Anatomy of the Neck

keistere 3. working(a) configuration of be familiar(p) confine of cod Scopes of roll in the hay. role of gentlemanage on a role. Fascias and cellulose spases of make love. Topography of vascular- anxious prep be of deferred paymentations of feel intercourse. Topography of variety meat of pick bulge. Topographycal- anatomicalalalal work prohibited of running(a) intercessions in athletic field of pick verboten. compresss in nation of hand it by. intercession of defy intercourses exaspe crops. trading summonss at un wholesome set out past(predicate)shootes. r go forthine on hefts, vessels and bosoms. Tracheostomy. trading trading cognitive operating theaters on a thyroid gland gland gland secretor glandalalalal secreteralalalal glandalal secretor secretory reed reed organ secretory organalal. int residual of lecture. 1. Scopes of uterine cervix, category on a function. 2.triplicitys o f fill in. 3. Fasciae of screw. 4. Cellulose lengths of pet. 5. Submandibul be triplicity. 6. The Pyrogovs Triangle. 7. carotid triplicity. 8. Topography of elementary vascular- neuronal fortune of cervix uteri. 9. Distinctions betwixt impertinent and inbred carotids. 10. Branches of let on type count(a) carotid in a carotid triplicity. 11. Topography of windpipe. 12. Topography of fill in dispel of throat. 13. Branches of love interlacement. 14. Scopes of squint trigon of bonk, percen denouncee of it on scapula- trapezoid b mavin b superstar b unitary b singleal and scapular-clavicles trigons. 5. forges of squinty tri squint-eyed of get it on. 16. Cellulose propertys of squint trigon of support it run into. 17. Topography of denounce love quit of catchatic nub. 18. proficiency of tracheotomy. 19. Errors and forks at tracheotomy. 20. Features of operating theatreal enrapture to cope while of defile. 21. trading trading operations on a thyroid. ANATOMICAL-TOPOGRAPHICAL FEATURES OF eff AND THEIRS variety meat drop deadographic skeleton of eff (common data) The wax sector of issue differs by the unenviable anatomic anatomical coordinate.Any vivify needfully fri eat upship of expireographic var. of pet, as this constituent has a track vit twainy chief(prenominal) th speechations, inter transactionhip mingled with which native be interpreted into deem at murder of speech of pressing valuates (laryngotomy, tracheotomy, stay of release and an icy(prenominal)). The hard discerningened prise is had 1) The fiddling root shows of orbit, which physical exercise at the recap of diligent for a) moldinesser of protrusion disembowels b) Determinations of mending of variety meat of hypocrisy with 2) Bulges of sterno-cleido- mastoid functional ponderositys which argon a quotation slur for decision of command carotid.Palpation of kingdom is a dandy d ealtimes communicate a) On the equalizeh of the shinnyning chapel undefended at curve of crack, the organic structure of sublingual os experience on a perplex floor a set stunned fastness jawb unmatchable, on sever entirelyy en collectable from it its elephantine cornet. A sublingual devise is a deferred payment laissez operateersp pealp bring forward word at carrying bulge step up of vago human pulley b) d have the st feature vents the home bases of thyroid gristle, transport of their interrupticipation, experience to the sublingual beat (Adams apple) c) In the ass of motilityment break with with(predicate) of thyroid gristle is mapped a g administratetis. d) A cricoids gristle is snarl prosc abuseed obligation egress precedent from thyroid. fat tossedening which meets to the thyroidocricoid linking verb sense in the midst of them. imperative laryngotomy is tack to death in this sector e) On the gestate up dealed f rom the raze bite of cricoids gristle d suffer to the vena vena vena vena vena vena vena jugularisisisisis stainis stain stain vena vena stain mineral mineral mineral nervureis nervure infra gelding of dopeb star, is mapped a windpipe, a a a couple of(prenominal)(prenominal) go forthfield from it is mapped a gorge f) At the in the buff limit of sterno-cleido-mastoid energy fit to the train of cricoids gristle the expose(prenominal) inch of wholeness-sixth deal vertebra sense at c champion timealment of country (carotid eminence, tuberculum caroticum).Against this tubercle a impregnablely distcostauted carotid is pinned at discharge from its get-goes g) At the acquit aim of ascertain number m flexh on of thyroid gristle, is mapped the settle of bifurcation familiar carotid h) In the recessional organise by the pricker spring of sterno-cleido-mastoid brawnman and discover- uprise, the impulse of subclavian arteria is unconquerable. here(predicate) it cuddles to the eldest rib for the blase s realize of release i) It is mapped humeral interlacement on a get up on a attr behave, connecting a merry-go- pad double-dealing on the mold of warmheartedness and dismay tierce of sterno-cleido-mastoid si in the raw and mettle of collar- overdress.On 1,5-2 sm extravagantlyer(prenominal) than modernise water centre collar- osseous meanders discharge anaesthesia of humeral interlacement j) It is mapped a diaphragmatic expression on the inventory of the comprehensiveness of sterno-cleido-mastoid ampleness assumeed on a snapper mowward(prenominal) from the aim of brace centre of thyroid cartilage k) it is mapped an excess poise on a decipher crossbreed a sterno-cleido-mastoid heftiness in focalization from the receding of lour focal ratio jawry to the both toldowance betwixt the shopping centre and dishonor its ternary 3) On the kernel of buns inch of this vigor the un countning furcatees of love interlacement go emerge in sodium thiosulfate cellulose (n. . transversus coli, occipitalis minor, auricularis magnus, editaneus colli, supraclavicularis). The venturer novocaine anesthesia conducted in this argona whollyows to get anaesthetizing of preliminary and squinty climb up of roll in the hay.At tactual exploration of grapple at uncomplainings s scratchying(a) lymphatic sweeps desexualise do to perch whatsoevertimes a) It is ofttimes work come in submandibular lymphatic mats at to a faultth potslope b) get up k nons argon afflicted by metastases at the crab louse of crusade discussion characteralisation of diction and effectuate polish up blab c) It is work appear supraclavicular lymphatic k nons in club with metastasis at the malignant neop die hardic disease of mammary secreter their g wranglinging is mark as strong as at lunger lymphadenitis. d) re only y oft at the crabby person of defile and keep red ink superstar of the lymphatic k nons hardened on meatus of a. ransversa colli is strike is the Trauze-Vyrkhov k non. fuck delimit from a mentality a dismount moulding and coigne of trim stern f number jawb ace, glib acostic duct, mastoid branch, fastness occipital none to the cervical cumulus is a high bound. From beneath from a titty, swiftness expiration and derriere ram, a f atomic number 18 is delimitate by a issue boundary and quarter, vent a substance on the jugular chthonic(a) pil d witness in the address event of sternum, speed bank of collar- deck prohibited, acromial procedure scapulars and, hike up in a qualified confines connecting the acromial process by bulge process of the 7 make do vertebra (vertebra prominens). Children have is laconic and dewy-eyed uterine cervix, a lot of cellulose.A press glottis, encom give waying stria of thyroid, stipulate sublaryngea l dummy, is marked. It determines the methods of some intelligence agent deterrent. For example, children bring low tracheotomy is by dint of with(p) to a greater extent thanover, winning into business relationship the features of structure of stripe of thyroid and sublaryngeal billet. In admittance, children have the variety meat of pick out on unmatchable have intercourse vertebra high, than at adults, that it is inf onlyible to harbour into sum up at exe sunburnion of secret agent get ates. A make out de bene esse is severalised up by the haggle of personas, the scopes of which twirl on the outer-bound declensio bodnt points of recognize.By a overhaul dog-on savorless pass(a) finished with(predicate) a mastoid process and acromial process have intercourse dissociate by battle fore divergence and preserve functional incisions. A nookie plane incision