Internal structure Ear throat nose. Anatomical structure of the nose: What you need to know about the sense of smell. The design of lymphatic outflow and nasal innervation
The structure of man's throat has its own characteristics. Diseases of the throat are widespread, their identification and therapy requires the involvement of specialists. In this case, the throat may be sick both as a result of diseases of other LOR-organs and due to infections. To diagnose and choose the treatment of the throat, you need to know from which it consists.
Role in the body
The throat is an integral part of the human respiratory system designed to provide an organism with oxygen.
Finding through the nostrils, the air moves to the throat, then trachea to the bronchum, then goes into the lungs. They absorb oxygen into the blood, which on the veins and arteries will distribute it to all internal organs. In addition, food falls through the throat inside the organism.
Its anatomy does not allow large foreign objects to penetrate the esophagus, violate the activity of the digestive system. In fact, the throat consists of two zones: larynx and pharynx. Inside the weight of the person there are voice ligaments required to play sounds.
The throat is behind the oral cavity. Her scientific name is Farinx. The throat has a cone-shaped form, its upper part is extended, the bottom is narrowed and lowered down. Farinx connects with a larynx in its lower part. Through a wide part, both the food and air goes. Therefore, the work of the muscles, which close one of the aisles, otherwise the pieces of food can get inside the trachea.
In the outer tissues of the pharynx there is a large amount of glands that produce the mucus needed to moisten the pharynx and food intake. The possibility of subsequent swallowing is provided by the muscles of the throat.
The structure of the pharynx includes 2 items:
- The nasooplip, connecting the area of \u200b\u200bthe nose with the throat in the upper part of it through the specific holes - the Hoans. At the bottom of the nasopharynx goes to the middle throat. In the lateral parts there are connections with auditory trumpets. The nasophal cavity has a mucous membrane, ensuring the production of mucus for moisturizing, purification from bacteria and dust of the incoming air. The smell function is directly related to the state of the nasopharynx.
- A fliplot, which is the middle part of the throat and consisting of tongue, almonds, solid sky. Sky almonds or glands ensure the protection of the body from infections. They consist of lymphoid tissue, which produces special substances opposing bacteria and viruses. Through the rotoglotum there is a compound of larynx and oral cavity, the movement of the air flow to the bronchum. Its mucosa is lined with a multilayer flat epithelium.
The ear consists of three parts:
Of course, prevention is the best treatment of any disease, but if you find yourself Laura Disorder, remember that the information is valid. Make sure you find a doctor who carries out the treatment of your disease ....- Outdoor Ear
- Middle ear
- Interior Ear
Outdoor Ear
The outdoor ear consists of ear shell and an outdoor auditory passage. Own sink - cartilage of a complex form. The cartilage part goes into the bone.
The cartilage passage contains hair follicles and glands allocating ear sulfur. Hair follicles There are only in the outer part of the auditory passage, there are no more in the deeper parts of the external auditory passage. The outer hearing pass changes its shape and size with age.
Topography of external auditory passage
Over the auditory passage there is a middle cranial fossa, behind the ear of a mastoid process; Below the joint lower jaw and parole glands.
Middle ear
Middle Ear includes:
- Eardrum
- Eustachian tube
- Summer cells
Eardrum
The eardrum consists of three layers: external epidermis, medium-elastic fibrous fibers of yellow and inner mucous membrane.
In the eardrum, two parts are distinguished: stretched ( pars Tensa.) and a not enough ( pars Flaccida.). There is no fibrous layer in Pars Flaccida. This area is only a smaller top drumpatch And it is not easy to see her. It is often called abrasing space; Chronic perforation of this area is potentially dangerous, as will be said below.
Identification points of the eardrum:
Handle hammer - a white tubercle, descending to the center of the eardrum. In its upper part there is a small seal - Side processed hammer.
Behind and ahead of the eardrum, there are two folds of the shirts, which come from the side process of the hammer. This is the back and front hammer folds, and a part of the eardrum above forms Pars Flaccida (a non-tunted eardrum).
So, the main identification points:
- Pup of eardrum
- Handle hammer
- Back hammer fold
- Side processed hammer
- Front hammer fold
- Light reflex (light cone).
The middle ear is divided into three parts: the upper part - attic - Abbravel deepening, mesotimpaanum - drum cavity and hypothimepanum - Lower part of the drum cavity.
Attic is a part of the middle ear, located above the hammer folds. It is divided into pockets with auditory bones, ligaments and mucous folds. In this area, infection can be localized. It should be noted that the average ear extends beyond the limits of the drumpeck.
Middle ear hearing bones
The average ear contains three bones: hammer, anvil and stirring.
Handle hammer firmly connects with the center of the eardrum. The foundation of the stupid closes the window of the eve of the middle ear.
Topography eardrum
From above is located middle cranial jam;
Mastoid (The largest cell, otherwise named by Antrum or cave) is behind. Before the eardrum carotid artery, below jugular vein.
Outdoor (lateral) wall The drum cavity is formed by the eardrum with its bone ring. Medial wall It is the outer wall of the labyrinth and has two windows: an oval window (connected to stirrup) and a round window, closed by a membrane (secondary eardrum).
Eustachian tube
Evstachyeva Pipe connects the eardrum with a nasophal. In adults it is closed and opens when swallowing.
Functions:
Barometric (Alignment of pressure in the middle ear almost to the level of external atmospheric pressure).
Drainage - output of the secret from the middle ear in the nasopharynk
Protective - Protects the middle ear from an infection that penetrates from the nasopharynx (with an air-dropleted path of transmission of infection).
Characteristics of Eustachius Pipe in Children
- Evstachyeva Tube is short, straight and wide. Compared to adults, it opens deeper into the nasopharynk.
- Evstachiev Pipe is constantly open.
- The newborn epithelium, the lining tube will underdesert.
Characteristics of the middle ear of newborns
- Up to three years can remain embryonic mixed tissue of the eardrum.
- There is no complete ossification of the wall of the drum cavity. There is a direct contact of the middle ear mucosa and a solid cerebral sheath.
The eardrum is thicker than an adult. It is located almost horizontally, which makes it difficult to inspect.
Characteristics of a precharge rate of newborns
Newborn has only one pneumatic cell - Antrum or Cave. Consequently, the newborn does not have masteditis, but an expire happens for frequent pathology at this age.
Nose and apparent nose sinuses
Outdoor nose
The outer nose is supported by bone and cartilage. The bone part is formed mainly from the nasal bones on each side and the frontal head of the upper jaw. The cartilage part consists of several cartilage, which support and attach the shape of the bottom and the tip of the nose.
Nose cavity
The nasal cavity is divided by a nasal partition into two parts having the same anatomical structure, but they may be asymmetrical.
Nasal cavity partition
The nasal colon partition consists of bone and cartilage tissue. The cartilage part of the partition is covered with perichondria, bone periosteum and mucous membrane. The curvature of the partition often becomes caused by nasal.
The lower front of the nose is called bleeding zone or Kiselbach zone. This is the area of \u200b\u200bnasal bleeding.
Lateral wall of the nasal cavity
On the lateral wall there are sinks, limiting three nasal passages: upper, medium and lower. The lower shell is formed by the bone, others are parts of the lattice bone. The mucous membrane is equipped with an erectile cloth and numerous blood vessels.
The nasal moves play an important role, they are drainage channels of the air sinuses. The appearance of pus in one of the moves has a diagnostic value in the infections of the sinuses of the nose.
Nose functions
- Filtration
- Moisturizing and adjustment of the temperature of entering light air.
- Voice resonance
- Aesthetic function
The functions of the nose are determined by the mucous membrane and its tissues. In some areas, such as sinks, this is the complex structure of the ciliary mucosa, glands, blood supply and connective tissue on the bone controlled by the autonomic nervous system. In this case, the sinks play the role of the valve mechanism, expanding or narrowing air channels and the air flow guide.
Cylier activity
The movement of the cilia is a means by which the mucous membrane cleans itself and removes unwanted materials. The fishing movement contributes to the promotion of the mucus formed in the nose from the nostrils into the throat. Any violation of normal activity causes unpleasant symptoms. Dripping from the nose or "Qatar", for which most often complains, this is nothing but the inability of the ciliary mechanism to cope with the thick mucus slowly flowing into the throat and accumulating there. Required conditions for normal cyiliary activity - the corresponding consistency of mucus and aeration.
Filtration and moisturizing
Dust, bacteria and other particles stick to the mucous membrane. Cilia, shrinking, delete them, promoting a throat together with the mucus, where it is smoothed. So implemented filtration.
Moisturizing and regulating the temperature of the incoming air into the lungs is one of the main functions. Air enters the lungs, having a temperature of about 30 ° C and 75-95% moisture. In the cold season, the air in the premises is heated and humidity drops. Regulation of humidity in the nose to normal level It may lead to overvoltage of the nasal mechanism.
Disruption of smell
Different factors can affect the smell. For example, the normal smell function may prevent the nasal congestion during inflammation. Sometimes it is disturbed due to the effects of toxic substances or injuries of the head with a violation of nerve endings, as a result of which the perception of odors is stopped.
Thus, if the patient has lost the ability to feel smells, this means that:
- respiratory hyposmy (reduced sense of smell)
- general hyposimia.
Violation of voice resonance occurs if the nose is laid. Then a person speaks into his nose and his voice acquires a vile shade.
There are two types of belliness:
- closed benchmark (with nasal congestion)
- open benchmark (reason - pathology of the cavity of the nose or mouth, for example, splitting the sky, other defects)
Nose deformation
Nose is located in the center of the face. The form of an external nose is directly related to the attractiveness of a person.
Putinous sinuses of nose
Around the nasal cavity there are eight apparel sinuses (4 pairs):
- topper sinus nose
- frontal
- golded sinus (divided into front and rear)
- wedge-shaped sinus.
Functions of the apparent sinuses of the nose
- Voice resonance
- Thermoregulation (the apparent sinuses protect our brain from too high or low temperatures).
- Protective, they protect the brain and eyes during head injuries (like an airbag).
- They perform the role of a powerful barrier protecting vital structures (cranial cavity and society) from infection.
Front group Pressing sinuses of the nose (maxillary, frontal and front grate cells) communicate with middle aisle.
Rear group (rear lattice cells and wedge-shaped sinuses) communicate with upper passage.
