HLAVA HEAD

HLAVA HEAD

klinicky zaměřená anatomie clinically oriented anatomy

Ivo Klepáček

Sources for study:

M.Grim,R.Druga et al.:Základy anatomie 5.

anatomie krajin těla

M.Schuenke et al.: Atlas of Anatomy. Head and Neuroanatomy

V.Seichert:Anatomická pitva

V.Seichert:A little anatomical atlas

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Linie mezi hlavou a krkem

Line between head and neck

Gnathion, menton, gonion, mastoideale, opisthokranion (inion)

Mozková část Brain part Obličejová část Face part

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Krajiny děleny podle kostí

Regiones are selected

following bone structures

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Regio frontalis, temporalis, parietalis, occipitalis

V

ymezení hlavy proti krku Hmatné body

ohraničení krajin a přehled fascií a hlavních prostorů

Palpable points, landmarks Head regiones

Head fasciae

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2 year

3 month

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S S kin kin

C C onnective onnective tissue tissue

A A p p oneurosis oneurosis

L L oose oose areolar areolar tissue tissue P P ericranium ericranium

S C A L P

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Musculus epicranius (epicranial muscle:

frontal, angular and occipital bellies)

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Masseter

M. temporalis

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Veins are from v.

venae jugularis

externa, supraorbitalis, occipitalis

arteriae upraorbitales, superficiales

temporales, posteriores

auriculares, occipitales nervi cervicales a větve trigeminu V₁,V₂

In subaponeurotic space

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Zranění hlavy a krvácení

Head injuries and hemorrhage

Blood between pericranium and

scalp proper is called

cephalohematoma;

is followed by hematoma in orbits

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OBLIČEJ FACE

Inervační zóny, tukové

těleso tváře, inervace v dutině ústní, cévy a

uzliny obličeje

Nerves in face, Head´s zones, fat pad, oral

cavity innervation, vessels and lymph nodes

in face

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trigonum

trigonum mortismortis Mimick

Mimickéé svaly csvaly céévy oblivy obličeje čeje Mimic

Mimic musclesmuscles fascefasce vesselsvessels

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Headovy

Headovy zzóónyny Head´Head´s s zoneszones

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Odtok mízy z měkkých částí

hlavy

Lymph outflow from the scalp

tissues

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1 3 2

4

I – sulcus centralis

II – fissura lateralis cerebri

Rudolph Ulrich Kroenlein (1847-1910 ) Swiss surgeon

pterion

Trepanation

Trepanation areaeareae trepanation

trepanation areasareas

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Prostory na hlavě Head spaces

Sp. parapharyngeum: prestyloideum (pterygomandibulare, parotideum, paratonsillare), retrostyloideum (parapharyngeum dorsale)

Sp. retropharyngeum

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Regio buccalis et infraorbitalis

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Regio

parotideomasseterica

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Glandula parotis

Hluboká Deep part (processus pharyngeus) Serózní tkáň Serous tissue

Ductus parotideus (of Stensen)

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Sup.:

Ala major ossis sphenoidalis Med.:

Lamina medialis

processus ptergoideus + pharynx

Ventr.:

Tuber maxillae Lat.:

Ramus mandibulae Dors.:

Septum styloideum

Fossa infratemporalis

Infratemporal fossa

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Pterygopalatine fossa (sphenopalatine)

Pterygoid

Pterygoid canalcanal

Greater

Greater palatine palatine canalcanal Sphenopalatine

Sphenopalatine foramen

foramen

Inferior

Inferior orbitalorbital fissurefissure

Round

Round foramenforamen

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™

Fossa infratemporalis

„Povrchová vrstva“

Infratemporal fossa

“superficial layer“

Tepny a žilní pleteně

Arteries and plexiform-like veins

“superficial layer“

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Mm.

pterygoidei

et variationes

a – m. pterygoideus lateralis b – m. pterygoideus medialis

f,g – pars superior et inferior m. pterygoideus lateralis

k,l– pars lateralis et medialis m. pterygoideus medialis

h,i,j – nadpočetné variety (supernumerary

varieties)

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g- lig. stylomandibulare fascia parotideomasseterica

a- lig. pterygospinosum h- lig. sphenomandibulare e- lig. pterygomandibulare - fascia interpterygoidea

