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Nasal Cavity • DR MOUIN ABBOUD pr of anatomy Faculity of medicin Damascus and sham universiies جهاز التنفس The Respiratory System مقدمة: • إن جهاز التنفس هو المسئول عن وظيفة التبادل الدموي الغازي وإضافة لذلك تقوم بعض أجزائه العلوية بإنتاج الصوت وضبطه • يتألف جهاز التنفس من: • أ ـ طرق تنفسية علوية وسفلية : يتم عبرها نقل الهواء الحامل لﻷكسجين بعد تهيئته إلى منطقة التبادل الدموي الغازي . • ب ـ الرئتين والتي تحتوي كل منها نهاية الطرق الهوائية منطقة التبادل الدموي الغازي والتي يصل إليها نهاية الشرايين الرئوية الحاملة لغاز الفحم . • ج ـ أجزاء مساعدة وضابطة )غشاء الرئة – الجدار الصدري – الحجاب الحاجز-الجهاز العصبي (. الطرق التنفسية العلوية في العنق • وهي: اﻷنف ـ البعلوم اﻷنفي ـ الحنجرة - الرغامى • وتكون هذه الطرق مبطنة بغشاء مخاطي غني باﻷوعية الدموية من أجل ترطيب الهواء الداخل وتدفئته. The Respiratory System in the Head and Neck • The Respiratory System in the Head and Neck are : – The nose and paranasal sinuses – The pharynx – The larynx – The trachea Respiratory System Figure 22.1 اﻷنف The Nose: • هو الجزء المتواجد في الوجه • ويتم عبره نقل الهواء كما يحتوي أعضاء الشم THE NOSE • The nose is an olfactory and respiratory organ. • It consists of nasal skeleton, which houses the nasal cavity • . The nose can be divided into : – The external nose . – The nasal cavity, both of which are divided by a septum into right and left halves وظائف اﻷنف • .1 تدفئة Warming و ترطيب Humidifying الهواء المستنشق. • .2 عملية تنظيف و احتجاز الغبار و العوامل الممرضة • .3 عملية الشم Smell . • .4 تنفتح عليه الجيوب الهوائية جانب اﻷنفية لتصريف المخاط الذي تنتجه، باﻹضافة إلى • القناة الدمعية التي تصرف الدمع إلى المجرى اﻷنفي. أقسام اﻷنف • يشمل اﻷنف قسمين: • اﻷنف الخارجي External Nose • اﻷنف الداخلي أو جوف اﻷنف Nasal Cavity الذي ينقسم بالوتيرة اﻷنفية لنصف أيمن ونصف أيسر. اﻷنف الظاهر External nose • هو الجزء الظاهر سطحيا في الوجه • يتكون من بنى عظمية وغضروفية مغطاة بالعضﻻت والجلد • يوصف له : ❑ ذروة حرة ❑ قاعدة ترتكز على الجبهة ❑ ظهر اﻷنف Dorsum of the nose الذي يتجه نحو اﻷمام . ❑ جناحا اﻷنف Alae of the nose: اللذان تحيط حافتاهما السفليتان بفتحتي اﻷنف اﻷماميتين أي بالمنخرين narinae اللذين يمر الهواء عبرهما إلى جوف اﻷنف . Structure of the Nose Figure 22.2a بنى اﻷنف الظاهر • القسم العظمي • يشكل النصف العلوي الصلب لﻷنف ويساهم بتشكيله: • العظم الجبهي. • العظمان اﻷنفيان :يدعمان جسر اﻷنف. • الناتئان الجبهيان للعظمين الفكيين :يدعمان جوانب اﻷنف • . العظم الفكيين :بشكل ثانوي. THE EXTERNAL NOSE • The external nose projects forwards from the face. • Its upper end or root is continuous with the forehead. • At its lower end (base) are the nares (nostrils) which are separated from each other by the nasal septum. • The sides of the nose meet in the midline anteriorly to form the dorsum. ▪ The upper part of the dorsum is the bridge and at ▪ the lower end of the dorsum is the tip of the nose. • The lateral margin, the ala nasi, is rounded and mobile بنى اﻷنف الظاهر • القسم الغضروفي: • يشكل القسم الغضروفي النصف السفلي المرن من اﻷنف ويتكون من عدة غضاريف: • 1.الغضروفان الوحشيان: Lateral cartilages • يقعان إلى اﻷسفل من العظم اﻷنفي. • يدعمان جوانب اﻷنف. • 2.الغضروفان الجناحيان الكبيران: Greater Alar.C • يدعمان بالدرجة اﻷولى الجدار اﻷنسي والجدار الوحشي لﻷنف • 3-الغضاريف الجناحية الصغيرة: Lesser Alar.C • عبارة عن 3 4 غضاريف تقوم بدعم كل منخر- . • 4.