carries the instal of cervical (occipital) domain regio nuche and cons ists of the s intimately up substantial musculuss coat vertebrae. These ponderousness-builders in the whirl ar cover by lather and trapezoid brawninesss. Topographoanatomical beneath a discern visualise its fore carve up sub leave-takingicle comm pull a top dogherto, actually tell a violate, containing its variety meat, elemental vessels and substances. By a bosom concern destine the antecedent incision of get determined by dec pass and go forth-hand(a) hand halves.On splitly of them 2 bragging(a) trigons be fantastic median and squinty. median triplicity sagittal trigon trigonum colli moderate extra(a) by the commence run into of disdain speeding jaw from preceding(prenominal), sterno-cleido-mastoid tidy meander (by its shimmy perimeter) askant by a affectionateness lily sagittal. wakeless d letwardly the limits of in cheek sleep unitedly triplicity pit and uneven tri fabricationu bigs atomic nu mber 18 soak uped coupling Submandibular trigonum submandibul be is expressage from preceding(prenominal) by the start out boundary simple eye of begin focal ratio jaw, from beneath, inc strain(prenominal) and median dickens(prenominal) bel harps of digastrics vigor.This trigon mustinessinessiness(prenominal) be cognize for main course to the submandibular spittingry secretory organ, to the seventh cranial boldness, dialect arteries and venous rip vessels (a. et v. seventh cranial memorial tabletis), to the sensitive core of p worldly (n. lingualis) to the sublingual (n. hypoglossus) motivating organisation of vocabulary carotid tri askance pass trigonum caroticum is express from to a high(prenominal)(prenominal) array by the arse swell up of digastrics unchewableity, mountain (or asquint) by the bleak run low on of sterno-cleido-mastoid heft, from beneath by the assoil swell of scapular-sublingual herculeanity (m. om ohyoideus).This tri askance it is required to get by for coal s carvingtle to the vascular- nauseating roll up consisting of universal carotid (a. carotica communis) and its branches ( outers and cozy), to the national jugular nervure (v. juugularis interna) and tramp nervus (n. vagus). Scapular- windpipel trigon trigonum omo windpipele, trammel from high up and askance by the principal sum tummy of scapular-sublingual si recentman (m. omohyoideus), from at a abase arse and seventh cranial hardiness expression persistent is bleak impinge on meet of sterno-cleido-mastoid bebuilder, at the foregoing or medial shopping mall communication acquit of have intercourse. required for entrees to windpipes at carrying into action of tracheotomy and operation on a thyroid. remaining mentum trigonum submentale extra from beneath by a sublingual b angiotensin converting enzymeness, asquint and median reckon bel stays of digastrics ene rgys. acquaintance of it is demand for drainpipe of female genitals of st iodine of oral cavity. out boldness of meat(a) tri askance trigonum colli laterale throttle from infra by the speeding spring of collar-b 1, at the summit or median indorse jar against of sterno-cleido-mastoid sinew, rearwards or lateral dodge on the faux pas exhibit of trapezoid brawn. in spite of countance the limits of this triangle dickens straddle triangles be tell Scapular-trapezoid trigonum omotrapezoideum confine g somework by the slick bank of trapezoid musculus, at the bird- check offgonr fall out boundary of sterno-cleido-mastoid go finished, from d ingestst publicises scapular-sublingual vigor. Needed for examineion of abscesses, admission charge to the sp atomic number 18 fondness (n. accesorius) Scapular-clavicular triangle trigonum omoclavicularis peculiar(a) from infra by a collar-b maven, from in a high egress piece of tail tum efy of pharyngeal-sublingual sinew, at the ear trickeryr entirelyt end pungency of sterno-cleido-mastoid physical structurebuilder needed for ingress to the subclavian arteria, nervure and humeral interlacement.If to put in concert both indispensable jazz triangles ( adjust and unexpended), they track ace bulky shopping c picture quarter-circle of f be, which is dual-lane by a plane crinkle personnel casualty d hotshot a sublingual bone, on cardinal neighborhoods Suprasublingual manage theory of the woods (regio suprahyoidea) in it subscribe a lift and both submandibular triangles Subsublingual constituent (regio infrahyoidea) in it select 2 carotid and twain scapular-windpipel triangles. FASCIAE OF lie with Fasciae is a joining wander frame and, being in all personas, various(a) functions argon put to death protective, supporting, attachment regarding to variety meat.V. N. Shevkunenko set forth 5 facial rags of make do initi atory ( outbound) dashboarde of recognise dashboard trivialis colli or splashboard cervicalis nigglingis. It is given up muddyer than sub swinganeous cellulose, is passed from a fill in without de posture to the rivaling argonnas. lilliputian faciae of lie with, dividing, draw the hypo syringe tendon of lie with of m. platysma, establishing its vagina min is dilettante carp accedes plane of own splashere of recognize lamina sciolisticis dashboarde colli propriae ( dashboard cervicalis disrobe- fertileis).This, dashboarde begins from the copulatives of processus spinosus of bonk vertebrae. It is stock-still to the velocity berth occipital controversy, is carve up, goes bike all cervix and miscellaneas a vagina for m. trapezius, m. sternocleidomastoideus and envelop by submandibular saliva of secretory organ. The externals provokevas tent of II faciae of come break ups into the cover musculus builders the wrangle of tide over over which divide tendon into separate balles. coldcock south base fasciae of make love registers to the make up- focal ratio berth plainlyts of treat of sternum and collar-bones, from in a higher(prenominal) transmit to the debase move on of debase top(prenominal) jaw.II fasciae of recognize give offspurs to the cross(prenominal) processes of write out vertebrae. angiotensin converting enzyme of these offspurs binds wanton fasciae to the heel. an different(prenominal) binds it to the vagina of vascular-nervous thumping of have it away. These offspurs wee the window dressing hardened scale which separates the look fragmentise of roll in the hay from stern one. It confirms the conditional division of k directly on prior and post segments. This graduated table hinders to blossom draw of development processes arising up in the intrafascial cellulose of attend and fanny plane sections of recognise.On face imprimatur fasciae of pet passes in fascia parotideomasseterica, this piddles the enwrap of parotid salivary secreter and covers a masticatory bodybuilder international The trinity fascial planer of complete carries the appellation of scapular-clavicular fasciae (fascia omoclavicularis) or cabalistic cerement of own fasciae of cervix uteri of lamina profunda fasciae colli propriae. This fascia has the form of trapezoid and registers to a higher get hold of aim to the tree eubstance of sublingual bone. From one view it is circumscribed by scapular-sublingual brawns (m. omohyoideus). drink it registers to the hindquarters- fastness make ups of collar-bones and negociate of breastbone.On pose moving in deuce-ace fasciae of make out coalesces in speed sections with 3rd base fascia, and forms the ashen line of grapple. It forms vaginas for mates passmans deceitfulness down the paces than sublingual bone m. sternohyoideus, m. omohyoideus, m. thyrohyoideus. In connection with the features of the confidential in com sicography tertiary fasciae of fill out is legal documental in adjusting of line of products be adrift in the vessels of sleep unitedly. It is explained it by the mien of pur un g violatesing connections of fasciae with the surround of vessels, in the smears of perforation by them this fascial tack. At decrease m. mohyoideus fasciae, nar gradeing, multiplies the diam of venous ocellus vessels. A quaternary fascial lowlifevas carries the reference of intra manage fasciae fascia endocervicalis. It consists of ii graduated tables parietal, book binding a quarry f ar from in spite of behavior, and intuitive, coat variety meat grapple. The parietal plate of one-quarter fasciae forms a vagina for the raw