What are human lips made of? Lips. Characteristics of the skin, transitional and mucous parts. Lip glands General structure and features of the oral cavity: lips, cheeks, palate

MOUTH LIPS (labia oris; Greek, chelos). Upper G. (labium sup.) and lower G. (labium inf.) in the region of the corners of the mouth (angulus oris), connecting with adhesions (commissura labiorum), form the oral fissure (rima oris). The upper G. is bounded by the base of the nose, the oral fissure and the nasolabial grooves (sulcus nasolabialis), the lower G. is limited by the oral fissure and the labiomental groove (sulcus mentolabialis).

In the process of ontogenesis, G. are formed from the jaw processes. The lower G. is formed at the end of the first month of uterine development as a result of fusion of the mandibular processes, the upper one - at the end of the second month when the right and left maxillary processes fuse with the median nasal process (see Face). Musculature in G. is available only in mammals. At the person in G.'s thickness bunches of mimic muscles are put, thanks to the Crimea G. have big mobility and participate not only in the act of capture and processing of food, but also in the act of the speech and in a facial expression.

Anatomy

The shape and size of the G. depend on the individual characteristics of the circular muscle of the mouth, the position or absence of the frontal teeth (see Bite), etc. In this regard, there are protruding G. (procheilia) and direct (orthocheilia), sunken G. (opistocheilia), commonly seen in the elderly and old age with loss of anterior teeth. Normally, the upper G. will stand somewhat in relation to the lower one. A groove (philtrum) runs vertically on the upper gyrus, dividing it into three parts: a middle part and two lateral parts. In the region of the red border, the groove ends with a labial tubercle (tuberculum labii sup.). The size of the labial tubercle varies considerably. The line that defines the border of the skin and the red border of the upper G. is called the Cupid's arc.

G. consist of skin, subcutaneous tissue, muscle layer and mucous membrane. G.'s skin is thin, contains hair follicles and a large number of sebaceous glands. Near the oral fissure, the skin passes into the red border, or intermediate part (pars intermedia), where the structure of the skin changes, approaching the structure of the oral mucosa. In the red border, the outer and inner zones are distinguished, especially sharply demarcated in newborns, in which the inner zone is covered with papillae; during the first weeks of life, the papillae of the red border smooth out and become inconspicuous. The epithelium covering the red border has a thin stratum corneum. In this part of the gum there are no hair follicles and sweat glands, but there are sebaceous glands, which are mainly concentrated in the region of the corners of the mouth, and there are more of them on the upper gum than on the lower. The red border gradually passes into the mucous membrane G.

The mucous membrane of G., covered with stratified squamous non-keratinized epithelium, has a pronounced under the mucous layer, where small salivary glands (glandulae labiales) are laid. The mucous membrane of G. passes into the mucous membrane of the cheeks and gums, forming folds along the midline of the vestibule of the oral cavity - frenulum (frenulum) of the upper and lower G. (Fig. 1). The muscular layer is formed by the circular muscle of the mouth (m. orbicularis oris), into which the fibers of some other facial muscles are woven.

blood supply G. comes mainly from the facial artery, edges at the level of the corners of the mouth is divided into the upper and lower labial arteries (a. labialis sup. et inf.). According to Yu. L. Zolotko, the blood supply to the upper G. from the facial artery occurs in 97.3% of cases, from the artery extending from the transverse artery of the face - in 1.8%, and from both simultaneously - in 0.9%. The blood supply of the lower G. is carried out from the facial artery in 95.5% of cases, from the median artery of the chin - in 0.8%, and from both - in 3.6%. Usually, the arteries of the right and left sides merge in the midline and form a continuous ring. However, V. M. Kalinichenko (1970) found that in some cases the blood supply to G. can be unilateral: the lower G. - in 19.6% of cases, the upper one - in 16.1%; at the same time, on one side, the labial artery is absent or extends only to the corner of the mouth of the corresponding side.

Veins form a dense network and flow into Ch. arr. into the facial vein. M. A. Sreseli (1957) in building venous network G. distinguishes two forms: at the first, a dense network of veins with many anastomoses around the mouth opening is observed, spreading in depth; at the second, two veins of the upper and two veins of the lower G. are clearly visible, connected by anastomoses.

Limph, vessels flow into the buccal, parotid, submandibular and cervical limf, nodes and deep cervical limf, nodes near the internal jugular vein (v. jugularis inf.). Besides, from lower G. outflow of a lymph occurs in submental limf, nodes.

sensitive innervation the upper G. is carried out by the second branch, and the lower G. - by the third branch of the trigeminal nerve; sympathetic nerve fibers depart from the upper cervical ganglion; motor nerve branches to G.'s muscles come from the facial nerve.

Pathology

Malformations

A significant place in the pathology of development of G. is occupied by congenital clefts; according to most authors, they are found in one in 1000 newborns. The occurrence of crevices is determined by Ch. arr. genetic factors, but may also be associated with impaired intrauterine development under the influence of endogenous and exogenous factors (burdened heredity, malnutrition, mental and physical injuries and diseases of the mother at the beginning of pregnancy, etc.). Isolated cases of violation of the fusion of the mandibular processes are described, with Krom there is a median cleft, as well as congenital fistulas of the lower G. in the form of blind canals of various depths lined with epithelium. Often there is a violation of the fusion of the maxillary and median nasal processes, which leads to the appearance of a congenital cleft of the upper G. (the so-called cleft lip). The forms of the clefts are different - from a small notch at the red border to the complete communication of the G.'s cleft with the opening of the nose. Sometimes the splitting of tissues can be limited only to the muscle layer, which is called a latent cleft; at the same time, at the place of separation of the muscle layer, a sinking furrow of the skin or mucous membrane is visible. Upper G.'s clefts can be unilateral and bilateral; in about 50% of cases, they are combined with a cleft of the alveolar process and palate and are accompanied by a deformity of the nose. A through bilateral cleft, as it were, separates the middle part of the upper G. together with the premaxillary bone, the edge will stand forward, remaining connected to the vomer and nasal septum. With a complete cleft of the upper G., the child has difficulty, and in some cases the act of sucking is impossible, breathing becomes superficial and frequent, and pneumonia often occurs as a complication.

Acheilia(absence of lips) is rare in congenital atresia of the mouth. Syncheilia is sometimes observed - the fusion of the lateral sections of the G., leading to a decrease in the oral fissure, as well as brachycheilia - the short middle part of the upper G.

Hypertrophy of the mucous glands and submucosal tissue manifests itself in the form of the so-called. double lip (labium duplex) - folds of the mucous membrane of G., edges are especially revealed when smiling.

There is often thickening and shortening frenulums top G.

Damage

Injuries occur as a result of falls, blows, bites, gunshot wounds to the face. Wounds can be incised, torn, bruised, with or without a tissue defect; by length - superficial, deep, through. Damage is accompanied by the rapid development of G.'s edema or significant bleeding. A feature of the wounds is a strong gaping of the wound, which creates the impression of a larger size than in reality, especially on the upper G. Damage to the lower G. with a tissue defect leads to saliva flowing out, which irritates and macerates the skin of the chin, making it difficult to eat.

G.'s gunshot wounds are usually not isolated: according to the materials of the Great Patriotic War isolated lip injuries accounted for 4% of facial injuries.

