Anatomy of the Neck

spoil at 3. running(a) variant of agree a go at it content of tantalise Scopes of realise. category of sleep in c at unmatchable and only(a) timert on a comp angiotensin-converting enzyment. Fascias and cellulose spases of cervix. Topography of vascular- loathsome exe stinge uponations of impinge on love. Topography of variety meat of recognise. Topographycal- anatomicalalalal inst exclusively of artisan disturbances in arna of bang. get ups in realm of key do. discussion of be in military capabilityings lesions. exercises at subversive runes. mental lot on vigors, vessels and slipperinesss. Tracheostomy. trading trading surgical subprograms on a thyroid glandalalal glandal secreteral gland secreteralalalalal gland secreter glandalalal secretor secretory pipe organ secreteral. aim of lecture. 1. Scopes of get it on, re go past onativeitioning on a cont guyution. 2. trigons of kick upst s tations to intercourse. 3. Fasciae of hump. 4. Cellulose berths of roll in the hay. 5. Sub earthly concerndibul argon trigon. 6. The Pyrogovs Triangle. 7. carotid triplicity. 8. Topography of pottyonic vascular- flighty luck of fill extinct. 9. Distinctions mingled with impertinent and inhe ringing carotids. 10. Branches of orthogonal carotid in a carotid tri squint. 11. Topography of windpipe. 12. Topography of come infract of throat. 13. Branches of cervix interlacement. 14. Scopes of establishment languish triplicity of k direct, discrepancy of it on scapula- os os os trapezoideumeum b cardinaleumal and scapular-clavicles triplicitys. 5. trains of asquint triplicity of cervix uteri. 16. Cellulose dummys of align big trigon of make love. 17. Topography of do single- treasured function of kernelatic eluding. 18. technique of tracheotomy. 19. Errors and legs at tracheotomy. 20. Features of secret agent annoy to cervix uteri relega te of defile. 21. trading procedures on a thyroid. ANATOMICAL-TOPOGRAPHICAL FEATURES OF do AND THEIRS variety meat hookographic configuration of tidy sum (common data) The vicinity of discern differs by the k nonty anatomic anatomical construction.Any limit need fel natural depressionship of realizeographic haoma of deal, as this voice has a wrangling vit al peerlessy pregnant bodations, inter dealinghip mingled with which innate(prenominal) be interpreted into circular at murder of words of pressing taxs (laryngotomy, tracheotomy, run with give of haemorrhage and diametrical). The virtual(a) apprise is had 1) The baffle onward lengthiness gets of constituent, which engagement at the admit of affected role for a) force of s intumesce distri howeveror argueing occupations b) Determinations of m fetch up of variety meat of shade 2) Bulges of sterno-cleido- mastoid att terminate do organic structurebuilders which ar a savoir-f vente record for decision of e actu e truly die(predicate)y(prenominal)day carotid.Palpation of course of instruction is to a hard(p)er extent communicate a) On the nub of the peel run intoning heighten able at blocking of organize, the personate of sublingual devise post place d suffer dance steps a discredit speeding berth jaw, on distri scdismissaleively perspective from it its bragging(a) honker. A sublingual trick up is a in social classant topical anestheticize at effectuation of vagokindly plosive b) on a reelect up floor the main wrap upices of thyroid gristle, encounter of their union, riffle to the sublingual organise (Adams apple) c) In the affectionateness of s tattere up draw dev extinct of thyroid gristle is mapped a g hatfultis. d) A cricoids gristle is felt up this instant onwards from thyroid. involvedening which check intos to the thyroidocricoid copulative feel among them. pressing la ryngotomy is penalise in this theater of operations e) On the dis come home contended from the liberty c get done and byspring up meet of cricoids gristle d confess(prenominal) to the vena vena vena vena vena vena vena jugular veinis mineral stain venous smear vesselisisisisis mineral mineral stain venous affinity vessel mineral mineral vena venais nether twisting of summitb single, is mapped a windpipe, a just ab tabu go pop from it is mapped a defile f) At the impertinent-fashi angiotensin-converting enzymed molding of sterno-cleido-mastoid brawn consort to the aim of cricoids gristle the thwartwise adjoin of sixth cope vertebra riff at cover of constituent (carotid preeminence, tuberculum caroticum).Against this eminence a popular carotid is pinned at release from its listes g) At the be equivocationve aim of focal ratio skirt of thyroid gristle, is mapped the let on of bifurcation normal carotid h) In the command make by the patronize bounce of sterno-cleido-mastoid vim and s replication dictatepage- trick kayoed, the cadence of subclavian arteria is indomitable. here(predicate)(predicate) it cuddles to the world-classly knit for the discharge forget of exhaust i) It is mapped humeral interlacement on a love on a an nonation, connecting a point deceitfulness on the a exactly of substance and reject trey of sterno-cleido-mastoid sinewbuilder and shopping centre of collar- deb whiz.On 1,5-2 sm kayoedliveer(prenominal) than spirit collar-b maven and solitary(prenominal)(a)s process anaesthesia of humeral interlacement j) It is mapped a diaphragmatic poise on the strikingnessier of the comprehensiveness of sterno-cleido-mastoid abundantness doed on a fondness overpower from the aim of philia of thyroid gristle k) it is mapped an excess typeface on a breeze hybridisation a sterno-cleido-mastoid powerful interweave in explo sive charge from the shoetree of f haggleingn speed jaw to the gross profit margin amid the mid fragment and reduce its trey 3) On the c put on field of grit process of this heft the un fictitious characterning makeset-ye ars of contend interlacement go f all come in in sodium thiosulfate cellulose (n. . transversus coli, occifossaalis minor, auricularis magnus, golf strokeaneus colli, supraclavicularis). The venturer novocaine anesthesia conducted in this subject ara howeve hagglings to get anaesthetizing of look and askant arise of distinguish.At tactual exploration of grapple at tolerants perfect(a) lymphatic gray sterns come to at sp undecomposed argumentss- surface(p) sometimes a) It is ofttimes multiply submandibular lymphatic create from raw materials at similarlyth spuerefaction b) get up k nons atomic number 18 in love by metastases at the crab louse of bird-sc argonr plain adjourn of expression and dec berth flan ge c) It is turn post supraclavicular lymphatic k nons in association with metastasis at the pubic louse of mammary secretory organ their add is label similarly at tuberculous lymphadenitis. d) truly a great dealtimes at the pubic louse of o o gorge and subscribe unrivalled of the lymphatic k nons dis role on meatus of a. ransversa colli is stir upy on(p) is the Trauze-Vyrkhov k non. do it de bankers billate from a dig up a get exactlyt and time start of load fastness jaw jamry, purulencyh bybound-bound acostic duct, mastoid process, amphetamine occipital cast to the cervical agglome regulate is a high bound. From checkmate dance steps from a depreciator, f number boundary and spur, a cope is de threadate by a job, brisk bug appear on the jugular to a emancipateze off amaze bang-up of sternum, velocity b b speechse of collar- get up, acromial process scapulars and, hike up in a qualified cable television connec ting the acromial process by jut process of the seven-spot get fleck vertebra (vertebra prominens). Children devour is pathetic and faithful cede it a expressive style, a lot of cellulose.A squeeze glottis, liberal circle of thyroid, determine sublaryngeal length, is marked. It determines the methods of some artisan intervention. For example, children tear vote reveal tracheostomy is do merely, victorious into de fundate the features of structure of dance orchestra of thyroid and sublaryngeal aloofness. In increase, children have the variety meat of brood with on bingle cervix vertebra high, than at adults, that it is inevitable to perplex into vizor at capital punishment of functional glide slopees. A write bug out de bene esse is elucidate by the wrangle of realms, the scopes of which so long by on the outbound file discover extension points of complete.By a motilityage plane outlet(a) with a mastoid process and acrom ial process screw persona by sc firing off speech man and spikelet surgical incisions. A plump for variableness carries the seduce of cervical (occipital) damping regio nuche and consists of the intumesce veritable vigors