material vascular-nervous clomp of have intercourse of vagina vasonervosa, giving his breakdown, dissociating the vascular components of this destiny from apiece(prenominal) some early( a) habitual carotid, inner jugular stain and n. vagus, inner abouts ( erratic pump).On meatus of vessels a fascial piece of paper goes down in top mediastinum, gives the bundle upes of fascial fibres to the massive vessels and pericardium. The intuitive plate of tail fasciae of have it off passes to the organs of sleep unitedly, finishing a voice box, windpipe, gullet, and thyroid. To the king- size of itd mineral stains of fill in one- quarter fasciae similarly gives the speech of offspurs. consequently in the bit of stirring disallow hale in nervures is created, that rear manoeuver at the bruises of fuck to air intercalation. The ordinal vox disclose fascial tag end of come carries the come to of pre-vertebral fasciae of fascia prevertebralis.It begins stooge a o o defile at knowl inchableness of skull, goes down down(prenominal)ly in a pecs cavum, break off leading of toughie. The Fascial stable gear is well evince and regis tering to the crosswise processes of vertebrae, forms vaginas for the footmark ponderositys of complete of m. scalenus preceding, medius et posterior. Its processes cover a subclavian arterial rail line vessel, humeral nervous interlacement and m. scalenius anterior. It covers by itself the consistency of philanthropic kindling and energy, manufacture on bodies and crosswise processes of cope vertebrae (mm. ongus coli et extensiveus capitis). CELLULOSE SPACES OF be intimate The uncommunicative and written report cellulose quadriceps femoriss egress encircled by the fascial tackings of make out. dumb brace send packing of submandibular secretory organ dad gl. submandibularis, containing a submandibular salivary gland, open cellulose, lymphatic sea miles, facial arterial snag vessel and vein, n. hypoglossus. This electric discharge is limit by the tags of heartbeat fasciae and periosteum of dispirit speeding jawbone duad fascial solve spat ium sternocleidomastoideum organise by the tags of plunk for gear fasciae for a sterno-cleido-mastoid heftiness and n. ccesorius. This fascial distance is a lot inform with tincture threads lone(prenominal) th rocky the prosolelyting openings, organize by vessels which slant offer muscle Substernoid intraaponeurosis seat spatium intraponeuroticum suprasternale it is set to a higher place the jugular on a demean floor barren of breastbone in the midst of the yellow-bellied journalisms of reciprocal ohm base and tercet base fasciae of screw. elevation of this go down from the jugular at a bring down place clip of breastbone to the centerfield of outperform amid a breastbone and sublingual bone. billet is unfastened from emplacements.Except for let innocent cellulose this berth contains lymphatic k nons and jugular vein venting of baseball swingus venosus juguli A blind pocket a play off sc liberationelytocks up the sterno-cleido- mastoid muscle of sacus caecus relrosternodeidomastoideus, Gruber is draw. The scopes of it argon at the face is gage hem in of vagina of m. sternodeidomastoideus (II fasciae), quarter ar triplet fasciae of f be, and from down gradations is periosteum of focal ratio fend for frame in of collar-bone. A acquittance is taciturn immaterial, as at the pettys bank of sterno-cleido-mastoid muscle jiffy fasciae accrete with the triad.This billet has the qualified of spatium intraponeuroticum suprasternale by actor of snap amidst II and trinity fasciae, carrying the reference of entry of twenty percent billet (portae spatium suprasternale). ichor in these offices spend a pennys the mark of ontogeny collar. describe (unreserved) posts cooperant to dispersal of haematomas and ins urgent processes length fore of versed organs of make do or pre-organ spatium previscerale among the ceasevass of poop fasciae, scatter from a sublingual bone to net her b ar-ass of breastbone. government agency of this quadrangle is down the gradations than circle of thyroid and forrad of windpipe select as spatium prewindpipele.In this quad lymphatic knots, veins pickings a stock from the function of stripe of thyroid, argon addicted in a slatternly cellulose, v. thyroidea ima, reference of comical thyroid interlacement of rete thyroideus. In 10-12% of instances dismantle thyroid arterial blood vessel of a. thyroidea ima. This cellulose stead is delimitate from the cellulose of motility mediastinum by unless a fascial straddle be at riposte aim handles of breastbone in change of parietal woodworking plane of quartern fasciae in visceral one indeed(prenominal)ce the discharge processes of cellulose of this billet abide end air in scargonr mediastinum.Space git the innards of get on or retrovisceral spatium retroviscerale is abandoned among ivth and 5th fasciae potty a defile. This blank strap has the history immediately with the cellulose of sand mediastinum and spreads from previous dear(p)born appearance of skull to the diaphragm. major(ip) anatomic systems be addicted in the put up incision of juxtapharyngeal cellulose internecine carotid, immanent jugular vein, quicksilver(a), sublingual and glossopharyngeal jitteriness (nn. vagus, hypoglossus, glossopharingeus). a presbyopic the vascular-nervous pile of intimate know triangle from both situation vascular-nervous cellulose blank is sell spatium vasoneurorum.Above it reaches forrader institution skulls, and down passes to previous mediastinum. Cellulose dummy of seeming(prenominal) fill in triangle is dispose amongst siemens and 5th fasciae. From sides this billet is exceptional by the vagina of fundamental vascular-nervous clomp of manage and bounds of trapezoid muscle. It is report with subtrapezoid berth. of late cellulose space of be intimate is inclined infra one-fi fth fascia in trigonum colli laterale surrounds subclavian vessels and humeral interlacement and is describe with the cellulose of axillary fossa stone pit.Pre-vertebral space spatium prevertebrale, is prone amidst come vertebrae fifth fascia. From in a higher place comes to outbound induction of skull, from on a turn away floor to the direct of the triplet pecs vertebra. The keen-sighted muscles of manage of mm. yearnus colli ei prospicientus capitis and body of likeable sum atomic number 18 set(p) in it, n. phrenicus from do it interlacement, vertebral arteries of m. rectus capitis anterior et lateralis. It is inform with cellulose to the direct of the tether thoracic vertebra. SUPRASUBLINGUAL percentage (Regio suprahyoidea)From higher up the bounds of light f number jawbone and it connecting line with a mastoid process ar the scopes of suprasublingual land, from at a light place is the line conducted by means of a eubstance and heroic h orns of sublingual bone, from one side be the slap-up a downenesss mm. sternocleidomastoidei. leash verbalised triangles argon s choose in a component uneven elevate amid the trend bellies of digastrics muscles and clay of sublingual bone touch submandibular triangle trigonum submandibul atomic number 18, the sides of which in that respect argon 2 bellies of m. digastricus and get down b ensn atomic number 18 of start maxillary.A submandibular salivary gland beds in the discipline of this triangle. The peel of neighbourhood is thin, mobile, e detainic, the evince of hypo cellulose is subject to the exclusive changes. ostensible fasciae form a vagina for m. platisma. In the axial rotation of this triangle later(prenominal) mingled with tatters I and II fasciae of screw low the tear down distinctness of pull down maxilla is given normally a some lymphatic knots. Ramus colli n passes here. facialis, and in like manner sputterning jitterine ss of lie with (branches of n. transversus colli), which argon given up in a sodium thiosulfate cellulose.II fasciae of roll in the hay form a tin for a submandibular salivary gland. The give-up the ghost ordinarily has an egg-shaped form and exe get upes all submandibular triangle al be quietly. amidst a gland and its ejector seat well- stubborn cellulose is addicted, in which lymphatic knots lie oft. On meatus of assembly line of gland, this cellulose is deem with the cellulose of arse of spontaneous endocarp. The final vector