Anatomy and physiology of large salivary glands. Easy salivary glaze
Surface part of the variety of salivary gland. Fascial slope capsule. Weak places of the capsule of the parole. Topography of facial nerve.
Surface part of the variety of salivary gland Located on the outer side of the chewing muscle. It often continues through the output of the gland to the front edge of the chewing muscle.
Deep part (pharyngeal process) of the parole salivary glandit reaches Knuts to a fatty fiber located at the side wall of the pharynx in front Department Side Occupatic Space. Lower process easy gland descends to the inner surface of the corner lower jaw.
Fascial slope capsule. Weak places of the capsule of the parish gland
Fascial Easy Capsule Developed differently: on the outer surface of the gland, on its front, bottom and rear sides it is thickened.
Fascial gland capsule It has two "weaknesses": one on the upper surface of the gland, adjacent to the outer auditory passage; The second is on the inner side of Pars profunda of the parcelial gland facing the front-inclusive space, between the cyllaughal process and the inner wonder muscle.
For purulent inflammation Easy salivary gland (parotitis) Pnu 4 times more often breaks into this space, to the wall of the pharynx than in an external hearing pass.
Topography of facial nerve.
In the thicker easy salivary gland There are important vascular-nerve formations.
Facial nerve, n. Facialis.. Coming out of the Formen Stylomastoideum, it penetrates through the capsule in the gland's bed, where it is divided into the upper and lower branches. RR depart from the upper branch. Temporales, Zygomatici et Buccalles, from Lower - R. Marginalis mandibularis and r. Colli. Upon exit from the gland of the facial nerve branch, Fascia Parotideomasseterica will try and sent to mimic muscles in subcutaneous tissue.
23.1. Anatomy and physiology of large salivary glands
Salivary glands - This is a group of secretory organs of various sizes, buildings and locations that produce saliva. Distinguish small and large salivary glands. Small (small) salivary glandsthere are in the mucous membrane of the oral cavity, they differ by their location: lip, pebble, roast, paternal, gums, and these glands are located in the mucous membrane of the nasopharynx and almonds. TO big salivary glandsrelate occoule, liftingand subjectglands.
Fig. 23.1.1.Easy iron (according to V.P. Vorobyev, 1936).
The skin is removed, the subcutaneous muscles of the neck, the parole and chewing fascia, nerves and partly vessels.
I - Skulent muscle; 2 - circular eye muscle; 3-output duct of the excavation gland; 4- addition valves of the gland; 5-chewing muscle; 6 - parole iron; 7- Surface temporal artery; 8 - surface temporal vein; 9- Breast-curable-cottage muscle;
10 - Outdoor carotid artery;
II- Outdoor jugular vein; 12 - subwage bone; 13 - contractile gland; 14 - dummy muscle; 15 - facial vein; 16 - facial artery; 17 - the triangular muscle of the mouth; 18 - peep muscle.
Easy iron(glandula. parotis) - steaming alveolar serous salivary gland, located in the near-chewing and chewing area. It is the largest of all salivary glands. It is located in a cessability of the pit and a little speaking beyond its limits (Fig. 23.1.1). The borders of the gland are: from above - Skulent arc and an outer hearing pass; rear - Country-like exproduction temporal bone and breast-key-bed-like muscle; ahead - covers the rear segment of the chewing muscle actually; book - falls slightly below the angle of the lower jaw; from the medial side - a short-shaped process of temporal bone with muscles starting from it and the wall of the throat. Equal iron is divided into two stakes: superficial and deep. The weight of the gland on average is 20-30 g. In the unchanged state of iron, it is bad forbidden under the skin, because Surrounded from the outer side with a dense and solid connective tissue capsule, and with the medial side of the capsule, the capsule is more subtle and unpositely (in this way, the varnish iron is communicated with the regulatory space). In places where the capsule is expressed, it firmly grows with muscles, fascia. From the gland capsule in its thickness there are numerous processes, which form a stroma gland and divide the een separate, but firmly connected to the total mass of the slices. Small salivary ducts are merged into larger (interdolkovaya), and then gradually connect into increasingly large ducts and, ultimately, are combined in the output duct of the excavation gland. In this dumping, the front edge of the chewing muscle has an extensive duct from the addition share of the near-dry gland, which is located above. An additional share is found in 60% of patients.
Fig. 23.1.2.Morphological structure of the parish gland: a) in a child; b) in youthful age; c) at middle age; d) old age (there is fat rebirth and sclerosis of parenchyma).
Through the head of the gland, there is a outer carotid artery (gives his branches - a.. temporalis. superficialis and a.. maxillahs.), vienna - v.. parotideae. anteriores. and postehores., which merge B. v.. facialis., facial nerve, ear-temporal nerve, also sympathetic and parasympathetic nerve fibers. Around the excavation gland and in its thickness there are lymphatic nodes (Section 9.2, the volume of this manual).
