Venous network of the face. Venous system of the face and neck. Atrophy and dislocation of deep and superficial fatty structures leads to the appearance of external signs of aging

Vessels of the face The main source of blood supply to the face is the external carotid artery. From the neck area, the facial artery comes to the face, which is projected onto the skin from the middle of the body of the lower jaw to the inner corner of the eye. Gives large branches: the arteries of the upper and lower lips and the final branch - the angular artery, anastomoses with the ophthalmic artery through the arteries of the nose.

The second large artery - the upper jaw (a. Shaxillaris) - departs from the external carotid artery in the thickness of the parotid gland at the level of the neck of the articular process of the lower jaw, goes into the deep region of the face, lies on the outer surface of the external pterygoid muscle and lies first in the temporal pterygoid cellular interval, then - in the interpterygoid interval.

A. maxillaris is the largest branch of the external carotid artery, it gives off 19-20 branches and supplies blood to the entire deep region of the face with masticatory muscles and the dentition. The artery is not available for ligation, therefore, if necessary, they resort to ligation of the external carotid artery on the neck in the carotid triangle. In the deep region of the face near the artery, it is customary to distinguish three sections:

1) Mandibular (pars mandibularis) - behind the neck of the articular process. The largest branch is the lower alveolar artery (a. alveolaris inferior);

2) Pterygoid (pars pterygoidea) - between the temporal muscle and the external pterygoid. Branches:

a) middle meningeal artery (a. meningea media);

b) deep temporal artery;

c) masticatory artery;

d) superior alveolar artery;

e) buccal arteries;

e) pterygoid arteries.

3) Pterygopalatine (pars pterygopalatine) - in the pterygopalatine fossa. Branches: infraorbital, pharyngeal, palatine, etc.

The venous system of the face is divided into two layers. The first layer of veins forms the system of the facial vein, v. facialis, the origins of which are the angular vein, supraorbital, external nasal, veins of the tubes, nose, as well as the posterior maxillary vein, v. retromandibularis, located in the thickness parotid gland. In the region of the root of the nose, the facial vein has wide anastomoses with the superior ophthalmic veins and through them with the sinus veins of the dura mater. In the sinus veins, infection is possible with carbuncles and boils of the upper lip, nose, with the development of thrombophlebitis (sinus thrombosis) and inflammation of the meninges.

The deep venous network of the face is represented by the pterygoid venous plexus (plexus pterygoideus). It drains into the submandibular vein. Thus, both systems are interconnected. It should be noted that the pterygoid plexus, which lies in the intermaxillary space, is associated with the sinus veins of the dura mater. The retromaxillary and facial veins merge posteriorly from the angle of the mandible into the common vein of the face, which flows into the internal jugular vein.

Facial nerves. The innervation of the face is carried out by the facial, trigeminal, glossopharyngeal nerves, cervical plexus.

Facial nerve (7th pair of cranial cerebral nerves) carries out mainly motor innervation of the mimic muscles of the face. From the pyramid of the temporal bone, the nerve exits through the stylomastoid foramen and forms the posterior auricular nerve 1 cm below.

The main trunk of the facial nerve enters the thickness of the gland and here it is divided into upper and lower branches, from which five groups of branches depart. The branches run radially from a point 1 cm down from the ear canal. At inflammatory processes paralysis and paresis of the facial nerve can occur in the gland. Incisions on the face are made only taking into account the course of the branches of the facial nerve. The nerve lies relatively shallow, exists great danger damage to its branches, which also leads to paralysis of the facial nerve or its individual branches.

The trigeminal nerve (5th pair of cranial nerves) is mixed (sensory-motor) in terms of its structure and function. Moving away from the brain stem, the nerve forms the semilunar gasser node. The node is located on the anterior surface at the top of the pyramid of the temporal bone, lies in the cavity formed by the dura mater. Three main branches of the trigeminal nerve depart from the anterior edge of the node: I) ophthalmic; 2) maxillary; 3) mandibular.

According to the topographic anatomical structure, the trigeminal nerve is one of the most complex. Its branches pass in hard-to-reach anatomical areas, enter into complex relationships with blood vessels. At the same time, since the nerve carries a sensitive pain innervation for the dentoalveolar apparatus, anesthesia of the branches of the nerve is necessary during operations on the face. Therefore, consider the exit points of large branches of the nerve to the face.

It should be immediately noted that the skin of the face receives pain innervation from the trigeminal nerve.