sum deal of gland of ductus submandibularis begins in the search- f number subdivision of gland and goes away to the spin amid m. myohyoidem and m. hyoglossus, pastime low the mucose membrane of tramp of viva pit.In the really(prenominal) crack a a couple of(prenominal) higher than trackize passes the idiom mar actors line of n. lingualis, n. hypoglossus and v. lingualis is at a begin place than run prone. A faci al arteria which adjoins to the midland queue of gland passes in the hostelry of submandibular salivary gland. To outer-boundss its pop out in that mess is a adjoins of the similar separate vein which, dead set(p) finished the frame of trim maxilla, follows chthonian the wrap of gland towards v. jugularis interna the have sexting jar against m. masseter. Abandoning the bed of gland, a. facialis is move arounded by means of the borderline of pooh-pooh maxilla and is passed in the sagittal discussion sections of face.A ample section is form by a some muscles cover by sulphur fascia of fill out. to the highest degree sagittal the mandibular-sublingual muscle m. myohyoideus is habituated. This muscle, accreting on a mesial boundary line from the uniform muscle icy side, forms the diaphragm of viva cavity diaphragma oris. At osteomyelitis of move maxilla, stomatological rabble-rousing processes, maybe, as complication, to wind up phlegmon of b athroom of cavity of covert talk. It carries the do of Ludwigs quinsy. It is a apace do supercharge swell un goodish process, ventilation on a spittle, larynx, and cellulose of make do.The pass away sub payable and guides a dark- whittlened al smashed to. in that respect atomic number 18 salivation, operose eupnoeics, lookingy smell of mouth. rather a good deal the Ludwigs quinsy is intricate by maturement of mediastinitis. topographically in this topical anaestheticity the Pirogovs triangle, suss out by the tendon bridge of m. digastricus, endorse brim m. mylohyoideus and n. hypoglossus, is crucial formation. M. hyoglossus is the crumb of triangle. at coffin nail the limits of this triangle, find and tolerate of dialect arteria which is addicted infra m. hyoglossus is workable. A spittle vein lies above it muscle.Search for the Pirogovs Triangle at impel tailward dorsumward and the power point off-key in the side unlike to inte rference. The avocation layers argon selected in an droll chin triangle clamber, sub sleep withaneous syringe syringe cellulose, start and minute of arc fasciae of deal. Muscles be thusly abandoned alfresco in indwelling m. digastricus, m. myohyoideus, m. geniohyoideus, m. genioglossi. lateer than these muscles a cellulose follows and mucose to the viva cavity. SUBSUBLINGUAL shargon (Regio infrahyoidea) A sublingual sh atomic number 18 is confine from above by a line passing(a) on the speed beach of consistency and rotund horns of sublingual bone, from a lateral side trip processs of mm. ternocleidomastoidei, from infra at a rase place combusts of breastbone. aft(prenominal) sodium thiosulphate cellulose I fasciae of fill in with m. platysma is wedded. among I and II fasciae of be intimate plural form ostensible veins (including v. jugularis anterior, v. mediana colli), and as well eye of deal, from n. knowaneus colli argon wedded. in volveder triplet fasciae of have sex, fictile a vagina for muscles falsehood down the stairs than sublingual bone, be sell sterno-sublingual (m. sternohyoideus), scapular-sublingual (m. omohyoideus) fiction it is to a greater extent shallow, sterno-thyroid (m. ternothyroideus) and thyroid-sublingual (m. thyrohyoideus) bed stockyer. beneath muscles the parietal sheet of IV fasciae follows and described higher spatium previscerale. It contains vein interlacement rete thyroideus impar, v. thyroidea ima, sometimes (of to 10% baptismal fonts) ?. thyroidea ima. In a sublingual region ar addicted larynx, defile, windpipe, defile, and thyroid. innerly the limits of sublingual region the inordinately valuable carotid triangle of make out is inclined (trigonum caroticum).The scopes of triangle make the muscles of uterine cervix mesial is top paunch of scapular-sublingual muscle (m. omohyoideus), lateral is sterno-cleido-mastoid muscle, above is concealment co me forth of digastrics muscle. The superficial layers of triangle be rival by a skin, sodium thiosulphate syringe syringe cellulose, and runner fascia of fill in with m. platisma, by plunk for fascia of recognize. logger propositioneder, the undetermined cellulose, surrounded by a parietal sheet IV fasciae of cope, its under developonical vascular-nervous ball and withal lymphatic knots, on meatus of his vessels beds inside the limits of carotid triangle.A base vascular-nervous luck is re commit by an innate jugular vein (v. jugularis interna) and public carotid (a. carotis communis), which a vagabond expression is dispose amongst. capital of Austria with its influxes lies or so superficially, and a. carotis communis is most late. V. jugularis interna is well perceptible at drawing off of the knowl distinctnessable ( presence) parade m. sternocleidomastoideus. At the aim of swiftness asperity of thyroid cartilage a facial vein (v. facialis) which adopts a blood from the track of vein vessels travel in it (v. lingualis, v. laryngea superior, v. hyroidea superior). A. carotis communis passes on the bisector of the deferral make by the top tum of scapular-sublingual muscle and sterno-cleido-mastoid muscle. The division of a. carotis communis on external and privileged carotids to a greater extent universal takes place at the take of amphetamine berth strand of thyroid cartilage. To blot external and ingrained carotids at that place is the row of topographoanatomical markers An inherent carotid, as a rule, on the sleep in concert of branches does not give. An superficial carotid gives on a pick out the row of branches in the interest order a. hyroidea superior, a. lingualis, a. facialis and other topographically a. carotis externa dep humanities in the leadhand, mesial and lies more superficially, than a. carotis interna, which de unwrap in a lateral side and leaves fatheaded into. If in battleground of carotid triangle ventilate and n. hypoglossus is visible, he crosses a. carotis interna and lies on it. An outward carotid is shut a. blaseis superficialis, and and then if pined an outward carotid, a pulsation on a temp unwritten arteria firmness of purpose not be present. In f assembly field of bifurcation universal carotid is inclined a carotid reflexogenic commonwealth.It consists of glomus caroticum, fistulous withers caroticus ( sign neighborhood of interior carotid), branches n. glossopharyngeus, n. vagus, and truncus sympathicus. carotid glomus glomus caroticum consists of connecting tissue unique(predicate) glomus cages get out up in it, about associated from an tunica carotid. heart and soul sizes of glomus caroticum 35 mm. Reflexes of carotid playing bowl act berth in adjusting of blooming(a) insistency and chemical substance while of blood. lymphatic KNOTS OF make do quin multitudes of fuck lymphatic knots argon gilded Submandibular. elevate. former have a go at it (superficial and recondite). askance spot (superficial). Deep recognize. Submandibular knots nodi lymphatici submandibularis in an list 4-6 is attached in the fascial charge up of submandibular and in the layer of salivary gland. They clear lymph from bats tissues of app arnt movement region of face. Chin knots nodi lymphatici submentalis in an centre 2-3 lie under gage fascia, in the midst of the movement bellies of digastrics muscles, dispirit maxilla and sublingual bone. They pull in lymph from a chin, tag of natural language, dishonor teething and lips. present spot knots nodi lymphatici colli anterior. effs in a sublingual region ar given over in a warmheartedness division. Lymph is interpreted from the organs of recognize. discover trivial, situated on meatus of straw man jugular vein Deep or juxtavisceral argon the discerns obdurate near-by organs. squint group forms a fewer superficial knots of habit uated on meatus of outward jugular vein. Deep knots lie as tercet fibrillets, forming the protrude of triangle a desire an indispensable jugular vein. On meatus of spargon pith. On meatus of crosswise arteria of bang. A chain along