The length of the elevated part of the output duct usually does not exceed 5-7 cm, the diameter (width) is 2-3 mm. The elderly he is wider than in children. Usually output duct focuses on the border of the upper and middle third of the gland. The transition of the intra-vegetable part of the duct into the extra-zealist is quite deep in the gland. Therefore, a part of the parotone gland is located over an elegant part of the output duct. The direction of the output duct may vary, i.e. It happens direct, arcuate, bending and very rarely forked. The output of the excavation gland passes through the outer surface. m..
masseter.,
driving through her front to 
paradise and passing through the fatty tissue cheeks and the cheek muscle opens on the mucous membrane of the cheek on the eve of the mouth (opposite the second top of the prayer).
Fig. 23.1.3.The structure of the parenchyma gland with the on-license of the intraheseist lymphatic UZ-LA. Micrograph of fabric of the parish jelly jelly. Coloring hematoxiline - eosin.
Macroscopically, the varnish iron, depending on the blood puzzle, has a pink or yellowish - gray, a bug stem and moderately dense consistency. The elderly gland is more pale, heavy, uneven density.
The main structural units of the parrenchyma of the paroles are alveolar end secretory departments (acins), compactly located in slices and consisting of glandular epithelium cells, small ducts are located between them. End secretory departments are represented by pyramidal cylindrical cells, wide bases that are adjacent to the baseal membrane (Fig. 23.1.2 - 23.1.3). Near the mouth there are glass-shaped cells that distinguish the mucus that form a chemical barrier for the ascending penetration of microbes through the ducts in the gland. With age, the zones of the interdolkova increase connective tissue, Separations of fat rebirth of parenchyma appear with a decrease in the mass of end secretory departments and iron tissue atrophy.
Large experimental material gives grounds for approval that the parenchyma of the salivary glands produces biologically active substances Hormone type: paroto -the growth factor of nerves and epithelium, timotlin- Transforming factor and others (Fleming H.S., 1960; Suzuki J. et al., 1975; Rybakova MG, 1982, etc.).
In practical healthy peopleFor one hour, the near-dry gland produces from 1 to 15 ml of nesive saliva (on average about 5 ml). In the norm of the pH of the saliva of the parish gland ranges from 5.6 to 7.6 (Andreeva T.B., 1965). In the formulation of the secret, the parole iron refers to purely serous glands.
Raissed glasses (glandula. submandiBularis.) - the pair of alveolar, in places tubular - alveolar salivary iron, which is located in the subband neck triangle (Fig. 23.1.4).
Located between the base of the lower jaw and both abdomen of the two-dimensional muscle. Upper the ultra-tapethrower of iron is adjacent to the same jaw (stemma of the submandibular gland) of the lower jaw, rear reaching her angle, coming to the rear abdomen m.. digastricus., to the shieldy-language, to the sternum-curable-apartment and medial walled muscles, and in front it comes into contact with the sub-band-tongue and with the front abdomen of the bubbly muscle. At a considerable distance of its front of iron is covered m.. mylohyoideus., and behind the back of its rear edge and enters into contact with the approaching gland. Near the angle of the lower jaw, the subband glazed is located close to the parole.
Fig. 23.1.4.Sublibeleless and pylinders, view from the inside (V.P. Vorobyev,
Median incision of the bottom of the oral cavity and the lower jaw; The mucous membrane is removed; Allocated gonducts.
1- Medical Wonder Muscle; 2- Penural nerve; 3- small sublingual ducts; 4- The mouth of the output duct of the subsident gland; 5- large sub-public duct; 6- body of the lower jaw; 7- pupping iron; 8-withdrawal duct of the subband; 9-maxive - subwit muscle; 10- subband iron.
Thus, the lifterness bed is limited: from the inside the diaphragm of the bottom of the oral cavity and the sub-language-pagan muscle; outside - the inner surface of the body of the lower jaw; below - front and rear abdomen of the bubbling muscle and its intermediate tendon.
The withdrawal duct of the subsidiary gland is, as a rule, from its upper-medial department. Going through the rear edge of the maxillary-speaking muscle is located on the lateral side of the sub-band-tongue muscle, and then passes between it and the maxillary - sub-language muscle. Next comes between the sub-speaking iron and more medially located chief - the pagan muscle. Outputs output duct on the mucous membrane of the oral cavity on the side of the Language Bridle. At the site of the outlet of the duct, the mucous membrane forms an elevation called which is called by an approximate meat (caruncula. sublingualis). The length of the output duct of the subband does not exceed 5-7 cm, and the width (diameter) of the lumen is 2-4 mm (A.V. Clements, 1960). The mouth of the output flow is significantly greater than in the parole (Pa. Zedgenydze, 1953; L. Sazama, 1971).