The first branch innervates the skin of the frontal and orbital regions.

The second branch of the trigeminal nerve gives pain innervation to the infraorbital region, nose, upper lip, teeth, and upper jaw. It leaves the skull through a round hole in the pterygopalatine fossa, gives the main branches. The infraorbital nerve exits through the inferior orbital fissure, enters the orbit, lies in the infraorbital groove, and exits through the infraorbital foramen. It is located 0.5 cm below the middle of the edge of the orbit, forms a "crow's foot", from which the labial, nasal branches extend to the lower eyelid. Along the way, the nerve gives off the upper posterior, middle and anterior alveolar nerves, they enter the upper jaw in the region of the tubercle. The named nerves are connected in the tubules of the alveolar process upper jaw and form the superior dental plexus.

In addition, in the pterygopalatine fossa, the pterygopalatine branches and branches of the maxillary nerve (n. petrosus major and n. facialis) form a vegetative pterygopalatine ganglion, from which the palatine nerves depart: large (exits through the large palatine opening), middle and posterior (enters through the small palatine hole), innervating the gum, soft and hard palate.

The posterior nasal nerves, a large branch of which, the nasopalatine nerve, exits through the incisal foramen and innervates the anterior palate.

The mandibular nerve exits through the foramen ovale. The mixed nerve carries motor innervation for the chewing muscles: temporal, chewing, pterygoid muscles. Its largest branches are the buccal, ear-temporal, inferior alveolar and lingual nerves. The inferior alveolar nerve runs down the inner surface external pterygoid muscle, then between the pterygoid muscles enters the mandibular foramen and exits into the mandibular canal together with the artery. Provides pain innervation of the teeth of the lower jaw, its final branch is n. mentales (chin). This nerve exits through the mental foramen. The lingual nerve goes to the tongue from below.

The mental nerve innervates the skin of the lower lip, the gums in the area of the canines and premolars, and the skin of the chin. The mental foramen is located in the middle of the distance between the lower edge of the jaw and the alveolar process.

Projection anatomy of the vessels and nerves of the facial part of the head:

1. The facial artery (a. facialis) is projected from the intersection of the anterior edge of the chewing muscle with the lower edge of the lower jaw in an upward direction to the inner corner of the eye.

2. The mandibular foramen (foramen mandibulare) is projected from the side of the oral cavity onto the buccal mucosa in the middle of the distance between the anterior and posterior edges of the lower jaw branch, 2.5-3 cm upward from its lower edge.

3. The infraorbital foramen (foramen infraorbitalis) is projected 0.5-0.8 cm downward from the middle of the lower orbital margin.

4. The chin hole (foramen mentalis) is projected at the middle of the height of the body of the lower jaw between the first and second small molars.

5. The trunk of the facial nerve (truncus n.facialls) corresponds to a horizontal line drawn through the base of the earlobe.

Incisions for purulent mumps

Indications. Phlegmon and abscess of the parotid gland.

Technique. The patient is placed on his back, his head is turned to the side. Three radial incisions are made 5-6 cm long. The incisions begin at the tragus of the ear: the upper one - along the lower edge of the zygomatic arch, the middle one - in the direction of the corner of the mouth, reaching the anterior edge of the masticatory muscle (m. masseter), the lower one - in the direction from the middle of the distance between the angle of the lower jaw and the chin, also reaching the front edge of m. masseter.

The direction of the incisions coincides with the course of the branches of the facial nerve (Fig. 83).

Dissect the skin with subcutaneous fat. Hooks expand the wound. The parotid-masticatory fascia is dissected with a scalpel along the grooved probe. Then the capsule and the surface layer of the parotid substance are dissected. salivary gland. The main danger in incisions is damage to the branches of the facial nerve, penetrating the radial thickness of the parotid salivary gland.

Nerve branches cannot be crossed. It should be borne in mind that the stenonic duct is projected along the line connecting the lower edge of the external auditory canal with the corner of the mouth or the wing of the nose, within these limits the incision should be made with extreme caution in order to avoid injury to the excretory duct of the parotid salivary gland. Gauze strips (tampons) are inserted into the incisions.

With the localization of abscesses in the deep parts of the gland (mandibular fossa), an incision is made according to Voyno-Yasenetsky. An incision 3 cm long is made with the head thrown back, from the earlobe downwards between the posterior edge of the ascending branch of the lower jaw and the anterior edge of the sternocleidomastoid muscle. The incision should be 1-1.5 cm behind the edge of the mandible so as not to damage the lower branch of the facial nerve, which remains in front of it.

