The area of \u200b\u200bthe deputyid proceeding is located behind own sink And covered it.
Borders correspond to the outlines of the deputyid process, which is good forgiven. From above, the border forms a line, which is a continuation of the Zoomy bone of the zicky process. For the projection of intraosny formations, its outer surface is divided into two lines 4 quadrant : The vertical line is carried out at the height of the process from the vertex to the middle of its base; The horizontal line divides this vertical in half. A cave, Antrum Mastoideum is projected on the front quadrant, on the front venture - the bone channel of the face nerve, Sanalis Facialis, on the ass - the rear cranial fossa and the sigmid venous sinus is projected on the rearview quadrant.
In subcutaneous tissue Often there are beams of the back ear muscles, the rear ear artery and vein, a. ET V. Auriculares Posteriores, rear branch of a big ear nerve, n. Auricularis Magnus (sensitive branch from cervical plexus), rear ear branch of facial nerve, r. Auricularis Posterior N. Facialis. Under the aponeurosis formed by the tendon of the breast-curable-bed-like muscle, NODI Lymphatici Mastoideae, which collect lymph from the dark - the occipital region, with rear surface Ear shells, from outdoor auditory passage and eardrum. Under the muscles beginning with the maternity process (m. SternocleIdomastoideus, the back of the abdomko m. Digastricus and m. Splenius), takes place the occipital artery, a. Occipitalis. The periosteum is firmly fascinated with the outer surface of the mastoid process, the trepanite triangle (Shipo), where the periosteum is easily peeling.
The borders of the triangle Shipip - In front of the rear edge of the external auditory passage and Spina SuprameAtica, from the back - Crista Mastoidea, and from above - a horizontal line, spent by the steam bone from the heater. Within the triangle of Shipipo there is a resonant cavity - a prechantable cave reporting through aditus ad antrum with a drum cavity.
Trepanation of the deputyid process , Mastoidotomia, Antrotomia
Indications: purulent inflammation The middle ear, complicated by purulent inflammation of the cells of the maternity process. The purpose of the operation is the removal of purulent exudate, granulations from the aircraft cells of the maternity process, autopsy and drainage of the mastoid cave, Antrum Mastoideum.
Anesthesia - anesthesia or local infiltration anesthesia 0.5% solution of novocaine. Position of the patient on the back; The head is turned into a healthy side; Own sink is drawn by Kepened. The skin with subcutaneous fiber dissect parallel to the attachment of the auricle, retreating from it to 1 cm. Pre-determine the projection of the trepanitan triangle ships. The projection of the triangle must be in the middle of operational access. Streeting the edges of the skin incision with an rally seater, is exposed on the front surface of the upper-end quadrant of a preparing a trepanite triangle on the front surface. The tripanation of the deputyid process within this triangle is starting with the separation of the periosteum by a dispenser. A sufficient autopsy of the cave is controlled by a curved probe, which examine the walls of the cave, and carefully come out of it through Aditus Ad Antrum into the drum cavity. Pump and granulation contained in the cave and other cells are removed by an acute spoon. The wound is squeezed above and below left in the graduate cave (strip of glove rubber).
The deputyid process: purulent mastoid (inflammation of the cells of the mastoid process as a complication of otitis).
Technique trepanation of a prepar process. Soft fabrics with periostellites are cut arcuate, retreating 1 cm back from the fastening line of the auricle. The perception is peeled and exposed the surface of the process. In the boundaries of the trepanite triangle, the cortical layer of the bone is removed by the chip and hammer. The hole of the trepanation is gradually expanding, penetrating deep into. Reveal the main cell of the maternity process (deputy peseller) and the cell gear adjacent to it. After the cave disclosure, the folkman spoon scrapes granulation from the cavity, the bone wound is tampony or drained, the skin wound is not sewn.
Violation of the boundaries of the trepanite triangle Shipi can cause a number of complications. Above the horizontal line, which is carried out through the upper edge of the outer auditory pass, cannot be disclosed with a mastoid process, since you can get into the middle cranial fossa and to infect it. Ahead of the drum-bed crack can be damaged by facial nerve. The trepanation of the deputy head of the post from the front edge of the depth-like tubes is also not recommended, since the S-shaped sinus can be injured.