Diseases

The skin of the lips is often affected by eczema, which is characterized by a rash of vesicles, weeping and hron, a recurrent course (see Eczema). In men, hron, inflammation is more often observed hair follicles(see Sycosis). The skin and mucous membrane of G. can be affected by herpes (see), lichen planus (see Lichen red flat), lupus erythematosus (see), etc. Lesions of the mucous membrane of G. (without skin lesions) is observed with stomatitis (see .), sometimes with candidiasis (see); some forms of an inflammation of a red border of G. are allocated under the name cheilitis (see).

Furuncles and carbuncles are difficult, especially when localized on the upper lip. M. A. Sreseli established that vein thrombosis, observed with purulent inflammation in the region of the upper G., sometimes spreads first along the facial vein, and then along the angular and superior ophthalmic veins, followed by the transition to the cavernous sinus; more often, thrombosis can spread along the venous anastomosis to the pterygoid plexus, then along the vein of the foramen ovale to the cavernous sinus. When localized purulent inflammation on the lower lip, vein thrombosis can spread along the venous anastomoses of the face, the pterygoid plexus and the vein of the foramen ovale, less often along the external jugular vein, followed by the transition to the sinuses of the dura mater.

For cutaneous anthrax G.'s lesion resembles a banal furuncle or carbuncle, however, the lesion is painless against the background sharp deterioration general condition, rapid increase in intoxication of the body; when examining the discharge from the lesion, anthrax bacteria are found (treatment - see Anthrax).

Tuberculous lesion of G. most often manifests itself in the form of lupus (see Tuberculosis of the skin).

G.'s defeat with syphilis can be in the primary period - the appearance of a hard chancre on the lip, in the secondary - the appearance of papules, in the tertiary period - gumma may appear in G.'s tissues; painlessness is characteristic (see Syphilis).

Tumors

From benign tumors, papilloma, keratoacanthoma, mixed tumors from small salivary glands, tumor-like vascular neoplasms - hemangioma and lymphangioma (usually found in early childhood), retention cyst. The most common malignant tumor of G. is cancer; angiosarcoma, neurogenic sarcoma, melanoma, etc. are extremely rare. Lower G.'s cancer quite often develops against the background of long-term precancerous changes - dyskeratosis, less often papilloma, keratoacanthoma. Dyskeratosis can be diffuse and focal: with diffuse, there is a loss of luster, dryness, coarsening, peeling of the red border; focal dyskeratosis is manifested by areas of leukoplakia (see) or hyperkeratosis (see) in the form of a flat or spiny horn protrusion. Erosions, ulcers, slit-like cracks characteristic of a malignant form of dyskeratosis can be observed (see). The transition of dyskeratosis to cancer is not always possible to catch clinically, if suspected, a gistol, a study should be made (see Biopsy).

Papilloma- a clearly delimited papillary formation on the red border or on the mucous membrane of the lip. The tumor is more often single, less often in the form of several formations, usually small in size (up to 0.5-1 cm in diameter), on a stalk or a wide base; acts as an exophyte above the surface of the red border or mucous membrane (tsvetn. Fig. 2). Its color is pink, the texture is soft, covered with normal, sometimes slightly thinned epithelium (see Papilloma, papillomatosis). The appearance of ulceration, bleeding or infiltration of the base of the papilloma are signs that cause suspicion of the onset of cancer.

Keratoacanthoma occurs more often on the red border of the lower G. in the form of a towering spherical tumor measuring 1-2 units in diameter (tsvetn. Fig. 3 and 4). The center of the tumor is crater-shaped, filled with horny masses, its edge is raised in the form of a clearly defined roller. The tumor increases quite rapidly in the first 3-4 weeks, then its growth stabilizes, and in some cases after 6-8 months. the tumor can spontaneously disappear, while the horny crust in the center disappears, the tumor flattens and a scar forms. Relapses are observed in 4-5% of cases (see Keratoacanthoma). The development of cancer from keratoacanthoma occurs in 20% of cases. Differential diagnosis with squamous cell carcinoma (clinically and even morphologically) is often difficult.

Mixed tumors from minor salivary glands on G. are observed extremely seldom. They are usually localized on the inner surface of G., covered with unchanged mucous membrane, clearly delimited (tsvetn. Fig. 5). Their consistency is dense, the surface is smooth. These tumors rarely reach large sizes, increase slowly; on gistol, a structure do not differ from similar tumors of big salivary glands (see. Mixed tumors ).

Hemangioma, simple or cavernous, has the form of a node or a diffuse bluish-reddish color of a tumor-like formation that causes G.'s deformity (tsvetn. Fig. 7). Its consistency is usually soft, when squeezed, it decreases in size. The mucous membrane over the hemangioma is thinned, sometimes there may be bleeding. Hemangioma increases slowly, but often spreads to neighboring areas of the face or oral cavity (see Hemangioma).

Lymphangioma manifests itself similarly (printing. Fig. 6), but the red border or mucous membrane has a normal color, it gives the impression of swelling of the lips (see Lymphangioma).

Retention cyst of the mucous gland quite often occurs on the inner surface of the lips, closer to the corner of the mouth (tsvetn. fig. 8); has the appearance of a bulging spherical shape up to 0.5-1 cm in diameter. The mucous membrane over the cyst is thinned, translucent, rarely whitish in the center. At a palpation in G.'s thickness the accurately delimited node of a soft and elastic consistence is defined. A retention cyst occurs due to a delay in secretion or obstruction of the duct of the mucous gland and contains a clear mucous fluid (see Cyst).

Cancer in 90-95% of observations, it is localized on the red border of the lower G. On the upper G., cancer often comes from the skin, spreading to the red border for the second time. Most patients with cancer of the lower G. are men aged 40-60 years. Predisposing factors - hron, mechanical, thermal and chemical. irritations, in particular smoking.

G.'s cancer is more often squamous keratinizing (80-95% of all cases), less often squamous non-keratinizing and extremely rare - undifferentiated.

On a wedge, a picture distinguish a papillary and ulcer form of cancer. The initial period of the papillary form is characterized by the appearance of a painless compaction of a rounded shape with fuzzy contours, covered with a crust, upon removal, a pink, easily bleeding area is found. As the process develops, the ridge-like edge of the tumor becomes noticeable, and then an ulcer is formed with uneven ridge-like edges, with a necrotic bottom in the center. With an ulcerative form, a long-term non-healing crack is first detected, which turns into an ulcer with roller-shaped edges and infiltrate in the underlying tissues; infiltration and destruction are faster than in the papillary form, the process is involved not only under the mucous, but also under the muscle layer G. More late period differences in the manifestation of papillary and ulcerative forms are erased, the ulcerative-infiltrative process prevails with the formation of an increasingly extensive G.'s defect (tsvetn. Fig. 9). For cancer of the lower G., lymphogenous metastasis is characteristic with damage to the submandibular and submental limf, nodes, and later deep cervical limf, nodes. Distant metastases are rare.

It is customary to distinguish four stages of cancer D. Stage I - a limited tumor or ulcer with a diameter of 1-1.5 cm in the thickness of the mucous membrane and the red border, without metastases. Stage II: a) a tumor or ulcer with a diameter of more than 1.5 cm, limited by the mucous membrane and under the mucous layer, occupying no more than half of the lower G., without metastases; b) a tumor or an ulcer of the same or smaller size, but in the presence of one or two mobile metastases in regional limf. nodes. Stage III: a) a tumor or ulcer that occupies most of the G. with germination of its thickness or spread to the corner of the mouth, cheek and soft tissues chin b) a tumor or ulcer of the same size or less spread, but with limited mobility of regional metastases. Stage IV - a decaying tumor that occupies most of the G. with germination of its entire thickness and spread to the jawbone, or a tumor with immobile metastases in regional lymph. nodes, or a tumor of any size with distant metastases.