Capsule The gland is formed by splitting the surface sheet of its own neck fascia. Capsule is dense outside and thin from the inside. Between the capsule and the iron is a loose fatty fiber, which makes it easy to deprive the gland (in the absence of inflammatory changes) from the surrounding soft tissues. In the fascial gland bed are located the lymph nodes (Section 9.2, Volume I of this manual). The weight of the gland is an average of 8 to 10 g, and after 50 years of age, the weight of the gland decreases (A.K. Harutyunov, 1956). Moderate density gland consistency, color - pinkish - yellow or gray - yellow.
The blood supply to the subsidiary gland is carried out at the expense of the facial, paternal and pre-arising arteries. Facial artery enters into the rear department of the subsidiary triangle (departs from the outer carotid artery). It is covered with a rear abdomen of the bubbly muscle and sewed with an approximate muscle. In this place, it goes apart and forward, sitting more often under the iron. Less often goes behind the gland, very rarely lies on the gland. Along the edge of the lower jaw, along the outer surface of the gland, from the face of the face artery, there is a subdiger artery, which gives small branches to the hardware. In the backyard of the lower level of the gland, between it and aponeurosis, there is a facial vein.
Pannaya nerveComing out of the gap between the walled muscles, it lies in directly under the mucous membrane of the oral cavity and passes between her and the rear pole of the puzzle gland. The position of the pagan nerve must be taken into account when conducting operational interventions on the output bond. Podium nerve It comes into a subband triangle between the rear abdomen of the two-dimensional muscle and the outer surface of the sub-band-tongue muscle. Being on the nerve muscle descends down, forming an arc, convex a book and covered with iron. In chronic inflammatory processes in the subband, the nerve may be in spikes and may be damaged during the excipation of the gland.
Facial nerveMore precisely its edge branch, runs about 1 cm below the lower edge of the lower jaw. Therefore, the incision in the subsidiary decreases are made by 1.5-2 cm below the lower edge of the jaw. The secretory fibers of iron gets from the vegetative submandibular node (ganglia).
In healthy people, within an hour, it is produced from 1 to 22 ml of trimmed saliva (on average about 12 ml). In the saliva of the pH of the pH range ranges from 6.9 to 7.8 (T.B. Andreeva, 1965).
By the nature of the secrecy, the subsidiary gland is mixed, i.e. Serous-mucous.
The epithelium of the ducts is the same as in the parole iron, with the only difference that it is more likely to be multi-layered (P. Rother, 1963). This can explain the significant resistance of the pressure of the contrast (during sialography) or washing liquid (in the treatment inflammatory diseases glands).
Podium Iron{ g.. sublingualis) - pair tubular - alveolar salivary gland, located at the bottom of the oral cavity. Podium Iron is located in the melting space of the oral cavity between the bridle of the tongue and the projection of the tooth of wisdom. Outside The iron is adjacent to the inner surface of the body of the lower jaw (to the deepening for the sub-surround gland). From the inside It borders with the sub-language-paternal and chief - the pagan muscles (the tongue nerve is adjacent to it, the final branches of the sub-speaking nerve, the paternal artery and vein, the output duct of the subsidiary gland). Below - It is in the interval between the maxillary-language and chores - sub-language muscles. From above - mucous membrane of the oral cavity. Iron is surrounded by a thin capsule, from which partitions are deployed, dividing the gland to the slices (Fig. 23.1.4).
The weight of the gland on average from 3 to 5 sizes varies (length on average from 1.5 to 3 cm). The color of the gland is gray - pink. Iron has a llude species, especially in the posterior departments, and separate their own ducts called small sublifting ducts.The latter are opened along the sub-band fold at the bottom of the oral cavity. The bulk of the gland is assembled into one common duct, which flows into the output duct of the contractor near its mouth. The length of the total output flow ranges from 1 to 2 cm, and the diameter is 1 to 2 mm. It is extremely rarely withdrawal duct of the influenza gland that can be opened independently about the mouth of the output duct of the subsidiary gland. The blood supply to the iron of the sub-speaking artery (departs from the gear artery), the venous outflow is carried out through the sublabit vein. Sympathetic innervation receives from the vegetative sub-public ganglia. Innervation - from the pagan nerve.
In the composition of the secretion of sub-surrounding iron relates to mixed serous - mucous glands.
In an adult, the selection of saliva is about 1000-1500 ml per day, and a lot depends on how this secretion is stimulated by food and other external and internal pulses (L. Sazama, 1971).
According to W. Pigman (1957) studies from large salivary glands, 69% saliva is released by contractile glands, 26% - near-the-surround and 5% - sublard.
The secretion of small salivary glands is evaluated using a filter paper of a certain mass, which is weighed after the study (V.I. Yakovlev, 1980). The average number of secreted small salivary glands is determined on the plot of the mucous membrane equal to 4 cm 2. Indicators that are found in the norm in practically healthy people are presented in Table 9.1.2 (volume of this manual).
The saliva contains lysozyme (see Table 9.1.1, Tom I of this manual), amylase, phosphatases, proteins, sodium, potassium ions, calcium, phosphorus, magnesium, paryotine and other chemicals, endocrine factors, enzymes.