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Indications: Purulent inflammation of the Middle .Uh, when distributing GN.VOS from the cavity of the Middle .Uh to the cells of the nips. The process and further in the cavity of the medium. And rear. Cher.yok and transverse. Sinus
Complications:danger of damage to SIGM. Sinus, Persons.Nerva, semicircular. Kanalov and Verkhne. Runs of the Barab. In order to avoid complications, trepanation within the borders of the triangle of Shipi and strictly parallel to the back. Raznok Nar.Slukh. Above the horizon, conducted through the top. Kray outer.Shluk. Parot to open the nobs. The output is not possible, because it is possible to get into the middle. Mounting. Skump and infect her soles. Kepened from the Barab Soszki. It is also dangerous - m. Vertika. Trepared the nobs. The edges of the nobs are not recommended - m. Open s-shaped sinus.
Technics: The arcuate incision dissect soft. Canya with periosteum, retreating 1 cm. From the line of attachment of the ears of the sink. The periosteum is peeling to the sides and expose Nar.Pov-n soster. Within TRIUN. Shipi with cholot and hammerremove the cortical bone layer. The trepanitative opening is gradually expanding, running deep into. It is necessary to operate widely open. SOLS. SOSTIC (SOSTS.PER) and all adjacent. To her cells, soda. After opening the nobs spoon folkmanscrangle granulation from cavity, bone wound tampony, do not sew the skin. In cases of distribution of GN.Procession from the cells of the nips. The process is on average. Through the entrance to the SOSTs. Move to the trepanation of the SOSTs. Opening is added to open the cavity of the medium. Tell, mainly the Upper part - Abbravel deepening and entering the cave. The skin is applied 2-3 seam, and drainage is introduced into the lower.
Elbow area and elbow joint
Lock Susta educated Three bones - shoulder, radiation and elbow so that radiation and elbow bones are tested with each other and with the shoulder.
On the shoulder bone There are:
- from the medial side - a block that corresponds to a semi-lunar clipping on the elbow bone;
- from the lateral side - the head that matches the hole on the head radial bone.
On the elbow bone is available incisura Radialis., articulated with the side surface of the radial bone head.
Thus, the elbow joint is represented by three joints with one cavity and a common capsule:
- plecelokteva ( articulatio Humeroulnaris.),
- plecelucheus ( articulatio Humeraradialis),
- brother-sensitive ( articulatio Radioulnaris Proximalis).
Both brace bone superstitis remain outside the custody of the joint.
Line elbow Sustava It takes on the transverse finger below the elbow fold. Epicondylus Lateralis Located 1cm, and epicondylus Medialis. On 2 cm above the articular line.
Capsule of elbow joint covers in front - m. Brachialis.,
rear - tendon m. triceps and m. anconeus..
In frontat the level of the head of the shoulder bone to the elbow capsule adjas deep branch of radiot nerve, but rear between olecranon and epicondylus Medialis Humeri. – elbow nerve.
Capsulethe joint is less durable than in front. The synovial sheath of the joint does not reach the line of attaching the fibrous part of the capsule and worst, moving to the bone. The gap between the synovial shell and the fibrous part of the capsule is filled with loose fatty tissue.
There are several "weak points" in the area of \u200b\u200bthe bravery joint: first- directed bookbag-shaped capsule protrusion ( recessus Sacciformis), sampled due to insufficient severity of the fibrous layer of the capsule. Second - Represents the rear-top department of the capsule.
Sustav Capsule Strengthen Bundles:
- lig. Anulare Radii. - ring-shaped bond, covering the head and beam cervix;
- lig. Collaterale Ulnare. - a bunch that comes from the internal screwdriver to the elbow bone;
- lig. Colladerale Radiale. - A bundle coming from the outer blade to the elbow bone.
Features of the elbow joint:
- complex configuration articular surfaces Bones and the close connection of the capsules with the proximal bones of the bones of the forearm leads to the fact that the message between the front and the hind of the joint cavity is carried out by means of narrow slots in its lateral departments. As a result, with the hunchback processes in the joint, the swollen synovial shell separates the front part of the articular cavity from the back, so the opening of the joint for the purpose of drainage should be carried out in front and rear.
- rear-top Division of the capsule, from the sides of olecranon And the tendons of the three-headed muscles, the places are protected only by the sections of the elbow area, as a result, during purulent clusters in the joint, protruding from the sides from the elbow process is formed.