Treatment

With purulent processes in G. (furuncle, carbuncle), treatment is mostly conservative; should not be squeezed out so-called. rods. Good results gives the use of local novocaine blockade with antibiotics with simultaneous intramuscular injection antibiotics a wide range actions. In the first stage of inflammation, during the period of infiltration, X-ray therapy at 120 kV, a filter of 1-3 mm Al, with a field that captures normal tissues surrounding the infiltrate by 1-1.5 cm, with a single dose of 15-25 r daily or every other day to a total dose of 75-125 r. Under the influence of radiation, the infiltrate disappears, surgical intervention is not required. Surgical treatment shown with a formed abscess (see Carbuncle, Furuncle).

Treatment malignant tumors can be divided into treatment primary tumor and regional metastases.

For the treatment of the primary tumor, radiation therapy or a combined method is used (in the first stage - radiation therapy, in the second - wide excision with primary plastic surgery). Treatment of regional metastases is carried out mainly by surgery.

Radiation therapy of G.'s cancer is carried out by methods of interstitial gamma therapy (see), close-focus X-ray therapy (see), electronic therapy (see), is more rare - application gamma therapy.

For the treatment of patients with stage I-II cancer, close-focus X-ray therapy and interstitial gamma therapy are indicated. In stage III, interstitial gamma therapy and electronic therapy have an advantage. In stage IV cancer, combined radiation therapy is indicated: remote gamma therapy or electron therapy, followed by the use of close-focus X-ray therapy or interstitial gamma therapy. With damage to the mucous membrane and skin of G., with localization of the tumor in the corners of the mouth, as well as with relapses of cancer, the interstitial method has an advantage.

A contraindication for radiotherapy is the presence of concomitant inflammatory process, on elimination to-rogo radiation therapy can be carried out. A contraindication for interstitial gamma therapy and close-focus X-ray therapy is also the spread of the tumor to bone tissue and the impossibility of determining its boundaries, and in case of relapses - significant radiation changes in the surrounding normal tissues.

For close-focus X-ray therapy, a single dose is 400-500 rad, the total dose to the focus is 6000-6500 rad; the irradiation field is not more than 25 cm 2 .

In the interstitial method, needles with 226 Ra, 60 Co are used; the most convenient are nylon threads with 60 Co granules. Radioactive drugs are administered after local anesthesia 0.25% solution of novocaine. Irradiation is continuous for 6-7 days. The total focal dose is 5000-7000 rad at a dose rate of 30-40 rad/hour.

For electronic therapy, devices of the Betatron type with a radiation energy of 8-15 MeV are used. Single dose 400 rad, total dose 5000-7000 rad if; used as the only method. When combined with the interstitial method, the dose from electronic therapy is reduced.

The application method using 60Co preparations allows for fractional treatment with a daily dose of 500-600 rad and a total dose of 5000-6500 rad.

During radiation therapy, protection of the alveolar part is mandatory mandible, edge is carried out by laying from organic glass or methyl methacrylate between G. and a jaw bone.

At the I stage of cancer of the lower G. a stable cure is achieved in 95-96% of cases; regional limf, nodes do not delete. Radiation therapy gives high percent radical cure, better cosmetic and functional results compared to the surgical method, fewer cases of relapses and metastases.

In the II-IV stages of cancer, in the treatment of the primary tumor, even in the absence of enlarged limf, nodes, an upper cervical excision should be performed, with a cut, not only submandibular and submental, but also deep cervical limf, nodes located in the area of bifurcation are removed carotid artery. In the presence of clinically significant regional metastases, preoperative remote gamma or electron therapy is indicated with the usual dose fractionation and a total dose of 4000-4500 rad. The operation is done after 2-3 weeks. after the end of radiation therapy.

Operations on G. taken to treat wounds, for purulent processes, for the treatment of tumors, etc.; a special place is occupied by operations in children and plastic surgery.

Primary debridement G.'s wounds should be carried out taking into account functional and cosmetic requirements. Excision of tissues should be minimal and only obviously unviable and crushed. With layer-by-layer suturing, it is imperative to restore the continuity of the circular muscle of the mouth. Particular care should be taken to suture the skin and the red border of the lips. In case of damage with a large defect in the tissues of the lips, when it is impossible to sew the edges of the wound without tension, primary plastic surgery should be applied using tissues from the areas of the face adjacent to the defect.

With a thick and shortened bridle, which limits the mobility of G., it is excised ( frenectomy) . In order to avoid scar formation, the middle incision is best done along the frenulum and using counter triangular flaps.

With the so-called the double lip is surgically removed; excess submucosal tissue and mucous glands and fix the mucous membrane to the muscle G.

The retention cyst is husked with suturing on the mucous membrane. A mixed tumor should be removed with the capsule and the mucosa covering it. Papilloma is excised with a small area of adjacent tissues. With small-sized hemangioma and lymphangioma, they resort to excision. With diffuse hemangioma, it can be reduced by introducing 70% alcohol into it to obtain tissue sclerosis. With keratoacanthoma, either excision or close-focus radiotherapy is used.

Treatment of children with congenital cleft lip. Cheiloplasty

Treatment of children with congenital cleft lip is only surgical.

Cheiloplasty(operative closure of the defect) is used to restore the anatomical integrity of the G., create the vestibule of the oral cavity, and also to correct the deformity of the wing of the nose and the bottom of the nasal passage, the nasal septum. Operation is done on the first - the third day after the birth in specialized to lay down. institutions. If the first days are missed, the operation is done in the third month of life (the second month is unfavorable, since immunobiological restructuring of the body occurs and surgical intervention complicated by suture separation). When cheiloplasty, one should take into account not only the shape of the cleft, but also prevent the occurrence of nasal deformity. In case of early primary rhinocheiloplasty, interventions on cartilages in the places of their growth zones should be avoided, it is not recommended to exfoliate and isolate the cartilages of the nose along the inner surface, notch, dissect or excise the internal and external legs of the alar cartilage, especially along the posterior edge, and apply a lamellar suture.

For the treatment of children with a cleft of the upper G., a variety of operations were proposed; a number of them are already of predominantly historical interest (operations on Orlrovsky - Maslov, Miro, etc.). The main stages of cheiloplasty are layer-by-layer stitching of the refreshed edges of the defect, restoration of the contour of the edge of the red border, lengthening of the middle section of the lip, with complete clefts, in addition, restoration of the bottom of the nasal opening and correction of the shape and position of the wing of the nose.

Rice. Fig. 2. Some stages of plastic surgery according to Obukhova - Limberg with unilateral cleft lip (1-3) and bilateral cleft (4-6): 1 and 4 - incision shapes; 2 and 5 - the position of the formed flaps after moving; 3 and 6 - sutures were placed on the displaced flaps.