In conclusion, I want to remind you that the names of the ducts of large salivary glands are associated with the names of scientists. So the duct of the parotid gland in everyday life is called stenon(Stenonii), lifterless - vartonov(Wartonii), the main base of the influenza gland - bartalinov(Bartalinii), and small lift gland ductures - Riviniev(Rivinii).
As already mentioned, most often tumors They are located in the surface fraction of the parole, then followed by the subband salivary iron and, then, sublard and small salivary glands. Since the optimal method of treatment benign neoplasms salivary glands is still surgical removalThe understanding of the anatomy of the salivary glands is necessary in order to avoid complications.
Salivary glands begin to form on the 6-9 week of intrauterine life. Large salivary glands occur from ectoderm, small salivary glands can occur both from ectoderma and from the endoderma. Since the capsule around the puzzleless salivary gland is formed earlier than around the ground, the lymphatic nodes sometimes migrate into the thickness of the latter. This explains the fact that in the near-dry salivary gland, in contrast to the subsidiary, lymphogenic metastases may occur.
Excretory unit any salivary gland Consists of acinus and duct. According to the nature of the secrelated, the acinuses are divided into serous, mucous and mixed. Of the acinuses, the secret arrives at first in inserting ducts, then in the excretory and, finally, in excretory. Around the acinuses and inserted ducts are mioepithelial cells that contribute to the passage of saliva by ducts.
Easy salivary glaze Secrets predominantly serous secret, sublingual and small salivary glands - mucinosic, subband iron - mixed.
Although actual easy iron It is represented only by one share, but from a surgical point of view, it is distinguished in it the surface share located the lateral of the facial nerve, and the deep share of the medial of the facial nerve is distinguished. Parasympathetic innervation The glands provide pregganionic fibers, originate from the lower saliva nucleus, which then in the composition of the language nerve (CN IX) exit from the skull cavity through the jugular hole.
(a) Large salivary glands.(b) Anatomy of the subband triangle. The relationship of the subband salivary gland with important vessels and nerves is shown.
Podium nerve passes below and deeper from the gland, facial artery and Vienna above and deeper.
After leaving the skull cavity preggangionary fibers Completed from the language nerve, form a drum nerve and again enter the cavity through the lower drum canal. In the cavity of the middle ear they pass over the cape of the snail, and then leave the temporal bone as a small rocky nerve. Small rocky nerve leaves the skull cavity through a round hole, where then its pregganese fibers form synapses with ear gangle. Postgangylionic fibers in the composition of a semiconductoral nerve innervate the parole salivary gland.
Output duct of the excavation gland Wears the name of the channel wallsen. It passes in the horizontal plane about 1 cm below zhilogo bone, Often in the immediate vicinity of the cheat branch of the facial nerve. Kepende from the chewing muscle duct is trying to the penette muscle and opens into the oral cavity at the level of the second top of the prayer. Arterial blood supply to iron receives from the external carotid artery system, the venous outflow is carried out in the rear facial vein. As mentioned above, the lymph nodes, lymphottki from which occurs in the lymph nodes of the jugular chain.
Easy iron Located inside the so-called variety of wedge in the form of a wedge, limited from above the zilly bone; in front of the chewing muscle, the lateral wonderland muscle and the branch of the lower jaw; From the bottom of the breast-curable-preceding muscle and the rear abdrub of the bubbly muscle. A deep share lies the lateral of the occasional space, a semi-shaped process, a shillion lunch and a sleepy vagina. Iron is shrouded in the near-wing fascia, which separates its zicky bone.
IN easy space Arranged facial, ear-visual and big ear nerves; Surface temporal and rear facial veins; Outdoor sleepy, surface temporal and inner maxillary artery.
After the exit is vessel vehicle front nerve (CHN VII) is a kleon and enters the eye-haired salivary gland. Before entering the head of the gland, he gives branches to the rear ear muscle, the rear abdomen of the two-minded muscle and the nearest muscle. Immediately after the entrance to the gland, the nerve is divided into two main branches: the upper and lower (goose paw). As a rule, the upper branch is divided into temporal and zilly nerves, and the bottom on the penetration, the edge mightyly adhesive and brushful nerves. Knowledge of these anatomical features is necessary in order not to damage the nerve during operations on the parole salivary gland.
Anatomy of the facial nerve after its exit from the veil vehicle. In the parenchyma of the near-dry salivary gland the nerve is divided into several branches.
Please note that the walls of the duct comes along with the flip branch of the nerve.
Salivary glands - This is a group of secretory organs of various sizes, buildings and locations that produce saliva. Breaks small and large salivary glands.
Small (small) salivary glands are in the mucous membrane of the oral cavity, they differ by their location; Light, pebble, paternal, gum, and these glands are located in the mucous membrane of the nasopharynx and almonds. Large salivary glands include near-dry, lifting glands and pylby glands.