The edges of the wound are stretched with sharp hooks and a blunt instrument (forceps), pass to a depth of 2.5 cm towards the styloid process and the posterior wall of the pharynx, penetrating through the tissue of the parotid gland (see Fig. 83).

Test tasks (choose the correct answer)

1. The transverse sinus corresponds to the anatomical formation of the bones of the skull:

1) external occipital protuberance;

2) mastoid process;

3) top vynyy line;

4) the bottom vynoy line.

2. The arteries of the soft tissues of the head have the following direction:

1) axial;

Topographic anatomy neck. Fascia of the neck and cellular spaces. Vascular bundles of the neck. Neck organs

Borders and external landmarks. The upper border of the neck area is drawn along the edge of the base of the lower jaw, through the tops of the mastoid processes and behind along the upper nuchal line. The lower border is drawn along the jugular notch of the sternum, along the upper edges of the clavicles, through the shoulder processes of the scapula (acromion) to the spinous process of the 7th cervical vertebra.

To facilitate orientation in the complex topography of the neck area, and above all in numerous vessels and nerves, various external landmarks are used, which can be divided into five groups: bone, cartilage, muscle, vascular and skin folds. Landmarks allow you to divide the neck into departments and regions, and also help plan operational approaches to the neck.

The median line divides the neck into right and left halves. The frontal plane, drawn through the transverse processes of the cervical vertebrae, divides the neck into anterior, visceral, and posterior muscular (vyya) sections. The transverse plane drawn through the hyoid bone divides the anterior neck into suprahyoid and infrahyoid regions.

The muscles of the anterior region of the neck form a special coordinate system in the form of triangles (Fig. 84).

The boundaries of the triangles are drawn along the contours of large muscles. The sternocleidomastoid muscle (sternocleidomastoid) divides each half of the anterior neck into internal and external (lateral) triangles. Within the inner triangle, a submandibular triangle is isolated, bounded by the bellies of the digastric muscle. An unpaired mental triangle is isolated between the anterior bellies of the digastric muscle. In addition, the carotid and scapular-tracheal triangles are located in the inner triangle. In the outer triangle, the scapular-trapezoid and scapular-clavicular triangles are distinguished. The triangles help you navigate the complex anatomy of the neck. Each triangle is distinguished by the peculiarity of the layered anatomy and the location of the neurovascular elements.

Layers. In the layered anatomy of the neck area, the issue of fascia and cellular spaces as anatomical elements that determine the course of purulent-inflammatory processes should be highlighted.

The fascia of the neck is an anatomical element that makes the neck one whole. The most widespread and practically acceptable is the classification of the fascia of the neck according to V. N. Shevkunenko (Fig. 85), according to which five fascia are distinguished on the neck (Table 12). Between the sheets of fascia are fatty tissue and lymphoid tissue, so the fascia determine the location of phlegmon on the neck (mainly adenophlegmon) and the direction of purulent streaks.

Vascular bundles of the neck. Two large neurovascular bundles are distinguished on the neck: the main and subclavian.

The main neurovascular bundle of the neck consists of the common carotid artery, internal jugular vein, vagus nerve. It is located on the neck in the region of the sternocleidomastoid (sternocleidomastoid) muscle and the carotid triangle. Thus, two sections are distinguished in the main sucisto-nerve bundle along the course of the carotid artery: the 1st section in the region of the sternocleidomastoid muscle, the 2nd section in the carotid triangle. In the region of the sternocleidomastoid muscle, the neurovascular bundle lies deep enough, covered by the muscle, the 2nd and 3rd fascia. The sheath of the bundle is formed by the parietal sheet of the 4th fascia and, in accordance with the laws of Pirogov, has a prismatic shape, the spurs of the vagina are fixed to the transverse processes of the cervical vertebrae.

The relative position of the elements of the neurovascular bundle is as follows: in front and outward from the artery lies a vein, between the vein and the artery and posteriorly is the vagus nerve.