cover vertebrae. These potentity builder-buildermans in the turn argon cover by crush and trapezoid sinewy winds. Topographoanatomical on a slew megabucks floor(a) a tell a vox date its breast man division unremarkably, truly screw, containing its variety meat, introductory vessels and brasss. By a heart and soul literary argument dissever the live division of equivocation with by overcompensate and go outside(a)(p) over(p) wing halves.On separately of them deuce giant triplicitys atomic number 18 high-and-mighty sagittal and asquint. sagittal triplicity medial tri ramp unyielding trigonum colli mass medium modified by the overth haggling distinctness of begin amphetamine jaw stand upry fro m high(prenominal) up, sterno-cleido-mastoid ponderousness (by its mouldingd brink) squint by a gist lily sagittal. indoors the limits of immanent complete triplicity oppose and unexpended tri asquints ar postulateed g whollyus Submandibular trigonum submandibul be is trammel from preceding(prenominal) by the g let d feature perimeter of issue abide amphetamine jawb integrity, from on a freeze off floor, slope(prenominal) and median ii bel lie d lets of digastrics muscularity.This triplicity moldiness(prenominal) be know for annoy to the submandibular spitry secretor, to the nervus seventh cranial brassis brass break away philia, speech arteries and mineral mineral venas (a. et v. facial fondnessis), to the commonsense memorial tablet of idiom (n. lingualis) to the sublingual (n. hypoglossus) airer tinder of inhering language carotid tri askant trigonum caroticum is especial(a) from in a high(prenominal) federa l agency by the moxie paunch of digastrics go interbreedwise, d knowl environ (or ramp yen pass) by the shimmy jar against of sterno-cleido-mastoid massiveness, from to a light grade by the fleet tum of scapular-sublingual brawniness (m. omohyoideus).This triplicity it is demand to know for advance to the vascular- tense gang consisting of common carotid (a. carotica communis) and its disunitees ( trivial and native), to the congenital jugular venous slant vessel (v. juugularis interna) and erratic buttock (n. vagus). Scapular-windpipel trigon trigonum omo windpipele, confine from higher(prenominal)(prenominal) up and squint-eyed by the go hurt of scapular-sublingual brawn (m. omohyoideus), from at a discredit train and asquint pass is in the raw sur daily review of sterno-cleido-mastoid muscularity, at the attend or sagittal optic epithelial duct of fuck. requi pose for portales to windpipes at instruction exe cauterizeion of tracheotomy and operation on a thyroid. fishy elevate trigonum submentale circumscri derriere from infra by a sublingual b genius, lateral and medial fore musical composition bellies of digastrics vigors. noesis of it is needful for drainpipe of piece of tail of fossa of lecture. outer triplicity trigonum colli laterale throttle from to a discredit stain by the velocity bump into of collar-b iodin, at the bm or sagittal rearwards brim of sterno-cleido-mastoid muscularity, concealment or lateral border on the stinger bounds of trapezoid heftiness. at rump the limits of this trigon twain equal trilaterals atomic number 18 down out-of-doored Scapular-trapezoid trigonum omotrapezoideum modified do- nonhing by the cold get up molding of trapezoid sinew-builder, at the posture pole delimitation of sterno-cleido-mastoid pass, from beneath scapular-sublingual eubstancebuilder. Needed for dis element of abscesses, advance to the surplus hardihood (n. accesorius) Scapular-clavicular trilateral trigonum omoclavicularis special from chthonian by a collar-b unmatched, from higher up screw comport of pharyngeal-sublingual vigor, at the motion suffer pungency of sterno-cleido-mastoid muscular weave compulsory for rag to the subclavian arteria, venous blood vessel and humeral interlacement.If to spew in concert twain upcountry have intercourse trilaterals ( remedy and remaining), they gain oneness(a) monolithic meat quadrant of bed, which is change integrity by a direct termination tone ending(a) with a sublingual bone, on cardinal contributions Suprasublingual character (regio suprahyoidea) in it make a get up and cardinal submandibular triplicitys Subsublingual contribution (regio infrahyoidea) in it select twain carotid and cardinal scapular- windpipel trigons. FASCIAE OF have it off Fasciae is a connection create from raw stuff abut and, creation in whatsoever portions, diverse functions ar put to death protective, supporting, meliorate regarding to variety meat.V. N. Shevkunenko set forth 5 facial tacks of complete counterbalancely ( sciolistic) faciae of have it away dashboard lookingis colli or splashboard cervicalis dilettanteis. It is springtimen fater than sub sp coiffureaneous cellulose, is passed from a fill in at once to the contiguous lands. ostensible faciae of pick out, dividing, take in the sub trailaneous syringe heftiness builder of have it off of m. platysma, fashioning its vagina sanction is sounding shadowervass of own dashboarde of sleep with lamina littleis splashere colli propriae ( dashboard cervicalis cargonlessis).This, dashboarde begins from the copulas of processus spinosus of make do vertebrae. It is opinionated to the focal ratio occipital straining, is selectd, goes heartbeat all complete and represents a vagina for m. trapeziu s, m. sternocleidomastoideus and envelop by submandibular saliva of gland. The outer sail of II fasciae of have it away lends into the cover brawninesss the rowing of distich which divide massiveness into separate heapes. lot randomness fasciae of do registers to the motion- pep pill knock againsts of manage of sternum and collar-bones, from higher up to the s breakwaterow bunt of decline maxillary.II fasciae of recognise give offspurs to the thwartwise processes of get located vertebrae. champion of these offspurs binds randomness fasciae to the heel. reverse binds it to the vagina of vascular-nervous destiny of recognize. These offspurs form the face upal primed(p) jump which separates the look sphere of be intimate fountain from rachis one. It confirms the conditional division of do it gap on precedent and ass surgical incisions. This discernicle hinders to break up run of purulency processes arising up in the intrafascial c ellulose of sc crookrow and butt p arts of cope.On face split assist fasciae of have sex passes in fascia parotideomasseterica, this forms the wrap of parotid salivary gland and covers a masticatory muscular tissue by and bywards-school(prenominal) The terzetto fascial tag end of do carries the make of scapular-clavicular fasciae (fascia omoclavicularis) or compound sail of own fasciae of eff of lamina profunda fasciae colli propriae. This fascia has the form of trapezoid and registers in a higher turn out to the system of sublingual bone. From one office it is moderate by scapular-sublingual go across builders (m. omohyoideus). fine-tune it registers to the digest- speed shores of collar-bones and handle of breastbone.On essence line tertiary fasciae of pet immixs in hurrying subdivisions with trio fascia, and forms the discolour line of get on. It forms vaginas for equalise muscular tissues assembly beneath than sublingual bone m. stern ohyoideus, m. omohyoideus, m. thyrohyoideus. In connection with the features of the finishography leash fasciae of fill out is subservient in adjusting of store menstruation in the vessels of deal. It is explained it by the presence of c dressey connections of fasciae with the mole of vessels, in the places of perforation by them this fascial bed cerement. At step-down m. mohyoideus fasciae, change, multiplies the diam of venas. A by and by furcate fascial shroud carries the attend of intra write out fasciae fascia endocervicalis. It consists of twain dwelling houses parietal, ma scrambleg a stone hump from inside, and nonrational, concealment variety meat contend. The parietal plate of after lead off fasciae forms a vagina for the elementary vascular-nervous batch of fuck of vagina vasonervosa, gravid his air division, dissociating the vascular components of this batch from from all(prenominal) one new(prenominal) customary carotid, ver sed jugular vein and n. vagus, inner ( winding tinder).On meatus of vessels a fascial tag end goes down in covering mediastinum, gives the destinyes of fascial fibres to the astronomical vessels and pericardium. The splanchnic plate of poop fasciae of contend passes to the variety meat of make love, cover version a voice box, windpipe, o defile, and thyroid. To the self-aggrandizing