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Fossa infratemporalis

„hluboká vrstva“

Infratemporal fossa

“deep layer“

Větve V₃ Mandibular branches

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Maxillary artery and division of the trigeminal nerve V3

are surrounded by the venous

pterygoid plexus

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Plexus pterygoideus

Pterygoid plexus

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Fossa

retromandibularis

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ZESÍLENÁ a ZESLABENÁ MÍSTA LEBKY, JEJICH |VÝVOJ,

ZLOMENINY

SKULL TRAJECTORIES,

DEVELOPMENT OF the SKULL PILLARS, FRACTURES

Fonticuli, změny tvaru lebky, kraniostenosy, „Battle sign“

Fontanellae, changes in skull external form, craniostenoses, Battle sign

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Pilíře:

špičákový, stoličkový (jařmový), pterygoidní,

dolní čelisti

Pillars (counterforts, buttresses):

canine, molar,

pterygoid, mandibular

Tahové a tlakové linie lebky

Traction and

pressure lines in skull

Deffez 1980

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Přerušení označených kostních linií signalizuje zlomeninu podle le Forta

Interruption of the labelled osseous lines indicates Le Fort fractures

(René Le Fort 1902)

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Fracture lines in mandible Traction and

pressure lines

•Condyle

•Upper Lower neck

Retromolar (angular)

•Through canine,

•Through mental region

•Krčku

•Retromolární

•Špičáková

•Bradové krajiny

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Cribriform plate ^{- I.}

Optic canal

- II., ophtalmic artery

Superior orbital fissure

- III., IV., V₁. (nasociliar, lacrimal,frontal), VI., superior orbital v.

Foramen lacerum

greater petrosal nerve and

sphenooccipital synchondroses) - internal carotid artery

Round foramen

V₂

Foramen ovale

- V₃., communicating veins

Foramen spinosum

- middle meningeal artery

Carotid canal

- internal carotid artery, sympathetic nerves (caroticotympanic)

Jugular foramen

- IX.,X.,XI. internal jugular vein

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Hlavní lomné linie v lebeční bazi main fracture lines in skull base

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Regio orbitalis

OČNICE ORBIT

Stěny a topografické vztahy, bulbární a retrobulbární oddíl

Walls and topographic relations, bulbar and retrobulbar space

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Palpebra et conjuctiva Eyelid and conjunctiva

Gll. tarsales – mastí okraje víček Gll. sebaceae – mastí brvy Gll. ciliares – potní

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Fissura orbitalis superior et canalis opticus et fissura

orbitalis inferior

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Vztah mezi orbitou, canalis opticus

a paranasálními dutinami

Relation between orbit, optic canal

and paranasal cavities

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Vztah mezi venae ophtalmicae, sinus casvernosus, plexus pterygoideus a v. facialis

Relation between ophtalmic veins, cavernous sinus, pterygoid plexus and facial vein

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UCHO, EAR

Zevní zvukovod, cavum tympani, labyrinthus osseus, tografické vztahy

External acoustic meatus, tympanic cavity, inner ear, topographic relations

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Zevní ucho External ear

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Tvar zevního zvukovodu

Form of the external

acoustic meatus Hlava

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NOS, NOSNÍ DUTINA NOSE, NASAL CAVITY

Složení, průchody, vedlejší dutiny nosní Structure, meatuses, paranasal sinuses

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Nasus externus - radix, dorsum, apex, ala nasi

Cartilagines nasales: alaris major - crus laterale et mediale, alaris minor, septi nasi – processus lateralis, cartilago

vomeronasalis

Septum nasi – pars ossea, membranacea, cartilaginea

M.

M. procerusprocerus

M. levatorM. levatorlabiilabiisup. sup. alaequealaequenasinasi M.

M. nasalisnasalis

M. depressorM. depressorseptisepti

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Cavum nasi proprium

deviatio septi nasi

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Wilhelm Kiesselbach(1839-1902) German otolaryngologist,

a.ethmoidalis ant. a. palatina major, a.

sphenopalatina, a. labialis superior

anterior ethmoid , great palatine arteries, sphenopalatine

sphenopalatine a.a. and superior labial a.

rr. septales a.ethmoidalis post. a. sphenopalatina Septal branches of the posterior ethmoid,

sphenopalatine arteries Plexus Kiesselbachi

Locus Kiesselbachi

Plexus nasopharyngeus Woodrofi

Little´s area

Tepny Arteries

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plexus

plexus cavernosi cavernosi concharum concharum : :