Above, the main neurovascular bundle is located in the carotid triangle (Fig. 86), which is bounded from above by the posterior leg of the digastric muscle, in front by the upper abdomen of the scapular-hyoid muscle, and behind by the anterior edge of the sternocleidomastoid muscle. The neurovascular bundle is not covered by muscle and 3rd fascia. With the head tilted back, the pulsation of the carotid artery is clearly visible on the neck, and upon palpation, the pulse here can be
determine even with a significant decrease blood pressure. The mutual arrangement of the elements of the neurovascular bundle remains the same, the venous elements lie more superficially, the common facial vein flows into the internal jugular vein. The common carotid artery in the carotid triangle at the level top edge thyroid cartilage (according to Pirogov) is divided into internal and external branches. It is practically important to know their differences. Anatomically sure sign external carotid artery - the presence of lateral branches in the carotid triangle, of which the superior thyroid, lingual and facial arteries are permanent. Ligation of the external carotid artery in order to stop bleeding during injuries of the maxillofacial region is performed immediately after the superior thyroid artery leaves. The internal carotid artery on the neck does not give branches. The internal carotid artery is usually divided into three sections:

1) from the bifurcation of the common carotid artery to the hypoglossal nerve;

2) from the hypoglossal nerve to the entry into the canal of the carotid artery and 3) intracranial. To perform surgical interventions, the internal carotid artery is available only in the first section.

The anatomical feature of the carotid triangle is the presence of large nerve trunks. As part of the main neurovascular bundle, the vagus nerve (the 10th pair of cranial nerves) goes here. Forming an arc, the external carotid artery crosses the hypoglossal nerve (12th pair of cranial nerves), here it gives off a descending branch lying on the anterior surface
common carotid artery, which further anastomoses with the cervical plexus (cervical loop). In the bifurcation of the common carotid artery lies the carotid glomerulus, the so-called intersleepy paraganglion, the receptor body (glomus caroticus). Behind the internal carotid artery lies the superior node of the sympathetic trunk. Location in a narrow space large vessels, cranial nerves, receptor formations, the sympathetic trunk makes the sleepy triangle stand out as a reflexogenic zone of the neck.

Sympathetic trunk. The cervical region of the sympathetic trunk has 3-4 nodes. The upper node is located at the level of the 2nd and 3rd cervical vertebrae, lies on the 5th fascia and the long muscle of the neck. The middle node is unstable, it is located at the intersection of the common carotid and inferior thyroid arteries, at the level of the 6th cervical vertebra, lies in the thickness of the 5th fascia. The intermediate node lies on the surface of the vertebral artery before entering the transverse processes, at the level of the upper edge of the 7th cervical vertebra. The lower, or stellate, node is located behind the subclavian artery, at the level of the lower edge of the 7th cervical vertebra.

The close proximity of the main neurovascular bundle to the sympathetic trunk and the presence of anastomoses with the vagus nerve explains the effect of Vishnevsky's vagosympathetic blockade. In some cases, vagosympathetic blockade can cause acute reflex cardiac arrest, which is associated with a departure from the superior sympathetic ganglion of the superior cervical cardiac nerve, and from the vagus nerve - the depressor nerve to the heart, the so-called nerve of Zion.

The subclavian neurovascular bundle is formed by the subclavian artery, subclavian vein, and brachial plexus. Three sections are distinguished along the course of the subclavian artery and according to its relationship with the anterior scalene muscle. The subclavian neurovascular bundle is located in the inner and outer triangles of the neck. In the inner triangle of the neck, the elements of the subclavian neurovascular bundle occupy the deep intermuscular spaces of the neck.

Deep intermuscular spaces of the neck. On the neck in the inner triangle in the deep layers of the sternocleidomastoid region, the following deep intermuscular spaces are distinguished: I) prescalene fissure; 2) stair-vertebral triangle; 3) interstitial gap.

The first intermuscular gap is the prescalene fissure (spatium antescalenum) in front and outside it is limited by the sternocleidomastoid muscle, behind - by the anterior scalene muscle, from the inside - by the sternohyoid and sternothyroid muscles. The spatium antescalenum contains the lower part of the main neurovascular bundle (a. carotis communis, v. jugularis interna, n. vagus), the phrenic nerve and Pirogov's venous angle - the fusion of the internal jugular vein and the subclavian. On the surface of the body, the venous angle is projected onto the sternoclavicular joint. All are poured into the venous angle large veins lower half of the neck (external jugular, vertebral, etc.). The thoracic lymphatic duct flows into the left venous angle. The right lymphatic duct flows into the right venous angle. The thoracic lymphatic duct (THD) is an unpaired formation. It is formed in the retroperitoneal space at the level of the 2nd lumbar vertebra. Two variants of the final section of the HLP are described at the place of its confluence with the venous angle: loose and main.