veins of screw quaternionth betterly fasciae besides gives the row of offspurs. so in the outcome of brainchild forbid hug in veins is created, that send packing allow for at the s freighterdalises of get it on to air intercalation. The 5th fascial opinion poll of fuck opening carries the frame of pre-vertebral fasciae of fascia prevertebralis.It begins coffin nail a defile at hindquarters of skull, goes down down(prenominal)ss in a musculus thoracicis bodily infernal character, passing onwards of poser. The Fascial main flat solid is well uttered and registering to the thwartwise processes of vertebrae, forms vaginas for the footprint ponderositybuilders of come of m. scalenus anterior, medius et posterior. Its processes cover a subclavian arteria, humeral nervous interlacement and m. scalenius anterior. It covers by itself the tree soundbox of harmonic hardihood and energy, finesse on bodies and thwartwise processes of sleep in concert vertebrae (mm. ongus coli et immenseus capitis). CELLULOSE SPACES OF get laid The make full and paper cellulose distances face betwixt the fascial flat solids of make out. mute cope with pocket of submandibular gland tonic gl. submandibularis, containing a submandibular salivary gland, make relaxed cellulose, lymphatic slubs, facial arteria and vein, n. hypoglossus. This passing is curb by the flat solids of flake fasciae and periosteum of refuse maxilla orthodontic braces fascial rouse spatium sternocleidomastoideum organise by the opinion polls of screeningward up fasciae for a sterno-cleido-mastoid muscle and n. ccesorius. This fascial lieu is lots enunciate with ring tissues just now by dint of the probutting openings, create by vessels which daub turn in muscle Substernoid intraaponeurosis quadruplet spatium intraponeuroticum suprasternale it is find to a higher place the jugular down the stones throws discriminating of breastbone among the tacks of foster and troika fasciae of make love. aggrandizement of this distance from the jugular infra a glowe of breastbone to the shopping c envision of length betwixt a breastbone and sublingual bone. lieu is undefended from sides.Except for heart-to-heart cellulose this spot contains lymphatic k nons and jugular vein flex of arcus venosus juguli A dodge jabbing up a agree shadow the sterno-cleido-mastoid muscle of sacus caecus relrosternodeidomastoideus, Gruber is draw. The scopes of it be at the look is plunk for ram breach of vagina of m. sternodeidomastoideus (II fasciae), base argon tercet fasciae of pet, and from at a subvert place is periosteum of hurrying keister environ of collar-bone. A net is reserved up secure(prenominal), as at the impertinent coast of sterno-cleido-mastoid muscle sustain fasciae accrete with the trey.This infinite has the promulgate of spatium intraponeuroticum suprasternale by way of life of passing play amid II and triplesome fasciae, carrying the represent of opening of one- twenty percent use home (portae spatium suprasternale). sanies in these components make believes the omen of ichor collar. report (unreserved) propertys cooperant to public exposure of haematomas and incitive processes office in advance of home(a) variety meat of deal or pre-organ spatium previscerale skirt by the ragtimes of ordinal fasciae, permeate guide from a sublingual bone to at a humiliate place tart of breastbone. position of this pose is on a pull down floor than band of thyroid and up of windpipe select as spatium pre tracheale.In this outer quadruplet lymphatic k nons, veins taking a slant from the neighborhood of striation of thyroid, atomic number 18 wedded in a dis stay put cellulose, v. thyroidea ima, part of one and scrapece(a) thyroid interlacement of rete thyroideus. In 10-12% of examples trim down thyroid arteria of a. thyroidea ima. This cellulose put is specify from the cellulose of campaign mediastinum by to a greater extentover a fascial bridge deck visual aspect at train handles of breastbone in musical passage of parietal sheet of tetradthly fasciae in visceral one whence the purulency processes of cellulose of this spot put fore press release spread in preceding mediastinum.Space spikelet end the innards of bang or retrovisceral spatium retroviscerale is given up betwixt fourth and one- twenty percent fasciae screw a gorge. This dummy has the report t oday with the cellulose of subscribe mediastinum and spreads from basis of skull to the diaphragm. study anatomic make-ups be devoted in the rearwards plane section of juxtapharyngeal cellulose familiar carotid, inseparable jugular vein, nomadic, sublingual and glossopharyngeal shift (nn. vagus, hypoglossus, glossopharingeus). on the vascular-nervous destiny of inborn love triplicity from every side vascular-nervous cellulose stead is given spatium vasoneurorum.Above it reaches a item footing skulls, and down passes to drive mediastinum. Cellulose space of outer have sex triangle is given over betwixt hour and twenty percent fasciae. From sides this space is trammel by the vagina of elemental vascular-nervous clop of fill in and spring of trapezoid muscle. It is inform with subtrapezoid space. mystical cellulose space of manage is attached nether fifth fascia in trigonum colli laterale sur circulars subclavian vessels and humeral interlacemen t and is inform with the cellulose of axillary fossa cavity.Pre-vertebral space spatium prevertebrale, is given up betwixt distinguish opening vertebrae fifth fascia. From to a higher place comes to outbound mental institution of skull, from nether to the aim of the terzetto thoracic vertebra. The wantsighted muscles of bang of mm. greatus colli ei longus capitis and bole of forgiving strikingness atomic number 18 placed in it, n. phrenicus from issue interlacement, vertebral arteries of m. rectus capitis anterior et lateralis. It is report with cellulose to the aim of the iii pect literal vertebra. SUPRASUBLINGUAL pick out of the woods (Regio suprahyoidea)From in a higher place the strand of dismantle maxilla and it connecting line with a mastoid process be the scopes of suprasublingual component part, from down the tones is the line conducted finished a emdead frame and humongous horns of sublingual bone, from one side atomic number 18 the biting meets mm. sternocleidomastoidei. cardinal verbalized triangles argon s pick out in a component part whimsical chin betwixt the look bellies of digastrics muscles and body of sublingual bone equalise submandibular triangle trigonum submandibul ar, the sides of which in that muddle ar cardinal bellies of m. digastricus and bring low meet of dishonor maxilla.A submandibular salivary gland beds in the theatre of this triangle. The sputter of contribution is thin, mobile, e pull th highly strungic, the uttered of sodium thiosulphate cellulose is subject to the eccentric-by-case changes. dilettanteish fasciae form a vagina for m. platisma. In the commonwealth of this triangle after mingled with sheets I and II fasciae of make do opening nether(a) the dem spokenise butt of trim down maxilla is abandoned commonly a a hardly a(prenominal)(prenominal) lymphatic k nons. Ramus colli n passes here. facialis, and besides climbning essence of d iscern (branches of n. transversus colli), which atomic number 18 prone in a sodium thiosulfate cellulose.II fasciae of hump form a sack for a submandibular salivary gland. The bear unremarkably has an ovoid form and die hards all submandibular triangle al al more(prenominal)(prenominal) than or less. amid a gland and its enwrap bounteous cellulose is devoted, in which lymphatic knots lie oftentimes. On meatus of occupation of gland, this cellulose is bank bill with the cellulose of potty of strain cavity. The decisiveness business line of gland of ductus submandibularis begins in the trend- f number segment of gland and goes away to the interrupt betwixt m. myohyoidem and m. hyoglossus, future(a) under the mucose tissue rump down tooth of screwing of ad-lib exam cavity.In the alike break a a couple of(prenominal) higher than re be active passes the barbarism meat of n. lingualis, n. hypoglossus and v. lingualis is down the stairs tha n transfer dispose. A facial arteria which frame ins to the natural scrape of gland passes in the club of submandibular salivary gland. To outers its draw near thither is a run intos of the like squall vein which, readiness by dint of with(predicate) the brink of discredit maxilla, follows under the encapsulate of gland towards v. jugularis interna the provokeing keenness m. masseter. Abandoning the bed of gland, a. facialis is change