ÎÎ v. sphenopalatinav. sphenopalatina ÎÎ plexus

plexus pterygoideuspterygoideus a)a) ÎÎ v. maxillarisv. maxillaris ÎÎ

v. v.

retromandibularis retromandibularis b)b) ÎÎ v. profundav. profunda

faciei

faciei Îv. Îv. facialisfacialis b) Îb) Î vvvv. . ethmoidalesethmoidales ÎÎ

vvvv. . ophtalmicaeophtalmicae

c) Îc) Î přpřes es lamina lamina cribrosacribrosa ÎÎ vv. vv. cerebricerebri

Žíly Veins

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¾¾ SenzorickáSenzorická, , smellsmell: : n. olfactoriusn. olfactorius

¾

¾ SenzitivníSenzitivní, sensitive:, sensitive: n. trigeminus n. trigeminus VV_{1 +1 +} VV₂₂

zz ÍÍ n. ophtalmicusn. ophtalmicus ÍÍ n. nasociliarisn. nasociliaris ÍÍ n. ethmoidalisn. ethmoidalis ant.ant. (strop (strop + + horníhorní třtřetina)etina)

zz ÍÍ n. maxillarisn. maxillaris ÍÍ rr. rr. nasalesnasales posterioresposteriores (sup. + inf(sup. + inf.).) ÍÍ n. infraorbitalisn. infraorbitalis (vestibulum)(vestibulum)

¾¾ AutonomníAutonomní, , autonomousautonomous: : věvětve z tve z ganglion pterygopalatinumganglion pterygopalatinum

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Vyústění paranasalních dutin Paranasal cavities - openings

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Frontalis

Ethmoidalis anterior

Maxillaris Antrum Highmori

8 yr

20 yr 12 yr

1 yr

60 yr

"Ostiomeatální

jednotka –

ostiomeatal unit funkční a

vývojové spojení sinusů

ostiomeatal unit"

N. Highmore:

Corporis humani disquisitio

anatomica; in qua sanguinis

circulationem in quavis corporis particula plurimis typis novis ac aenigmatum

medicorum succincta dilucidatione

ornatam prosecuutus est.

Hagai-Comitis [The Hague], 1651.

The sinus was well known to anatomists before Highmore. It had been illustrated by Leonardo da Vinci (1452-1519) and had been noticed by Giulio Casserio (1561-1616)

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Podle Waterse

Waters (Towne) projection

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Examination of the sinuses

Frontal - examined by pressing the finger upward beneath the medial end of the superior orbital margin

Ethmoid - palpated by pressing the finger medial against the medial wall of the orbit

Maxillar - tenderness after pressing the finger against the anterior wall of the maxilla below the inferior orbital

margin

Sphenoid - examined using nasal probe

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DUTINA ÚSTNÍ ORAL CAVITY

Vestibulum, patro, jazyk, slinné žlázy Vestibule, palatum, tongue

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Regio labialis et mentalis Lip Chin

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Vestibulum Vestible

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Sulcus gingivae Gingival sulcus

(pocket)

Paramarginal sulcus Free gingival groove

Gingiva = relation to the teeth – “cuff (collar) attachment“

Volná Free: Interdental; embrasured; circumdental Připojená Attached: Adjacent, fixed

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Palatum durum Hard palatum Palatum molle

Soft palatum uranos

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Reliéf patra s řasami, Palatal relief with rugae,

foveolae palatinae, papila icisiva

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Utv Utv á á ř ř ení en í sekundá sekund árn rn ího patra í ho patra secondary secondary palate palate formation formation

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Palatum molle

Soft palate

– dorzálně dorsal view

– ventrálně ventral view

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Vývoj patra Vývoj patra a roz

a roz š š t t ě ě py patra py patra Palate

Palate development development and and cleft cleft palate palate

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Clefts Clefts

Developmental unfusing

of the embryonal processes in the face

Congenital or teratogenic influences

Multifactorial Multifactorial

Anticonvulsant drugs

(phenobarbital, diphenylhydantoin)

Cytostatics Cytostatics

Imunosupressive

Imunosupressive drugsdrugs, , Tetracycline,Tetracycline, Irradiation

Irradiation Diabetes

Hypoglykemia Epilepsia

Stress

corticoids

! Prevention Prevention – – to to end end of of month

month 2 2 of of pregnancy pregnancy ! ! Diagnosis

Diagnosis in time in time (after ( after 3rd 3rd critical

critical period; period; interruption interruption ? ?