Fig.1. Easy iron (according to V.P. Vorobyev, 1936). The skin is removed, the subcutaneous muscles of the neck, the parole and chewing fascia, nerves and partly vessels.
1 - Skull muscle; 2 - circular eye muscle; 3 - output duct of the excavation gland; 4 - add-on slices of the gland; 5 - chewing muscle; 6 - parole iron; 7 - Surface temporal artery; 8 - surface temporal vein; 9 - BRAIN-COLICE-CHILDREN MUSIC; 10 - external carotid artery; 11 - outer jugular vein; 12 - subwage bone; 13 - contractile gland; 14 - dummy muscle; 15 - facial vein; 16 - facial artery; 17 - the triangular muscle of the mouth; 18 - peep muscle.
Easy iron (Glandula Parotis) - steaming alveolar serous salivary iron, located in the near-wing-chewing area. It is the largest of all salivary glands. It is located in a cessability of the fossa and a little speaking beyond its limits (Fig. 1.6.1.). The boundaries of the gland are: from above - a cheek arc and an outer hearing pass; Rear is a precedial process of temporal bone and breast-curable-cottage muscle; Ahead - covers the rear segment of the chewing muscle itself; the book - falls slightly below the angle of the lower jaw; From the medial side - a short-shaped process of temporal bone with muscles starting from it and the wall of the throat. Equal iron is divided into two stakes: superficial and deep. The weight of the gland on average is 20-30 g. In the unchanged state of iron, it is bad forbidden under the skin, because Surrounded from the outer side with a dense and solid connective tissue capsule, and with the medial side of the capsule, the capsule is more subtle and unpositely (in this way, the varnish iron is communicated with the regulatory space). In places where the capsule is expressed, it firmly grows with muscles, fascia. Numerous processes, which form the stroma gland and divide it to separate, but firmly connected to the total mass of the gland to its thickness. Small salivary ducts are merged into larger (interdolkovaya), and then gradually connect into increasingly large ducts and, ultimately, are combined in the output duct of the excavation gland. In this dumping, the front edge of the chewing muscle has an extensive duct from the addition share of the near-dry gland, which is located above. An additional share of 60% of the surveyed are detected.
Through the turn of the gland, there is an outdoor carotid article (gives his branches - A.temporalis superficialis and a.maxillaris), Vienna - V.Parotidea Anteriores and Posteriores, which are merged into V.Facialis, face nerve, ear-temporal nerve, as well as sympathetic and Parasympathetic nerve fibers. Around the excavation gland and in its thicker are lymphatic nodes. The length of the elevated part of the output duct usually does not exceed 5-7 cm, the diameter (width) is 2-3 mm. The elderly he is wider than in children. Usually output duct focuses on the border of the upper and middle third of the gland. The transition of the intra-vegetable part of the duct into the extra-zealist is quite deep in the gland. Therefore, a part of the parotone gland is located over an elegant part of the output duct. The direction of the output duct may vary, i.e. It happens direct, arcuate, bending and very rarely forked. The withdrawal duct of the excavation gland passes along the outer surface of M.Masseter, driving through its front edge and passing through the fat tranquil's cheeks and the penette muscle opens on the mucous membrane of the cheek on the eve of the mouth (opposite the second top molar).
Macroscopically parole iron, depending on the blood flow, has a pinkish or yellowish gray color, a bug surface and moderately dense consistency. The elderly gland is more pale, heavy, uneven density.
The main structural units of the parrenchyma of the paroles are alveolar end secretory departments (acins), compactly located in slices and consisting of glandular epithelium cells, small ducts are located between them. End secretory departments are represented by pyramidal cells, a wide base that is adjusted to the basal membrane. Near the mouth there are glass-shaped cells that distinguish the mucus that form a chemical barrier for the ascending penetration of microbes through the ducts in the gland. With age, the zones of interdolk connecting tissue increase, sections of the fat rebirth of parenchyma appear with a decrease in the mass of end secretory departments and iron tissue atrophy.
The large experimental material gives grounds for the assertion that the parenchyma of the salivary glands produces biologically active substances of the type of hormones; Parotine is the growth factor of nerves and epithelium, Timotlin - transforming factor and others (Fleming H.S., 1960; Suzuki J. et a! .. 1975; Rybakova M.G. 1982, etc.).
In practically healthy people, for one hour, the near-dry iron produces from 1 to 15 ml of unstimulated saliva (on average about 5 ml). In the norm of the pH of the saliva of the parish gland ranges from 5.6 to 7.6 (Andreeva T.B., 1965). In the formulation of the secret, the parole iron refers to purely serous glands.