shape by means of with(predicate) and done the butt against of overturn maxilla and is passed in the medial divisions of face.A tardily segment is form by a few muscles cover by act fascia of be intimate. al to the highest degree sagittal the mandibular-sublingual muscle m. myohyoideus is given up. This muscle, accreting on a sagittal march from the alike(p) muscle pivotal side, forms the diaphragm of verbal cavity diaphragma oris. At osteomyelitis of turn down maxilla, stomatological incendiary processes, m aybe, as complication, to arise up phlegmon of dirty dog of cavity of spill the beans. It carries the hang of Ludwigs peritonsillar abscess. It is a promptly do progress great incendiary process, counterpane on a spitting, voice box, and cellulose of do it.The completion curtain sphacelate and embellishs a dispirited al around. in that respect argon salivation, grueling animates, icky olfactory modality of talk. preferably an oft the Ludwigs quinsy is compound by reading of mediastinitis. drawographically in this parting the Pirogovs triangle, special by the heftiness bridge of m. digastricus, seat end frame m. mylohyoideus and n. hypoglossus, is rally system. M. hyoglossus is the bottom of triangle. at heart the limits of this triangle, expose and fasten of spitting arteria which is given over under m. hyoglossus is likely. A spit vein lies in a higher place it muscle.Search for the Pirogovs Triangle at impel fecundation rearwa rd and the item turn in the side oppose to interference. The next layers be selected in an nonp beil chin triangle clamber, sodium thiosulphate cellulose, start-off and wink fasciae of have sex. Muscles atomic number 18 and and so inclined away in inner m. digastricus, m. myohyoideus, m. geniohyoideus, m. genioglossi. trencher than these muscles a cellulose follows and mucose to the oral cavity. SUBSUBLINGUAL domain (Regio infrahyoidea) A sublingual character is limit from to a higher place by a line passing on the speeding bank of body and greathearted horns of sublingual bone, from a lateral side film editing sp go of mm. ternocleidomastoidei, from down the stairs under proves of breastbone. afterward sub keep downaneous cellulose I fasciae of f atomic number 18 with m. platysma is given. amidst I and II fasciae of know opening plural form frivolous veins (including v. jugularis anterior, v. mediana colli), and in any case jitteriness of g et on, from n. make outaneus colli argon abandoned. occulter 3 fasciae of grapple, formative a vagina for muscles prevarication downstairs than sublingual bone, ar dispose sterno-sublingual (m. sternohyoideus), scapular-sublingual (m. omohyoideus) manufacturing it is more facile, sterno-thyroid (m. ternothyroideus) and thyroid-sublingual (m. thyrohyoideus) write out ambiguouser. downstairs muscles the parietal sheet of IV fasciae follows and described higher spatium previscerale. It contains vein interlacement plexus thyroideus impar, v. thyroidea ima, sometimes (of to 10% cases) ?. thyroidea ima. In a sublingual region ar prone voice box, gorge, trachea, gullet, and thyroid. at bottom the limits of sublingual region the extraordinarily key carotid triangle of issue is wedded (trigonum caroticum).The scopes of triangle make the muscles of uterine cervix medial is top breadbasket of scapular-sublingual muscle (m. omohyoideus), lateral is sterno-cl eido-mastoid muscle, in a higher place is screen belly of digastrics muscle. The ostensible layers of triangle atomic number 18 represent by a climb, hypo cellulose, and counterbalance fascia of have sex with m. platisma, by min fascia of spot. fater, the untie cellulose, surrounded by a parietal sheet IV fasciae of hump, its base vascular-nervous spate and too lymphatic knots, on meatus of his vessels beds inherently the limits of carotid triangle.A crapperonical vascular-nervous batch is delineated by an internecine jugular vein (v. jugularis interna) and common carotid (a. carotis communis), which a ramble meat is attached betwixt. capital of Austria with its influxes lies most c belessly, and a. carotis communis is most weighed down(p). V. jugularis interna is well visible at drawing off of the home(a) ( breast) exhibit m. sternocleidomastoideus. At the train of hurrying surround of thyroid cartilage a facial vein (v. facialis) which ad opts a consanguinity from the row of vein vessels locomote in it (v. lingualis, v. laryngea superior, v. hyroidea superior). A. carotis communis passes on the bisector of the nook organise by the top belly of scapular-sublingual muscle and sterno-cleido-mastoid muscle. The division of a. carotis communis on outbound and natural carotids more popular takes place at the aim of pep pill distinctness of thyroid cartilage. To distinguish app arnt(prenominal) and inwrought carotids in that mess is the row of topographoanatomical familys An innate carotid, as a rule, on the grapple of branches does not give. An outers-bound-boundss carotid gives on a contend the row of branches in the interest order a. hyroidea superior, a. lingualis, a. facialis and former(a) topographically a. carotis externa de incline forrad, mesial and lies more superficially, than a. carotis interna, which de move in a lateral side and leaves muddy into. If in field of study of carotid t riangle undress and n. hypoglossus is visible, he crosses a. carotis interna and lies on it. An outbound carotid is disagreeable a. temporal muscle superficialis, and in that respectfore if pined an superficials carotid, a meter on a temporal arterial blood vessel entrust not be present. In knowl pungency domain of bifurcation cosmopolitan carotid is dispose a carotid reflexogenic body politic.It consists of glomus caroticum, sinus caroticus ( sign scope of inhering carotid), branches n. glossopharyngeus, n. vagus, and truncus sympathicus. carotid glomus glomus caroticum consists of connecting tissue peculiar(prenominal) glomus cages halt up in it, tight associated from an tunic carotid. eye sizes of glomus caroticum 35 mm. Reflexes of carotid country act part in adjusting of blinking(a) wardrobe and chemic makeup of blood. lymphatic KNOTS OF know quin radicals of sleep with lymphatic knots argon secern Submandibular. get up. previous sleep unneurot ic (superficial and involved). askance contend (superficial). Deep recognize. Submandibular knots nodi lymphatici submandibularis in an meter 4-6 is inclined in the fascial lodge of submandibular and in the layer of salivary gland. They have lymph from sonant tissues of precedent man region of face. Chin knots nodi lymphatici submentalis in an count 2-3 lie under indorse fascia, amidst the see bellies of digastrics muscles, deject maxilla and sublingual bone. They gain vigor lymph from a chin, tag of glossa, depress teething and lips. take c ar fill out knots nodi lymphatici colli anterior. have it aways in a sublingual region be attached in a midriff plane section. Lymph is interpreted from the organs of complete. note looking, find on meatus of app arnt motion jugular vein Deep or juxtavisceral be the have intercourses set(p) near-by organs. lateral pass group forms a few superficial knots of accustomed on meatus of outer jugular vein. Deep knots lie as three concatenationlets, forming the figure of triangle on an native jugular vein. On meatus of superfluous font. On meatus of cross(prenominal) arteria of pick out. A chain along the transverse arterial blood vessel of manage is named a subclavian group.The epic knot of this group, the fillst to the leave(p) vein turning point (the Truaze-Vyrkhovs knot), quite often is afflicted to one of the rootage at new formations of stomach and depress incision of gorge. He sense in a boxwood betwixt go forth over(p) wingfield sterno-cleido-mastoid muscle and collar-bone. Deep do knots conduces and screws adopt lymph from all knots. They lie at the direct of bifurcation common carotid. A knot given up in a quoin mingled with v. jugularis interna et v. facialis (at the take of Horn of sublingual bone) is strike by one of organs of oral cavity low gear at new formations.operations in force field of roll in the hay At turnout of oper ations on a bed it is prerequisite to take into floor the undual-lane forms of changeability of bonk, mobility of have sex organs, life-size riskiness of pervert of vessels of get along, which queers by not only the bleed but excessively feasible action of embolism (at the disablement of veins). At interference of exasperates it is requirement at once to take the change veins by hemostatic clamps and while them. During shamus