Three critical periods:

25.- 35. day isolated lip cleft 37.- 53. day isolated palate cleft where shelves are damaged

53.-57. day isolated palate cleft due to mandible growth

retardation

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Developmental unfusing

of the embryonal processes in the face Congenital or teratogenic influences

Clefts Clefts

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Jazyk Glossa

Lingua Tongue

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Lingua, glossa tongue

Pohyblivý svalověepitelový orgán Mobile musculoepithelial organ;

Located in the oral cavity and pharynx

Žvýkání Mastication, Polykání Deglutition,

Řeč Speech Formuje sousto

Squeezing food into pharynx during swallowing;

Pomáhá artikulovartt slovaForming words during

speaking

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a Plica sublingualis b Caruncula

sublingualis c Frenulum labii

inferius

d Plica buccogingivalis e Frennulum linguae f Plica fimbriata

Plicae gingivolabiales

* Area sublingualis

** Area submandibularis

Canalis paralingualis Paralingual canal =

between hyoglossus and genioglossus

Spodina dutiny ústní cavum oris bottom

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Vnitřní svaly jazyka Intrinsic lingual muscles

alter lingual shape

Superior and inferior longitudinal, transverse, vertical muscles

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Styloglossus Palatoglossus

Hyoglossus Genioglossus

Zevní svaly jazyka

Extrinsic

lingual muscles alter the

position of the tongue

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Musculi genioglossi are separated

by the lingual septum Between hyoglossus

and genioglossus muscles there

is (para)lingual canal

Septum linguae je v kořeni a spodině jazyka řídké s minimem vazivových vláken

Lingual septum can be defibered;

after this abscess cavity appears

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Glandulae salivariae Salivary glands

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Glandula parotidea Sublingualis

Sublingualis anterior Submandibularis

1:1

3:2 1:3

Vztahy mezi serózní a mukózní složkou Relation between serous

and mucous parts

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Glandula

sublingualis

Mukoserózní tkáň Mucoserous tissue

Ductus sublingualis major et minores (of Santorini)

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Panoramatický snímek

panoramic x – ray photo

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HLAVA NOVOROZENCE NEWBORN HEAD

Fontanellae, uspořádání, charakteristika

Fontanelles (fonticuli) , arrangement, characteristics Hlava Hlava Head

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Dovolují vzájemné přiblížení a částečné překrytí („hnětení“ - molding) kostí během

porodu

They permit shifts of bones against each other especially through

delivery

anterior, posterior mastoidealis, sphenoidealis

Fontanellae

fonticuli

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configuratio x conformatio

změna tvaru novorozenecké lebky z původního převážně mesokefalického na jiný

změna tvaru novorozenecké lebky lebky vyvolaná podsouvání lupínků v důsledku tlaku

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Scaphocephaly, turinencephaly, acrocephaly, plagiocephaly

Hyperosifikace ve švech Sutural hyperosification

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PLENY MOZKOVÉ A MOZEK MENINGEAL MEMBRANES

AND BRAIN

Nitrolební krvácení, šíření infekce,

cirkulace a poruchy cirkulace mozkomíšního moku

Intracranial leakage, spreading of inflammatory products, CSF circulation, its disturbances

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Dura mater, Arachnoid membrane, Pia mater Epidural space, Subdural space, Subarachnoid space

Meningeal

Meningeal membranesmembranes insideinside skullskull andand coveringcovering brainbrain

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Hematoma, hemorrhage:

extradural (epidural) -

from the middle meningeal artery

dural border (subdural) - ^{from the} cerebral veins

subarachnoid -

is usually

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ant.

middle

post.

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Cirkulace mozkomíšního

moku

Circulation of the CSF (cerebrospinal

fluid)

From the choroid plexus – ventricle I.,II. –

interventricular foramina ventricle III.. -

- aquaduct cerebri – ventricle IV. – cerebellomedullar

cistern – subarachnoid space – arachnoid granulations – sagittal sinus

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Hlava END

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