɫɬɜɚɯ ɫɨɨɛɳɚɸɳɢɯɫɹ ɦɟɠɞɭ ɫɨɛɨɣ ɩɪɨɯɨɞɹɬ ɫɨɫɭɞɵ ɢ ɧɟ ɪɜɵ ɨɤɪɭɠɟɧɧɵɟ ɤɥɟɬɱɚɬɤɨɣ Ɂɞɟɫɶ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɩɨɜɟɪɯɧɨɫɬɧɨ ɤɪɵɥɨɜɢɞɧɨɟ

27

ɫɩɥɟɬɟɧɢɟ ɚ ɝɥɭɛɠɟ ± ɜɟɪɯɧɟɱɟɥɸɫɬɧɚɹ ɚɪɬɟɪɢɹ ɫ ɟɟ ɜɟɬɜɹɦɢ ɢ ɜɟɬɜɢ ɧɢɠɧɟɱɟ ɥɸɫɬɧɨɝɨ ɧɟɪɜɚ

ȼ ɩɨɞɜɢɫɨɱɧɨɣ ɹɦɤɟ ɩɪɨɯɨɞɢɬ ɜɟɪɯɧɟɱɟɥɸɫɬɧɚɹ ɚɪɬɟɪɢɹ ɫ ɜɟɬɜɹɦɢ ɩɟɪɜɨɝɨ ɜɬɨɪɨɝɨ ɢ ɬɪɟɬɶɟɝɨ ɨɬɪɟɡɤɨɜ ɪɢɫ 4.17) Ɂɚ ɫɭɫɬɚɜɧɵɦ ɨɬɪɨɫɬɤɨɦ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ ɪɚɫɩɨɥɚɝɚɸɬɫɹ ɫɥɟɞɭɸɳɢɟ ɨɫɧɨɜɧɵɟ ɟɟ ɜɟɬɜɢ ɝɥɭɛɨɤɚɹ ɭɲɧɚɹ ɚɪɬɟɪɢɹ a. auricularis profunda ɛɚɪɚɛɚɧɧɚɹ ɚɪɬɟɪɢɹ a. tympanica ɫɪɟɞɧɹɹ ɦɟɧɢɧɝɟɚɥɶɧɚɹ ɚɪɬɟɪɢɹ (a. meningea media ɩɪɨɧɢɤɚɸɳɚɹ ɜ ɩɨɥɨɫɬɶ ɱɟɪɟɩɚ ɱɟɪɟɡ ɨɫɬɢɫɬɨɟ ɨɬɜɟɪɫɬɢɟ for. spinosum ɧɢɠɧɹɹ ɚɥɶɜɟɨɥɹɪɧɚɹ ɚɪɬɟɪɢɹ a. alveolaris inferior ɢɞɟɬ ɤ ɧɢɠɧɢɦ ɡɭ ɛɚɦ ɦɟɧɢɧɝɟɚɥɶɧɚɹ ɞɨɛɚɜɨɱɧɚɹ ɚɪɬɟɪɢɹ a. meningea accessorius) ȼɟɬɜɢ ɪɚɫɩɨɥɨɠɟɧɧɵɟ ɧɚ ɭɪɨɜɧɟ ɜɵɪɟɡɤɢ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ ɚ ɬɚɤɠɟ ɜɟɧɟɱɧɨɝɨ ɨɬɪɨɫɬɤɚ ɫɥɟɞɭɸɳɢɟ ɝɥɭɛɨɤɢɟ ɜɢɫɨɱɧɵɟ ɚɪɬɟɪɢɢ aa. temporales profundae ɠɟɜɚɬɟɥɶɧɚɹ ɚɪɬɟɪɢɹ a. masseterica ɳɟɱɧɚɹ ɚɪɬɟɪɢɹ a. buccalis ɤɪɵɥɨɜɢɞɧɵɟ ɜɟɬɜɢ rr. pterygoidei ɡɚɞɧɹɹ ɜɟɪɯɧɹɹ ɚɥɶɜɟɨɥɹɪɧɚɹ ɚɪɬɟɪɢɹ a. alveolaris superior posterior ɢɞɟɬ ɤ ɜɟɪɯɧɢɦ ɡɭɛɚɦ ɜɟɬɜɢ III ɨɬɞɟɥɚ ɩɨɞɝɥɚɡɧɢɱɧɚɹ ɚɪɬɟɪɢɹ a. infraorbitalis) ɩɪɨɯɨɞɢɬ ɱɟɪɟɡ ɨɞɧɨɢɦɟɧɧɨɟ ɨɬɜɟɪɫɬɢɟ ɢ ɜɵɯɨɞɢɬ ɧɚ ɩɟɪɟɞɧɸɸ ɩɨɜɟɪɯɧɨɫɬɶ ɥɢɰɚ ɝɞɟ ɚɧɚɫɬɨɦɨɡɢɪɭɟɬ ɫ ɥɢɰɟɜɨɣ ɚɪɬɟɪɢɟɣ ɨɬ ɩɨɞɝɥɚɡɧɢɱɧɵɯ ɚɪɬɟɪɢɣ ɨɬɯɨɞɹɬ ɩɟɪɟɞɧɢɟ ɜɟɪɯɧɢɟ ɚɥɶɜɟɨɥɹɪɧɵɟ ɚɪɬɟɪɢɢ aa. alveolares superiores anteriores)), ɧɢɫɯɨɞɹɳɚɹ ɧɟɛɧɚɹ ɚɪɬɟɪɢɹ a. palatina descendens ɤɨɬɨɪɚɹ ɜ ɞɚɥɶɧɟɣɲɟɦ ɪɚɡɜɟɬɜɥɹɟɬɫɹ ɧɚ ɛɨɥɶɲɭɸ ɢ ɦɚɥɭɸ ɧɟɛɧɭɸ ɚɪɬɟɪɢɢ a. palatina major et aa. palatinae minores).