Nose-tear duct Reported with the lower aisle.
It should be noted that while the bottom and middle aisles are open from both ends the frontal passage is closed in front. This means that during the front rosicopy, it is impossible to see the rose rear group of the sinuses.
Pressing sinuses of the nose in children
The newborn is well developed only a lattice sinus. Other sinuses are underdeveloped.
The development of the maxillary sinus is completed by 4-5 years of life. The frontal sinus has the longest period of development - up to 11-13 years.
ENT authorities: throat
The pharynx consists of three parts - nasal, oral and gentle.
Nasopharynx Located above the soft sky line.
Rotoglot It is located below this line and extends to the tip of the nastestrian.
Hypotharynkx, the gastal part begins at the level of the tip of the nastestrian and extends to the robust cartilage.
The throat is reported to neighboring bodies through seven holes:
- two Hoans (with nasal cavity)
- two holes of the auditory passage (with drum cavity)
- throat (with oral cavity)
- aperture of Gortani.
- aperture of the esophagus
Nasopharynx
At the junction of the sky and the rear wall are the clusters of lymphoid fabric - adenoids or pipper almonds. Front of the nasopharynx is connected to the back of the nose, with the rear ends of three nasal shells on each side and the rear edge of the nasal septum in the middle.
In the side walls there are holes in evstachiyev pipe. Behind them pipe almonds.
In children, 5-6 years old, almonds are often increased. They can block the boys and be the cause of the nasal congestion.
Rotoglot
The nasopharynx and the rotogling are separated by a soft sky - a strong moving muscle partition. In its middle a tongue hangs. On both sides of the sky, there are mucous-muscular folds connecting with the tongue. This is the back and front ladies Zev.
There is a place between sky sky almond, lower at the base of the language, the cluster of lymphoid tissue, called pagon almond.
On the rear wall of the rotogling, the numerous small clusters of lymphoid tissue, which under certain conditions may increase and inflame.
Lymphoepithelial ring Gotka
The lymphoepithelial ring of the pharynx consists of 6 almonds (3 in the nasopharynx, 3 in the rotoglot):
- two palas almonds,
- two pipe almonds,
- sulfing almond
- standing almond.
Hypotharynkx (Gunding)
This is part of the pharynx in the same level with a larynx. Between the base of the language and the front part of the Gundarotka are two loafinka. They are divided in the middle of the pagan-doped ligament and are limited to a pharyngo-dotted ligament. These are the folds of the mucous membrane, which are joined to the rear of the base of the alignment. Behind these bundles begin pear-like apertures On one on each side.
Larynx
Lane consists of a cartilage base connected by ligaments and muscles covered with muscles and mucous membranes. Mix pair and unpaired cartilage.
Paired cartilage:
- blue
- rozhkovoid
- wedge-shaped.
Unpaired cartilage:
- pisnevoid
- thyroid
- digid
In the depths of the larynx there are two folds of the pink mucosa, stretching in the front direction back. it false voice ligaments. Between true and false voice ligaments there is a space called ventricles Large. Lower lip of the ventricle is formed by a muscular beam - true voice ligaments. At sight, they have a whitish color and a narrow shape.
Cavity GLAGE
In the cavity of the pharynx allocate:
- Spell trimming (over false voice ligaments)
- The average space (between false and true voice ligaments).
- Surminate space (below voice ligaments) is the narrowest part of the pharynx.
The throat (Pharynx) is a hollow organ consisting of muscles in which respiratory and digestive paths are crossed. The throat is located in the front area of \u200b\u200bthe neck, ahead of the bodies of the cervical vertebrae, ranging from the castor of the skull to the VI of the cervical vertebra, where it goes into the esophagus
Clinical anatomy of the incomplete sinuses
The incomplete sinuses are air cavities placed around the nasal cavity and connected to it with narrow holes. They are called bones, which are located. All sinuses paired are divided into the front (maxillary, frontal, front and middle cells of the lattice bone) and rear (wedge-shaped and rear cells of the lattice bone).
Clinical anatomy of the nasal cavity
The nasal cavity (Cavum NASI) is a channel passing in the sagittal direction through the facial skeleton. It is located between the front cranial pamph, the oral cavity, paired topless and lattice bones. The outward nasal cavity opens with nostrils (front nose holes), and back - by Hoans (rear nose holes). All throughout it is divided in the middle of a nasal partition (Septum NASI) consisting of bone and cartilage ...
Clinical Anatomy of Outdoor Nose
The outer nose (Nasus Extenws) is located in the middle of the face and is a bone-cartilage formation of a pyramidal shape, covered with leather. The top of the nose in the junction area with the forehead is called the nose root (Radix NASI), the back of the nose (DORSUM NASI) ending with its tip (Apex NASI) is located below. The side surfaces form nasal rods, downstairs turning into the wings of the nose.
Clinical anatomy of the vestibular analyzer. Receptor education
With mechanical displacement of cilia cells, the electric charge changes in the endolymph and the excitation or braking of the receptor cell activity occurs. The movement of the fibrils (cilia) of the Hair Apparatus from Stereocilence to Kinzity is accompanied by a negative potential (depolarization) in the endolymph, leads to the excitation of receptor cells and enhancing afferent pulses. And vice versa, the displacement of cilia from the cinestial towards the stereocilence of accompanied ...
Clinical Anatomy of the vestibular analyzer
In the pyramid of the temporal bone, the body is placed, which for his form was called "Labyrinth". The structural formations of the labyrinth are called a sentence-snippene organ (Fig. 16). It distinguishes vestibular and snail departments.
Anatomy of the auditory analyzer. The inner wall of the drum cavity
The inner wall of the drum cavity is the most difficult compared to other formations of the middle ear. It contains two holes - a snail window (Fenestra Cochleae) and a runway window (FENESTRA VESTIBULI), as well as convexity - Cape (Promontorium). The running window is behind and on top of the cape, the snail window is behind and below the cape. The running window is closed by the base of the stupid, the snail window is a fibrous membrane (secondary eardrum).
Anatomy of the auditory analyzer
The auditory system is a sound analyzer. It distinguishes sound and sound visible devices. The sound-conducting apparatus includes an outdoor ear, secondary ear, labyrinth windows, membrane formations and liquid media of the inner ear; Sound-skinning - Hair Cells, auditory nerve, neural formations of the brain barrel and hearing centers.
X-ray study of the ear
To identify destructive changes in the walls of the middle ear, as well as determining the prevalence of the destructive process, an x-ray study is carried out. Along with the usual radiographs obtained in three main projections, a computer tomography is applied, which allows to clarify the smallest structures of the middle ear.
"Introduction to otorinolaryngology. Brief information from the anatomy and physiology of ENT organs. Methods of examination and diagnostics "
Otoidolaryngology (abbreviated ENT) has become an independent specialty since the second half of the XIX century. She studies ear disease (OTOS), nose (rhinos), pharynx and larynx - throat (Laryngos). Currently, recognizing the fact of expanding the meaning of the concept, this specialty received the name "otorinolaryngology - surgery of the head and neck" in the world.
Some moments of the history of otorinolaryngology
Information on the structure, functions and diseases of the ear and upper respiratory tract are available in the writings of the hippocratic (460-377 BC), Celsius (I cent. E.), Galen (I-II century n. E.) . Although at that time there was still no one-piece idea of \u200b\u200bthe structure of the entire organism and individual organs of the human body, including LOR-Body.
In the writings of the XVI century, A. Vezaliy (1514-1564) gave a description of the departments of the ear, Eustachius (1540-1574) for the first time described the structure of the hearing pipe, Falopia (1523-1562) - the channel of the face nerve, a dear labyrinth, a drum cavity.
Professor Anatomy from Bologna A. Valsalva (1666-1723) In his "Treatise on Human's ear" (1704), many features of the Ear structure clarified. He put into practice his method of self-utilization of the middle ear, which is widely used in our time.
In Russia, otorinolaryngological terminology was first collected and published by M. Ambodik in dictionaries in surgery, anatomy and physiology (1780-1783).
In Moscow, St. Petersburg, Kharkov, Kazan and some other cities at the end of the 19th and early XX century, the operations on the ENT organs were made by common surgeons.
In the first half of the 19th century, many surgeons have already been performed by a prepanation of a mastoid process about various ear diseases, a core (tracheostomy) in the stenosis of larynx, plastic operations. Russian doctors surgeons in 1826 a surgery was described on the frontal sinuses of the nose. Czech scientist Purkinier in 1820 proved the relationship between Nistagma and dizziness. Evald in the experiment studied the patterns of the function of the semicircular channels of the inner ear (the laws of Evald).
In medical science, the allocation of otorhinolaryngology (abbreviated ENT), or ear disease (OTOS), the nose (Rhinos), pharynx and larynx - throat (Laryngos) in an independent specialty occurred in the second half of the XIX century. The beginning of the formation of discipline is associated with the invention of endoscopic research methods, which gave a doctor the opportunity to study the inner picture of these bodies both normally and in various diseases, to produce diagnostic and therapeutic manipulations, as well as surgical interventions. The basis of the combination of diseases of the ear, nose and throat in one discipline was an anatomy-topographic unity of these organs, their close physiological and functional relationship.
In 1841, the German doctor of Hoffman began to inspect the Elor organs with the help of a mirror. Soon a concave mirror with a hole in the middle began to be attached on the head and got the name of the frontal reflector.
In 1854, the teacher of singing Manuel Garcia invented the method of indirect laryngoscopy. He introduced himself into his throat a small mirror on a long handle and examined the reflection in it through another large mirror. So he saw a picture of the inner surface of the larynx. The method was appreciated by some prominent clinicians of Europe and was introduced into clinical practice. Later, the rear methods were developed, and then the front and middle rosicopy, puncture of the maxillary sinuses.
In 1851, Courtes (1822-1876) first described the microscopic structure of the spiral body (Cortis organ), the reisner studied the membrane, separating the snail move from the Staircase of the Travel (this reisner of the membrane). Gelmagolts in 1859 created the theory of hearing (resonance of the fibers of the basal membrane caused by frequency).
One of the founders of otorinolaryngology in Western Europe is the Vienna Scientific Politzer (1835-1920). He studied the clinic of the middle ear disease, including non-negative - adhesive otitis, rejection, introduced endoural microsurgery. The method of purging the ears currently proposed by the Politzer is currently applied worldwide.
