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Klinicky Zaměřená Anatomie Clinically Oriented Anatomy HLAVA HEAD klinicky zaměřená anatomie clinically oriented anatomy M.Grim,R.Druga et al.:Základy anatomie 5. anatomie krajin těla M.Schuenke et al.: Atlas of Anatomy. Head and Neuroanatomy V.Seichert:Anatomická pitva V.Seichert:A little anatomical atlas IKIvo Klepáček HLAVA HEAD Linie mezi hlavou a krkem Gnathion, menton, Line between head Mozková část Brain part gonion, mastoideale, opisthokranion (inion) and neckIKObličejová část Face part Krajiny vymezuje povrchová projekce kostí a svalů Regiones are selected following bone and muscular IKstructures S C A L P Kůže Skin Podkožní vazivo s hustými svazky Connective tissue kolagenu Aponeurosis (epicranial membrane) Aponeurosis (galea aponeurotica Řídké vazivo Loose areolar tissue PeriostIK perikranium Pericranium V subaponeurotické vrstvě Venae ústí do v.jugularis ext., v. supraorbitalis, v. occipitalis Arteriae jsou z aa. supraorbitales, superficiales temporales, auriculares posteriores, occipitales Nervi jsou z cervikálních segmentů IKV1,V2 IK Musculus epicranius (epicranial muscle: IKfrontal, angular and occipital bellies) kožní linie hlavy a krku IKskin lines of the head and neck SMAS superficial musculoaponeurotic system povrchový svalově-aponeurotický systém Přibližný rozsah: Relative extent: • musculus frontalis et orbicularis oculi • platysma • fascia temporalis superficialis • fascia parotideomasseterica Nervová vlákna vstupují do svalů ve více než v jednom místě NervousIKfibers enter mimic muscles in more than one point Lateral temporal cheek (forehead) Middle forehead Lateral orbital Central Medial Superior Orbital Middle Inferior Orbital Nasolabial Lateral temporal-cheek Jowl Pre-platysma fat after P.M.Prendergast IK2013 Superior temporal septum Interior temporal Orbicularis retaining ligament septum Medial canthus Lateral canthus Zygomatic ligament Retinacula (McGregor patch) cutis Lateral cheek septum Superior cheek septum Masseteric Platysma-auricular ligament cutaneous ligaments Lore´s lig.) Mandibular ligament after P.M.Prendergast IK2013 H.Chang:Arterial anatomy of subdermal plexus of the face. Keio J IKMed 50: (1)31-34 Povrchové tvaru vřetene nebo pásku nebo kruhové Hluboké ploché částečně překryté vazivově-tukovou tkání Kožní reliéf je přibližně určen tvarem kostí a svalů a utvářením podkožní tkáně Skin relief is roughly determined by muscles and bones Superficial spindle-like or strip-like or round and formation of the IKDeep flat , partially overlapped by fibrous and fat tissue subcutaneous tissue Mimické svaly cévy obličeje Mimic muscles face vessels IKtrigonum mortis Depressor anguli oris arogance odpor Zygomaticus arrogance smích aversion laugh Levator labii superioris pláč Levator alae nasi cry hořký pláč PetrovickýIK a spol. 2001 hopeless cry Trakční svaly: pars labialis m. levator labii superioris alaequae nasi, levator labii superioris, zygomaticus minor, depressor labii inferioris, pars labialis platysmatis Kolmo se připojují do rtu (deprese, protrakce, everse) Svaly kolem koutku: m. levator anguli oris, depressor anguli oris, levator labii superioris, zygomaticus major, pars modiolaris platysmatis, buccinator, risorius, orbicularis oris, m. incisivus superior et m. incisivus inferior HýbouIK koutkem (elevace, deprese, konstrikce a dilatace rima oris) 10 mm IK5 mm IK sutura tympanomastoidea Motor ická “drop off point nejvíce vystupující bod“ inervace z nervus facialis IKVII.nervus n. VII. : Tzv. „facial danger zones“ - oblasti, kdeIK je zranitelněji uložen PetrovickýIK a spol. 2001 Headovy zóny IKHead´s zones IK Apparatus lacrimalis Lacrimal apparatus IK Fissura orbitalis superior et canalis opticus et fissura IKorbitalis inferior Vztah mezi orbitou, canalis opticus a paranasálními dutinami .... Relation between orbit, optic canal and paranasal IKcavities Vztah mezi venae ophtalmicae, sinus cavernosus, plexus pterygoideus a v. facialis Relation between ophtalmic veins, cavernous sinus, pterygoid IKplexus and facial vein IK IK FAT PAD has to be differed from Tukové těleso tváře the following ones: The buccal fat pad The malar fat pad (it is directly below the skin of the cheek). It is (Bichat pillow, corpus implicated in the formation of hollow cheeks and the nasolabial fold. adiposum Bichati) a jeho rozšíření IKand its extensions aa. temporalis media (a.temp.superf.) a. temporalis profunda ant., post. (a. maxillaris) pars ventralis 3.6cm2 pars media pars dorsalis Spatium interfasciale Nn. temporales profundi pars media Plexus pterygoideus Klidové střední postavení 90% vřetének M. temporalis IKet fascia temporalis Tendo IKcentralis Digitationes tendineae M. masseter a. (r.) masseterica (-us) (z a. maxillaris) 2.9cm2 N. massericus IKPlexus pterygoideus Pars superficialis rozbíhající se šlachy Pars media