The most rational are the methods of Obukhova-Limberg, Frolova and the modified Le Mesurier method. Using the Obukhova-Limberg method, the base of the wing of the nose is created using a flip triangular flap, as described above, the middle part of the G. is lengthened, for which the skin is cut in the region of the edge of the G. defect in the horizontal direction, the edges of the wound are bred to the desired length of the lip and into the formed defect a triangular flap is sutured, cut in the lower part of the other side of the defect (Fig. 2).

Le Mesurier (AV Le Mesurier) in 1949 proposed instead of a triangular flap to cut out a quadrangular flap on the outer area of G.. When planning the operation and choosing the length of the incisions, the author proposes to be guided by the height of G. healthy child the same age and weight.

L. E. Frolova (1956) is limited to cutting out a triangular flap only in the lower part of the upper G. The narrowing of the nasal opening and the formation of an oval wing of the nose is achieved by the formation of an apron-shaped flap from the mucous membrane with its base in the region of the edge of the pear-shaped opening. The possibility of a significant mobilization of the mucous membrane allows you to create a volume vestibule of the oral cavity.

Plastic surgery for G.'s tissue defects of various origins can be performed using local tissues, free skin grafting, and the Filatov stem; sometimes these methods are combined. The most favorable functional and cosmetic results are obtained by operations with the movement of tissue sections taken in the vicinity of the defect. When carrying out plastic surgeries on G., one should especially carefully treat the preserved muscles of the oral region. The basic principles of G.'s restoration operations with the help of musculocutaneous flaps from the oral area, developed in the 19th century, have not lost their practical significance. The most common operations are as follows.

Lip plasty according to Bruns - restoration of the upper G. with two quadrangular flaps cut in the area of the nasolabial folds on both sides of the defect (Fig. 3, 4 and 5). The flaps are brought together over the area of the defect and connected with sutures placed on the skin, muscles and mucous membrane. The similarity of the red border is created by stitching the mucous membrane and skin of the flaps.

Lipplasty according to Sedillo - replacement of a total defect of the upper G. On the sides of the defect in the entire thickness of the right and left cheeks, two rectangular flaps are formed in the vertical direction with their base on the sides of the wings of the nose (Fig. 3, 1-3). The flaps are turned upwards by 90° and sutured in layers along the midline. Skin and mucous sutures are applied along the lower edge of the flaps, which creates a semblance of a red border. If it is necessary to replace extensive G.'s defects, combined with a defect in the adjacent part of the face, use the Filatov stem (see Plastic surgery).

Lip plastic according to Abbey - replacement of a defect in one G. with a flap on a leg from another G. The operation is shown with a sunken and flattened upper G. The upper G. is cut through in a vertical direction. After dilution of the edges of the wound, a through triangular defect is formed, which is replaced by a triangular pedicled flap, excised throughout the entire thickness of the lower G. After 10-12 days, its feeding leg is crossed and the upper G. is finally formed (Fig. 3, 6-9). The described methods can also be used to restore the lower G. A number of variants of these operations are proposed, which are used both for symmetrical and for unilateral defects of various origins.

The immediate results of cheiloplasty in children are favorable. Partial divergence of seams, according to G. A. Vasiliev (1964), is observed in 3-6.2% of cases; total discrepancy does not exceed 1%. The occurrence of secondary deformities of the nose and upper glans after cheiloplasty largely depends on the underdevelopment of the edge of the piriform opening on the side of the cleft. In order to prevent this deformation, replanting under the base of the wing of the nose of the lower turbinate is used or bone autoplasty of the lower edge of the piriform opening is performed. Corrective operations for secondary deformities of the nose and upper glans should be done at the age of 12-14 years. This period is justified by the ontogenetic development of the face and the age-related anthropometry of the external nose.

Bibliography:

Anatomy- Burian F. Atlas of plastic surgery, trans. from Czech., vol. 2, p. 86, Prague - M., 1967; Zolotareva T.N. and Toporov G. N. Surgical anatomy of the head, p. 161, M., 1968; 3 o l o t k o Yu. L. Atlas topographic anatomy person, part 1, p. 105, M., 1964; Kudrin I. S. Anatomy of the organs of the oral cavity, p. 62, M., 1968; Falin L. I. Histology and embryology of the oral cavity and teeth, M., 1963, bibliogr.

Pathology- Congenital cleft lip and palate, ed. A. I. Evdokimova et al., M., 1964; Glazunov M. F. Selected works, p. 234, L., 1971, bibliogr.; DoletskyS. I. and Isakov Yu. F. Pediatric surgery, p. 289, Moscow, 1970; Kozlova A. V. Radiation therapy of malignant tumors, M., 1971; Korelenstein R. Ya. Keratoacanthoma of the red border of the lips, Vopr, oncol., t. 17, No. 1, p. 67, 1971, bibliogr.; Mashkilleyson A. L. Precancer of the red border and oral mucosa, M., 1970, bibliogr.; Messina V. M. Primary skin plasty in trauma of the soft tissues of the face, M., 1970, bibliogr.; M and x e of l with about N of H. M. and d river. Cosmetic surgery faces, M., 1965, bibliogr.; Naumov P. V. Primary recovery operations in the treatment of tumors of the soft tissues of the face, M., 1973, bibliogr.; Novik I. O. Diseases of the teeth and oral mucosa in children, M., 1971, bibliogr.; Pashkov B. M. Lesions of the oral mucosa in skin and venereal diseases, M., 1963, bibliogr.; Perez le-guinee. A. iSarkisyanYu. X. Clinical radiology, M., 1973; Guide to surgical dentistry, ed. A. I. Evdokimova, p. 436, 474, M., 1972; Semiotics and diagnosis of malignant tumors, ed. A. I. Serebrov and S. A. Holdin, p. 189, L., 1970; T and-t a p e in V.I. Reconstructive surgeon gia of congenital cleft lip and palate, Chisinau, 1965, bibliogr.; U rb a n o-v and h L. I. Inflammatory diseases red border of lips, Kyiv, 1974; Frolova L. E. Treatment of congenital cleft lip, Tashkent, 1967.

P. V. Naumov; R. V. Mikhailova (rad.), G. V. Falileev (onc.).

In technology, lips or sponges are called longitudinal protrusions on the edges of some tools and devices that serve to capture and hold workpieces, just as the lips of the mouth serve to capture food. Sponges are supplied with a vice, pliers, round-nose pliers.

Structure

The outer, visible, surface of the lips is covered with skin, passing into the mucous membrane of their back surface, facing the teeth, - it is covered with a mucous membrane, smooth, moist and passes into the mucous membrane of the alveolar processes - into the surface of the gums.

In the structure of each lip, three parts are distinguished: skin, intermediate and mucous.

skin part, pars-cutanea, has the structure of the skin. Covered with stratified squamous keratinized epithelium, contains sebaceous and sweat glands, as well as hair;
intermediate part, pars intermedia, plot Pink colour, also has skin covering, but the stratum corneum is preserved only in the outer zone, where it becomes thin and transparent. The place where the skin passes into the mucous membrane - the red border - is replete with translucent blood vessels, which determine the red color of the edge of the lip, and contains a large number of nerve endings, due to which the red edge of the lip is very sensitive.
mucous part, pars mucosa occupying rear surface lips, covered with stratified squamous non-keratinized epithelium. This is where the ducts of the salivary glands open.

The thickness of the lips is formed by: mainly the circular muscle of the mouth, loose connective tissue, skin and mucous membrane.

When the mucous membrane of the lips passes into the gums, two median vertical folds are formed, called frenulum of the upper lip And frenulum of the lower lip.