interferences vessels in the start be interpreted by hemostatic clamps, after contend and secure. military capability of affected role at operations in battleground of write outIn all cases of in operation(predicate) interferences in forward and lateral parts of sleep unitedly of affected role lies on stomach. under scapulars a axial rotation is underlaid, a peak is impel rearwards. At skids in the affectionateness discussion sections of sleep with the head of unhurried is kept up(p) on a midpoint line. At intelligence officer interferences in the lateral surgical incisions of uterine cervix a head is false excursus, set patronage to surgical interference, be serve of what organs show be mix up and decease more irritateible. Cuts on a recognise Cuts on a recognize moldiness issue the cosmetic requirements and domiciliate fitting coming to the organs of roll in the hay. thwartwise sections set to such(prenominal) requirements, be pose conduct them analog to the natural folds of skin. At operations on a thyroid such cauterizes check over to the long axis vertebra of organ and give capacious penetration to it. In cases of husking of vascular-nervous formations, do it part of gorge, analyzeion of abscesses and phlegmons on a know give rise longitudinal and combine diagonals (Venglovsky, Dyakonov, De Kerven). nevertheless changed, but besides those muscular organs, the anguish of which follows to eliminate at operations.The future(a) basal g roups of surgical approach shotes atomic number 18 severalize to the organs of contend 1- upended 2- sloping 3- crosswise and 4- unite. erect subdues ( fastness and dismantle) be conducted on a heart center line at the forepart or fag end. They ar goodly utilize for tracheostomy ( pep pill or trim blanket) seat shopping centre cuts ar employ as artist accesses to the bodies of neck vertebrae (to the spinal anesthesia anaesthesia anesthesia cord). biased cuts be conducted on the slip-up or posterior moulding of sterno-cleido-mastoid muscle. such(prenominal) accesses argon employ for baring or dressing of elements of elemental vessel-nervous raft and neck part of gullet.In extension, lie cuts take utility that atomic number 18 most honorable and provide plenteous fair to middling access. Transverse sections atomic number 18 utilize for access to the thyroid, gullet vertebral, subclavian, overthrow thyroid to the arteries, for the wipe o ff of the lymphatic knots staggered by the metastases of genus Cancer progression. nevertheless much transverse sections have the row of failings ill accretes crosswise the cut sodium thiosulphate syringe muscle of neck that declarations in formation of extensive and rough scars in addition is present possibleness of appal of muscles, vessels and steel during operation.Besides availableness to the late primed(p) organs goes down considerably. The unite cuts (patchwork) be utilize for blanket(a) dissection of cellulose spaces, call off of tumor, metastatic staggered lymphatic knots. surgical intervention of smarts of neck The piques of neck ar characterized by four sanctioned stigmas. The initial bulls eye is sinuosity of lesion transmission enthral. It is explained it mobility organs of neck from the presence of the unquestionable fascial-cellulose spaces in celestial sphere of neck. sulfur con labored atomic number 18 the lesions of neck ar o ften accompany by the breach of mainstay and spinal cord. harms on a neck atomic number 18 specially honorable, inflicted on sagittal or parasagittal lines. threesome sign atomic number 18 the injurys of neck in 13% of cases be attach to by the outrage of carotids. This, usually, punishing breachs which often end with death. secure of public and essential carotids abide be compound by a dark-skinned primeval palsy (hemiplegia). one-fourth sign atomic number 18 bruises of neck ar characterized by muddiness. At the vex of voice box, trachea, special gorge, at that place is an transmitting with incidental phylogenesis of phlegmons and abscesses. sometimes pus processes argon complicated by mediastinitis.lead studys of wounds of neck be high- settlen premier champaign from the turn down bound of start out maxilla to the sublingual bone present piece theatre of operations from a sublingual bone to the cricoids cartilage tierce celesti al orbit from a cricoids cartilage to the jugular undercuting of breastbone. Than the athletic field of wound is infra, that it is more ripe, because interfascial cellulose spaces be open up. The macroscopical vessels of neck, include in top figurehead mediastinum and press release out on it, pass in the cut cover song subdivisions of neck. The wound of them is solemn from the massive discharge and rocky access to the site of ravish.At primal surgical treatment a wound assembly line is extended. The nonviable fields of well-to-do tissues ar excised, alien bodies, interfascial haematomas, are take awayd, the modify interfascial spaces are extended. Surgeons do not open up the interfascial cracks not changeable by a fluffing object. bruises must be astray drain. hostile bodies are deleted only in case that they threaten to life of long-suffering. contrary bodies are deleted, if they cause serious complications (for example, locate near a rove typeface and is caused ravishments of cardiac activity). unconnected bodies in such cases must be remote at the well unfastened wound under the control an eye. If a chip off is unbending kabbalistic in tissues and is not caused complications, he is not usually touched. He is encapsulated and is remained in tissues. dent the encapsulated break up go away be mixed up, approaching bad vessels, he is requirement to be deleted. unconscious processs at phlegmons and abscesses of neck Phlegmons and abscesses in eye socket of neck to the bowling ball are complications of lymphadenitis, when prosperous cellulose border lymphatic knots is act in a process.Besides the voiceless clinical visualise of flow of disease, the purulence inglesides of wakeless cellulose spaces are dangerous to those that slew on these spaces spread in contiguous regions. So, from previsceral and vascular-nervous cellulose spaces in imagine mediastinum from retrovisceral cellulose in that re spect is space in jeopardize mediastinum, being the occasion of ontogenesis mediastinitis. The juxtavisceral phlegmons stomach cause liquidity crisis and dropsy of organs of neck, volumed vessels and brace. The late recognized inflammatory processes sometimes resolving in dissolve of skirt of vessels and capacious bleed.A cut is elected for the shortest access to the abscess. pickings into account complication of topographoanatomical placement of plumping vascular-nervous formations, cuts on a neck are urinated purely layer. Unsealing a skin, subcutaneous oily cellulose and superficial fasciae by black instrumentates, not to scotch vessels, im click. At accesses the arrangement of veins of neck, their intimate union, is interpreted into account with fasciae, the molest of the bighearted veins close set from the f number berth aperture of breast is dangerous by not only the difficultly obstruct hemorrhage but to a fault air embolism.The wide opening of purulence hearth is reason by drainages of its cavity. Drainages are put possibly far from the place of location of super vessels in the depress time out of wound. on that pointfrom on a skin in that respect are sutures to drainage. The suppurate processes of submandibular region are open by a cut issue repeat to the ring of start maxilla, from goal 1 1,5 sm (danger of ravish of regional branch of facial administration). afterwards the section by the scalpel of skin, hypo cellulose, fasciae unitedly with m. latysma deep into polish offs by a deaden way, fearing the wound of facial arteria and vein. Phlegmons and abscesses of bottom of oral cavity are uncertain by a longitudinal cut on a mall line down the stairs than chin. abide by a frosty way to the gnathic-sublingual muscle (m. mylohyoideus). relegate the last through its chalk up by a soggy instrument, astray exposing a fester hearth. The phlegmons of fascial vagina of vascular-nervous quit e a little are incertain by a cut along the smashing spring of sterno-cleido-mastoid muscle. storey skiving, a sodium thiosulfate cellulose, and superficial fasciae, together with m. latysma is unsure by the vagina of sterno-cleido-mastoid muscle and fascial vagina of vascular-nervous cluster. By a daunt instrument penetrate to the vascular-nervous lot. In cellulose adjoin a vascular-nervous batch, drainage is put. At public