The Vienna Bilrot Surgeon in 1875 made a complete extirpation of the larynx.
The German otologist G. Schwartz (1837-1910) with its students developed the technique of a simple treason of a prepar procession. Custer in 1889 suggested that after a simple trepanation, to remove the rear bone wall of the auditory passage, and Cautoufal - and the outer wall of the attic. Thus was created by the technique of radical or general-human EU operation.
N. I. Pirogov described a number of features of anatomy and topography of LOR-organs. Regardless of the Walder, he studied a lymphadenoid sipboard, which in the literature is called Ring Waldeer-Pirogov.
In St. Petersburg, the largest therapists of the country S. P. Botkin (1832-1889) and G. A. Zaharin (1829-1897) contributed to the development of new directions of medicine - Othiatia, Larginology and Riology. At that time, they still existed separately.
Pupil S. P. Botkin N. P. Simanovsky (1854-1922) for the first time in Russia, organized in 1892 by the United Clinic of Ear Diseases, Nose and Horny, and in 1893 he achieved the inclusion of otorhinolaryngology to the mandatory course of teaching students in the St. Petersburg military The Medical Academy, while in the West this discipline was not taught to students. N. P. Simanovsky organized the construction of a special clinic for otorinolaryngological patients, which began to function in 1902. This clinic has become the largest for that time therapeutic, scientific and pedagogical center for ear diseases, nose and throat.
Until the Russian revolution of 1917, the otorinolaryngology in Belarus was in the infancy. Only in major cities (Minsk, Vitebsk, Mogilev, Gomel, Grodno, Brest) worked one or two specialists who took patients in their home offices. Stationary aid was modest, turned out to be in particularly urgent cases and then only on the bed allotted in the surgical department. In most cases, patients for surgical treatment were sent to Moscow, Petersburg, Kiev, Baku, Warsaw and even Königsberg and Berlin.
The new period in the development of otorinolaryngology in Belarus began with the creation of a clinic of ear diseases, throat and nose of the Belarusian Medical Institute (1926). The first director of her and the head of the Lor Department (1926-1938) became prof. S. M. Bukrak. The main direction in the work of the clinic were questions to eliminate regional pathology - the scleromers of the respiratory tract. The great merits of S. M. Buraka in the development of otorinolaryngology should be noted. S. M. Burak created his school of otorinolaryngologists.
By 1941, in Minsk, in addition to the Lor Clinic, 4 hospital functions (with a total number of beds about 60). The number of LOR specialists in Minsk by this time reached 30. ENT hospitals and cabinets were deployed in all regional cities and some district centers (Orsha, Slutsk, Borisov, Rogachev).
In 1938, an ENT clinic was opened at the Vitebsk Medical Institute (Head of the Department - prof. G. X. Karpilov).
War and fascist occupation caused a strong damage to ENT. Rich medical equipment was cleared and destroyed, from 30 ENT specialists in Minsk there were only two.
In 1944-1945 Research work was limited to understanding the experience of ENT-service in the Great Patriotic War. Since 1946, the clinic resumed the scientific development of issues on scleromic respiratory tract.
There is a Lor Department as part of the Belarusian Medical Academy of Postgraduate Education, where doctors acquire specialization and improve their qualifications. The main directions of research work is the treatment of chronic medium otites, stenosis of the larynx.
At the Department of Vitebsk Medical University, the main scientific problems - LOR-ONKOSBOLOGIANCE, the ear-absorbing surgery, etc.
In September 1961, a clinic was opened and the Department of Lor-Diseases of the Grodno Medical Institute was organized. The clinic is improved and operations on the ear with mastoidoplasty, gentle methods for the treatment of malignant larynx neoplasms.
Received dynamic development and disposal service in the republic. On the basis of neurology, neurosurgery and physiotherapy, there is a clinical degeneraological laboratory, which a long time was headed by Professor I. A. Skolut. For the first time in the Soviet Union, the technique of electronistagmography and electric power consumption was developed here.
Anatomy and nose physiology
The nose is divided into the outer nose, the cavity of the nose and the incomplete sinuses.
Outdoor nose
The outer nose has the appearance of a triangular pyramid, the base of which is drawn by the post. The upper part of the outer nose, bordering the frontal area, is called the root of the nose. The book from him is the back, which goes into the top of the nose. The side surfaces of the outer nose form the wings of the outer nose.
The bottom edge of the wings of the nose along with the moving part of the nose partition form the cutout of the nostrils.
The outer nasal skeleton is represented by two thin nose bones, which are connected to each other along the midline and form the back of the outdoor nose in its upper part. In the skin of the wings and the tip of the nose there is a lot song hardwareIn chronic inflammation of which, as well as the blockage of output ducts, acne can develop. This area of \u200b\u200bthe outer nose contains a lot of sweat glands.
The skin of the outer nose receives blood from the face artery. At the tip of the nasal artery form a very thick vascular network, providing good blood supply to the region. The venous outflow from the exterior nose area (tip, wings, as well as the top lip area) is carried out at the expense of the facial vein, which goes into the upper ordown, flowing into the cavernous sine, located in the middle crankname. This condition makes it extremely dangerous to the development of a furuncle in the field of outdoor nose and the upper lip, due to the possibility of spreading infection on venous ways to the skull cavity, which can lead to sepsis.
Lymphotok is carried out due to lymphatic vessels accompanying arteries and veins of this area. A series of lymphatic vessels flows into deep and surface cervical nodes.
The innervation of the skin of the outer nose is carried out at the expense of the eye and maxillary branches of the trigeminal nerve.
Nose cavity
The nasal cavity is separated by a partition on the right and left half. The front of the nose cavity through the nostrils is reported to the environment, and behind the boasts with the upper part of the throat - the nasooplot.
The blood supply to the nasal cavity is carried out from the maxillary artery, one of the end branches of the outer carotid artery. From it, a wedge-shaped-packer, part of the nasal cavity, through the hole of the same name is approximately at the level of the rear end of the middle shell. It gives branches for the side wall of the nose and the nose partition, through the cutting canal anastomoses with a large sky artery and the artery of the upper lip.
In addition, the front and rear lattice arterys, separating from the eye artery, which is the branch of the inner carotid artery penetrate the nose cavity.
Thus, the blood supply to the nasal cavity is carried out from the system of internal and outer carotid arteries and therefore not always the interference of the outer carotid artery leads to a stop of persistent nose bleeding.
Vienna of the nasal cavities are located more superficially relative to the arteries and form in the mucous membrane of the nasal shells, the nose partition is several plexuses. Thanks to the venous network with numerous anastomoses, severe complications are possible, such as thrombophlebitis of the Chelyusnolitse region, the thrombosis of the enemy, the veins of the cavernous sinus, the development of sepsis.
Occonduct sinus
Topper (Gaimortova) Obsadis is the most voluminous, located in the body of the upper jaw. The newborn sinuses has a sliding form and occupies a limited space between the front wall of the sinus, the lower wall of the orbit and the alveolar process.
The frontal sinus is in the thick of the frontal bone.
The lambyrin is a complex structure and consists of a large number of air-capacious cells. The number of cells can vary from 8 to 20 on each side. Each cells have its own outlet, opening in the middle nose (front and middle cells) or to the top nose (rear cells).
The wedge-shaped sinus is located in the body of a wedge-shaped bone, the stop from the nose cavity. The sinus is separated by a bone partition into two parts. The withdrawal opening of the wedge-shaped sinus opens into the upper nasal stroke. Near the wedge-shaped sinus are the pituitary gland, the crossroads of optic nerves, cavernous sinus.
Nose physiology
The nose performs the following functions:
The respiratory function - the cavity of the nose and the nasal sinuses are involved. In disruption of nasal respiration (breathing through the mouth), the body receives 78% oxygen from the norm, appears headache, fatigue, increase intracranial pressure, etc. In children, this leads to the wrong teething, the curvature of the nasal partition, the deformation of the facial skeleton, bronchial asthma, night incontinence of urine and other pathology.
The protective function - the air is cleared, warmed and moistened.
Olfactory function, decrease in the smell is called hyposhythmia, complete absence - anosmia, smell perversion - how to
The resonator function consists in strengthening the tones of voice and giving it an individual tone. Violation of air in the nasal cavity and sinuses causes a closed benchmark, and with free breathing through the nose, but the violation of the movement of a soft sky (the cleft of a soft sky, paralysis) is observed open benchmark.
Anatomy and ear physiology
Anatomically ear is divided into
outdoor ear
middle Eha
the inner ear is a labyrinth, which distinguishes snail, run-up and semicircular channels.
Snail, the outside and secondary ear is an hearing body, which includes not only the receptor apparatus (cortis organ), but also a complex sound-conducting system designed to deliver sound oscillations to the receptor.
Outdoor Ear
The outdoor ear consists of ear shell and an outdoor auditory passage.
The ear sink has a complex configuration and is divided into two departments: a lobe, which is a skin duplication with a fatty tissue inside, and a part consisting of cartilage covered with thin skin. Own sink has curls, anti-guns, kids, antiques. The goselle covers the entrance to the outer hearing pass. Pressing the goat area is painful in the inflammatory process in the outer auditory passage, and in children and in the acute average middle average, because in early childhood (up to 3-4 years), the outer hearing pass does not have a bone department and therefore it happens shorter.
Own sink, confusedly narrowing, goes into an outdoor auditory passage.
The cartilage department of an external auditory passage consisting partially made of cartilage tissue, it borders with a capsule of the near-dry salivary gland. The lower wall has several transversely running gaps in a cartilaginous fabric. Through them, the inflammatory process can spread to the parole.
In the cartilage department there are many glands producing ear sulfur. There are also hair with hair bulbs that can be inflamed when the pathogenic flora penetrates and cause the formation of a furuncle.
The front wall of the outer auditory passage is closely bordered with the temporomandibular joint and with each chewing movement there is a movement of this wall. In cases where a furuncle is developing on this wall, each chewing movement enhances pain.
The bone department of an external auditory pass is lined with thin skin, on the border with the cartilage department there is a narrowing.
The top wall of the bone department is bordered by the medium cranial pamph, the rear - with a cottage process.
Middle ear
The middle ear consists of three parts: the hearing tube, the drum cavity, the system of air-capable cavities of the mastoid process. All these cavities are seduced by a single mucous membrane.