Superior and inferior labial arteries, mental artery (aa. labiales, superior et inferior, mentalis).

Anthropological aspect

In anthropology, lips are distinguished by the thickness, direction and contour of the upper lip, the width of the mouth opening. According to the thickness of the lips are divided into thin, medium, thick, swollen. The upper lip can protrude forward (procheilia), have a vertical profile (orthocheilia), less often - recede back (opisthocheilia). The thickest (swollen) lips and procheilia are characteristic of the equatorial (Negro-Australoid) race. Caucasians are characterized by orthocheilism. The thinnest lips are found among some peoples in the North of Europe and Asia. The upper lip can have a different contour - concave, straight, convex. The latter is especially characteristic of the Pygmies of Central Africa and the Semangs (Malacca Peninsula). The height and profile of the upper lip, the thickness of the lips, and the width of the mouth also vary with age and gender. With age, the thickness of the lips (after 25 years) and procheilia decrease, the height of the upper lip and the width of the mouth increase.

Physiology

Participation in meals

Participation in facial expressions

Participation in sound production

Being the last barrier to the air exhaled through the oral cavity, the lips are involved in the formation of speech sounds and are an important part of the articulatory apparatus - the human speech organs.

Due to the great mobility of the lower jaw relative to the upper lower lip, along with the tongue and soft palate, it belongs to the active organs of speech. The upper lip belongs to the passive organs of speech because of its lesser mobility.

A stream of air passes through the lips when pronouncing all the sounds of speech, but most important role they play when pronouncing labial consonants and rounded vowels.

Consonant sounds are formed when the flow of exhaled air overcomes the barrier in the oral cavity. Consonants are called labial (labial) if the barrier is the lips.

labial consonants

The labial consonants are divided into two categories according to which organ serves as the passive organ paired with the active lower lip. If the air barrier is formed by the contact of the lower lip with the upper lip, then the resulting consonants will be labial-labial (bilabial, bilabial), and if the lower lip touches the upper teeth, then labio-dental (labiodental).

The category of bilabial consonants includes nasal sonorant [m] and noisy voiced [b] and deaf [p] (in Russian, both hard (velar) and soft (palatal)). The labio-dental consonants are represented by noisy [v] and [f].

Rounded vowels

When pronouncing vowels, the lips can either occupy a neutral relaxed position or be tense. For example, for an English closed vowel, a tense stretching of the lips in a horizontal plane is characteristic.

However, rounded (labialized) vowels include those sounds of human languages, during the pronunciation of which the lips are rounded and in varying degrees pulled forward. In many languages, labialization is one of the important classifying features of vowel phonemes. Such vowels are [o] with moderate labialization and [y] ([u]) with strong. In Russian, rounded vowels correspond both to the letters O and U, and to the vowel components of the pronunciation of the iotized vowels Yo and Yu. In a number of other languages, rounded vowels are opposed to each other in terms of the degree of openness-closeness (raising the tongue to the palate): so in French, German and Turkish are contrasted with the sounds [o] and [ö], [u] and [ü].

Labialization in the flow of speech

Since the organs of articulation in the flow of speech connect adjacent sounds with each other, even non-labial consonants acquire a labial overtone in the vicinity of labialized vowels, that is, they become labialized. The result of this is indicated in the international phonetic transcription by a circle under the consonant symbol.

Questions of medicine and cosmetology

Lips can be the site of localization of a number of diseases and serve as an indicator of the state of other body systems. From the number infectious diseases herpes appears on the lips. With nervous excitement, the lips may tremble. Nervous twitching of the lips may be evidence of disorders in the central and peripheral nervous systems. Blue lips can occur both from cold and heart failure.

Lip care

Lip care serves both cosmetic and hygienic purposes. For cosmetic purposes, lipstick is applied to the lips containing pigments of various brightness and shades - usually a color close to the natural pinkish red of the lips, to enhance their visibility on the woman's face, since the lips are part of her attractiveness and are used for kissing.

Both men and women can use hygienic balms and colorless lipstick to combat dry lips and their pain that can cause cracking. Women's cosmetic lipstick also contains moisturizing ingredients and fats.

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An excerpt characterizing the Lips

By the time I was ten, I had become very attached to my father.
I have always adored him. But, unfortunately, in my early childhood he traveled a lot and was at home too rarely. Every day spent with him at that time was a holiday for me, which I then remembered for a long time, and I collected all the words spoken by dad, bit by bit, trying to keep them in my soul, like a precious gift.
From an early age, I always had the impression that I had to earn my father's attention. I don't know where it came from or why. No one has ever prevented me from seeing him or talking to him. On the contrary, my mother always tried not to disturb us if she saw us together. And dad was always happy to spend with me all his free time left from work. We went to the forest with him, planted strawberries in our garden, went to the river for a swim, or just talked under our favorite old apple tree, which is what I liked to do almost the most.

In the forest for the first mushrooms...

On the bank of the Nemunas River (Neman)

Dad was a great conversationalist, and I was ready to listen to him for hours if the opportunity came across ... Probably just his strict attitude to life, the alignment of life values, the never-changing habit of not getting anything for nothing, all this created for me the impression that I must deserve it too...
I remember very well how, as a very young child, I hung around his neck when he returned home from business trips, endlessly repeating how much I love him. And dad looked at me seriously and answered: “If you love me, you don’t have to tell me this, but you always have to show ...”
And it was precisely these words of his that remained an unwritten law for me for the rest of my life ... True, I probably didn’t always succeed very well in “showing”, but I always tried honestly.
And in general, for everything that I am now, I owe it to my father, who, step by step, sculpted my future “I”, never giving any concessions, despite how selflessly and sincerely he loved me. In the most difficult years of my life, my father was my “island of calm”, where I could return at any time, knowing that they were always waiting for me there.
Having lived a very difficult and stormy life himself, he wanted to be sure for sure that I would be able to stand up for myself in any circumstances that were unfavorable for me and would not break down from any troubles in life.
Actually, I can say with all my heart that I was very, very lucky with my parents. If they were a little different, who knows where I would be now, and whether I would be at all ...
I also think that fate brought my parents together for a reason. Because it seemed to be absolutely impossible to meet them ...
My dad was born in Siberia, in the distant city of Kurgan. Siberia was not the original place of residence of my father's family. This was the decision of the then "fair" Soviet government and, as was always the case, was not subject to discussion ...
So, my real grandparents, one fine morning, were rudely escorted out of their beloved and very beautiful, huge family estate, cut off from their usual life, and put into a completely creepy, dirty and cold car, following the frightening direction - Siberia ...
Everything that I will talk about further, I have collected bit by bit from the memoirs and letters of our relatives in France, England, as well as from the stories and memoirs of my relatives and friends in Russia and Lithuania.
To my great regret, I was able to do this only after my father's death, after many, many years ...
Their grandfather's sister Alexandra Obolenskaya (later - Alexis Obolensky) was also exiled with them, and Vasily and Anna Seryogin, who voluntarily went, followed grandfather by their own choice, since Vasily Nikandrovich for many years was grandfather's attorney in all his affairs and one of the most his close friends.