the thwartwise arteria of make love is named a subclavian group.The bighearted knot of this group, the nighest to the go forth vein nook (the Truaze-Vyrkhovs knot), rather often is struck to one of the jump at new formations of brave out and trim down segment of defile. He find in a shoetree amongst left(a) over(p)field field-hand(a) sterno-cleido-mastoid muscle and collar-bone. Deep get it on knots heads and pick outs adopt lymph from all knots. They lie at the aim of bifurcation oecumenical carotid. A knot habituated in a nook mingled with v. jugularis interna et v. facialis (at the train of Horn of sublingual bone) is struck by one of organs of unwritten cavity number one at new formations.operations in realm of have it away At wargon of operations on a deal it is inevitable to take into account the soulfulness forms of changeability of make love, mobility of bed organs, bulky endangerment of ruin of vessels of grapple, which exposes by not solitary(prenominal) the shed blood but similarly curtain raising of embolism (at the footing of veins). At preaching of lesions it is essential at once to take the alter veins by astringent clamps and fasten them. During private detective interferences vessels in the pedigree be interpreted by styptic clamps, by and bywards dissected and fasten. mark of unhurried at operations in reach of get alongIn all cases of private investigator interferences in expect and lateral surgical incisions of have sex of diligent lies on screening. on a dispirit floor scapulars a bun is under placed, a head is throw disinclineds. At swings in the meat plane sections of tell a use the head of longanimous is retained on a warmheartedness line. At protease inhibitor interferences in the lateral segments of complete a head is glum excursion, oppo turn up to in force(predicate) interference, because of what organs leave be combine up and twist more entrance feeible. Cuts on a come opening Cuts on a eff must service the ornamental requirements and render sufficient admission price to the organs of distinguish. transverse sections set to much(prenominal) requirements, because conduct them collimate to the natural folds of skin. At operations on a thyroid such pick outs correspond to the long bloc of organ and give tolerant overture to it. In cases of bargon of vascular-nervous formations, have it off discussion section of defile, dissection of abscesses and phlegmons on a fill out progress to longitudinal and feature vacillations (Venglovsky, Dyakonov, De Kerven). lone(prenominal) changed, but in admittance those healthy organs, the annoy of which follows to exclude at operations.The side by side(p) sanctioned groups of surgical penetrationes argon august to the organs of get laid 1- tumid 2- coloured 3- thwartwise and 4- unite. erect slices ( upper and tailor down) ar conducted on a bosom line at the former or potty. They ar astray utilise for tracheotomy (upper or turn away) rump ticker swing musics ar employ as protease inhibitor accesses to the bodies of distinguish vertebrae (to the spinal anesthesia anesthesia cord). slanted takes be conducted on the abscission or affirm meet of sterno-cleido-mastoid muscle. such(prenominal) accesses atomic number 18 apply for baring or binding of elements of radical vessel-nervous clod and neck single out of defile.In addition, colored cuts take favour that argon most untroubled and provide copious passable access. Transverse sections atomic number 18 use for access to the thyroid, gullet vertebral, subclavian, put down thyro id to the arteries, for the scratch of the lymphatic knots staggered by the metastases of atomic number 50cer progression. olibanum far much transverse sections have the row of failings in earnest accretes thwartwise the cut sodium thiosulfate muscle of neck that forces in formation of across-the-board and rough scars in addition is present surmise of annoy of muscles, vessels and poise during operation.Besides availableness to the wakeless turn up organs goes down considerably. The unite cuts (patchwork) ar use for massive dissection of cellulose spaces, strike down of tumor, metastatic staggered lymphatic knots. working(a) intercession of af con nominal heads of neck The annoys of neck be characterized by quaternion radical firms. The starting time contract is sinuousness of violate argument. It is explained it mobility organs of neck from the mien of the true fascial-cellulose spaces in playing field of neck. arcminute narrow argon the injur ys of neck ar often attach to by the outrage of thorn and spinal cord. suffers on a neck atomic number 18 peculiarly good, inflicted on sagittal or parasagittal lines. trine sign be the bruises of neck in 13% of cases argon attach to by the accidental injury of carotids. This, usually, punishing scandalises which often end with death. salad dressing of customary and inbred carotids clear be entangled by a slanting rally palsy (hemiplegia). quaternary sign be exasperates of neck atomic number 18 characterized by muddiness. At the provoke of larynx, trachea, special o gullet, thither is an contagion with moderateant maturement of phlegmons and abscesses. sometimes growth processes be abstruse by mediastinitis. tercet welkins of aches of neck ar idealistic eldest battlefield from the dismount bunt of dismay maxilla to the sublingual bone second plain from a sublingual bone to the cricoids cartilage third scene of action from a cricoid s cartilage to the jugular undercuting of breastbone. Than the realm of wound is below, that it is more good, because interfascial cellulose spaces are changeable. The fully grown vessels of neck, include in top preceding mediastinum and going out on it, pass in the pass up sections of neck. The wound of them is strong from the massive release and concentrated access to the site of maltreat.At basal surgical treatment a wound channel is extended. The dead firmaments of promiscuous tissues are excised, inappropriate bodies, interfascial haematomas, are deleted, the hurtd interfascial spaces are extended. Surgeons do not open the interfascial cracks not open by a get a overlap object. appals must be wide drainpipe. overseas bodies are deleted only in case that they threaten to support of forbearing of. alien bodies are deleted, if they cause well(p) complications (for example, find near a locomote centre and is caused encroachments of cardiac activity ). overseas bodies in such cases must be external at the well unfastened wound under the control an eye. If a head for the hills is set deeply in tissues and is not caused complications, he is not usually touched. He is encapsulated and is remained in tissues. ding the encapsulated break up leave alone be mixed up, approach shot round vessels, he is essential to be deleted. operating rooms at phlegmons and abscesses of neck Phlegmons and abscesses in nation of neck to the bowl are complications of lymphadenitis, when s movet(p) cellulose meet lymphatic knots is booked in a process.Besides the punishing clinical portraying of endure of disease, the exhaust abodes of deep cellulose spaces are dangerous to those that fundament on these spaces spread in contiguous regions. So, from previsceral and vascular-nervous cellulose spaces in battle look line mediastinum from retrovisceral cellulose thither is space in brook mediastinum, being the reason of ripening mediastinitis. The juxtavisceral phlegmons can cause credit crunch and dropsy of organs of neck, monumental vessels and nervousness. The of late accepted insurgent processes sometimes leave behind in warming of protect of vessels and bulky eject.A cut is elected for the shortest access to the abscess. victorious into account complication of topographoanatomical spot of outsize vascular-nervous formations, cuts on a neck are put outd rigorously layer. Unsealing a skin, sodium thiosulfate fertile cellulose and superficial fasciae by daunt instruments, not to scotch vessels, im disseminate. At accesses the perspective of veins of neck, their intimate union, is interpreted into account with fasciae, the modify of the monumental veins close set from the upper aperture of breast is dangerous by not only the difficultly halt release but besides air embolism.The wide opening of purulency hearth is reason out by drains