The eardrum is part of the middle ear, its mucous membrane is one with the mucous membrane of other departments of the middle ear. The eardrum is a thin membrane consisting of two parts: large - stretched and smaller-non-tentative. The stretched part consists of three layers: an external epidermal, internal (mucous membrane of the middle ear), a median fibrous, consisting of fibers that are radially and circular, closely intertwined.
A notaway part consists of only two layers - it does not have a fibrous layer.
Normally, the refill is a grayish-bluish color and somewhat drawn towards the drum cavity, in connection with which it is determined by the deepening, which is called the "navel". Aimed into the outer hearing passage of a beam of light, reflected from the eardrum, gives a light glare - a light cone, which, at normal condition, the eardrum always occupies one position. This light cone has a diagnostic value. In addition to him, on the eardrum, it is necessary to distinguish the handle hammer, which goes back and top down. The angle formed by the handle of the hammer and the light cone is open. In the upper arm of the handle hammer, a small protrusion is visible - a short thrower of a hammer, from which the moves (front and rear), separating the stretched part of the membrane, are shifted. The membrane is divided into 4 quadrants: front-top, front-line, gum and rear-line.
The drum cavity is the central department of the middle ear, has a rather complicated structure and a volume of about 1 cm3. The cavity has six walls.
The hearing tube (Eustachiyeva tube) in an adult has a length of about 3.5 cm and consists of two departments - bone and cartilage. The sip of the hearing tube opens on the side wall of the nasopharynx at the level of the rear ends of the nasal shells. The cavity of the pipe is lined with a mucous membrane with a fiscal epithelium. Its cilia flickering towards the nasal part of the pharynx and thereby prevent the microflora's mineral cavity infection, constantly present there. In addition, the fixed epithelium provides the drainage function of the pipe. The lumen of the pipe opens with swallowing movements, and the air enters the middle ear. At the same time, the pressure is equalized between the outer medium and the cavities of the middle ear, which is very important for the normal functioning of the hearing organ. In children under two years, the auditory pipe is shorter and wider than at an older age.
Mastoid
The system of cells of the maternity process is diverse depending on the degree of development of air-capacious cells. Highlight different types Building of preserved processes:
pneumatic,
sclerotic,
diploeetic.
Cave (Antrum) is a large cage directly communicating with the drum cavity. The projection of the cave on the surface of the temporal bone is within the triangle of Shipi. The mucous membrane of the middle ear is a mucoperio, and practically does not contain glands.
Interior Ear
The inner ear is represented by the bone and connecting labyrinth and is located in the temporal bone. The space between the bone and connecting labyrinth is filled with perilimph (modified spinal fluid), the membrane labyrinth is filled with endolymph. The labyrinth consists of three departments - the run-up, snail, three semicircular channels.
The average part of the labyrinth and connects with the eardrum through the round and oval window. The oval window is closed by a stupid plate. On the eve of the parent apparatus, which performs a vestibular function.
Snail represents a spiral channel, in which the Cortiev is located is the peripheral department of the auditory analyzer.
Semicircular channels are located in three mutually perpendicular planes: horizontal, frontal, sagital. In the extended part of the channels (ampoule), nerve cells are located, which, together with the olitone apparatus, represent the peripheral vestibular analyzer department.
Physiology of ear
There are two most important analyzers in the ear - auditory and vestibular. Each analyzer consists of 3 parts: the peripheral part (these are receptors that perceive certain types of irritation), nerve conductors and the central part (located in the cerebral cortex and analyzes irritation).
The auditory analyzer - starts from the ear shell and ends in the temporal share of the hemisphere. The peripheral part is divided into two departments - sounding and sound periphery.
SUPERING Division - Air - this:
own sink - catches sounds
outdoor hearing aisle - obstacles reduce hearing
drumpot - oscillations
chain of auditory bones, stirrup disc is inserted into the runway window
perilimph - the oscillations of the stirrups cause perilimphs oscillations and, moving along the snail curls, it transmits fluctuations on Cortis organ.
There is also a bone conduction, which occurs at the expense of the mastoid process and bones of the skull, bypassing the middle ear.
Sound-observing department is the nervous cells of the cortis organ. Sound perception is a complex process of turning the energy of sound oscillations in nervous impulse and holding a cerebral cortex of the brain, where the analysis and understanding of the impulses received.
The vestibular analyzer provides coordination of movements, equilibrium of the body and muscle tone. The rectilinear movement causes the displacement of the rolled apparatus in the run-up, rotational and angular - leads to endolymph movement in semicircular channels and irritation of nerve receptors located here. Next, the pulses go into the cerebellum are transmitted in the spinal cord and on the musculoskeletal system. The peripheral part of the vestibular analyzer is located in semicircular channels.
Anatomy, pharyngeal physiology
The throat is a muscular tube starting at the base of the skull and reaching the level of 7 cervical vertebra. Below the chuck goes into the esophagus.
According to anatomy-physiological characteristics and from a clinical point of view, the throat is divided into three parts:
nasopharynx,
rotoglot
gARTANTROGLE.
The conventional boundaries between these parts consider the continuation of the solid sky plane back and the plane spent through the top edge of the nastestrian.
The nasophack is behind Hoan. It is located on the arch of it, a sipstage almond is located on the side walls, sipstage mouths are visible, surrounded by a cartilaginous roller. The bow of the nasopharynk goes into the Rothoglotka.
It includes:
soft heaven with tongue
the visible part of the rear wall of the throat,
zev, which is limited to the root of the tongue, skydly almonds with silent almonds and a soft sky.
Therefore, it is properly denoted by zev as a hole limited by these formations.
The mucous membrane of the rear wall of the pharynx contains elements of lymphoid fabric that can form:
rounded elevations - "Granules";
behind the rear pacifices - rollers.
The mucous membrane of the rear wall of the oral part of the pharynx is coated with a flat epithelium, contains a significant amount of glands and is innervated by the Language nerve.
The chunk almonds are located in the Rothoglock. Each packer is located in the almond niche, limited from the front and behind the muscular formations - the front and rear packers.
The almond sky is a cluster of reticular tissue with a large number of follicle-sided mucosa containing lymphocytes. The free surface of the almond is addressed inside the pharynx. Lakun's mouths are winding strokes delving into the crowd of almonds. Follicles are located along Lakun. The reticular tissue is fitting with a stromb of almonds consisting of connective tissue. "Pseudocapsula Almonds" facing laterally and fucked with the muscles of the pharynx.
The structure of the Sky Almonds:
on top of the almonds are covered with a fibrous shell - a capsule from which connective tissue fibers depart. As a result, cells filled with lymphocytes, fat and plasma cells are formed - these are follicles. On the free surface of the almonds there are cracks or lacuna, which go into the depths of the almonds and are branched there. Lacuna accumulates the incident epithelium, lymphocytes, microbes, food residues and form traffic jams that contribute to the development of the inflammatory process in the almonds. Shallow lacuna are cleaned independently when swallowing, in deep - plugs are saved and lead to the development of the chronic process.
In the throat there is a crossroads of respiratory and digestive paths. The throat performs 4 functions - breathing, swallowing, rumor and protective.
The outflow of lymphs from palatal almonds is mainly carried out in the nodes located at the front edge of the quotation muscle, on the border of its upper and middle third.
Sky, pharyngeal almonds, cluster of lymphoid fabric in the area of \u200b\u200bhearing pipes constitute the lymphatic pharyngeal ring of the pirogov-valtera. One of the important functions of the Sky Almonds is to participate in the formation of immunity.
The blood supply to the pharynx is carried out from the external carotid artery system.
Clinical anatomy of Larry
Larynx (Larynx) is a hollow organ that the top department opens in the altarlotka, and the bottom goes into the trachea. Located the larynx under the sub-bandy bone on the front surface of the neck. From the inside, the ladies are lined with a mucous membrane and consists of a cartilage skeleton connected by ligaments, joints and muscles. The top edge of the larynx is located on the border of IV and V cervical vertebrae, and the lower edge corresponds to the Vi cervical vertebra. Outside, the larynx is covered with muscles, subcutaneous tissue and leather, which is easily shifted, which allows its palpation. Lanes makes active movements up and down when talking, singing, breathing and swallowing. In addition to active movements, it is passively shifted to the right and left, while there is a so-called attitudes of cartilage larynx. In the case of damage to the malignant tumor, the active mobility of the larynx decreases, as well as the passive offset.
In men in the upper thyroid cart, it is clearly visible and the protrusion or elevation is torn - Kadyk, or Adamovo Apple (Prominentia Laryngea, s. Pomum Adami). In women and children, it is less pronounced, soft and palpator his definition is difficult. In the bottom of the larynx, in front of the thyroid and hand-shaped cartilage, you can easily try the area of \u200b\u200bthe conical ligament (Lig. Conicum, s. Cricothyreideum), which dissect (conicotomy) if necessary, urgent respiratory recovery in the case of asphyxia.
Counties Lastani
The skeleton of the larynx makes the cartilages (Cartilagines Laringis) connected by ligaments. Three single and three paired larynx cartilages are distinguished:
Three single:
pisnevoid cartilage (Cartilago Cricoidea);
cartilago Thyreoidea;
higilago Epiglotica (Epiglottis).
Three pairs:
cartilagines ARYTAENOIDEA);
rozhoidal cartilatae (Corniculatae);
wedge-shaped cartilages (Cartilagines Cuneiformes, s. Wrisbergi).
Cricoidea Cricoidea (CRICOIDEA) is the basis of the skeleton of the larynx. In shape, it really resembles a ring backward. The narrow part facing forward is called arc (Arcus), and an extended rear-in-print or plate (Lamina). The side surfaces of the hand-shaped cartilage have the upper and lower articular areas for articulation with silence and thyroid cartilage, respectively.
Cartilago Thyreoidea, the largest chucks of larynx, is located above the hand-view cartilage. The thyroid cartilage confirms its name and external species And the role of protecting the inside of the body. Two irregular shapes of quadrangular plates, of which it consists of cartilage, in the front of the battle in front of the midline form a comb, at the top edge of which there is a clipping (Incisura Thyreidea). On the inner surface of the angle formed by the shield cartilage plates, there is an elevation to which voice folds are attached. On both sides, the rear pavements of the shield cartilage plates have leaving up and down the process - the upper and lower horns (Cornua). The lower - shorter - serve to articulate with pisnoid cartilage, and the upper aimed in the direction of the sub-band bone, where they are connected to the large horns of the shield-speaking membrane. On the outdoor surface The thyroid cartilage plates are the oblique line (Linea Oblique), which goes back in the back and from top to bottom to which part of the outdoor muscles of the larynx is attached.