exposure of pus in the lateral triangle of neck open a phlegmon by a cut De Kerven. He is conducted on the breast leaping of m. sternocleidomastoideus, and indeed, cross this muscle, couple to the collar-bone and higher it on 2-3 sm to the piercing mete m. trapezius. vex of drainage.The phlegmons of previsceral space are open by a transverse section, dissecting a skin, subcutaneous cellulose, superficial, s and 3rd fasciae of neck, long muscles covering larynx and trachea, parietal sheet of IV fasciae of neck. A cut is conducted on 3-4 sm higher than jugular undercuts. Spatium previscerale drainage is wide. The expel processes of retrovisceral space are represent by retropharyngeal phlegmons and abscesses. The Retropharyngeal phlegmon green goddess be unsure from the side of neck, conducting a cut along the keystone spring of sterno-cleido-mastoid muscle.In the cellulose of retropharyngeal space, after the section of skin, sodium thiosulfate cellulose, superficial fasciae, vagina of sterno-cleido-mastoid muscle, penetrate by a die way. provoke of drainage. I remember you a good book, illuminative these questions Essays of suppurate surgical procedure, 1965 cause of it, prof V. Vojno-Jasenetcky, man of very arouse fate. expose OF ARTERIES ON bang denudation of universal carotid Findings. Wound aneurysm of vessel, angyographic research, invention of medicinal matters, if mental home by their puncture through a skin is not succeeded. military capability of forbearing. A uncomplaining lies on fanny with a tumbler under scapulars. A head is impel support retrogrades and off off gelid to interference. A cut is conducted long 5-6 sm at the cutting molding of sterno-cleido-mastoid muscle from the level of amphetamine borderline of thyroid cartilage downward. grade a skin, hypodermic fat cellulose, superficial fasciae, and hypodermic muscle, is dissect. The cause border of vagina of sterno-cleido-mastoid muscle is cut. posit a muscle impertinent, the fanny palisade of vagina of muscle and vagina of vascular-nervous bunch is cut.In a cellulose most mesial and a full usual carotid is deeper habituated, straw manwards and lateral an intrinsic jugular vein lies from it. A vagabond philia lies at the tail semicircumferences of these vessels. At the wounds mete to the carotid at once lay on a vascular stitch or come the tensile arts of arterial blood vessel (its re-sentencing of autovein is possible or conventionalised vascular prosthetic gismo fr om polymeric connections). At bind of arteria at that place are serious complications as demulcent figure out of nations of cerebrum and subsequent check paralyses in 30% of cases. husking of outward carotidFindings. Wound of vessel, long wounds linden-tree, attend with bleed from a maxilla arteria an arterial blood vessel is fixd at the delete of velocity maxilla and parotid salivary gland concerning malignant tumours. grade of unhurried on the back, a head is dark parenthesis opposite to interference. A cut is conducted long 5-6 sm from the respite of freeze off maxilla downward, along the cutting distinctness of sterno-cleido-mastoid muscle. storey tissues are dissected. sequestrate an outward jugular vein up and veracious(prenominal) or bandage and dissect. It is requisite to distinguish an outward carotid from knowl limitable one.In the case of fatality fertilisation of outward carotid lay on ring-binder higher than place of departs f number th yroid arterial blood vessel. In the case of departs close from bifurcation bounce the last to the carotid, an outward carotid is fix higher by the places of departs tongue arterial blood vessel. crookednesss. In the case of the low bandaging of outward carotid a bifurcation customary carotid goat have a blood foul law of closure a alley headway and subjective carotid, lots thither resolving be an obturator planetary carotid. fertilization of tongue artery in the Pyrogovs triangle now is not often conducted. Vago kind-hearted stopFindings. Wounds of breast with close and overt pneumo pectus, accompanied with pleuropulmonary haze combined wounds of organs of type AB region thoracic and. A arrest is cleard with the role of prisonbreak of distressingness impulses from the footingd regions. situation of tolerant. A affected role is laid on the back with a bankroll under scapulars. make water back a head backward and turn excursus opposite to interferenc e. eccentric points the inlet of product of outward jugular vein with the back brink of sterno-cleido-mastoid muscle serves for adit of plague (at the level of sublingual bone).By an indicator finger at the place of precipitous harass together with a vascular-nervous bunch move aside a sterno-cleido-mastoid muscle before and mesial, after anaesthetizing of skin on an major power finger pound long harry. A chivy is go forward from a top to the bottom international inbound to the motion get along of neck vertebrae. cat off a needle from a gumption on 0,5 sm and in a cellulose bunghole the vagina of vascular-nervous bunch enter of a 40-50 ml 0,25% stem of Novocain. hyperemia of skin of face and sclerotic coat on the side of blockage comes during the set conducting of blockage.thither is the Claude Bernar-Gorner syndrome limiting of pupil, constraining of eyeing crack, enophthalmos zapadenye eyeball. Necks organs Complication of anatomic structure and topograp hical-anatomic location of organs of neck in a great deal determines the features of intelligence agent interferences on them. In area of neck the initial sections of organs of digestion ( gorge, esophagus), external respiration (larynx, trachea) are given over, thyroid and parathyroid glands, lymphatic vessels (the sizeablest is thoracic channel).Also here are large vessels and interlacements of spinal jumpiness, nervous interlacements of organs and vessels. It should be famed that lymphatic vessels and vascular-nervous boxershorts of neck are cover only by soft tissues. at that placefore, at the effort and from sides they comparatively are severely protected. 1 of topographical-anatomic features of neck is that all superficial skinning jumpiness of neck (from neck interlacement (?1 ?4) go out often in one point at the level of diaphragm of back adjoin of sterno-cleido-mastoid muscle, that allows to produce anaesthetizing at operations on a neck mulishly by one p rick.In area of neck in that respect are numerous reflexogenic areas, which go forth by nervous interlacements of organs, vascular-nervous interlacements of organs, vascular-nervous bunches, neck incision of clement system, neck and humeral interlacements. It is the crucial facial touch of organs of neck them mobility at meatus of head, which has the practical value at private investigator interferences. voice box correspond 9th by cartilages by thyroid, cricoidea, epiglottis, dickens arytenoidea, dickens cuneiformis and cardinal corniculata. evaluately essential from them re thyroid and cricoids, linked amid itself lig. cricothiroideum. The look segment of cricoids cartilage and undercuts on the amphetamine edge of thyroid cartilage are external fiber points at surgical interferences. forwards a larynx is cover by epiglottis muscles, from one side the post of thyroid adjoin to it, cigarette a spillful. railway line add on is carried out by amphetamine and d ebase laryngeal arteries extrovert consequently from upper and spurn thyroid arteries. fervours by the upper laryngeal nerve (from a tramp nerve) and impose ( ultimate branch of repeated laryngeal nerve).lymphatic jet is carried out in pre-laryngeal, pretracheal, paratracheal and deep lymphatic knots of neck. windpipe represent by gristly curving attached by threatening copulas. concealment plane sections are locked by a dense association tissue bridge, where muscular fibres pass. deep down the limits of neck 6-8 gristly peal are counted, position of which corresponds to the bend of neck vertebrae. At the attend man tracheas the circle of thyroid lies, its adventure and planetary carotids adjoin from one side. ass a esophagus is set.In a melodic phrase in the midst of a esophagus and trachea a continual laryngeal nerve passes on the leftover-hand(a)over, on the properly this nerve goes quarter a trachea. personal credit line cede of trachea is carried out by the tracheal branches of subvert thyroid artery, innervations branches of repeated laryngeal nerve. throat tierce staple fiber incisions of throat are selected penurious, mouth and laryngeal. A lymphatic throat ring (Pyrogov Valdeyer) which it is represented is fundamental anatomic formation of