IKPars profunda hustěji u sebe uložené šlachy Fascie ve vztahu ke komplexu žláza sval: Parotidea (1.parotideomasseterica, 2.lamina profunda fasciae parotidae, 3.tractus angularis (navazuje na lig. IKstylomandibulare)) Lamina profunda fasciae parotideae Styalgie - dráždění n. IX Eagle s. * Pars parotidea After Jost , G, Levet, V.: Parotid Fascia parotideomasseterica fascia and Face lifting: A critical Pars parotidea (lamina superficialis) Evaluation of the SMAS concept. Plastic and Reconstructive Surg, Pars masseterica 74:42-51, 1983 IKmodified Povrchová Superficial part Glandula parotis Hluboká Deep part (processus pharyngeus) Serózní tkáň Serous tissue IKDuctus parotideus (Stenoni, of Stensen) pterygomandibularis pterygoideus proprius rr. pterygoidei (a. maxillaris) The musculus pterygoïdeus proprius: an in-vivo approach with magnetic 1.7cm2 resonance imaging Snoeck T, Provyn S,Balestra C, Parlak B,Emonts P, Sesbouë B,6 and Clarys JP J. Anat. Published online 2010 Oct (1)5:679-682 pars sphenoidea profunda m. temporalis, pars medialis m. temporalis,pars. secunda m. zygomaticomandibularis, capout accesorium m. temporalis, m. sphenomandibularis, venter anteriomedialis m. temporalis 1.8cm2 PlexusIK pterygoideus IK g- lig. stylomandibulare fascia parotideomasseterica a- lig. pterygospinosum h- lig. sphenomandibulare e- lig. pterygomandibulare IKfascia interpterygoidea silnější lamina fibroelastica Retroarticulární hydroelastický Tenká polštář Zenkerův lamina (obsahujeIK cévy) elastica Fossa infratemporalis Infratemporal fossa Sup.: Ala major ossis sphenoidalis Med.: Lamina medialis processus ptergoideus + pharynx Ventr.: Tuber maxillae Lat.: Ramus mandibulae Dors.: IKSeptum styloideum Fossa infratemporalis „Povrchová vrstva“ Infratemporal fossa “superficial layer“ Tepny a žilní pleteně ArteriesIK and plexiform-like veins Plexus pterygoideus IKPterygoid plexus Fossa infratemporalis „hluboká vrstva“ Infratemporal fossa “deep layer“ Mandibular branches IK(V3) Fossa retromandibularis et Prostory na hlavě Head spaces Sp. parapharyngeum: prestyloideum (pterygomandibulare, parotideum, paratonsillare), retrostyloideum (parapharyngeum dorsale) IKSp. retropharyngeum Cribriform plate - I. Optic canal - II., ophtalmic artery Superior orbital fissure - III., IV., V1. (nasociliar, lacrimal,frontal), VI., superior orbital v. Foramen lacerum greater petrosal nerve and sphenooccipital synchondroses) - internal carotid artery Round foramen V2 Foramen ovale - V3., communicating veins Foramen spinosum - middle meningeal artery Carotid canal - internal carotid artery, sympathetic nerves (caroticotympanic) Jugular foramen IK- IX.,X.,XI. internal jugular vein Limen nasi = line between skin and respiratory epithelium Agger nasi = swelling on the lateral nasal wall at level of middle concha Recessus apicis nasi = recess to nasal top Nasal septum (nasal vestibule) Proper nasal cavity contains vibrissae (Cavitas nasi propria) pars respiratoria (respiratory epithelium) 2 pars olfactoria (olfactory epithelium about 10cm on superior septum andIK upper nasal concha) Vyústění paranasalních dutin IKParanasal cavities - openings N. Highmore: Corporis humani Frontal 20 yr disquisitio Ethmoidalis anatomica; in qua anterior ethmoid 12 yr sanguinis circulationem in Maxillary 8 yr quavis corporis particula plurimis typis novis ac aenigmatum “ostiomeatal unit“ 4 yr medicorum succincta 1 yr dilucidatione Functional and ornatam prosecuutus est. developmental Hagai-Comitis [The connection Hague], 1651. between sinuses Antrum Highmori (of 60 yr Higmore) The sinus was well known to anatomists before Highmore. It had been illustrated by Leonardo da Vinci (1452IK-1519) and had been noticed by Giulio Casserio (1561-1616) Upper posteroanterior projection Following Waters (Towne) IKprojection Tepny Arteries Wilhelm Kiesselbach (1839-1902) German a.ethmoidalis ant. a. palatina major, a. otolaryngologist, sphenopalatina, a. labialis superior Plexus Kiesselbachi anterior ethmoid , great palatine arteries, Little´s area sphenopalatine a. and superior labial a. Locus Kiesselbachi rr. septales a.ethmoidalis post. a. sphenopalatina Plexus nasopharyngeus Woodrofi Septal branches of the posterior ethmoid, IKsphenopalatine arteries Žíly Veins plexus cavernosi concharum: v. sphenopalatina plexus pterygoideus a) v. maxillaris v. retromandibularis b) v. profunda faciei v. facialis b) vv. ethmoidales vv. ophtalmicae c) via lamina cribrosa IK vv. cerebri PalatalIK relief with rugae, foveolae palatinae, papila icisiva IK Palatum molle Soft palate – ventrálně ventral view – dorzálně dorsalIK view Lingua, glossa tongue Pohyblivý svalověepitelový orgán Mobile musculoepithelial organ; Located in the oral cavity and pharynx Žvýkání Mastication, Polykání Deglutition, Řeč Speech Formuje sousto Squeezing food
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