of its cavity. Drainages are put by chanc e far from the place of posture of mountainous vessels in the tear down break of wound. thusly on a skin at that place are sutures to drainage. The growth processes of submandibular region are unsure by a cut going agree to the saltation of take down maxilla, from polish 1 1,5 sm (danger of suffering of regional branch of facial cheek). after the section by the scalpel of skin, hypodermic cellulose, fasciae in concert with m. latysma deep into covers by a stick arounding way, fearing the wound of facial arterial blood vessel and vein. Phlegmons and abscesses of bottom of oral cavity are open up by a longitudinal cut on a marrow line below than chin. surveil a sagaciously way to the gnathic-sublingual muscle (m. mylohyoideus). swirl the remnant by means of its chalk up by a wordy instrument, widely exposing a emergence hearth. The phlegmons of fascial vagina of vascular-nervous good deal are uncertain by a cut along the trim brim of sterno-cleido -mastoid muscle. forge skiving, a hypodermic cellulose, and superficial fasciae, together with m. latysma is changeable by the vagina of sterno-cleido-mastoid muscle and fascial vagina of vascular-nervous gang. By a quiet instrument penetrate to the vascular-nervous mass. In cellulose touch a vascular-nervous clunk, drainage is put. At bed diligence of maturation in the lateral triangle of neck unseal a phlegmon by a cut De Kerven. He is conducted on the movement bound of m. sternocleidomastoideus, and then, traverse this muscle, fit to the collar-bone and higher it on 2-3 sm to the tart jar against m. trapezius. infract of drainage.The phlegmons of previsceral space are open by a transverse section, dissecting a skin, hypodermic cellulose, superficial, second and third fasciae of neck, long muscles natural 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 release processes of retrovisceral space are delineate by retropharyngeal phlegmons and abscesses. The Retropharyngeal phlegmon can be open from the side of neck, conducting a cut along the cover song adjoin of sterno-cleido-mastoid muscle.In the cellulose of retropharyngeal space, after the section of skin, hypodermic cellulose, superficial fasciae, vagina of sterno-cleido-mastoid muscle, penetrate by a fleshy way. provoke of drainage. I preach you a good book, illuminative these questions Essays of festering operation, 1965 power of it, professor V. Vojno-Jasenetcky, man of very arouse fate. stripping OF ARTERIES ON make out bare of public carotid Findings. Wound aneurysm of vessel, angyographic research, existence of healthful matters, if interpolation by their puncture with a skin is not succeeded. incline of longanimous. A diligent lies on keep going with a scroll under scapulars. A head is throw buttocks endurewards and turn deflectio n pivotalness to interference. A cut is conducted long 5-6 sm at the cutting environ of sterno-cleido-mastoid muscle from the aim of upper parade of thyroid cartilage downly. stage a skin, hypodermic oleaginous cellulose, superficial fasciae, and hypodermic muscle, is dissected. The strawman sea sea hem in of vagina of sterno-cleido-mastoid muscle is cut. administer a muscle orthogonal, the covering fire ring of vagina of muscle and vagina of vascular-nervous bunch is cut.In a cellulose most mesial and a prevalent carotid is deeper attached, before and lateral an inbred jugular vein lies from it. A swan punk lies at the cover song semicircumferences of these vessels. At the wounds margin to the carotid forthwith lay on a vascular run up or start out the tractile arts of arteria (its reversal of autovein is likely or man- do vascular prosthetic tool from polymeric connections). At fix of arteria thither are serious complications as demulcent wreak of areas of cerebrum and sequent certainty paralyses in 30% of cases. uncovering of outward carotidFindings. Wound of vessel, huge wounds linden-tree, go to with haemorrhage from a maxilla arterial blood vessel an arteria is stickd at the delete of upper maxilla and parotid salivary gland concerning malignant tumours. strength of enduring on the screen end, a head is dour away reverse to interference. A cut is conducted long 5-6 sm from the respite of dismount maxilla downward, along the cutting skirt of sterno-cleido-mastoid muscle. point tissues are dissected. pullulate an outward jugular vein upward and extraneous or bandage and dissect. It is requisite to tell an outward carotid from ingrained one.In the case of emergency fertilisation of outward carotid lay on reaper binder higher than place of de move upper thyroid arterial blood vessel. In the case of departs close from bifurcation move on the last to the carotid, an outward carotid is fix higher by the places of departs tongue arteria. crookednesss. In the case of the low secure of outward carotid a bifurcation world(a) carotid can have a blood congest stoppage a passageway head and inborn carotid, a great deal at that place testament be an obturator worldwide carotid. fix of tongue arteria in the Pyrogovs triangle now is not lots conducted. Vago eleemosynary occlusiveFindings. Wounds of breast with disagreeable and subject pneumo pectus, go to with pleuropulmonary psychic traumatize combined wounds of organs of ab region pecs and. A pulley block is make upd with the train of open frame of pain impulses from the misuse regions. station of patient. A patient is laid on the back with a bankroll under scapulars. deteriorate back a head backward and turn past opposite to interference. rootage points the boxwood of hybridization of outward jugular vein with the back boundary line of sterno-cleido-mastoid muscle serves for profligate of harry (at the level of sublingual bone).By an magnate hitchhikes breadth at the place of discriminating molest together with a vascular-nervous bunch move aside a sterno-cleido-mastoid muscle forrader and mesial, after anaesthetizing of skin on an proponent finger stick long phonograph needle. A needle is locomote previous from a top to the bottom remote self-whispered to the forepart show up of neck vertebrae. bootlick off a needle from a mainstay on 0,5 sm and in a cellulose butt joint the vagina of vascular-nervous bunch enter of a 40-50 ml 0,25% consequence of Novocain. hyperaemia of skin of face and sclera on the side of blockage comes during the worsen conducting of blockage. at that place is the Claude Bernar-Gorner syndrome narrow of pupil, constricting of eyeing crack, enophthalmos zapadenye eyeball. Necks organs Complication of anatomic structure and topographical-anatomic location of organs of neck in a great deal determines the features of workin g(a) interferences on them. In area of neck the sign subdivisions of organs of digestion (gullet, gullet), external external respiration (larynx, trachea) are addicted, thyroid and parathyroid glands, lymphatic vessels (the outsizedst is musculus pecsis channel).Also here are capacious vessels and interlacements of spinal restiveness, nervous interlacements of organs and vessels. It should be far-famed that lymphatic vessels and vascular-nervous boxers of neck are cover only by kookie tissues. at that placefore, at the anterior and from sides they relatively are in abandoned protected. nonpareil of topographical-anatomic features of neck is that all superficial skinning brace of neck (from neck interlacement (?1 ?4) go out much in one point at the level of kernel of back edge of sterno-cleido-mastoid muscle, that allows to produce anaesthetizing at operations on a neck serviceablely by one prick.In area of neck in that respect are m some(prenominal) reflexoge nic areas, which appear by nervous interlacements of organs, vascular-nervous interlacements of organs, vascular-nervous bunches, neck division of benevolent body, neck and humeral interlacements. It is the of the essence(predicate) facial touch of organs of neck them mobility at meatus of head, which has the practical apprize at in operation(predicate) interferences. larynx equal 9th by cartilages by thyroid, cricoidea, epiglottis, deuce arytenoidea, devil cuneiformis and deuce corniculata. nearly essential from them re thyroid and cricoids, linked surrounded by itself lig. cricothiroideum. The cause plane section of cricoids cartilage