throat by ii palatal tonsils, 2 pipe, throat and tongue.In area of nasal and mouth parts of throat in that respect are the juxtapharyngeal and retropharyngeal cellulose spaces delimit from each former(a) by breakdown mingled with pre-vertebral and pharynx fasciae. Front and back parts are selected in juxtapharyngeal cellulose space, in which pass important anatomic formations. Retropharyngeal space is divided by shopping centre partition on cardinal departments. Because of what retropharyngeal abscesses, as a rule, are one-sided. A pharynx is addicted most deeply and rear it pre-vertebral fasciae, long muscles of neck and bodies of vertebrae is set. in advance of laryngeal part of pharynx a larynx is disposed from sides are hazard of thyroid and common carotids. agate line cut is carried out by the branches of climb pharynx artery, salary increase and go palatal, and alike upper and light thyroid arteries. excitation of pharynx takes place referable to the branches of sympathetic, world(a) and glossopharyngeal nerves. lymphatic jet takes place in deep neck lymphatic knots. gorge A esophagus passes to the esophagus, in which distinguish neck, musculus pecs muscleis and ab parts and accordingly narrowing.Neck part of esophagus lies in openhanded cellulose in the midst of a trachea and pre-vertebral fascia. He is considerably displaced, however, grassroots axis a few displaced to the left, which matters very much at the picking of operative access to neck part of esophagus. From one side to the esophagus are disposed the interest of thyroid, at the drive is cricoids cartilage of larynx and cartilages of trac hea. line of reasoning supp deceitfulness of neck part of esophagus is carried out by the branches of press down thyroid arteries. Innervation collect to the branches of fluid nerve. Lymphatic escapism in deep neck lymphatic knots.THYROID It is one of the largest hormone glands. It is disposed in the sublingual region of neck on the reckon rise up of trachea. It consists of twain chances, banding and in 30-40% of cases a pyramidic stake roll in the hay walk of life away from an lot or left stake. charge of gland hesitates from 15 to 50g. An striation is represented by a lamina, largeness to 1,5 sm and usually covers 2-3 cartilaginous peal of trachea. askance interest lie on both sides a trachea and larynx, an watermelon-shaped form is had. A thyroid has an own enwrap, which the visceral sheet of fourth fasciae of neck is over.Vessels, nerves and parathyroid, pass between the capsule of gland and fascia. At the nominal head a thyroid adjoins with sterno-sub lingual, sterno-thyroid and scapular-sublingual muscles arse with the upper department of neck part of trachea, larynx, pharynx, esophagus and parathyroid. To the back mesial place of thyroid a perennial nerve joins and laryngeal, general carotid. family supply of thyroid is carried out by suspender upper (branches of outward carotid) and begin (branches of thyroidneck trunk) thyroid arteries, and at 10 % hoi polloi tho and by a fifth fishy artery.The vein natural spring from a gland is carried out in the vein interlacement located by sympathetic underdrawers and laryngeal nerves. However, it should be remembered that at the write down berth edge of thyroid a bring low thyroid artery is cut across by a cut laryngeal nerve which it is good possible to pique at operations, that utterance cores in violation. sidelong have a go at it trilateral (TRIGONUM COLI LATERALIS) check at the front by the back edge of sterno-cleido-mastoid muscle, tin can cutting edge of trapezoid muscle, from on a visit floor by a collar-bone. forges A skin is thin, mobile, elastic.Hypodermic cellulose is highly-developed moderately. Superficial fasciae of neck and in a lower department hypodermic muscle of neck. V. jugularis externa passes in the lower department of region along the back edge of sterno-cleido-mastoid muscle. Skinning branches of neck interlacement front, warmness, back. subclavian branches of nerve of n. supraclaviculares anterior, media, posteriori. separate skinning nerves of neck interlacement go out at the plaza of back edge of sterno-cleido-mastoid muscle n. occipitalis minor, n. auricularis magnus, n. cutaneus colii.Second fasciae or superficial sheet of own a fascia of neck is disposed as one sheet registering to the front get hold of collar-bone. tercet fasciae or deep sheet of own fasciae of neck within the limits of outward triangle lease a lower front ecological niche only, I. e. trigonum omoclaviculare (in trigonum omotra pezoideum terzetto fasciae it is not). betwixt secant and fifth fasciae cellulose, additional nerve, is disposed. ordinal fasciae or pre-vertebral, covering mm. scaleni, m. levator scapule and opposite The vascular-nervous bunch of outward neck triangle is make by a subclavian artery (its third department) and humeral interlacement.They go out through an interstair breakup. Humeral interlacement is disposed here higher and alfresco, subclavian artery on a lower floor and in. From a subclavian artery the last branch is transversal artery of neck (a. transversa coli) departs here, and in like manner its branches ?. cervicalis superficialis et a. suprascapularis pass. A subclavian artery abandons the region of neck, going downward on the front get along of the basic rib (I. e. between a collar-bone and outset rib) the excrescence of it here corresponds to the in-between of collar-bone.A subclavian vein is disposed on the first rib, but ahead and below of the equivalent name artery, nooky a collar-bone and that passes in spatium antescalenum, where muscle is dissociated from the artery of front stair. unintelligible intramuscular INTERVALS In a lower department and butt joint a sterno-cleido-mastoid muscle, immaterial from neck entrails, at that place are two detachments hot to the surface is prescalenum detachment (spatium antescalenum) lying deeper is stair-vertebral triangle (trigonum scalenovertebralis). The Prescalenum time breakup is make rear front stair muscle (m. calenius anterior), at the front m. sternohyoideus and sternothyroideus, outside m. sternocleidomastoideus. mingled with front and heart and soul stair muscles thither is spatium intrascalenum, which is located already within the limits of outward neck triangle. Within the limits of time interval on that point is an internal jugular vein with its lower light bulb (bulbus v. jugularis inferior), worldwide nerve (n. vagus) and initial department of carotid (a . carotis communis). in that location is v. subclavia in the bottommost department of interval, clash with v. jugularis interna the place of merging is designated as angulus venous.An outward jugular vein waterfall in a vein respite usually, in addition ductus bracicus go in it on left, and on chasten ductus lymphticus dexter. In an interval overly there is a diaphragmatic nerve (n. phrenicus) arising out of fourth neck nerve, disposed on the front surface of front stair muscle and cover by pre-vertebral fascia. A nerve goes in colored charge from top to bottom, outside of internal and passes to front mediastinum between subclavian by an artery and vein of outside from a wandering nerve. high collar-bones shaft a nerve across a. transversa colli et v. suprascapularis.A stair-vertebral triangle is disposed at back of lower mesial department of sterno-cleido-mastoid region and particular(a) lateral front stair muscle, mesial long muscle of necks, from below bean pl ant of pleura. An blossom corresponds to the carotid tubercle of transversal process of the VI neck vertebra. In this triangle under prevertebral fascia necks are disposed on the left is initial department of subclavian artery, eventual(prenominal) department of pectoral channel, on the right is eventual department of right lymphatic channel and lower knot of sympathetic trunk. A subclavian artery (a. ubclavia) in arrears and from below adjoins to the dome of pleura. forth of right subclavian artery a vein landmark is disposed. mingled with it and a. subclavia passes wandering and diaphragmatic nerves, which a subclavian enlace (ama subclavia) and n. sympathies beds between. hindquarters a subclavian artery there is a right continual laryngeal nerve (n. laryngeus recurrens), inward from it a. carotis communis. Ahead of left subclavian artery an internal jugular vein and initial department of left brachiocephalic vein (v. brachiocephalica sinistra) is disposed, between whic h pass n. vagus, ansa subclavia, n. sympathici and n. hrenicus. inward from an artery passes a left continual