In the prescalene fissure is the terminal section of the subclavian vein. The vein crosses the clavicle at the border of the inner and middle third of the clavicle and lies on the first rib. The subclavian vein originates from lower bound the first rib and is a continuation of the axillary vein. The topography of the right and left subclavian veins is almost the same. At the subclavian vein, two sections can be distinguished: behind the clavicle and at the exit from under the clavicle in the trigonum clavipectorale. The subclavian vein runs between the anterior surface of the first rib and the posterior surface of the clavicle. The length of the subclavian vein is 3-4 cm, the diameter is 1-1.5 cm or more. The subclavian vein lies in front of the anterior scalene muscle. The vein is characterized by a constant location, its walls are fixed in the gap between the first rib and the clavicle, the periosteum of these formations and the spurs of the fifth fascia. In this regard, the subclavian vein does not spasm, its walls never collapse. This makes it possible to perform puncture and catheterization of the subclavian vein during severe hypovolemia (shock, massive blood loss). The high volumetric blood flow velocity in the subclavian vein prevents the formation of blood clots and the loss of fibrin on the catheter. At the lower edge of the middle third of the clavicle, the subclavian ar
the terium and vein are separated by the anterior scalene muscle. The artery is further away from the vein, which avoids the mistake of hitting an artery instead of a vein. At the same time, the artery separates the vein from the trunks brachial plexus. Above the clavicle, the vein is located closer to the dome of the pleura, below the clavicle, it is separated from the pleura by the first rib.

Immediately behind the sternoclavicular joint, the subclavian vein joins with the internal jugular vein, the brachiocephalic veins are formed on the right and left, which enter the mediastinum and, having joined, form the superior vena cava. Thus, throughout the front, the subclavian vein is covered by the clavicle. His highest point the subclavian vein reaches at the level of the middle of the clavicle, where it rises to its upper edge. In front of the subclavian vein, the phrenic nerve crosses, in addition, the thoracic lymphatic duct passes to the left above the top of the lung, which flows into the venous angle formed by the confluence of the internal jugular and subclavian veins.

Features of the subclavian vein in young children. In newborns and young children, due to the high standing of the chest (the jugular notch of the sternum is projected onto 1 thoracic vertebra), the neck is relatively short. Its shape is cylindrical. The subclavian vein is thin-walled, tightly adjacent to the 1st rib and the clavicle directly behind the costal-subclavian ligament. The terminal segment of the subclavian vein venous angle lies directly on the dome of the pleura, covering it in front. In newborns, the diameter of the vein ranges from 3 to 5 mm, in children under 5 years old - from 3 to 7 mm, over 5 years old - from 6 to 11 mm. The subclavian vein is covered in front by the clavicle and only in young children can protrude slightly above the clavicle. The subclavian vein is accompanied throughout by loose fiber, which is especially well developed in children. In children of the first five years of life, the subclavian vein is projected onto the middle of the clavicle; at an older age, the projection point of the vein shifts medially and is located on the border of the middle and inner third of the clavicle.

The second intermuscular space - the scalene-vertebral triangle (trigonum scalenovertebrale) - is located posterior to the prescalene fissure. The outer face of the triangle is formed by the anterior scalene muscle, the inner one by the long muscle of the head, the base by the dome of the pleura, and the apex by the transverse process of the 6th cervical vertebra. In the triangle lies the 1st division of the subclavian artery. The significance of this department is very high, since three important branches pass here: the vertebral, thyroid, and internal thoracic arteries. The anatomical features of the position of the vertebral artery make it possible to relatively freely manipulate only in a small area from its mouth to the entry into the bone canal of the cervical vertebrae, i.e., in the scaleno-vertebral triangle - its first section. The second section is located in the bone canal, the third - at the exit from the atlas with the formation of a siphon, and the fourth - intracranial. The stair-vertebral triangle is the second reflexogenic zone of the neck, since behind the subclavian artery lies the lower node of the sympathetic trunk, in front of the vagus - the nerve, outside on the anterior scalene muscle - the phrenic nerve (Fig. 87).

middle scalene muscles. Here lie the second section of the subclavian artery with the outgoing costal-cervical trunk and bundles of the brachial plexus.