Alexandra (Alexis) Obolenskaya Vasily and Anna Seryogin

Probably, one had to be a truly FRIEND in order to find the strength in oneself to make such a choice and go to own will where they were going, as they go only to their own death. And this "death", unfortunately, was then called Siberia ...
I was always very sad and hurt for our, so proud, but so mercilessly trampled by Bolshevik boots, beautiful Siberia! ... And no words can tell how much suffering, pain, lives and tears this proud, but exhausted to the limit, land absorbed ... Is it because it was once the heart of our ancestral homeland, "far-sighted revolutionaries" decided to denigrate and destroy this land, choosing it for their diabolical purposes?... After all, for many people, even after many years, Siberia still remained a "cursed" land, where someone's father died, someone's brother, someone then the son ... or maybe even someone's whole family.
My grandmother, whom I, to my great chagrin, never knew, at that time was pregnant with my father and endured the road very hard. But, of course, there was no need to wait for help from anywhere ... So the young Princess Elena, instead of the quiet rustle of books in the family library or the usual sounds of the piano when she played her favorite works, this time listened only to the ominous sound of wheels, which, as it were menacingly they were counting the remaining hours of her life, so fragile and turned into a real nightmare... She was sitting on some sacks at the dirty car window and staring at the last pitiful traces of the "civilization" so familiar and familiar to her going farther and farther away...
Grandpa's sister, Alexandra, with the help of friends, managed to escape at one of the stops. By common agreement, she was supposed to get (if she was lucky) to France, where at the moment her whole family lived. True, none of those present could imagine how she could do this, but since this was their only, albeit small, but certainly the last hope, it was too much luxury to refuse it for their completely hopeless situation. At that moment, Alexandra's husband, Dmitry, was also in France, with the help of whom they hoped, already from there, to try to help the grandfather's family get out of that nightmare into which life had so ruthlessly thrown them, with the vile hands of brutalized people ...
Upon arrival in Kurgan, they were settled in a cold basement, without explaining anything and without answering any questions. Two days later, some people came for grandfather, and stated that they allegedly came to “escort” him to another “destination” ... They took him away like a criminal, not allowing him to take any things with him, and not deigning to explain where and for how long they are taking it. Nobody ever saw Grandpa again. After some time, an unknown military man brought grandfather's personal belongings to the grandmother in a dirty coal sack ... without explaining anything and leaving no hope of seeing him alive. On this, any information about grandfather's fate ceased, as if he had disappeared from the face of the earth without any traces and evidence ...
The tormented, tormented heart of poor Princess Elena did not want to accept such a terrible loss, and she literally bombarded the local staff officer with requests to clarify the circumstances of the death of her beloved Nikolai. But the "red" officers were blind and deaf to the requests of a lonely woman, as they called her - "from the noble", who was for them just one of the thousands and thousands of nameless "numbered" units that meant nothing in their cold and cruel world ... It was a real hell, from which there was no way out back to that familiar and kind world in which her home, her friends, and everything that she was accustomed to from an early age, and that she loved so much and sincerely, remained .. And there was no one who could help or even gave the slightest hope of surviving.
The Seryogins tried to keep their presence of mind for three, and tried by any means to cheer up Princess Elena, but she went deeper and deeper into an almost complete stupor, and sometimes sat for days on end in an indifferently frozen state, almost not reacting to the attempts of her friends to save her heart and mind from final depression. There were only two things that briefly brought her back to the real world - if someone started talking about her unborn child or if any, even the slightest, new details came about about the alleged death of her beloved Nikolai. She desperately wanted to know (while she was still alive) what really happened, and where her husband was, or at least where his body was buried (or abandoned).
Unfortunately, there is almost no information left about the life of these two courageous and bright people, Helena and Nicholas de Rohan-Hesse-Obolensky, but even those few lines from the two remaining letters of Elena to her daughter-in-law, Alexandra, which somehow survived in the family archives of Alexandra in France, show how deeply and tenderly she loved her missing husband princess. Only a few handwritten sheets have survived, some lines of which, unfortunately, cannot be made out at all. But even what has been achieved screams with deep pain about a great human misfortune, which, without having experienced it, is not easy to understand and impossible to accept.

The lips are the beginning of the oral cavity. The mucosa of the lips passes from the skin, so here they are borderline located in the thickness of the lips:

1 - skin part or intermediate,

2 - transitional part (intermediate),

3 - proper mucous membrane (inner part).

The skin part has the structure of the skin. The skin has hair. Glands are found both sebaceous and sweat. The transition part is divided into:

Outer (smooth) zone,

Internal (villous), papillary.

outdoor area- what is behind the line of closing of the lips. The epidermis is thin, especially the stratum corneum, so the capillaries are easily translucent, red. The connective tissue lies under the epidermis and does not form deep papillae, smoothly adjoining the epithelium. Under the epidermis are the sebaceous glands, and the sweat glands are gradually reduced. In the area of closing of the lips, they secrete villous part. The epithelium is thick. Deep papillae protrude into it. The connective tissue contains large blood vessels. They provide color and are necessary for warming or cooling food, etc. After the birth of a child, deep villi form on the epithelium. They irritate the skin of the mother's nipple, which promotes milk flow. With the end of breastfeeding, the villi are reduced.

The mucous (inner) part of the lip represented by a mucous membrane (stratified squamous non-keratinized epithelium). The lamina propria with blood vessels form a transition to the submucosal base, where the secretory sections of the tubular-alveolar salivary glands are located, they are quite large. The muscles of the lips are located deeper - the striated muscles, they are still underdeveloped. Bundles of muscle fibers: circular and longitudinal.

The basis of the lips are the circular muscles of the mouth and skeletal muscle tissue. The buccal mucosa has a number of features in its various parts:

1) Maxillary (upper part);

2) Mandibular (lower part);

3) Intermediate.

The 1st and 2nd have the same structure, and the intermediate one has features (up to 1 cm wide) and stretches to the branches of the lower jaw. In this place there are reduced skin glands (sweat and sebaceous).

The mucous membrane of the gums has a number of features. The epithelium may be partially keratinized or have signs of keratinization. The connective tissue protrudes into the epithelium with deep papillae. In the shell itself there are coarse bundles of fibrous structures that are woven into the periosteum. In the area bordering the teeth, the gingival mucosa loses these features (there is no keratinization, fibrous structures and deep papillae).

The mucosa of the hard palate has the same features as the gums.

The mucosa of the soft palate and uvula. This formation is based on fibrous structures and muscle tissues. The mucosa is covered with different epithelium. On the side of the oral cavity, there is a stratified non-keratinized epithelium, and on the side of the nasal cavity, a pseudo-multilayered epithelium with ciliated cilia. There are salivary glands in the oral mucosa. They can be between muscle structures. Large glands are located outside the wall of the digestive canal (sublingual, parotid, etc.).

Three parts are distinguished in the lip: skin (pars cutanea), intermediate (pars intermedia) and mucous (pars mucosa). In the thickness of the lips are striated muscles

The skin part of the lip has the structure of the skin. It is covered with stratified squamous keratinized epithelium and is supplied with sebaceous, sweat glands and hair. The epithelium of this part is located on the basement membrane; under the membrane lies loose fibrous connective tissue, forming high papillae that protrude into the epithelium.