Rauntlamandibular (Glandula submandibularis) is a pair of alveolar, places of tubular-alveolar salivary iron, which is located in the subband neck triangle. Located between the base of the lower jaw and both abdomen of the two-dimensional muscle. The topless of its part of the iron is adjacent to the same hole (the hole of the submandibular gland) of the lower jaw, rear reaching the corner, coming to the rear abstraction M.Digastricus, to the nearest-speaking, to the sternum-curable-cottage and medial wonderful muscles, and in front it comes in contact with it - language and with the front abdomen of the bubbly muscle.
At a significant distance of its front part of the iron is covered with M.MylOhyoideus, and behind the back of its rear edge and enters into contact with the sub-surround iron. Near the angle of the lower jaw, the subband glazed is located close to the parole.
Thus, the bed of the lifting gland is limited; From the inside the diaphragm of the bottom of the oral cavity and the sub-band-tongue muscle; Outside - the inner surface of the body of the lower jaw; On the bottom - the front and rear abdomen of the two-dimensional muscles and its intermediate tendon.
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Fig.2. Sublibeleless and sub-surfactant glands, view from the inside (according to V.P. Vorobyev, 1936). Median incision of the bottom of the oral cavity and the lower jaw; The mucous membrane is removed; Allocated gonducts.
1 - medial wing like muscle; 2 - tongue nerve; 3 - small sublingual ducts; 4 - the mouth of the output duct of the subsident gland; 5 - large subwage duct; 6 - body of the lower jaw; 7 - Podium Iron; 8 - output duct of the subband; 9 - maxillary muscle; 10 - subband iron.
The withdrawal duct of the subsidiary gland is usually from the upper day of its department. Going through the rear edge of the maxillary-speaking muscle is located on the lateral side of the sub-language-pagan muscle, and then passes between it and the maxillary-speaking muscle. Next comes between an approximate iron and a more medially located chief muscle. Outputs output duct on the mucous membrane of the oral cavity on the side of the Language Bridle. At the site of the duct opening, the mucous membrane forms an exaltation, which is called a sublingual meat (Caruncula sublingualis). The length of the output duct of the subband does not exceed 5-7 cm, and the width (diameter) of the lumen is 2-4 mm (A.V. Clements, 1960). The mouth of the output flow is significantly greater than in the parole (G.A. Zedgenydze, 1953; L. Sazama, 1971).
Capsule The gland is formed by splitting the surface sheet of its own neck fascia. Capsule is dense outside and thin from the inside. Between the capsule and the iron is a loose fatty fiber, which makes it easy to deprive the gland (in the absence of inflammatory changes) from the surrounding soft tissues. Lymphatic nodes are located in the fascial bedside bed. The weight of the gland is an average of 8 to 10 g, and after 50 years of age, the weight of the gland decreases (A.K. Harutyunov, 1956). Consistency of temperate density glands, color - pinkish yellow or gray-yellow.
The blood supply to the subsidiary gland is carried out at the expense of the facial, paternal and pre-arising arteries. Facial artery enters into the rear department of the subsidiary triangle (departs from the outer carotid artery). It is covered with the rear abdomen of the bubbly muscle and a seer-speaking muscle. In this place, it goes apart and forward, sitting more often under the iron. Less often goes behind the gland, very rarely lies on the gland.
Along the edge of the lower jaw, along the outer surface of the gland, from the face of the face artery, there is a subdiger artery, which gives small branches to the hardware. In the backyard of the lower level of the gland, between it and aponeurosis, there is a facial vein.
The paternal nerve, coming out of the gap between the walled muscles, falls directly under the mucous membrane of the mouth of the oral cavity and passes between her and the rear pole of the lifting gland. The position of the pagan nerve must be considered when conducting operational interventions On the output stamp of the gland. The sub-speaking nerve enters the subband triangle between the rear abdomen of the two-dimensional muscle and the outer surface of the sub-alpine tongue muscle. Being on the nerve muscle descends down, forming an arc, convex a book and covered with iron. With chronic inflammatory processes In the subband nerve, the nerve may be in spikes and possibly damage during the excipation of the gland.
The facial nerve, or rather its edge branch, runs about 1 cm below the lower edge of the lower jaw. Therefore, the incision in the subsidiary decreases are made by 1.5-2 cm below the lower edge of the jaw. The secretory fibers of iron gets from the vegetative submandibular node (ganglia).
In healthy people, over an hour is produced from 1 to 22 ml of unstimulated saliva (on average about 12 ml). In the saliva of the pH of the pH range ranges from 6.9 to 7.8 (T.B. Andreeva, 1965). By the nature of the secrecy, the subsidiary gland is mixed, i.e. Serous-mucous.
The epithelium of the ducts is the same as in the parole iron, with the only difference that it is more likely to be multi-layered (P. Rother, 1963). This can explain the significant resistance of the pressure of the contrast (during the sialography) or the washing fluid (in the treatment of inflammatory diseases of the gland).