Higilago Epiglottica (Cartilago Epiglottica), or the Nastrostic, is a leaf shape plate resembling flower petal. A wide part of it will be freely over the thyroid cartilage, located behind the root of the tongue and is called petal. The narrow bottom of the stalk (petiolus epiglottis) is attached to the inner surface of the corner of the thyroid cartilage. The form of the nastestrian petal varies depending on how much it is trapped back, is elongated or folded, with which the errors in the intubation of the trachea are sometimes associated with.
Cartilagines Arythenoideae (Cartilagines Arythenoideae) have the shape of a triangular pyramid, the tops of which are directed up, several forces and medial. The base of the pyramid is articulated with the articular surface of the sealing of the pisteward cartilage. The front corner of the base of the sneak-shaped cartilage is the voice process (Processus Vocalis) - the voice muscle is attached, and the rear and side perverse carriage muscles are attached (Processus Muscularis). To the lateral surface of the pyramid of the sneak-shaped cartilage in the region of the front of his third, where the oblong fossa is located, the second part of the voice muscle is recorded.
Wedge-shaped cartilage (Cartilagines Cuneiformes, s. Wrisbergi) are located in the thicker of the Cherpealonadcaneal fold.
Cartilagines Corniculatae (Cartilagines Corniculatae) are located above the top of the evapoal cartilage. Wedge-shaped and horned cartilage - small seismian cartilage, not permanent in form and sizes.
Sustaines of Gortani.
In the larynx there are two paired joints.
Pisnostechy-shaped joint (Articulatio Cricothyreoidea) is formed by the side surface of the pisteward cartilage and the lower horn of the thyroid cartilage. Showing in this joint forward or backward, the thyroid cartilage thus increases or reduces the tension of the voice folds, changing the height of the voice.
The pisnopal-shaped joint (ARTICULATIO CRICOARYTENOIDEA) is formed by the lower surface of the diaspora shaft cartilage of the upper articular platform of the plate of the folding cartilage. Movement in the PisnoPalo-shaped joint (forward, back, medial and laterally) determine the width of the voice gap.
Lunch bales.
The main ligaments of the larynx include:
shield-speaking median and side (tig. Hyothyreoideum Medi¬um et lateralis);
shtonad city (tig. thyreoepiglotticum);
podium-dotted (Tig. Hyoepiglotticum);
pisnotracheal (Tig. Cricotracheale);
pisnotechyovoid (Lig. cricothyrideum);
cherpealonad city (LIG. ARYEPIGLOTTICU);
pagorant-high-profiled median and lateral (Lig. Glossoepiglotticum Medium et lateraalis).
The shield-speaking median and lateral ligaments are parts of the shield-speaking membrane (Membrana Thyrohyoidea), with which the larynges are suspended with an approximate bone. The median shield-speaking bunch connects the top edge of the thyroid cartilage with the body of the sub-band bone, and the lateral - with large horses of the sub-band bone. Through the hole in the outer part of the shield-speaking membrane passes the vascular-nerving beam of the larynx.
Shieldonadantic bunch connects the palpist with a thyroid cartilage in the top of its edge.
Podium-doped bundle connects the epiglott with the body of the sub-band bone.
Pisnoteral bunch binds the larynx with the trachea; Located between the first-shaped cartilage and the first rings of the larynx.
Pisnostechidoid, or conical, binding binds the top edge of an arc of the pisnoid cartilage and the lower edge of the thyroid cartilage. Pisnotechnoid bunch is a continuation of the elastic membrane of the larynx (Conus Elasticus), which begins on the inner surface of the shield cartilage plates in the area of \u200b\u200bits corner. From here, elastic beams fanually diverge to the book in the direction of the hand-shaped cartilage arc in the form of a cone, forming a conical bunch. The elastic membrane forms a layer between the inner surface of the finishing and mucous membrane of the larynx.
Voice fold is a topless beam of an elastic cone; Covers voice muscle, which is stretched between the inner surface of the thyroid cartilage in front and voice procession (Processus Vocalis) of the Blue Cartication.
A cerepelonad chungy bundle is located between the side edge of the nastestrian and the inner edge of the sneak-shaped cartilage.
The paganon-mining median and side ligaments connect the middle and side part of the root of the tongue with the front surface of the nastestrian, between them there are recesses - the right and left pits of the Nastestrian (Vlakela).
Muscles Large
All the muscles of the larynx can be divided into two large groups:
outdoor muscles involved in the movement of the whole larynx as a whole;
internal muscles, resulting in the movement of the cartilage larynx relative to each other; These muscles are involved in ensuring respiratory functions, sound formation and swallowing.
Outdoor muscles, depending on the place of attachment, they can be divided into two groups:
The first group includes two paired muscles, one end of which is attached to the thyroid cart, and the other - to the skeleton bones:
breast-shaped (T. SternothyroidEus);
shield-speaking (t. thyrohyodeus).
The muscles of the second group are attached to the sublard bone and to the skeleton bones:
breast-speaking (T. Sternohyoideus);
bladder-pupping (t. omohyoideus);
shieldy-language (T. Stylohyoideus);
bubbly (t. Digastricus);
children-pupping (T. Geniohyoideus).
The internal muscles of the larynx perform in the larynx two main functions:
Change the position of the epiglottian during the act of swallowing and inhalation, performing the valve function.
The position of the epiglotter changes two pairs of anthong muscle.
The Cherpealonad City Muscle (M. ARYEPIGLOTTICUS) is located between the top of the sinking cartilage and the side edges of the nastestrian. Being covered with a mucous membrane, this muscle forms a cerepelonadectural fold in the side of the side department of the entrance to the larynx. With the act of swallowing, the reduction of the ceremonial monitoring muscles leads to a pull-off of the haunter back and the book, so that the entrance to the laryn is covered and the food shifts laterally into the pear-shaped hole to the entrance to the esophagus.
The shield-dumpan muscle (m. Thyroepiglotticus) is stretched on the sides of the shields of the shields of the bond between the inner surface of the thyroid cartilage angle and the side edge of the nastestrian. With the reduction of the shield-dumpan muscle, the Nastestrian rises and the entrance to the larynx opens.
Lateral Persdna Person-shaped muscle (m. Cricoarytenoideus Lateralis) (pair) begins on the side surface of the painted cartilage and is attached to the muscular process of scariable cartilage. With its reduction, muscle processes move forward and down, and voice processes come closer, narrowing the voice gap.
The transverse scarlet muscle (m. Arytenoideus transverse) connects the rear surfaces of the sneak-shaped cartilage, which when it is reduced to come closer, narrowing the voice gap mainly in the rear third.
The oblique scarlet muscle (m. Arytenoideus Obliqus) (pair) begins on the rear surface of the muscular process of one sneak-shaped cartilage and is attached in the area of \u200b\u200bthe tops of the skip-shaped cartilage of the opposite side. Both oblique damage muscles reinforces the function of the transverse scarlet muscle, located directly behind it, intersecting with each other at an acute angle.
The rear perraspalo-shaped muscle (m. Cricoarytenoideus post, s. Posticus) begins on the back surface of the handwritten cartilage and is attached to the muscular process of scarlet flipper. When inhaling it is shortened, the muscle processes of the scariable cartilages are turned off by the kice, and the voice processes together with voice folds depart to the sides, expanding the lumen of the larynx. This is the only muscle that reveals the voice gap. With its paralysis, the lumen of the larynx and breathing becomes impossible.
The plot muscle (m. Thyreoarytaenoides) begins on the inner surface of the plates of the thyroid cartilage. Heading the Force and upstairs, it is attached to the lateral edge of the scarlet cartilage. With the reduction of the scariable cartilage - rotates around its longitudinal axis of the duct and shifts the Kepenta.
Pisno-shaped muscle (m. Cricothyroideus) is attached by one end to the front surface of the hand-shaped cartilage arc on the side of the midline, the other to the lower edge of the thyroid cartilage. When reducing this muscle, the thyroid cartilage leans forward, the voice folds are stretched, and the voice slot is narrowing.
Voice muscle (m. Vocalis) - three-chapted, constitutes the main mass of voice fold; It begins in the region of the lower third of the angle formed by the internal surfaces of the plates of the thyroid cartilage, and is attached to the voiced process of the scariable cartilage.
According to the medial edge of the muscle, a narrow strip of elastic connective tissue is passed, it belongs to it a significant role in the formation of sound. When reducing this muscle, voice folds are thickened and shortening, the elasticity, shape and tension of its individual sites change, which plays an important role in the votition.
Clinical Physiology Large
Lanes, trachea and bronchi are part of the respiratory system and perform the following important functions: respiratory, protective and voting.
Respiratory function. The muscles of the larynx extend the voice slot, which, with a calm breath, has a triangular shape.
Protective function. When the air jet passes through the larynx and the trachea, cleaning, warming and humidification of air continues. In addition, the larynx plays the role of a barrier that prevents the penetration of foreign bodies into the lower respiratory tract.
Voice-forming function. During the pronouncement of sound, the voice gap is closed, voice ligaments are: in a tense and closed state. Then, under the pressure of the air, it opens for a short time, causing vibration of exhaled air. Thus, a sound is formed, which acquires additional color when exposed to three resonses of the tori:
The lower resonator makes up lungs, trachea and bronchi;
The upper resonator is the oral cavity, the nose in the incomplete sinuses.
Three sound characteristics distinguish: height, power and timbre.
The height of the tone is determined by the number of vocal folds per second and is measured in hertz. The tone height depends on the length of the voice folds, the power of the voltage and the position of the native. In the process of growth, the child is changing the size of voice folds and age changes occur - a mutation expressed in boys during puberty.
The power of the sound is associated with the power of exhalation and the force of closure of voice folds.
otorhinolaryngology nose ear larynx
Methods of survey, diagnosis and treatment of ENT organs
Methods of research of the nose and the apparent sinuses.
Patient surveys are produced in a specially equipped office protected from bright sunlight. The patient is located on a chair next to the instrumental table to the right of the light source. The explorer puts on the head of the frontal reflector and illuminates the area of \u200b\u200bthe nose with a bunch of reflected light.