Intermediate lips consists of two zones: outer (smooth) and inner (villous). In the outer zone, the stratum corneum of the epithelium is preserved, but becomes thinner and more transparent. There is no hair in this zone, the sweat glands gradually disappear, and only the sebaceous glands remain, opening their ducts to the surface of the epithelium. There are more sebaceous glands in the upper lip, especially in the corner of the mouth. The lamina propria is a continuation of the connective tissue base of the skin; her papillae in this zone are low. The inner zone in newborns is covered with epithelial papillae, which are sometimes called villi. These epithelial papillae gradually smooth out and become inconspicuous as the organism grows. The epithelium of the inner zone of the transitional part of the lip of an adult is 3-4 times thicker than in the outer zone, devoid of the stratum corneum. Sebaceous glands are usually absent here. Loose fibrous connective tissue lying under the epithelium, protruding into the epithelium, forms very high papillae, in which there are numerous capillaries. The blood circulating in them shines through the epithelium and causes the red color of the lips. The papillae contain a huge number of nerve endings, so the red edge of the lip is very sensitive.

The mucous part of the lip is covered with stratified squamous non-keratinized epithelium. However, in the cells of the surface layer of the epithelium, a small amount of keratin grains can still be found. The epithelial layer in the mucous part of the lip is much thicker than in the skin. The lamina propria here forms papillae, but they are less high than in the adjacent transitional part. The muscular lamina of the mucous membrane is absent, and therefore the lamina propria, without a sharp border, passes into the submucosa, adjacent directly to the striated muscles.

In the submucosa are the secretory sections of the salivary labial glands (gll. labiales). The glands are quite large, sometimes reaching the size of a pea. By structure, these are complex alveolar-tubular glands. By the nature of the secret, they belong to the mixed mucous-protein glands. Their excretory ducts are lined with stratified squamous nonkeratinized epithelium and open on the surface of the lip.

urinary system. Kidneys. Sources and main stages of development. The structure and features of blood circulation. Nephrons, their varieties, structure, histophysiology. Structural Foundations endocrine function kidneys. Age changes.

The development of the urinary system in embryogenesis proceeds in three phases, with three paired organs successively laid down: the pronephros, the primary kidney, and the permanent kidney.

The pronephric is involved in the laying of the mesonephric duct, the primary is involved in the formation of the gonads.

The final kidney begins to form at the 4-5th week of embryonic development from two sources: the outgrowth of the mesonephric duct and nephrogenic tissue.

(from anatomy - location, macrostructure, etc.)

The boundary between the cortical and medulla is uneven: sections of the cortical substance descend into the medulla, forming the renal columns (Bertiny columns), and the medulla penetrates into the cortex, forming the so-called brain rays (Ferrein's rays).

The structural and functional unit of the kidney is the nephron, the number of which in the kidney reaches 1-2 million. The composition of the nephron includes: The cortical substance contains all the renal corpuscles and all the convoluted parts of the proximal and distal tubules. In the medulla and brain rays there are direct tubules - the loop of Henle and the collecting ducts, which, due to the parallelism of their course, give this zone a striated appearance.

Cortical nephrons have a renal corpuscle located in the outer part of the cortex and a relatively short loop of Henle located in the outer part of the medulla.

in juxtamedullary nephrons the renal corpuscle is located deep - on the border with the medulla, and the long loop of Henle penetrates the medulla up to the tops of the pyramids.

The blood circulation of the kidney provides renal artery. Entering the gates of the organ, it splits into interlobar arteries, which run radially between the pyramids and along the medulla to its border with the cortical. Here, the interlobar arteries branch into arcuate arteries that run along this border at the bottom of the renal columns. Further, the blood circulation of the cortical and medulla is provided by different vascular systems.

Into the cortex interlobular arteries depart from the arcuate arteries, which then divide into intralobular arteries. From the latter (or immediately from the interlobular) the afferent arterioles begin. Moreover, from the upper intralobular arteries, the afferent arterioles are sent to the cortical nephrons. and from the lower - to the juxta-medullary. In the renal corpuscle, the afferent arteriole breaks up into capillaries that form the vascular glomerulus (primary, "wonderful" network of capillaries), from which the efferent arteriole is then formed. In cortical nephrons, the efferent arteriole is approximately two times smaller in diameter than the afferent arteriole. This creates a pressure of 50-70 mm Hg in the capillary network of the glomerulus. Art. This fact is an important condition for the first phase of urine formation - filtration of the liquid part of the plasma from the vessels of the glomerulus into the capsule of the renal corpuscle.

The efferent arterioles again break up into capillaries, which braid the convoluted tubules of nephrons in the cortical substance. From this secondary capillary network, the tissues of the organ are nourished, and in addition, reabsorption takes place in it. useful substances from the lumen of the convoluted tubules into the blood. From the capillaries of the peritubular network, blood flows into upper divisions kidneys into the stellate veins, then into the interlobular and arcuate veins. Then she enters

interlobar and renal veins, which accompany the arteries of the same name throughout.

medulla supply blood to the true direct arteries, which originate from the arcuate arteries, and the false direct arteries, which originate from the juxtamedullary nephrons that carry out arterioles.

The renal corpuscle is composed of the vascular glomerulus and the double-walled capsule of the glomerulus.

The CAPSULE consists of inner and outer sheets, the outer sheet is formed by a single-layer squamous epithelium, the inner one is made of cells - podocytes; the inner sheet surrounds the capillaries of the vascular glomerulus and has a basement membrane in common with them; podocytes, among other functions, form a basement membrane and participate in its renewal

The VASCULAR GLUMER consists of capillaries, capillaries of the fenestrated type, the basement membrane is common both for the capillary and for the inner leaflet of the capsule; the basement membrane is thick, three-layered; the capillaries of the vascular glomerulus are formed due to the branching of the afferent arteriole, when leaving the renal corpuscle, the capillaries are connected to form the efferent arteriole

CAVITY OF THE CAPSULE communicates with the lumen of the proximal convoluted tubule, primary urine is filtered into the cavity of the capsule, which from the cavity of the capsule immediately enters the proximal convoluted tubule

RENAL FILTER - the barrier between blood and primary urine consists of: 1) fenestrated capillary endothelium of the vascular glomerulus; 2) thick three-layer basement membrane and 3) podocytes - cells of the inner leaf of the capsule (see figure below)

MEZANGIUM - the area located between the capillaries, where they are not covered by podocytes; mesangium is formed by loose connective tissue containing somewhat modified fibroblasts called mesangial cells, they are involved in the renewal of the basement membrane of capillaries and podocytes, can form its new components and phagocytize old ones

FUNCTION OF THE RENAL BODY - formation (filtration) of primary urine

3The concept of the blood system and its tissue components. Blood is like tissue, its shaped elements. Platelets (platelets), their number, size, structure, functions, life expectancy.

Blood system includes blood, hematopoietic organs - red bone marrow, thymus, spleen, The lymph nodes, lymphoid tissue of non-hematopoietic organs.

System elements blood have a common origin - from the mesenchyme and structural and functional features, obey the general laws of neurohumoral regulation, united by the close interaction of all links.

blood like tissue. Blood and lymph, which are tissues of mesenchymal origin, form the internal environment of the body. Both tissues are closely interconnected, in them there is a constant exchange of shaped elements, as well as substances in the plasma.

Formed elements of blood. Blood is a liquid tissue circulating through the blood vessels, consisting of two main components - plasma and shaped elements suspended in it - erythrocytes, leukocytes And platelets (platelets). On average, a human body weighing 70 kg contains about 5-5.5 liters of blood.