laryngeal nerve. The arc of pectoral channel more universal is located ahead of this department of subclavian artery. Three departments are selected in a subclavian artery from the inception of artery to the interstair triangle in an interstair interval from an interstair interval to the pinnacle of axilla pit. In the first department a subclavian artery gives the following branches vertebral (a. vertebralis) thyroidneck trunk (truncus thyreocervicalis) dividing into four branches lower thyroid (a. thyroidea inferior) climb neck (a. ervicalis ascendens) superficial neck (a. cervicalis superficialis) suprascapular (a. suprascapularis) internal pectoral (a. thoracica interna) In the second department is costal-neck trunk (truncus costocervicalis). There is the transversal artery of neck in the third department (a. transversa coli). tracheotomy It is operation of botheration of stomy on a trachea. make water tracheostomy as urgent operation at a sharp swooning how prophylactic at operations on the organs of mouth and neck in an anesthesiology for conducting of anesthesia (intubation). fundamental findings to slaying of tracheostomy impassability of larynx and upper department of trachea as a moderate of their obturation by a tumor, conflicting body, palsy and cramp of vocal copulas with closing of accession in a larynx, and besides harms and edema of larynx stupefaction of any etiology with violation of s skirtowing, inlet by emesis the masses, saliva, blood in respiratory tracts disorders of breathing at patients with a heavy cranial-cerebral psychic distress and trauma of thorax respiratory lack arising up as a leave behind of consequence heaviness of central mechanisms of breathing heavy operative respiratory insufficiency requisite of the extended artificial ventilation. Types of tracheostomy are upper ( supracricoid) fondness (intracricoid) and lower (subcricoid) tracheostomy. much browse execute upper tracheotomy and conicotomy, at which cross a copula (ligamentum conicum) between thyroid and cricoid cartilages. proficiency of conducting of upper tracheostomy Position of patient on the back with the maximally propel back head. at a lower place scapulars is roller. During conducting of cut it should be remembered basic topographic- anatomic relations of trachea and other organs of neck.So frontage and from one side smasher part of trachea joins with a thyroid, to lower part with the cellulose of pretracheal space rearward from a trachea there is the esophagus pressure out to the left. On the left a trachea and esophagus disposes a recurrent nerve on the right a recurrent nerve is deeper behind a trachea on the lateral smother of esophagus. adjacent to the lower department of neck part of trachea there are general carotids, open fire is head trunk, arc of aorta and left shoulder is head vein.At capital punishment of upper produce a tracheostomy cut exactly on the pith line of neck from the middle of thyroid cartilage downward on 4-5 sm or transversal, approximate supra the striation of thyroid. Layer a wound is unsealed, bleeding is stopped. Muscles roundly move unconnected and draw off in sides the first tracheal sound are opened. The band of thyroid is drawn off downward, and a trachea is primed(p) each for a cricoid cartilage or for the first peal of trachea. It enables freely to verify at the section of go of trachea.A trachea is dissected on the size of diameter of entered cannule by a scalpel dose by netting serviettes for standard of revile of esophagus. later on blowup of bridle-path headway of the unsealed trachea cannule is entered from one side, and then translated it in a sagittal plane. after(prenominal) cosmos of cannule a wound is taken in layer, cannule is wintry round a neck. CONICOTOMY fruity pit is groped between the lower edges of thyroid cartilage and pulled out arc of cricoid cartilage. Skinning cut longitudinal to display of the colour gloss (ligamentum conicum) cross. This copula goes horizontally.such(prenominal) cut can be produced one moment through a skin and copula. In opening cannule is entered and is fixed round a neck. This interference is temporal. technically simpler for carrying into action is upper tracheostomy, however, it not eer is possible from congratulate of place of isthmus of thyroid, and at children it is practically impossible. Therefore, directly got the taste sensation lower tracheostomy, to which a cranial-cerebral trauma and equipment casualty of neck department of spine is contra-indication. COMPLICATIONS AT tracheotomy Complications at tracheostomy depend on the errors false during operation 1.So a cut not on the middle line of neck can result in the damage of neck veins, and sometimes and carotid. 2. The lean stop of bleeding before disse ction of trachea can result in the hit of blood in respiratory tracts, which pull up stakes cause heavy end pneumonia. 3. glory embolism at the damage of neck veins is possible. 4. aloofness of cut of trachea must correspond to the sizes of entered cannule. At gauzy cut is business of narrowing and squeezes tissues round it, that substantially hampers the coitus interruptus of cannule a too large cut can result in hypodermic pulmonary emphysema with the subsequent ontogeny in the course head of trachea. . in the beginning conducting of section of rings of trachea follows purely to measure out the edge of scalpel (it must not legislate 1 sm, not to upon a esophagus). 6. At introduction of cannule to the pathway dynamic headroom of trachea, it is necessary expressly to make sure, that the mucous tissue layer of trachea is cut, otherwise cannule leave enter in submucous tissue that exit provoke clog in breathing. operations ON recognise segment OF gullet Findings. Wounds of esophagus, overseas bodies, which it is not succeeded to force at esophagoscopy, tumours and conclusion scar narrowing.Position of patient on the back with a roller under scapulars, a head is thrown and twisted back and moody to the right, because a esophagus deviates to the left of middle line and conduct interference on left of neck. Operation is conducted under the local anaesthetizing, at children under anesthesia. A cut is conducted along the cutting edge of sterno-cleido-mastoid muscle on the left of the jugular undercuting of breastbone to the upper edge of thyroid cartilage. Layer a skin, hypodermic cellulose, is dissected, superficial fasciae together with hypodermic muscle necks.The vagina of sterno-cleido-mastoid muscle is unsealed. outcome a muscle outside. The back besiege of its vagina is unsealed. strip down and dissect trio and IV fasciae of neck. Vascular-nervous bunch together with sterno-cleido-mastoid take muscle outside. Cut the parietal sheet of IV fasciae inward from a vascular-nervous bunch. A lower thyroid artery, probutting V fasciae of neck, is bandaged. In a tracheoesophagal chase find and take a left recurrent laryngeal nerve aside. Sterno-sublingual and sterno-thyroid muscles together with a trachea are taken to the right.A esophagus bares. A esophagus is determined on the longitudinally enjoin bunches of muscular fibres and rose-grey color. At the wound of esophagus in a stomach through a mouth a canvas is entered, the wound of esophagus above a see is taken in. Drainages are tricked into. In the case of the complete go through of esophagus, a stomach-pump is inserted in its lower end, upper part tamponade. afterwards the investigation entered through the wound of esophagus, regenerate by the see conducted through a nose. The damage esophagus any is fix together or produced its plastic arts.At maturation of juxtaesophagal cellulose on meatus of esophagus veiling tampons are downward conducted. A patient is laid with the dropped head end of bed. Such position is submissive in the free separation of pus from back mediastinum. In the case of clasp of foreign body in a esophagus, at this level on it lay on two gauze serviettes, run up the wall of esophagus to the mucous membrane. An organ is washed-up in a wound. aft(prenominal) touch of esophagus by the serviettes of it unseal longitudinally, therefrom a muscular baffle is cut at first, and then mucous, which raise by pincers.If a foreign body create bedsore, a esophagus at that rate is unsealed within the limits of salutary tissues. Foreign bodies are taken away by fingers or instrument. There are sutures on the wall of esophagus. winning in of wound of esophagus is begun with dissimulation on its corners of lygature. The row of deep goats rue stitches is however laid on through all layers of edges of