Patient survey steps:
Inspection of the external nose - shape, skin color, palpation: swelling of soft tissues, bone attitudes
Front rosicopy - is performed using a nose mirror. Attention is drawn to the shape of the partition, the state of the nasal shells, the color of the mucous, the presence of mucus, pus, crusts.
Rear Rososcopy - for holding a nasophal mirror and a spatula. It is examined by the nasopharynx, boaans, the mouth of the hearing pipes, the couch.
The respiratory function is investigated using a wave sample - a piece of fluffy wool drive to one nostril, closing the other and observed for its movement.
The olfactory function is determined by four standard solutions. These may be: 0.5% pp acetic acid (weak odor); Pure wine alcohol (medium odor); Valerian tincture (strong); Summer alcohol (ultrasive).
Pressing sinuses are investigated by radiography, diaphanoscopy (in the dark room, translucent with an electric bulb - the method has historical value), puncture of the sinuses using the needle of Kulikovsky, as well as trend-inunction of the sinuses (frontal).
General methods Treatment:
Treatment is divided into two groups - conservative and surgical.
Conservative treatment includes: nasal toilet with cotton wick phytylts (or washing with sodium salt solid, infusion of medicinal herbs), infusion into the nose medicines Drops (adult 3 - 5 drops, children - 1 - 3), the introduction of ointments (wool is wound on the probe, also drug substances are introduced using turf), insufflation of powders (using a special powder industry), inhalation warming thermal procedures.
Surgical treatment methods include: cutting the nasal shells (conmatomy), resection of the curvature of the nasal septum, the bottom of the lower nasal shells, galvanokustics (mystery of the electric current), cryotherapy (moxibustion by cold with liquid nitrogen), moxication of chemicals
Methods for studying the auditory analyzer.
Collect Anamneza
Outdoor inspection and palpation
Otoscopy - determines the condition of the external auditory passage and the state of the eardrum. It is carried out with the help of a ear funnel.
Functional studies ear. Includes the study of the auditory and vestibular functions.
The auditory function is examined with:
Success and colloquial speech. Conditions - soundproofed room, complete silence, room length not less than 6 meters. (the norm is a honest speech - 6m, spoken - 20m)
Aerial conductivity is determined by the chalkton - they bring to the outer auditory passage, bone - the totamons are put on a chipped process or a dark area.
With the help of an audiometer, the sounds entering headphones are fixed in the form of a curve, which is called an audiogram.
Research methods of the vestibular function.
The rotational test is carried out using a paves chairs.
Caloric sample - In the outer hearing pass, it is injected with a syringe of Jean warm water (43g.), And then cold (18gr.)
Pressoroid or fistula trial - the rubber can be injected with air into the outer hearing pass.
These samples allow to identify vegetative reactions (pulse, blood pressure, sweating, etc.), sensory (dizziness) and nystagm.
The human ear perceives the height of the sound from 16 to 20,000 Hertz. Sounds below 16 Hertz - infrasound, above 20000Heres - ultrasound. Low sounds cause oscillations of endolymph, reaching the top of the snail, high sounds - at the base of the snail. With age, the rumor worsens and shifts towards low frequencies.
Exemplary sound volume location:
Cheeping speech - 30db
Spoken speech - 60dB
Street noise - 70DB
Loud speech - 80db
Creek at the ear - up to 110db
Jet engine - 120DB. A person has such a sound causes pain.
Research methods for hearing function:
Thick and conversational speech (rate - 6 meters whisper, spoken - 20 meters)
Chapelonami
Audiometry - The resulting curve is called an audiogram
Research methods of the vestibular function:
Rotational sample in a paves chair
Coloric sample (in the outer hearing pass, warm and cold water with a syringe of Jean)
Pressor or fistula (in the outer hearing pass the air with a rubber cylinder)
The reactions of the body are detected: pulse, blood pressure, sweating, dizziness, nystagm (involuntary movements eye apples).
Methods of studge research
Outdoor inspection - submandibular lymph nodes are palpable.
Inspection of the middle department of the pharyngoscopy. It is carried out with a spatula. Inspecting the oral mucosa, soft sky and tongue, front and rear arches, the surface of the tonsils, the presence of Lakun content.
Inspection of the Gundogotage - hypoparianoscopy. It is carried out with the help of a gustral mirror.
The finger study of the nasopharynx is carried out in children to determine the dimensions of adenoids
General principles of therapy and care
Gargling.
Inhalation
Irrigation of the mucous membrane
Washing Lakun Almonds with a special syringe with nozzles.
Lubrication with the mucous membranes by antiseptic solutions (solution of the ligol) with a long probe with cutting, which wata is wound.
Warming compress on the neck or submandibular area with angina.
The survey of the larynx begin with inspection and palpation of the cartilage larynx and soft tissues of the neck. In an external examination, it is necessary to establish the shape of the larynx during palpation to determine the cartilage, their mobility, the presence of pain, attitudes.
Indirect and straight laryngoscopy.
For other methods, the study of the larynx include: stroboscopy, which gives an idea of \u200b\u200bthe movement of voice folds, radiography, tomography, endoscopy using fiberglass optics, endophotography.
Scheme of the structure of the ear
Ear - an organ of hearing and equilibrium. Located in the temporal bone. It is divisible: the outdoor woolly earnest ear - bone and membrane labyrinth, between them Perilimf, in a webcate - endolymph1. Easy sink cartilage with a superior leather fat (the fabric forms the lobe) 1. Barbed cavity - Hearing bones: Hummer Avvatnya is the middle part The labyrinth, here is the parental apparatus 2. Announced hearing passage of a webpble-cartilage department (contains hair bulbs, Silent and sulfurges) The bone department between the departments is a narrowing2.tellite tube (connects the drum cavity with the nasopharynx) The bone department (1 \\ 3 of length) is in the clutch-cartilage (2 \\ 3 length) is in the closed state, disclosed when swallowing and yawn2. The snail is a spiral body, here is the Cortiev organ (peripheral hearing analyzer department) 3. Embankment - layers: leather (outer) connecting and woven (medium) mucous membrane (internal) 3.Side proceeds are aircraft cavities connected to the drum cavity3. Horizontal Frontal Suggital Horizontal Channels Are Lobbular Analyzer Cells
Bibliography
1.Abdirov Ch.A., Yushchenko A. A., Vdovina N. A. Guide to combat Leproy - Nukus: Karakalpakstan, 1987.-171 p.
2.Avilova OM Surgical treatment of stenosis and injuries of larynx and trachea // Surgery of trachea and bronchi - M., 1986-s. 8-8.
3.Agaeva N.X., Sultanova S.M. Features of the course of complications of chronic purulent medium otitis in pregnant women and fencers // Vestn. Otorinolaryngology - 1985.-№ 4, -s. 26-29.
4.Ageev S.A. Furuncules of the nose // Urgent otorinolaryngology - M., 1984 - pp. 68-73.
.Adamia M.V. On sanitizing operations in chronic purulent middle otitis / M.V. Adamia, P.Z. Katsarov // VII Congress Otorinolar. Ussr: Tez. Dokl. - Kiev, 1989. - P. 5-6.
6.Adamia M.V. Functional microsurgery of chronic mesotimpane patients / M.V. Adamia // controversial issues of otorhinolaryngology. - 2000. - № 1. P. 71-73.
.Adamia M.V., Katsarova P.Z. On the expansive operations in chronic purulent average otitis // Tez. Dokl. VII Congress Otorhinolar. USSR 4-6 Oct., 1989, - Odessa, Kiev, 1989. - S.5-6
Tags: Introduction to otorinolaryngology. Brief information about the anatomy and physiology of ENT organs. Examination and diagnostics methods Lecture Medicine, Physical Culture, Health
Otorinolaryngology
Palchun Vladimir Timofeevich -
pyophissor, Corresponding Member of the RAMS, Academician of the International Academy of Otorinolaryngology, Surgery ready for both her, Honored Worker Chaukuky, Head of the Department of Economics of the Russian State Medical University, under his leadership, protected 54 candidates and 2 doctoral discs. V.T. Palchun is the chairman of the board of the Moscow scientific and practical society of otorinolaryngologists and the editor-in-chief of the journal "Vestnik Swim.-U Larginology"
In T Palchun - author 400 scientific papers, including 9 mono. Rafia and 4 textbooks. It has 30 copyright certificates and patents. For scientific and practical development, hemoped gold, silver and bronze medals of VDNH. 
demik Academy of Security Defense and Property, Dr. Honey. Sciences, Professor, Director of the Moskoe Scientific Research and Society of Tuta's Ear,
the throat and nose of the Ministry of Health of the Russian Federation under the All Doctor and RPI candidate dissertations are protected. A. And Kryukov - author of 90 scientific (SHOT, including 10 patents, one study - ■ IKA (et al<..) и учебного кинофильма «Заболевания носа и околоносовых пазух» (соавтор сценапия), удостоенного премии 5азелыжсго фестиваля нау шых и научно популярных фильмов, заместитель главного рецакп >r< журнала «Чсстник оториноларингологии»
.Guide for doctors
V.T.Palchun, A.I.Kryukov
Otorinolaryngology
Moscow "Medicine" 2001
UDC 616.21 /.28(035.3) BBK 56.8 P14
Palchun V.T., Kryukov A.I.
P14 Otorinolaryngology: Guide for doctors. - M.: Medicine, 2001. - 616 E.: IL. ISBN 5-225-04612-6
The leadership presents materials on the history of the emergence and development of otorinolaryngology. In the first section, from the position of the clinic, the anatomical, physiological and functional features of the upper respiratory tract, auditory and vestibular analyzers are considered. Based on this material, classical methods of study of each JLOP-body are presented. In the second part, diseases of the nose and the incomplete sinuses, pharynx, larynx, ear are sequentially described. Separately presents neurological complications and sepsis, jlop-organ tumors, specific diseases (tuberculosis, syphilis, vegetable granuchisosis, diphtheria, AIDS). Considered issues of professional selection in otorhinolaryngology. Methodical recommendations for the examination and preparation of the history of the disease of the patient in the hospital are given.
For otorinolaryngologists and general practitioners.
Palchun U.T., Kryukov A.I.