Blood functions. The main functions of the blood are respiratory (transfer of oxygen from the lungs to all organs and carbon dioxide from the organs to the lungs); trophic (delivery to organs nutrients); protective (ensuring humoral and cellular immunity, blood clotting in case of injuries); excretory (removal and transportation to the kidneys of metabolic products); homeostatic (maintaining constancy internal environment organism, including immune homeostasis).

Blood plates. Platelets are 2-4 microns in size.

Quantity in human blood ranges from 2.0 10 9 l to 4.0 10 9 l. Platelets are non-nuclear fragments of the cytoplasm, separated from megakaryocytes - giant cells in the bone marrow.

Platelets in the bloodstream have the shape of a biconvex disc. In the platelets, a lighter peripheral part is revealed - hyalomere and the darker, grainy part - granulomer.

There are 5 main types of platelets in the population platelets: 1) young, 2) mature, 3) old, 4) degenerative, 5) gigantic forms of irritation.

plasmalemma has a thick layer of glycocalyx, forms invaginations with outgoing tubules, also covered with glycocalyx. The plasma membrane contains glycoproteins that function as surface receptors involved in the processes of adhesion and aggregation of platelets.

cytoskeleton well developed in platelets and represented by actin microfilaments and bundles of microtubules arranged circularly in the hyalomere and adjacent to the inner part of the plasmalemma. Elements of the cytoskeleton maintain the shape of platelets, participate in the formation of their processes.

Functions. The main function of platelets is participation in the process of blood clotting - a protective reaction of the body to damage and preventing blood loss. An important function of platelets is their participation in the metabolism of serotonin.

Lifespan platelets - an average of 9-10 days.

Smooth, moist and passes into the mucous membrane of the alveolar processes - into the surface of the gums.

In the structure of each lip, three parts are distinguished: skin, intermediate and mucous.

skin part, pars-cutanea, has the structure of the skin. Covered with stratified squamous keratinized epithelium, contains sebaceous and sweat glands, as well as hair;
intermediate part, pars intermedia, - a pink area, also has a skin, but the stratum corneum is preserved only in the outer zone, where it becomes thin and transparent. The place of transition of the skin into the mucous membrane - the red border - is replete with translucent blood vessels, which determine the red color of the edge of the lip, and contains a large number of nerve endings, due to which the red edge of the lip is very sensitive.
mucous part, pars mucosa, occupying the posterior surface of the lips, is covered with stratified squamous non-keratinized epithelium. This is where the ducts of the salivary glands open.

The thickness of the lips is formed by: mainly the circular muscle of the mouth, loose connective tissue, skin and mucous membrane.

When the mucous membrane of the lips passes into the gums, two median vertical folds are formed, called frenulum of the upper lip And frenulum of the lower lip.

Frenulum of the lower lip (lat. frenulum labii inferioris) connects the middle of the lower lip with the gum, the frenulum of the upper lip (lat. frenulum labii superioris) connects the middle of the upper lip with the gum.

The upper lip is separated from the cheeks by a nasolabial fold. The lower lip is delimited from the chin by a horizontally running chin-labial groove. Both corners of the mouth have connections of one and the other lip through labial adhesions.

In the submucosal tissue of the lips lie in in large numbers mucous labial glands, reaching the size of a pea; excretory ducts of these glands open on the surface of the mucous part of both lips.

innervation

The lips have a hundred times more nerve endings than the fingertips.

Sensory innervation is provided by branches of the trigeminal nerve

upper labial branches ( rr. labiales superiores) of the infraorbital nerve (- maxillary nerve - the second branch of the trigeminal nerve) innervate the upper lip, as well as to a large extent the skin of the face from the upper lip to the lower eyelid, except for the nose bridge.
buccal nerve ( n. buccalis) - branch of the mandibular nerve ( n. mandibularis) (third branch of the trigeminal nerve);
lower labial branches ( rr. labiales inferiores) mental nerve ( n. mentalis), branches of the inferior alveolar nerve ( n. alveolaris inferior) (- mandibular nerve - trigeminal nerve) innervate the skin and mucous membrane of the lower lip, as well as the anterior surface of the gums;

motor innervation

buccal branches and marginal branch of the lower jaw of the parotid plexus (facial nerve).

blood supply

facial artery:

Superior and inferior labial arteries, mental artery (aa. labiales, superior et inferior, mentalis).

Anthropological aspect

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LIPS- (lat. labium lip), a term used to refer to some anat. formations, for example: labium anterius et posterius orificii uteri externi (anterior and posterior lip of the external opening of the cervix); labia pudendi majora et minora (large ... ... Big Medical Encyclopedia

Cm … Synonym dictionary

Big Encyclopedic Dictionary

Pomeranian names in the north of the USSR of sea bays and bays deeply protruding into the land (Dvinskaya Bay, Baydaratskaya Bay, Ob Bay). Large rivers usually flow into the lips, so their waters are always desalinated to one degree or another. Lip biocenoses ... ... Ecological dictionary

lips- greedy (Bryusov); scarlet (Bryusov, Meln. Pechersky, May, Nekrasov, Radimov, Gumilyov); vampire (White); funny (Gorodetsky); convex (Moravian); proud (Mei); proud (Turgenev, Hoffmann); good-natured (Stanyukovich); tremblingly greedy (White);… … Dictionary of epithets

lips- LIPS, obsolete, trad. poet. mouth... Dictionary-thesaurus of synonyms of Russian speech

1) G. mouth (labia oris) skin folds surrounding the mouth opening. Absent in most turtles, birds and adult cloacals due to the development of a horny beak on the jaws. G. fish usually abound in taste and touch. organs and help ... ... Biological encyclopedic dictionary

LIPS- To dream of thick, ugly lips on someone's face - to hasty and rash decisions. Beautifully defined full lips - you will achieve harmony in relationships with loved ones, to abundance in the house. For those who love, such a dream promises reciprocity. Thin lips - … Dream Interpretation Melnikov

1) motionless skin folds surrounding the mouth opening in fish, amphibians and reptiles. With the development of the beak, lips are absent (turtles, birds, adult cloacal mammals). In humans and mammals, mobile fibers ... ... encyclopedic Dictionary

lips- (labia oris) muscular formation that limits the oral fissure. Outside covered with skin, inside with a mucous membrane. The thickness of the lips is circular muscle mouth. On the skin of the upper lip there is a median depression of the philtrum, in the middle on ... ... Glossary of terms and concepts on human anatomy

Books

Congenital cleft lip and palate , S. V. Chuikin , L. S. Persin , N. A. Davletshin , Current issues of dentistry childhood and maxillofacial surgery. At the present level, the issues of etiology, pathogenesis, clinic, diagnosis and treatment are considered ... Category: Types of surgery. Surgical diseases Publisher:

What are human lips made of? Lips. Characteristics of the skin, transitional and mucous parts. Lip glands General structure and features of the oral cavity: lips, cheeks, palate

Anatomy

Pathology

Malformations

Damage

Diseases

Tumors

Treatment

Treatment of children with congenital cleft lip. Cheiloplasty

Structure

Anthropological aspect

Physiology

Participation in meals

Participation in facial expressions

Participation in sound production

labial consonants

Rounded vowels

Labialization in the flow of speech

Questions of medicine and cosmetology

Lip care

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An excerpt characterizing the Lips

innervation

blood supply

Anthropological aspect

see also

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See what "Lips" are in other dictionaries:

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