The third section of the subclavian artery is located in the outer triangle of the neck, here the transverse artery of the neck departs from the artery, all elements of the subclavian neurovascular bundle are connected together to go into the axillary fossa on the upper limb. A vein lies medially from the artery, posteriorly, above and outwards, 1 cm from the artery - the bundles of the brachial plexus. The lateral part of the subclavian vein is located anterior and inferior to the subclavian artery. Both of these vessels cross the upper surface of the 1st rib. Behind the subclavian artery is the dome of the pleura, which rises above the sternal end of the clavicle.

(v. facialis communis) see the list of anat. terms.

- Neat brickwork, designed to be perceived in its natural form - without plastering, plastering, whitewashing, painting and cladding ...
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- a paired venous duct in the embryo, formed by the confluence of the anterior and posterior cardinal V., flowing first into the venous sinus of the heart, and later into the atria ...
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common carotid artery,a.carotiscommunis,passes in the carotid triangle and at the level of the upper edge of the thyroid cartilage or the body of the hyoid bone is divided into a.carotis externa and a.carotis interna (bifurcation). To temporarily stop bleeding, a.carotis communis is pressed against the tuberculum caroticum of the VI cervical vertebra at the level of the lower edge of the cricoid cartilage.

External carotid artery, a.carotis externa,Supplies blood to the outer parts of the head and neck. From the external carotid artery, slightly higher than its beginning, departs superior artery thyroid gland, a.thvroidea superior and goes down and forward to the thyroid gland. Along the way, it gives off a.laryngea superior, which supplies blood to the mucous membrane of the larynx. The lingual artery, a.lingualis, leaves at the level of the large horns of the hyoid bone and goes up through Pi Rogov's triangle (formed by the posterior edge of m..mylohyoideus, the posterior belly of m.digastricus and the trunk of n.hypoglossus) to the tongue. Facial artery, a.facialis departs slightly above the lingual artery at the level of the angle of the lower jaw, passes inside from the posterior abdomen m.digastricus and goes to m.masseter, where at its anterior edge it bends over the lower edge of the jaw to the face. Then this artery goes to the medial corner of the eye, where its final branch - a.angularis anastomoses with a.dorsalis nasi (a.ophthalmica branch from the internal carotid artery system). It supplies blood to the pharynx and soft palate, palatine tonsils, submandibular gland, muscles of the floor of the mouth, sublingual glands, upper and lower lips. The ascending pharyngeal artery, a.pharynqea assendens, starts from the inner surface of the external carotid artery at its very beginning and supplies blood to the lateral wall of the pharynx, the soft palate and partially the palatine tonsil, and its branches penetrate into the cranial cavity to the meninges. A.stemocleidomastoidea is directed and supplies blood to the muscle of the same name. Occipital artery, a.occipitalis starts at rear surface external carotid artery and under the posterior abdomen m.digastricus goes to the occiput, supplies the skin and muscle of this area, the auricle, hard meninges. The posterior ear artery, a.auricularis posterior, passes over the posterior abdomen of m.digastricus and goes to the skin behind auricle blood supply to the skin and muscles of this area, facial nerve and middle ear. Superficial temporal artery, a.temporalis superficialis, one of the two terminal branches of the external carotid artery. Passes in front of the external auditory canal to the temporal region, is located under the skin on the fascia of the temporal muscle. Its terminal branches are ramus frontalis and ramus parietalis. blood supply m.temporalis and soft covers of the cranial vault. Along the way, this artery gives off branches to the parotid salivary gland, to the lateral surface of the auricle, to the external ear canal, soft tissues in the area of the outer corner of the eye, m.orbicularis oculi and to zygomatic bone. The maxillary artery, a.maxillaris, is another terminal branch of the external carotid artery. Gives the following branches: middle meningeal artery, a.meninqea media, (to the dura mater of the brain); lower alveolar artery, a.alveolaris inferior (before entering the canal of the lower jaw, it gives ramus mylohyoideus to the muscle of the same name, in the mandibular canal it gives branches to the teeth, interalveolar septa and mucous membrane, and leaving the canal a.mentalis branches in the soft tissues of the lower lip and chin); infraorbital artery, a.infraorbitalis. enters the orbit through the fissura orbitalis interior and through the canalis infraorbitalis enters the anterior surface of the maxillary bone (supplies upper teeth, mucous membrane of the alveolar process and maxillary sinus); pterygopalatine artery, a.sphenopalatina. penetrating through the opening of the same name into the nasal cavity, it branches in the nasal mucosa. A.maxilaris also gives branches to the sky, throat, auditory tube, part of the vessels descends into the canalis palatinus majores et minores and branches in the hard and soft palate.