Ɋɢɫ 4.17 Ƚɥɭɛɨɤɢɟ ɚɪɬɟ ɪɢɢ ɢ ɧɟɪɜɵ ɥɢɰɚ

1 ² a. temporalis superficialis;

2 ² n. auriculotemporalis;

3 ² n. facialis;

4 ² ɚ. carotis externa;

5 ² m. temporalis;

6 ² a. temporalis profunda;

7 ² a. meningea media;

8 ² a. maxillaris;

9 ² a. buccalis;

10 ² n. buccalis;

11 ² n. alveolaris inferior;

12 ² n. lingualis;

13 ² m. buccinator;

14 ² a. et n. submentales.

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ȼ ɩɟɪɟɞɧɟɦ ɨɬɞɟɥɟ ɨɤɨɥɨɝɥɨɬɨɱɧɨɝɨ ɩɪɨɫɬɪɚɧɫɬɜɚ ɪɚɫɩɨɥɚɝɚɸɬɫɹ ɜɟɬɜɢ ɜɨɫ ɯɨɞɹɳɟɣ ɧɟɛɧɨɣ ɚɪɬɟɪɢɢ ɢ ɨɞɧɨɢɦɟɧɧɵɟ ɜɟɧɵ ɢɝɪɚɸɳɢɟ ɧɟɫɨɦɧɟɧɧɭɸ ɪɨɥɶ ɜ ɪɚɫɩɪɨɫɬɪɚɧɟɧɢɢ ɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɩɪɨɰɟɫɫɚ ɢɡ ɪɚɣɨɧɚ ɦɢɧɞɚɥɢɧɵ Ʉɥɟɬɱɚɬɤɚ ɨɤɨɥɨɝɥɨɬɨɱɧɨɝɨ ɩɪɨɫɬɪɚɧɫɬɜɚ ɩɟɪɟɯɨɞɢɬ ɜ ɤɥɟɬɱɚɬɤɭ ɞɧɚ ɪɨɬɨɜɨɣ ɩɨɥɨɫɬɢ

Ɋɢɫ 4.18 Ɉɤɨɥɨɝɥɨɬɨɱɧɨɟ ɩɪɨɫɬɪɚɧɫɬɜɨ ɧɚ ɩɨɩɟɪɟɱɧɨɦ ɫɪɟɡɟ

1 ² m. pterygoideus medialis;

2 ² ɩɟɪɟɞɧɢɣ ɨɬɞɟɥ ɩɚɪɚɮɚɪɢɧɝɟ ɚɥɶɧɨɝɨ ɩɪɨɫɬɪɚɧɫɬɜɚ 3 ² ɝɥɨɬɨɱɧɵɣ ɨɬɪɨɫɬɨɤ ɨɤɨɥɨɭɲ

ɧɨɣ ɠɟɥɟɡɵ ² aponeurosis stylopharingeus; 5 ² ɩɨɡɜɨɧɨɱɧɨ-

ɝɥɨɬɨɱɧɵɣ ɨɬɪɨɫɬɨɤ ² spatium retropha-ryngeum et nodi retropharyngei;

7 ² a. carotis interna;

8 ² mm. prevertebrales; 9 ² v. jugularis interna; 10 ² ɡɚɞɧɢɣ ɨɬɞɟɥ ɩɚ ɪɚɮɚɪɢɧɝɟɚɥɶɧɨɝɨ ɩɪɨɫɬɪɚɧɫɬɜɚ

11 ² m. digastricus;

12 ² m. sternocleidomastoideus;

13 ² gl. parotidea; 14 ² n. facialis;

15 ² ductus parotideus;

16 ² m. masseter; 17 ² mandibula.

30