Podium Iron (G.Sublingvalis) - pair tubular-alveolar salivary gland, located at the bottom of the mouth. Podium Iron is located in the melting space of the oral cavity between the bridle of the tongue and the projection of the tooth of wisdom. Outside, iron is adjacent to the inner surface of the body of the lower jaw (to the deepening for the sub-surround gland). From the inside it borders with the sub-language-paternal and chore-tongue muscles (the tongue nerve is adjacent to it, the final branches of the sub-surround nerve, the paternal artery and vein, withdrawal duct of the subsidiary gland). The bottom - is in the interval between the maxillary and speakers and the chore-the-speaking muscles. From above - mucosa shell of the oral cavity. Iron is surrounded by a thin capsule, from which partitions are deployed, dividing the gland to the slices (Fig. 1.6.4.).
The weight of the gland on average from 3 to 5 sizes varies (length on average from 1.5 to 3 cm). The color of the gland is gray-pink. Iron has an idle look, especially in the posterior departments, and separately their own ducts, which are called small sublingual ducts. The latter are opened along the sub-band fold at the bottom of the oral cavity. The bulk of the gland is assembled into one common duct, which flows into the output duct of the contractor near its mouth. The length of the total output flow ranges from 1 to 2 cm, and the diameter is from 1 to 2 mm. Extremely rarely withdrawal duct of the influenza gland can be opened independently about the mouth of the output duct of the subsidiary gland
The blood supply to the iron of the sub-speaking artery (departs from the gear artery), the venous outflow is carried out through the sublabit vein. Sympathetic innervation receives from the vegetative sub-public ganglia. Innervation - from the pagan nerve.
In the composition of the secretion of subwage iron refers to mixed serous-mucous glands. In an adult, the secretion of saliva of all glands is about 1000-1500 ml per day, and a lot depends on how this secretion is stimulated by food and other external and internal factors (L. Sazama, 1971).
According to W. Pigman (1957) research from big salivary glands 69% of saliva is released by contractile glands, 26% - near-void and 5% - sublard. The secretion of small salivary glands is evaluated using a filter paper of a certain mass, which before and after the study is weighed (V.I. Yakovlev, 1980). The average number of secreted small salivary glands is determined on the plot of the mucous membrane equal to 4 cm2.
Saliva contains lysozyme, amylase, phosphatases, proteins, sodium ions, potassium, calcium, phosphorus, magnesium, paryotine and others chemical substances, Endocrine factors, enzymes. In conclusion, I remind you that the names of the ducts of large salivary glands are associated with the names of scientists. So duct of the excavation gland in everyday life is called Stenonii (Stenonii), the subband - Vartonov (WartonII), the main base of the influence gland - Bartalinov (Bartalinii), and the small rivini-rivine gland ducts (Rivinii).
A.A. Timofeev
Guide maxillofacial Surgery and surgical dentistry
Ticket 60.
1. Side area of \u200b\u200bface, division on the area. 2. Easy chewing: a) borders, b) external benchmarks, c) layers, fascia and cellular gaps, vessels and nerves. 3. Topography of the parole (weaknesses of the capsule) and its output duct (projection on the skin).
1. Side facial division on the area.
Side region (Regio Facialis Lateralis):
a) near-chewing (regio parotideomasseterica),
b) cheek (regio buccalis),
c) deep lateral area of \u200b\u200bthe face (according to the pirogor - the intercelion space) or the oss region (Regio Facialis Lateralis PROFUNDA).
2. Easy chewing area: borders, external benchmarks, layers, fascia, and fiberglass, vessels and nerves.
A) the boundaries of the near-chewing area of \u200b\u200bthe face:
From above - a cheek arc,
In front - the front edge of the chewing muscle,
Rear and below - the edge of the jaw.
B) external benchmarks easy-chewing area persons:
The angle and the lower edge of the lower jaw, the cheekbone arc, the outer hearing pass and the palpable front edge of the chewing muscle.
IN) Layers of the near-chewing area persons.
1- The skin of the near-chewing area is thin, men are covered with hair.
2-subcutaneous fiber of the near-chewing area is permeated with connective tanks, binding the skin with its own fascia.
The 3- surface fascia of the near-chewing region is expressed only in the front area of \u200b\u200bthe region, where the lower jaw is thrown and attached to the skin Platysma.
4- Own fascia area, Fascia Parotideomasseterica, rather dense, forms a chewing muscle case, passing the shock in the fascial porcelain capsule of the cheek. Behind your own fascia, splitting, forms a capsule of the parole salivary gland.
5-chewing muscle, m. Masseter.
D) fascia of the near-chewing area persons.
1. Surface fascia
The surface fascination of the nearby-chewing region is expressed only in the front area of \u200b\u200bthe region, where it turns through the lower jaw and is attached to the skin Platysma.
2. Own fascia
After removal of surface fascia, its own, the so-called parotideomasseterica face of the Fascia Parotideomasseterica is open. Fascia is attached to bone protrusions (skilled arc, lower edge of the lower jaw and its angle). It is rather dense, forms a capsule of the parotid gland in such a way that it is split at the rear edge of it on two sheets, which converge at the front edge of the gland. Next, the fascia covers the outer surface of the chewing muscle to its front edge (forms the chewing muscle case).