Internal carotid artery, a.carotis interna, departs from the common carotid artery and rises up, enters the canalis caroticus of the temporal bone. In the neck area, it does not give branches. In the skull, it gives off the following branches:

Sleepy-tympanic branches, rr.caroticotvmpanici. penetrate into the tympanic cavity;

Eye artery, a.ophthalmica. penetrates through the canalis opticus into the cavity of the orbit and supplies blood hard shell brain, lacrimal gland (a.lacrimalis), eyeball and its muscles, to the eyelids (aa.palpebrales laterales et mediales), to the mucous membrane of the nasal cavity (aa.ethmoidales anterior et posterior), to the skin of the eyebrow (a.supraorbitalis) , to the skin of the nose (a.dorsalis nasi);

Front cerebral artery, a.cerebri anterior, supplies blood to the cerebral cortex;

The middle cerebral artery, a.cerebri media, supplies blood to the brain;

Choroid plexus artery, a.chorioidea:

Posterior communicating artery, a.communicans posterior.

Venous blood from the organs of the oral cavity and tissues of the maxillofacial region flows through the jugular vein system. Internal jugular vein, v.jugularis interna receives blood from the head and neck. The tributaries of the internal jugular vein are divided into intracranial and extracranial. The former include the sinuses of the hard shell of the brain and the veins of the brain, cranial bones, orbit, and hard shell that flow into them. To the second: the facial vein, v.facialis (corresponds to the course of the corresponding artery, synonymous with v.facialis anterior), the retromaxillary vein. v.retromandibularis (collects blood from the temporal and parotid regions); pharyngeal veins, w.pharvnqeae; lingual vein, v.lingualis; superior thyroid veins, vv.thvroideae superiores (corresponding to the course of the corresponding arteries); middle thyroid vein, v.thvroideae media.

Common facial vein(v.facialis communis) - a vein that is the direct common trunk of v.facialis anterior et v.retromandibularis (facialis posterior), which flows into v.jugularis interna.

External jugular vein, v.jugularis externa,begins behind the auricle at the level of the angle of the lower jaw in the region of the retromaxillary fossa (goes down covering m.platysma), crosses m.stemocleidomastoidea and along the posterior edge of this muscle at the level of the hyoid bone is connected to a common trunk withanterior jugular vein, v.jugularis anterior,which collect blood from small veins below the chin and go down the front surface of the neck, joins v.subclavia.

pterygoid venous plexus, plexus venosus pterygoideus,is located in the infratemporal fossa. It collects blood from the meninges of the brain, from the superior pharyngeal plexus, from the inner, middle and outer ear, from the parotid gland, masticatory muscles, partly from the orbital vein, from the mucous membrane of the nasal and oral cavities, and also from the teeth. Merges into v.retromandibulis. v.facialis communis. and then in v.iucularis interna.

Sources:

1. "Guide to maxillofacial surgery and surgical dentistry" - A.A. Timofeev, Kyiv, 2002

2. “Atlas of human anatomy”, volume III. Teaching about vessels. R.D. Sinelnikov. Moscow, 1996

Edited by:

Rice. Anatomical ATLAS. WIKIPEDIA

K O S M A C E V T I C A

BEGINNER'S GUIDE

VENOUS SYSTEM

VENOUS OUTFLOW

The veins in the area of the face and neck anastomose widely with each other and are located almost everywhere in 2 layers and form a looped venous network there. Veins, as a rule, go along with the arteries and repeat their direction, and bear names corresponding to all those arteries that they accompany. Superficial veins of the face, through which blood flows from the skin, subcutaneous tissue, facial muscles, flow into the facial vein, which corresponds to the branches of the facial artery.
There is a term in classical massage- large venous outflow. Venous outflow - the outflow of venous blood through the veins. Massage movements are designed in accordance with anatomical structure head and neck and veins, through which blood moves from the head to the heart, it flows through the three main pairs of veins: the external and internal jugular veins and the vertebral veins, which through the transverse processes of the cervical vertebrae.
Blood from the head and neck regions enters the heart through the internal jugular veins, which pass through the neck on both sides. Like the carotid arteries, they are protected by carotid fascial sheaths, right and left.
Unlike other venous vessels of the body - the veins in these areas, as a rule, do not have any valves at all, and the blood flows through them under the action of only gravity alone, and, also, due to the negative pressure in the veins located in thoracic human body.
Superficial veins become visible when a person strains the muscles ... They can be seen on the neck of singers when they sing loudly and the muscles tense.