غضروف الوتيرة: Septal Cartilage • يقع بين الغضروفين الوحشيين، وهو عبارة عن صفيحة عمودية رقيقة تقسم اﻷنف • (المنخرين والجوف اﻷنفي )إلى نصفين أيمن وأيسر. Structure of the Nose Figure 22.2b العضﻻت المتعلقة باﻷنف Nasal musculature • العضﻻت الرافعة: Elevators • العضلة الناشلة Procerus • العضلة رافعة الشفة العلوية وجناح اﻷنف Levator labii superioris alaequae nasi • العضﻻت الخافضة: Depressor • الجزء الجناحي للعضلة اﻷنفية. alar part of nasalis • العضلة خافضة الوتيرة. Depressor septi • العضﻻت الضاغطة للمنخر: Compressor • الجزء المعترض للعضلة اﻷنفية. • العضﻻت موسعة المنخر: Dilator • العضلة موسعة المنخرDilator naris anterior التروية الشريانية لﻷنف الخارجي • تتم بوساطة فروع من الشريانين السباتيين • السباتي الظاهر : عبر الشرايين الزاوي والشفوي العلوي) فرعي الوجهي )والشريان تحت الحجاج( فرع الفكي) • والسباتي الباطن عبر شريان ظهر اﻷنف من الشريان العيني. Blood Supply of the External Nose • The skin of the external nose is supplied by branches of the ophthalmic and the maxillary arteries • The skin of the ala and the lower part of the septum are supplied by branches from the facial artery. تعصيب اﻷنف الخارجي • يتم التعصيب الحسي لجلد اﻷنف الخارجي عبر: • العصب العيني phthalmic عبر فرعيه :تحت البكري Infratrochlear. N . • و الفرع الخارجي للعصب الغربالي اﻷمام • العصب الفكي : Maxillary من خﻻل العصب تحت الحجاج Infra Trochlear. N Nerve Supply of the External Nose • The infratrochlear and external nasal branches of the ophthalmic nerve (CN V) • and the infraorbital branch of the maxillary nerve (CN V) جوف اﻷنف • هو جوف كبير يقسم بالحاجز اﻷنفي الى جوفين أيمن واﻷيسر • له اتصاﻻت مع الخارج ومع أجواف مجاورة . THE INTERNAL NOSE The Nasal Cavity • The nasal cavity is divided into left and right conduits by the nasal septum • Each conduit : – starts interiorly by two openings the external nares (nostrils) – The nasal vestibule is the area of the nasal cavity lying just inside the nostril – communicates posteriorly with the nasopharynx with two openings the internal nares (choanae) . اتصاﻻت جوف اﻻنف • له عدة اتصاﻻت مع الجوار منها : – باﻷمام مع الخارج عن طريق بفتحتي اﻷنف الظاهرتين تسميان بالمنخرين –يتصل في الخلف مع البلعوم اﻷنفي بفتحتي اﻷنف الداخليتان والتي تسمى بالمنعرين (choanae – اتصال مع الجيوب الهوائية جانب اﻷنفية )مثال الجبهي والجيب الوتدي والجيب الفكي والخﻻيا الغربالية (. – يتصل في الوحشي مع جوف الحجاج )قناة دمعية أنفية ( –اتصال مع الحفرة الجناحية الحنكية عبر الثقبة الوتدية الحنكية –اتصال مع جوف الفم عبر الثقبة القاطعية –اتصال مع جوف القحف عبر الثقوب بالصفيحة المصفاوية واﻷقنية الغربالية اﻷمامية والخلفية Gateways • There are a number of routes by which nerves and vessels enter and leave the soft tissues lining each nasal cavity , and these include : ❖the cribriform plate, ❖sphenopalatine foramen, ❖ the incisive canal, ❖ small foramina in the lateral wall, and around the margin of the nares. تقسيمات جوف اﻷنف •ينقسم جوف اﻷنف إلى جوفين: • أيمن وأيسر • يفصل بينهما الحاجز اﻷنفي )الوتيرة ( . الهيكل العظمي لجوف اﻷنف • يوصف لكل جوف انفي فتحات وجدران تشكل حدود الجوف اﻻنفي : • الفتحات العظمية : •فتحة عظمية واقعة في اﻷمام والوحشي واﻷسفل تسمى الفتحة الكمثرية piriform aperture. )يحددها العظم ىالفكي مع عظمي اﻻنف ( •ينفتح جوف اﻷنف في الخلف على البلعوم بفتحتين تسميان المنعرين )الكوتين( تتحدد بين الميكعة والصفيحة الجناحية اﻻنسية للوتدي والصفيحة اﻻفقية للحنكي. جدران جوف اﻻنف • الجدار العلوي :وهو سقف اﻷنف يتشكل من: قسم من العظم الغربالي )الصفيحة المثقبة( • الجداره السفلي : يتشكل من الحنك الصلب والرخو . • الجدار الوحشي : يتميز بوجود القرينات ) المحارات ( التي تتغطى بالغشاء المخاطي السميك الغني باﻷوعية الدموية • الجدار اﻷنسي :وهو الحاجز اﻷنفي أو الوتيرة، ويقسم اﻷنف إلى قسمين. الجدار العلوي • وهو سقف اﻷنف يتكون من: • في اﻷمام، من العظمان اﻷنفيان، والشوكة اﻷنفية من العظم الجبهي، وتكون تحت جسر اﻷنف. • في قسمه اﻷوسط ( تحت الحفرة القحفية اﻷمامية )من : الصفيحة المصفوية( اﻷفقية )للعظم الغربالي Cribriform plateحيث تكون مثقبة فتمر منها ألياف العصبين الشميين • .كما يشارك العظم الوتدي وجناحي الميكعة في الخلف. The roof • The roof is narrow and is formed : ❖anteriorly beneath the bridge of the nose by the nasal and frontal bones, ❖ in the middle by the cribriform plate of the ethmoid, located beneath the anterior cranial fossa, ❖Underlying the mucosa, the roof is perforated superiorly by openings in the cribriform plate, and anterior to these openings by a separate foramen for the anterior ethmoidal nerve and vessels. Lateral wall of the nasal cavity. A. Bones الجدار السفلي • أو اﻷرضية • ملساء و مقعرة أعرض من السقف . • يتشكل من الحنك الصلب والرخو . • الحنك الصلب :. Hard palate • يتألف بشكل رئيسي من: • السطح العلوي للناتئ الحنكي للفكي. • الصفيحة اﻻفقية للحنكي • ويتميز بالعﻻمات التالية : • القناة القاطعية :هي التقاء الناتئين الحنكيين للفكي • الناتئ الهرمي :التقاء الصفيحة اﻷفقية مع العمودية للعظم الحنكي... توجد ضمنه • الثقوب الحنكية الصغرى( انظر للصورة السفلية في الصفحة التالية) • الثقوب الحنكية الكبرى :توجد في الصفيحة اﻷفقية Floor of the nasal cavity (superior view). The floor • The floor of each nasal cavity is smooth, concave, and much wider than the roof. • It consists of: ❖ soft tissues of the external nose; ❖ the upper surface of the palatine process of the maxilla, ❖ and the horizontal plate of the palatine bone, which together form the hard palate. • The naris opens anteriorly into the floor, • and the superior aperture of the incisive canal is deep to the mucosa immediately lateral to the nasal septum near the front of the hard palate الجدار اﻷنسي أو الحاجز اﻷنفي أو الوتيرة • ويتألف من: • 1 ـ غضروف الوتيرة باﻻمام septal nasal cartilage • 2-الصفيحة القائمة للعظم الغربالي the perpendicular plate of the ethmoid bone في اﻷمام واﻷعلى. • 3 ـ عظم الميكعة Vomer في الخلف واﻷسفل. • وتساهم بعض البنى العظمية مساهمات صغيرة في تشكيل الوتيرة أيضا : • .العظمين اﻷنفيين حيث يلتقيان على الخط الناصف • .الشوكة اﻷنفية Nasal spine للعظم الجبهي. • خطم أو منقار Rostrum العظم الوتدي • العرف القاطعي للعظم الفكي العلوي. of the maxillaincisor crest. • أعراف العظمين الفكي والحنكي، اذ يتشكل تبارز على الخط الناصف ناتجة عن التقاء • الناتئ الحنكي للفكي و الصفيحة اﻷفقية للحنكي على الخط الناصف. The medial wall • The medial wall of each nasal cavity is the mucosa-covered surface of the thin nasal septum, which is oriented vertically in the median sagittal plane and separates the right and left nasal cavities from each other. • The nasal septum consists of: ❖ the septal nasal cartilage anteriorly; ❖ posteriorly, mainly the vomer ❖ and the perpendicular
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