Thus, the surface sheet of its own fascia of the parotideomasseterica face of Fascia Parotideomasseterica surrounds the parotone salivary gland - forms a capsule.
The capsule has leaves: external and internal. Outdoor leaf capsules Tight, sangs are departed from it, which divide the gland to the cells. It not only surrounds the gland, but also gives the process penetrating the gland between her slices. As a result, the purulent inflammatory process in the gland (purulent vapotitis) is developing unevenly and not everywhere at the same time.
Internal capsule sheetless dense, thinner (weaknesses) in the field of cartilage exterior auditory passage and pharynx: Piping process. Therefore, the purulent process in the parotid gland can pass into the outer hearing pass (otitis otitis) and into the front-inclination (parafaring) space. In the course of the movement of the duct, fascia thickens, forming heavy rishe.
E) the cellular space of the near-chewing area persons
The cellular space of the near-dry saliva is formed by the near-chewing fascia.
E) Vessels and nerves of the near-chewing area persons
In the thickness of the gland capsule are facial nerve, outdoor carotid artery and recorded vein.
In the thicker of the gland, there are two finite branches, which gives two finite branches here, which is desired vein, having two roots: superficial temporal and vein from the walled plexus. In the thicker of the gland forms the plexus of the facial nerve.
3. Topography of the parole (weaknesses of the capsule) and its output duct (projection on the skin).
Easy salivary iron, Glandula Parotidea is a large exocrine iron, located in the near-wing-chewing area of \u200b\u200bthe face.
The iron is projected on the skin of the face in the form of a triangle, the base of the triangle is a cheeky arc, a vertex - an angle of jaws. One side connects the angle of jaws with a peak of a mastoid process, the other is an angle of jaws with a mid-zylovoy arc.
The withdrawal duct of the excavation gland is projected into the triangle between the wing of the nose and the angle of the mouth by 2.5 - 3 cm of the kice from the angle of the mouth, or on the line, carried out on the base of the ear of the ear to the corner of the mouth.
Stenons The duct opens to the oral cavity at the level of the second mlaro of the upper jaw
Topography of the orphan vein and facial veins on Corning.
1 - nobble vein; 2 - v. angularis; 3 - compound v. Ophthalmica Inferior with Plexus Pterygoideus; 4 - Facial Front Vienna; 5 - general facial vein; 6 - jugular vein; 7 - Posadinjeperless Vienna; 8 - surface temporal vein; 9 - Plexus Pterygoideus; 10 - lower ornamental vein; 11 - cavernoy sinus; 12 - the upper ordable Vienna V. Ophthalmica Superior.
Horizontal cutting of the facial skull department.
1 - Branch of the Lower Jaw, 2 - Body of the second cervical vertebra, 3 - Chewing Muscle, 4 - Medial Wildlows Muscle, 5 - Shilovoid Process and Muscular Bundle (Riolane Bunder), 6 - Poverty Muscles, 7 - Easy Slinary Iron, 8 - Harness , 9 is a vascular-nervous beam (internal carotid artery, inner jugular vein, wandering, tongue-cell, sub-band, added nerves, upper node of the sympathetic barrel), 10 - sky almonds. In - Easy-wing-chewing fascia, M - Intergreed Fascia, D - Occollectric Fascia, E - Povery Fascia, F Silphous Vertebral Sprog Fascium, Z - Cylinder-tag, fascia (sewer-diaphragm).
Ticket 61.
1. Topography of facial nerve: a) stroke, b) branches, c) depth of occurrence, d) projection on the skin.
2. Justification of operational access on the face.
1. Topography of facial nerve.
The facial nerve (7th pair of cranial brain nerves) carries out mainly motor innervation of the facial muscles. The facial nerve comes out of the skull cavity through the inner hearing hole (Porus Acusticus Internus) (rear cranial fossa of the skull base) with the 8th CHMNPEDVOCOCHLEARIS (N. Vestibulocochlearis) and (a. Labirinti).
a) the course of facial nerve
From the pyramid of the temporal bone, the nerve comes out through the velocity vehicle (ForaMen Stylomastoideum) and 1 cm below forms the rear ear nerve.
b) branches of facial nerve
The main barrel of facial nerve is included in the turn of the gland and here it is divided into the upper (Pars Temporalis) and the lower branches (Pars Cervicalis), from which five branches are departed.
Facial nerve branches:
Temporal branches (RR. Temporales);
Zymatic branches (RR. Zygomatici);
Flipped branches (RR. Buccales);
The edge branch of the lower jaw (r. Marginalis Mandibulan);
Cervical branch (r. Colli).
The branches go radiarno from the point of 1 cm book from the auditory pass.
d) the depth of the facial nerve
Nerve lies relatively shallow