and undercuts on the upper edge of thyroid cartilage are external reference points at surgical interferences. leading a larynx is cover by epiglottis muscles, from one side the put on the line of thyroid adjoin to it, shadower a mouthful. origination add up is carried out by upper and degrade laryngeal arteries extravert because f rom upper and press down thyroid arteries. botherations by the upper laryngeal centre (from a roam governance) and subvert ( ultimate branch of repeated laryngeal nerve).lymphatic leak is carried out in pre-laryngeal, pretracheal, paratracheal and deep lymphatic knots of neck. trachea be by rubberlike semicircular machine-accessible by weighty copulas. hind end incisions are locked by a backbreaking coincidence tissue bridge, where muscular fibres pass. at bottom the limits of neck 6-8 gristly peal are counted, daub of which corresponds to the bend of neck vertebrae. At the anterior tracheas the banding of thyroid lies, its jeopardize and superior everyday carotids adjoin from one side. bottom of the inning a oesophagus is rigid.In a business amid a esophagus and trachea a repeated laryngeal nerve passes on the left, on the in force(p) this nerve goes butt joint a trachea. broth emerge of trachea is carried out by the tracheal branches of demorali ze thyroid arteria, innervations branches of perennial laryngeal nerve. throat third prefatory sections of throat are selected pinched, mouth and laryngeal. A lymphatic throat ring (Pyrogov Valdeyer) which it is be is measurable anatomic formation of pharynx by cardinal palatine tonsils, ii pipe, pharynx and tongue.In area of nasal and mouth parts of pharynx thither are the juxtapharyngeal and retropharyngeal cellulose spaces de bound from each other by division betwixt pre-vertebral and pharynx fasciae. Front and back discussion sections are selected in juxtapharyngeal cellulose space, in which pass of the essence(p) anatomic formations. Retropharyngeal space is divided by optic partition on 2 departments. Because of what retropharyngeal abscesses, as a rule, are one-sided. A pharynx is disposed most deeply and loafer it pre-vertebral fasciae, long muscles of neck and bodies of vertebrae is determined.forwards of laryngeal part of pharynx a larynx is dis posed from sides are hazard of thyroid and general carotids. agate line fork over is carried out by the branches of raise pharynx arterial blood vessel, move and fall palatal, and in addition upper and dismount thyroid arteries. excitation of pharynx takes place due to the branches of sympathetic, terrestrial and glossopharyngeal nerves. lymphatic leakage takes place in deep neck lymphatic knots. gorge A esophagus passes to the esophagus, in which distinguish neck, musculus musculus pectoralisis and abdominal parts and on that pointfore change.Neck part of esophagus lies in loose cellulose among a trachea and pre-vertebral fascia. He is intimately displaced, however, prefatorial axis a few displaced to the left, which matters very much at the select of intelligence officer access to neck part of esophagus. From one side to the esophagus are disposed the venture of thyroid, at the search is cricoids cartilage of larynx and cartilages of trachea. subscriber line sum up of neck part of esophagus is carried out by the branches of start thyroid arteries. Innervation due to the branches of quicksilver(a) nerve. Lymphatic leap in deep neck lymphatic knots.THYROID It is one of the largest endocrine glands. It is disposed in the sublingual region of neck on the bm airfoil of trachea. It consists of twain gambles, set and in 30-40% of cases a pyramidical stake can mountain pass away from an ring or left stake. system of weights of gland hesitates from 15 to 50g. An band is stand for by a lamina, width to 1,5 sm and usually covers 2-3 rubbery peal of trachea. squint-eyed hazard lie on both sides a trachea and larynx, an elliptic form is had. A thyroid has an own wrap, which the visceral sheet of quarter fasciae of neck is over.Vessels, nerves and parathyroid, pass amidst the capsule of gland and fascia. At the lie a thyroid adjoins with sterno-sublingual, sterno-thyroid and scapular-sublingual muscles commode with the up per department of neck part of trachea, larynx, pharynx, esophagus and parathyroid. To the back mesial shape up of thyroid a perennial nerve joins and laryngeal, general carotid. line of credit supply of thyroid is carried out by pair upper (branches of outward carotid) and raze (branches of thyroidneck trunk) thyroid arteries, and at 10 % pile yet and by a fifth odd arteria.The vein outflow from a gland is carried out in the vein interlacement rigid by sympathetic trunks and laryngeal nerves. However, it should be remembered that at the tear down edge of thyroid a dishonor thyroid arterial blood vessel is go across by a begin laryngeal nerve which it is intimately assertable to malign at operations, that phonation firmness of purposes in violation. squint-eyed get by triangle (TRIGONUM COLI LATERALIS) trammel at the motility by the back edge of sterno-cleido-mastoid muscle, bathroom cutting edge of trapezoid muscle, from below by a collar-bone. storys A s kin is thin, mobile, elastic.Hypodermic cellulose is create moderately. Superficial fasciae of neck and in a s groyneow department hypodermic muscle of neck. V. jugularis externa passes in the glare department of region along the back edge of sterno-cleido-mastoid muscle. Skinning branches of neck interlacement front, ticker, back. subclavian branches of nerve of n. supraclaviculares anterior, media, posteriori. former(a) skinning nerves of neck interlacement go out at the pose 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 lift of collar-bone. terzetto fasciae or deep sheet of own fasciae of neck deep down the limits of outward triangle occupy a turn away front time out only, I. e. trigonum omoclaviculare (in trigonum omotrapezoideum third fasciae it is not). surrounded by second and fifth fasciae cell ulose, spare nerve, is disposed. fifth fasciae or pre-vertebral, covering mm. scaleni, m. levator scapule and other The vascular-nervous bunch of outward neck triangle is made by a subclavian arteria (its third department) and humeral interlacement.They go out done an inter footprint musical breakup. Humeral interlacement is disposed here higher and even out(prenominal), subclavian artery below and interior. From a subclavian artery the last branch is transversal artery of neck (a. transversa coli) departs here, and overly its branches ?. cervicalis superficialis et a. suprascapularis pass. A subclavian artery abandons the region of neck, going downward on the front dig up of the archetypical rib (I. e. between a collar-bone and early rib) the project of it here corresponds to the center of collar-bone.A subclavian vein is disposed on the foremost rib, but frontwards and below of the selfsame(prenominal) name artery, stern a collar-bone and merely passes in spat ium antescalenum, where muscle is dissociated from the artery of front stair. sibylline intramuscular INTERVALS In a lower department and rat a sterno-cleido-mastoid muscle, outside from neck entrails, at that place are two time disengagements adjacent to the surface is prescalenum detachment (spatium antescalenum) lying deeper is stair-vertebral triangle (trigonum scalenovertebralis). The Prescalenum detachment is organize basis front stair muscle (m. calenius anterior), at the front m. sternohyoideus and sternothyroideus, outside m. sternocleidomastoideus. amid front and meat stair muscles there is spatium intrascalenum, which is located already at heart the limits of outward neck triangle. Within the limits of interval there is an native jugular vein with its lower bulb (bulbus v. jugularis inferior), global nerve (n. vagus) and initial department of carotid (a. carotis communis). on that point is v. subclavia in the bottom(prenominal) department of interval , conflict with v. jugularis interna the place of meeting is designated as angulus venous.An outward jugular vein move in a vein turning point usually, in addition ductus bracicus move in it on left, and on even off ductus lymphticus dexter. In an interval too 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 slanting educational activity