Otorhinolaryngology: Guidelines for Physicians. - M.: ME- DITSINA, 2001. ISBN 5-225-04612-6
The Guide Contains Information on the History of Otorhinolaryngology. Part I Presents Clinical Aspects of Anatomic, Physiologic and Functional Features of the Upper Respiratory Tracts, Acoustic and Vestibular Analyzers. Classic Methods of Examination of Each Ent-Organ Are Outlined. Part II Describes Diseases of the Nose, ParanaSal Sinuses, Larynx, Pharynx, Ear. Separate chapters consider neurological complications and sepsis, ENT tumors, specific diseases (tuberculosis, syphilis, Wegener "s granulomatosis, diphtheria, AIDS), occupational selection in otorhinolaryngology. Guidelines are provided on examination of patients and documenting case records in hospital.
Intended for Otorhinolaryngologists and General Practitioners.
BBK 56.8.
ISBN 5-225-04612-6 © V.T.Palchun, A.I.Kryukov, 2001
List of abbreviations
Hell - blood pressure
ADS - adsorbed difterine-tetanus serum ADSM - adsorbed diphtheria-tetanus serum
upgraded ADHS - adsorbed "Copllow Difterino-Tetznachny Serum
HIV - human immunodeficiency virus WCC - Medical and Advisory Commission VTEK. - medical and labor expert commission DVS-syndrome - Disseminated intravascular coagulation syndrome
DSVP - Longlatile hearing caused potentials
IVL - artificial lung ventilation
KSVP - short-tent auditory caused potentials
CT - Computer Tomography
NLA - neuroleptanalgesia
PDS - anti-informy serum
RSK - Complement Binding Reaction
SVP - Hearing caused potentials
ESO - Erythrocyte settlement speed
AIDS - acquired immunodeficiency syndrome
UHF - ultrawhigh frequency
UFO - ultraviolet irradiation
Fung - the phenomenon of accelerated increases
CPN - chronic renal failure
ECG - electrocardiography
EEG - electroencephalography
Preface
Each year in our country there is a replenishment of the series of otorinolaryngologists with young doctors, which have just graduated from medical institutions. In the otolaningology, they come after studying in clinical order and internships, work in clinics and hospitals. The formation of a specialist continues for several years, during which theoretical knowledge is refracted into practical skills, personal experience accumulates. For this period of work of young doctors, we have prepared this guide in which all the nosology of the specialty is systematized, based on modern science data from the position of the doctor, and not a student. There were no such publications in the domestic literature, the last edition in which the main problems of the specialty were considered 6 years ago.
The results of the guidelines were based on the results of a great scientific work of the authors, as well as their rich (30-year-old) experience of medical and pedagogical work on the basis of the Lor Clinic of the Russian State Medical University and the Moscow Research Institute of Ear, throat and nose of the Ministry of Health of the Russian Federation. They held thousands of operations on the ENT organs, including the most modern micro-operating on the ear, endolymphatic bag, the incomplete sinuses, the cavities of the nose and larynx, etc., trained otorhinolaryngology hundreds of young doctors (annually in the clinic and institute specialize 30-40 clinical orders , interns, graduate students).
This leadership is intended primarily for young, novice doctors, but at the same time will present interest both for experienced spitialists - allergists and ophthalmologists, since it covered modern views on strategic and tactical approaches in otorhinolaryngology.
.Introduction
Consideration of the history of otorinolaryngology includes familiarization with the factors that contributed to its emergence, development stages and the state at present. Otaginolaryngology is one of the most important sections of medicine, it originated and developed together with a total of medical practice in the dawn of human development thousands of years ago, which is confirmed only by archaeological finds and discovered human activity at that time, since writing appeared much later. In ancient letters already contained information about the treatment of diseases of various organs, including the upper respiratory tract. However, only through many centuries in the writings of an ancient Greek doctor of the Hippocrat (460-377 BC) and his students for the first time in history were summarized a variety of medicine, including about ear diseases, throats and nose, in combination with their own experience. It is generally recognized that Hippocrates laid the foundations of a medical case, so he is called the Father of Medicine. In later works by K. Sells (I-II centuries. AD), Gi de Schemica (XIV century) and other scientists are more detailed information on the structure, functions and diseases of the nose, pharynx and ear. However, during this period, medicine was unfulfining, only at the end of the Middle Ages, there is significant progress in the development of medicine, its separation takes place on separate specialties, which is primarily due to the study of human anatomy. In the famous works of A.Vazaliya (1514-1564), in particular, the overall structure of the ear, B. Evstachius (1510-1574) described the hearing tube, the drum string and muscles of the middle ear, Pullopy (1523-1562) - Channel Facial nerve, a ear maze, drum cavity, A.Valsalva (1666-1723) in the "Treatise on Human Ear" (1704) outlined the anatomy of the ear and clarified many anatomical features of the structure of this body. He introduced into practice the Middle Ear Self-Production Method The name that is widely applied at present. In Russia, for the first time, M. Ambodites in the dictionaries in surgery (1780), anatomy and physiology (1783) are generalized otorinolaryngological terminology.
Thus, the otorhinolaryngology originated in ancient times as part of medicine, as specialties allocated, it entered surgery. The next stage of development was the allocation of otorinolaryngology into an independent, separate medical discipline from surgery.
The factors predetermined this were: 1) the immediate anatomical proximity of the cavities of the nose, pharynx, larynx and ear and the availability of a message between them. It is important that the fact that the mucous membrane of these organs moves from one to another; 2) Physiological relationship: when breathing, air passes through the nose, a throat and larynx, is cleaned, heated and can enter (and exit) into the middle Ear due to certain mechanisms. Etiology and pathogenesis of these bodies are largely interconnected and interdependent; 3) Nose, throat, larynx and ear are deeply reported oblong cavities with limited outdoor access, which combines the methods of their inspection.
The last event that was the impetus for the allocation of otozhenolaryngology as an independent industry of medicine, was the creation of the method of the same type of lighting and inspection of the upper respiratory tract and ear. Initially, Kramer created a design in which a beam of light from an artificial source (the sunlight was previously used) passed through a cylinder and a lens, which ensured its centralization. However, this method for a number of reasons began to be applied much later. A simpler technique in 1841 was offered a practitioner Hofman doctor. He modified the previously used method of illuminating these organs with the help of a mirror, however, the mirror closed the field of view and the inspection was incomplete. Hofman took the Amalgam on a small section of the mirror in the form of a circle, through which the doctor could inspect the cavity lit by the light reflected from the mirror. At the same time, the axis of view was in the center of the light beam. Subsequently began to use a round concave mirror with a hole in the center, which was attached to the head using a dressing [Trelch A., 1829-1890]. This mirror got the name "frontal" reflector. In this form, it is also used at present.
The mirror of Hoffmann was first used to inspect the ear, using a ear funnel (which was suggested by Neurburg, Holrogery, etc.), then, apparently, made a nasal expander (Frankel, Duplica, Stein, etc.) from an ear funnel, allowing to produce a fairly complete inspection internal nose and therapeutic manipulation in it.
The final stage of the creation of the inspection methods of the upper respiratory tract and the ear was the invention of indirect laryngoscopy professor of singing manuel Garcia from London in 1854. Trying to see the organ of sounding, he used a small mirror attached to the handle, which led to the base of the soft sky tongue. Standing in front of a large mirror and using reflected light that fell on the mirror, which was in the mouth, he saw in a large mirror this is a mirror in which the inner surface of the larynx was visible. This method quickly appreciated physicians. Already in 1861, in Russia, K. Rowfus (St. Petersburg), and then I. Zaborovsky (Moscow) reported on the press on the use of indirect laryngoscopy (the method was called) and the possibility of fulfilling with its help intractorous operational interventions. In the next this issue, the work was devoted to the work of T.Thest (1861), I. Zhukovsky (1861), and in 1884 the leadership was published on the use of laryngoscopy in the diagnosis and treatment of larynx diseases, the well-known General Surgeon V.Nikitin.
Finally, in 1859, Cramak suggested the rear rosicopy, which is performed like indirect laryngoscopy, but use the mirror of even smaller sizes on the handle, which is carried out by the soft sky, and at the same time it is drawn at an angle of 45 ° to the nakedness. A bundle of light from the reflector, reflected in this mirror, illuminates the nasopharynk, and, since the axis of view is in the center of this beam, the image enters the eye of the researcher.
Thus, all the conditions were created for the formation and development of independent discipline, which was called "oto-anchorlingology" (from Greek. OTOS - Ear, Rhinos - Nose, Pharyngos - Throach and Laryngos - Glow), Abbreviated - ENT (in this abbreviation throat and Mountains are combined into one concept - throat). However, several decades have existed separately otiatry and rinolaringology, and only at the beginning of the XX century. They were combined into one discipline.
One of the founders of Othiatia in Western Europe is A. Politzer (1835-1920), which created a large specialized scientific and practical center in Vienna. Its main works (leadership, atlas) are devoted to the problems of othiatria. In the XIX century Outo-ringing centers in France, England, and at the end of the century, in Germany, Austria and Russia are arising and developing. During this period, discoveries were made in different areas of otorinolaryngology. Thus, Cooper (1768-1841) carried out a puncture of the maxillary sinus through the dental alveolo and the front wall at a sinusitis, and in Russia K.Sim in 1880 developed the method of puncture of this sinus through the lower nasal stroke. In 1884, the Russian doctor V.Anarez proposed a method of local appliquancy anesthesia with cocaine mucosa, and later A.V. Vishenevsky and A.D. Speransky - the method of infiltration anesthesia, which made it possible to produce extensive operations on ENT organs. In 1844, the Hischkee described the histological structure of the eardrum, in 1851, the Italian Court (1822-1876), for the first time, reported on the structure of the snelles receptor, which was called him name - Cortiev (spiral) organ. The anatomical and physiological studies of the snelles receptor allowed Helmholtz (1821 - 1894) to create a resonant, or spatial, theory of hearing (1863), which is currently recognized correctly.