JUGULAR VEIN

In addition to the veins through which blood flows from the face, there are a number of vessels connecting neighboring veins (through which blood flows from the skull away from the brain) in the areas of the venous sinuses, and the veins of the skull. Along with bony veins (found in the bones of the skull), they represent a potential route of infection from the skull to the brain.

ANASTOMOSES

There is a huge number blood vessels connecting the arteries of the left side of the face with the arteries of the right and branches of the internal carotid artery with the branches of the external. Such connecting vessels are called anastomoses. They are important, for example, in the treatment of a cut lip, when it is necessary to clamp both facial arteries - the right and left - in order to stop the bleeding. A large accumulation of blood vessels in the head means that an injury to this area of the body causes profuse bleeding. This is due not only to the large amount of blood entering here, but also to the fact that the vessels are protected from instantaneous clamping of the subcutaneous connective tissue. The consequence of a large number of anastomoses is also that the likelihood of infection spreading through them increases. For example, boils in the nose can lead to thrombosis (blood clot blockage) of the facial vein. This in turn will lead to the transfer of thrombus material through the superior ophthalmic vein to the cavernous sinus (a paired organ located in the sphenoid bone of the skull), where blood from the brain, eyes and nose enters. The result of thrombosis can be fatal if antibiotics are not used. From the skull, blood flows through the cerebral sinuses into the internal jugular vein, which runs along the anterior-lateral surface of the neck.

TRUCKS OF THE INTERNAL JUGULAR VEIN.

Internal jugular vein, carries blood from the cranial cavity and neck organs; starting at the jugular foramen, in which it forms an extension, the vein descends. At the lower end of the internal jugular vein, before connecting it with the subclavian vein, a second thickening is formed; in the neck above this thickening in the vein there is one or two valves. On its way to the neck, the internal jugular vein is covered by the middle clavicular mastoid muscle and the scapular-hyoid muscle.

The tributaries of the internal jugular vein are divided into intracranial and extracranial. The former include the sinuses of the hard shell of the brain, and the veins of the brain that flow into them, the veins of the cranial bones, the veins of the organ of hearing, the veins of the orbit and the veins of the hard shell. The second includes the veins of the outer surface of the skull and the face, which flow into the internal jugular vein along its course.

There are connections between the intracranial and extracranial veins through the so-called graduates passing through the corresponding holes in the cranial bones. On its way, the internal jugular vein receives the following tributaries:

1. Facial vein. Its tributaries correspond to the branches of the facial artery and carry blood from various formations of the face.

2. Pozamandibular vein, collects blood from the temporal region. Further down, it flows into the trunk, which carries blood out of the plexus, called the "dense plexus", after which the vein passes through the thickness of the parotid gland along with the outer carotid artery, below the angle of the lower jaw and there it merges with the facial vein.

The shortest path connecting the facial vein with the pterygoid plexus is the anatostomotic vein, which is located at the level of the alveolar margin of the mandible.
Connecting surface and deep veins face, the anastomotic vein can become a pathway for the spread of the infectious principle and therefore is of practical importance. There are also anastomoses of the facial vein with the ophthalmic veins. Thus, there are anastomotic connections between the intracranial and extracranial veins, as well as between the deep and superficial veins of the face. As a result, a multi-tiered venous system of the head and a connection between its various divisions are formed.

3. The pharyngeal veins form a plexus on the pharynx and flow either directly into the internal jugular vein or flow into the facial vein.

4. Lingual vein, accompanies the artery of the same name.

5. Superior thyroid veins, collect blood from the upper parts of the thyroid gland and larynx.

6. The middle thyroid vein, departs from the lateral edge of the thyroid gland and flows into the internal jugular vein. At the lower edge of the thyroid gland there is an unpaired venous plexus, the outflow from which occurs through the superior thyroid veins into the internal jugular vein, as well as through the middle thyroid vein and inferior thyroid vein into the veins of the anterior mediastinum.

Massage lines for lymphatic drainage and exercises that revitalize the lymph flow practically coincide with the venous blood flow pattern. If you do a massage against the venous current, there is a danger of "sending", say, a blood clot against the outflow of venous blood and blocking the vessel with it. And the direction of movements, identical to the lymph flow pattern for massage and exercise, is safe.