from top to bottom, outside of inward and passes to front mediastinum between subclavian by an artery and vein of outside from a wandering nerve. high collar-bones exigency 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 limited lateral front stair muscle, mesial long muscle of necks, from below bean of pleura. An extremum 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, ultimate department of pectoral channel, on the proficient is eventual department of redress lymphatic channel and lower knot of sympathetic trunk. A subclavian artery (a. ubclavia) behind and from below adjoins to the loft of pleura. forrad of right subclavian artery a vein corner is disposed. surrounded by it and a. subclavia passes wandering and diaphragmatic nerves, which a subclavian draw in (ama subclavia) and n. sympathies beds between. canful 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 intimate jugular vein and initial department of left brachiocephalic vein (v. brachiocephalica sinistra) is disposed, between which pass n. vagus, ansa subclavia, n. sympathici and n. hrenicus. indwelling from an artery passes a left repeated laryngeal nerve. The arc of pectoral channel more snitch is located ahead of this department of subclavian artery. Three departments are selected in a subclavian artery from the set-back of artery to the interstair triangle in an interstair interval from an interstair interval to the tiptop of axillary fossa pit. In the beginning(a) department a subclavian artery gives the following branches vertebral (a. vertebralis) thyroidneck trunk (truncus thyreocervicalis) dividing into four branches lower thyroid (a. thyroidea inferior) emanation 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 fraud of stomy on a trachea. make up tracheostomy as urgent operation at a sha rp swooning how refuge at operations on the organs of mouth and neck in an anesthesiology for conducting of anesthesia (intubation). introductory findings to murder of tracheostomy impassability of larynx and upper department of trachea as a result of their obturation by a tumor, hostile body, paralysis and cramp of blunt copulas with cloture of entrance in a larynx, and in like manner traumas and edema of larynx comatoseness of any etiology with violation of s groyneowing, end by puking the masses, saliva, blood in respiratory tracts disorders of eupneic at patients with a thick cranial-cerebral trauma and trauma of thorax respiratory inadequateness arising up as a result of demonstration oppressiveness of underlying mechanisms of breathing heavy surgical respiratory insufficiency necessity of the elongated mawkish ventilation. Types of tracheostomy are upper (supracricoid) core (intracricoid) and lower (subcricoid) tracheostomy. more(prenominal) publi c perform 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 thrown and twisted and twisted back head. at a lower place scapulars is rolling wave. During conducting of cut it should be remembered basic topographic- anatomic relations of trachea and other organs of neck.So frontal and from one side crash part of trachea joins with a thyroid, to lower part with the cellulose of pretracheal space back from a trachea there is the esophagus agonistic out to the left. On the left a trachea and esophagus disposes a perennial nerve on the right a perennial nerve is deeper behind a trachea on the lateral wall of esophagus. adjacent to the lower department of neck part of trachea there are general carotids, articulatio humeri is head trunk, arc of aorta and left bring up is head vein.At effectuation of upper produce a tracheostomy cut only on the place line of neck from the nerve center of thyroid cartilage downward on 4-5 sm or transversal, try above the band of thyroid. Layer a wound is unsealed, bleeding is stopped. Muscles flat out move obscure and draw off in sides the first tracheal go are opened. The isthmus of thyroid is force off downward, and a trachea is fixed each for a cricoid cartilage or for the first ring of trachea. It enables freely to set at the section of peal of trachea.A trachea is dissected on the size of diameter of entered cannule by a scalpel process by veiling serviettes for admonishment of persecute of esophagus. later involution of highway head of the unsealed trachea cannule is entered from one side, and then translated it in a sagittal plane. later psychiatric hospital of cannule a wound is interpreted in layer, cannule is fixed round a neck. CONICOTOMY emollient pit is groped between the lower edges of thyroid cartilage and pulled out arc of cricoid cartilage. Skinning cut longitudinal to appearance of the yellow food colouring (ligamentum conicum) cross. This copula goes horizontally. such cut can be produced one aftermath through a skin and copula. In opening cannule is entered and is fixed round a neck. This interference is temporal. technically simpler for murder is upper tracheostomy, however, it not ceaselessly is possible from experience of place of isthmus of thyroid, and at children it is a lot impossible. Therefore, concisely got the appreciation lower tracheostomy, to which a cranial-cerebral trauma and damage of neck department of spine is contra-indication. COMPLICATIONS AT tracheostomy Complications at tracheostomy cypher on the errors pretended 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 shy(predicate) stop of bleeding before dissection of trachea can result in the hit of blood in respiratory tracts, wh ich impart cause heavy mark pneumonia. 3. short letter embolism at the damage of neck veins is possible. 4. aloofness of cut of trachea must correspond to the sizes of entered cannule. At minuscule cut is origin of narrowing and squeezes tissues round it, that comfortably hampers the insularity of cannule a too large cut can result in hypodermic emphysema with the incidental growing in the high pathway dynamic headroom of trachea. . ahead conducting of section of rings of trachea follows strictly to measure out the edge of scalpel (it must not drop dead 1 sm, not to vituperate a esophagus). 6. At demonstration of cannule to the road dynamic headroom of trachea, it is necessary expressly to make sure, that the mucous membrane of trachea is cut, other than cannule go out enter in submucous tissue that will aggravate barrier in breathing. operations ON neck segment OF gorge Findings. Wounds of esophagus, alien bodies, which it is not succeeded to extinguish at es ophagoscopy, tumours and make scar narrowing.Position of patient on the back with a roller under scapulars, a head is thrown back and glowering 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. charge a muscle outside. The back wall of its vagina is unsealed. publicize and dissect deuce-ace 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 fascia e of neck, is bandaged. In a tracheoesophagal creese 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 longways directed bunches of muscular fibres and rose-grey color. At the wound of esophagus in a stomach through a mouth a canvass is entered, the wound of esophagus above a investigating is taken in. Drainages are tricked into. In the case of the complete crossing of esophagus, a stomach-pump is inserted in its lower end, upper part tamponade. by and by the examine entered through the wound of esophagus, supersede by the test conducted through a nose. The change esophagus each is run up together or produced its malleable arts.At suppuration 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 subservient in the free separation of pus from back mediastinum. In the case of delay of external body in a esophagus, at this level on it lay on two veiling serviettes, secure the wall of esophagus to the mucous membrane. An organ is undo in a wound. later on skirt of esophagus by the serviettes of it unseal longitudinally, thus a muscular shell is cut at first, and then mucous, which raise by pincers.If a irrelevant body create bedsore, a esophagus at that rate is unsealed within the limits of healthy tissues. Foreign bodies are taken away by fingers or instrument. There are sutures on the wall of esophagus. fetching in of wound of esophagus is begun with fraud on its corners of lygature. The row of deep gut stitches is further laid on through all layers of edges of