In Russia, the first therapeutic ear branch was created in St. Petersburg already in 1850 (F.P.ONKel, 1814-1879). In the same period, in private clinics of St. Petersburg and Moscow, tested patients with ear diseases. At the end of the XIX century. N.I. Pirogov In the study of frozen corpses using saws in three planes, described, in particular, the features of the anatomy and the topography of the ENT organs, as well as the lymphadenoid pharyngeal ring (regardless of the Walder), called the Walder Ring - Pirogov. The German Otologist G. Shevarace has developed the technique of simple tripanation of a predominant process. Custer (1889) has expanded this operation due to a very important addition: he suggested removing the rear bone wall of the auditory passage and thereby unite the area of \u200b\u200bthe deputy head and the auditory pass into one cavity. Sanging Operation on the middle ear acquired a completed look after the proposal of the Queufil to remove the lateral bone wall of the attic. This operation was called radical. Currently, it has become more gentle: the hearing bones and the mucous membrane of the medial wall of the drum cavity is not removed, so the operation began to be called a hearing-saving operation on the middle ear.
The largest therapists of the country contributed to the formation and development of a born specialty. D.I. Koshlakov - Student S.P. Kotkin became the first professor of laryngology in Russia, and his second student A.F.prussak - the first professor of Othiatia. The association of Othiatia, Larginology and Riology also carried out the student S.P. Kotkin - N.P. Simanovsky in 1892, and in 1893 he also achieved the inclusion of the already united discipline to the obligatory course of teaching students in the St. Petersburg Military Medical Academy, The time in European countries there was no such teaching. In 1903, N.P.Simanovsky founded in St. Petersburg the first scientific society on ear, nasal and throat diseases, and in 1909 he began to publish the first magazine "Bulletin of ear, nasal and throat diseases" in this specialty. His disciples were
I.Voyachek, M.F. Shatovich, N.V. Belogolovoye, N.M.Aspisov, etc., who later became the most prominent scientists and organizers in otorinolaryngology. N.P.Simanovsky deservedly consider the patriarch of otorinolaryngology in Russia.
At the same time - the end of the XIX - the beginning of the XX century. - In Moscow, on the basis of the Old-Ekaterininskaya hospital, the prominent surgeon E.M.Stpanov organizes the optional reading of lectures on otorinolaryngology, builds a separate building for the ENT branch, where the therapeutic and scientific base was created to prepare otorinolaryngologists. Sentor E.M.Stepanova prof. S.F. Shtein also organizes the construction of the Lor Clinic (subsequently she was a clinical base of the 1st Moscow Medical Institute. IM Schechenov is currently the Moscow Medical Academy. I.M. Suchenova). In Moscow University worked privat-docent
S.Prevezhensky (studied the problem of deafness and hearing loss) and
E.N. Malyutin (laid the foundations of phythriaria). In 1892, the first Russian textbook on the otorhinolaryngology MSZhirmunsky was published. In 1908 in St. Petersburg and in 1910, the All-Russian Congresses of otorinolaryngologists took place in Moscow, which with certain frequency (usually after 5 years) are carried out to the present.
In the first half of the XX century. A great contribution to the domestic otorinolaryngology was made by V.I. Voyachek, the works of which are devoted to the study of the pathology of the inner ear, the peculiarities of helping the patients and wounded in wartime, the improvement of the technique of various operations in the Jiop authorities. His follower became C.L.Hilov, who developed the problems of the physiology and pathology of the vestibular apparatus. He was awarded the Purkinje International Prize for the Monograph "Equilibrium". The main provisions of this book are relevant and at present. A prominent scientist and public figure L.T.levin headed the Department of Otagonolaryngology in the Leningrad Institute for the Improvement of Doctors. He published the capital leadership of "surgical diseases of the ear." Subsequently, this department was headed by V.P. Ermolaev, published extensive materials on phythriatia and clinical audiology. In the 1st Moscow Medical Institute (now - the Medical Academy named after M.N. Semevertov) in the development of otorinolaryngology, A.F.Ivanov and A.G. Lihachev, who made a number of scientific papers on various specialty issues. In the same institute, the Department of Otaginolaryngology was led by Academician of AMN USSR N.A. Preparensky, for a number of years he headed the All-Union Scientific Society of Otorinolangologists and published work on various specialty issues. The head of the second department of this institute was prof. Ya.S. Temkin, a peaceful scientist engaged in learning the lesions of the hearing body. His fundamental monograph "Headup and deafness" and other works were translated into German and English, he conducted extensive studies on the study of professional pathology of hearing, is a collaborator for students. In 1919, the Department of Ear Diseases, Horrel and Nose in the 2nd Moscow Medical Institute (since 1993 - Russian State Medical University) organized and led the major scientist and public figure L.I. Sverzhevsky (1867-1941). He was the organizer of the All-Russian (1933) and All-Union (1940) scientific congresses of otorhinolaryngologists, the creator and the first leader of the Moscow Institute of Ear, Horrel and Nose (1936), the organizer and first chief editor of the Journal of Otorinolaryngology Journal (1936), which is published and currently time. The activities of L.I. Sverzhevsky and his scientific school is devoted to the dissertation work of M.Golosovsky (1964). The Big Pleiad of scientists came out of the Moskovsky Research Institute of Ear, Horrel and Nose of the Ministry of Health of the Russian Federation.
A large scientist in the field of deserved scientist of the Russian Federation, Professor A.S. Balovshchenskaya published a number of monographs and scientific articles in which he presented to those developed by the degeneration characteristics of other rhinogenic neurological complications.
The follower of A.I. Sverzhevsky and his successor at the Department and in the editorial office of the journal was B.S.Prepezhensky (1892-1970) - one of the largest organizers of otorinolaryngology in the country. He led a long time for a long time by the Moscow scientific society of otorinolaryngologists, he was the editor-in-chief of the central specialty of the journal "Bulletin of Otorinolaryngology", the organizer and participant of scientific congresses, the author of numerous scientific works. Monographs, books and articles of the Honored Worker of Science, Academician of AMN USSR B.S.Preparensky are devoted to various issues of the specialty. He paid especially much attention to studying the problems of intake and deafness, tonsillar pathology and allergies in otorinolaryngology. He is a co-author of the textbook and many otorhinolaryngology guides.
Subsequently, departments and otorinolaryngology clinics were organized with all medical institutes. They were led by large scientists who made a large scientific and practical contribution to the development of otorinolaryngology. Among them (except already mentioned) were M.F. Shatovich (1869-1936), which conducted research on the study of the physiology of the upper respiratory tract, N.M.Аspaisov (1877-1952) - the author of works on Labyrinthology, S.A.Prozkuryakov, Which suggested many options for restoration operations on the ENT organs. A versatile clinician scientist, a brilliant surgeon, Honored Worker of Science, Head of the Department of Otagonolaryngology of the Moscow Institute of Postgraduate Education V.S.Pogos, made a significant contribution to Laura-Oncology. His works on this issue are recognized worldwide.
In our country there are two research institutes of otorinolaryngology - in Moscow (director - prof. A.I.Kryukov) and St. Petersburg (director - prof. Yu.K. Yanov). With each medical institute, the Department of Otorinolaryngology was organized, as a rule, having a therapeutic base in a large hospital, in almost every hospital there is a specialized ENT service. All this ensures the possibility of providing affordable and qualified assistance in the otorinolaryngology to the entire population, creates conditions for scientific work, advanced training, student learning, i.e. Development of specialty.
Thus, the otorinolaryngology, originating as an independent discipline in the middle of the XIX century, has now turned into the most important section of medicine.
Part I Clinical anatomy and physiology of the upper respiratory tract and ear. Methods of research of ENT organs
Otaginolaryngology - science and practical discipline on diseases of the ear, nose, pharynx and larynx (abbreviated - ENT). Given the applied nature of the leadership, it is advisable to basic content - the description of the disease - to prevent information on clinical anatomy, physiology and methods for the study of these bodies. Since the diseases of ENT organs are often interrelated with pathology nearby esophagus and trachea, some questions regarding the structure and functions of these bodies should also be stated.
Chapter 1 Clinical Anatomy and Nose Physiology and Occolone Obsomes
1.1. Clinical Anatomy of Outdoor Nose
Hoc (Nasus) consists of an external nose and a nasal cavity.
The outer nose (Nasus Externus) is represented by a bone-cartilage cable in the form of a pyramid (Fig. 1.1), covered with skin. It distinguishes the tip, root (bridge), back, rods and wings.
Bone part of the isow It consists of pair flat nasal bones and frontal outflow of the upper jaw. These bones, together with the front nose, form a pear-shaped hole of the facial skeleton. Chrying part of the isow consists of pair triangular and wing, as well as additional cartilage; The wings of the nose in its lower-beetles are deprived of the cartilage basis. The skin in the lower third of the nose has a lot of sebaceous glands. Going through the edge of the entrance to the nose (nostrils), it lins the walls of the anticipation of the nose (Vestibulum NASI) for 4-5 mm. Here on the skin there is a large amount of hair, which causes the possibility of borunkulov and Sicoz. In the area of \u200b\u200bthe wings of the nose under the skin there are muscles, expanding and narrowing in the nose.
The outer nose, like all the soft fabrics of the person, is characterized by abundant blood supply: the branches from the maxillary and the orpriculture arteries are coming to it, from the external and internal carotid arteries system, respectively. The veins of the outer nose are removed through the front facial vein into the inner jugular vein and in large numbers - on the veins of the nasal cavity, then through the plexus veins in the venous plexus of the Plexus Pterygoideus and in the cavernous sine (Sinus Caver- Nosus), the average brain ( V.MENINGEA MEDIA) and then into the inner jugular (V.jugularis Interna) vein.
Lymphottok from the outer nose is carried out mainly into submandibular lymph nodes. The muscles of the outer nose are innervated by sprigs of the face nerve (N.Facialis), the leather - the first (eye nerve - n.ophtalmicus) and the second (maxillary nerve - n.maxiLlaris) branches of three
Fig. 1.1. Outdoor nose.
a - Front view: 1 - nasal bone; 2 - abnormal extension of the upper jaw; 3 - triangular side cartilage; 4 - large chryshai wings of the nose; 5 - cartilage nasal partitions, b - side view: 6 - seismian cartilage
.
nice nerve, hopeless (n.supraorbitalis) and under-judicial (n.infraorbitalis) nerves.
The plastic skin-cartilaginous structure of the front of the outer nose allows for certain limits to shift it on the side without the subsequent rack of deformation. However, a strong mechanical impact on the bone offshore of the nose is often accompanied by nasal bone fractures, often with a displacement of fragments, and with stronger injury - the fracture of the frontal process of the upper jaw.
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