Blood supply: Rete Articulare Cubitiformed by branches a. Brachialis, a. Radialis. and a. Ulnaris..
The elbow articular network is 4 anastomosis:
- upper elbow collateral artery with back branch elbow return artery;
- lower elbow collateral artery with the front branch of the elbow recovery artery;
- radiation collateral artery with radiation return artery;
- middle collateral artery with a return interceptional artery.
Venous outflow - According to the provisions of the same name.
Lymphotok: In elbow and axillary lymph nodes.
Innervation: branches nN. Radialis, Medianus, et ulnaris.
Rib cage. Layers
Borders: Upper - along the tier cut, according to the upper edge of the clavicle, key-acromic joints and according to the conventional lines, conducted from this joints to an accelerable process of the VII vertebra. Lower - from the base of the sword-shaped process, along the edges of the rib arcs up to x ribs, from where, on the conventional lines through the free ends of the XI and XII ribs to an octic process of the XII of the thoracic vertebra. The chest area is separated from upper limbs On the left and right of the line passing in front of the deltoid-thoracic furrow, and behind the medial edge of the deltoid muscle.
Treanation of a mastoid process (Antrotomia) - Schwartz operation, radical trepanation of a mastoid process (Mastoidotomia) - operation tank.
The tripanation of the deputyid process was first produced by Petitite 1750) and later by the Prussian Military Physician Yasser 1776). This operation, however, did not get distribution, since their technique was insufficiently thought out.
In 1873, Schwartz for the first time developed certain testimony for the autopsy of Antrumm Astoideum with purulent inflammation of the middle ear.
Operational interference on the mastoid process and the drum cavity is entirely related to the region of about t and and and and. These include events in the spread of purulent inflammation from the cavity of the middle ear on the cells of the mastoid process, and further - to the cavity of the middle and rear cranial pits and Sinus Transversus.
Accordingly, this is being taken:
a) an autopsy of a mining process - Schwartz-rod operation (Trepanatio Processus Mastoidei);
b) the opening of the village and the middle ear (Antrectomia et Atticotomia);
c) Opening Sinus Transversus at all its length before Bulbi v.jugularis inclusive.
Operation in this small area requires exact orientation in topographic features It is mainly due to the location of the Sinus Sigmoidea, the directions of the channel n.facialis and the degree of distribution of the cells of the maternity process.
In the circumstances specified for the technique, the circumstances are focused on the triangle Shipi.
the front is the rear edge of the outer hearing aid with the superstum located above the hearing hole (SPINA SUPRAMEATUM HENLE), from the back - a large-shaped scallop (Crista Mastoidea, from above - a horizontal line, which is a continuation of the Zoomie arc.
The practical value of the triangle of Shipi is also in the fact that within its limits the trepanitative opening is superimposed: its posterior wall corresponds to the position of Sinus Sigmoidea, the top - temporal share The brain, the front - Canal N.Facialis.
The testing of the tripanation of the deputyid process is: acute purulent inflammation of the cells of the mastoid process (purulent mastoid), chronic inflammation middle ear.
The purpose of the operation is the evacuation of the purulent exudate, removal of granulation from the coarse cavities of the maternity process with inflammatory processes In it and drainage of the resulting cavity.
Technique: disseminated arcuate cut soft fabrics With periosteus, retreating to 1 cm. From the line of attachment of the ear shell. The periosteum is peeling to the sides and expose the outer surface of the presenter process. Within the triangle of ships with the help of chisels and hammers remove the cortical layer. The trepanitative opening is gradually expanding, running deep into. Perhaps, it is necessary to widely open the main cell of the Antrum Mastoideum mining cell) and all adjacent cells containing pus.
At the opening of the Antrum Mastoideum, the spoonful of folkman is scranched from cavity, and the bone wound is tampony, the skin wound is not sewn.
In cases of propagation of the purulent process from the cells of the maternity process on the middle ear through (Aditus ad Antrum), another opening of the cavity of the middle ear is added to the trepanation of the mining process, mainly the upper part of it is the RESESSUSUS EPITYMPANICI. As a result, one common cavity from the Recessus, Aditus and Antrum is obtained. Apply 2-3 silk seams, and drainage is introduced into the lower corner of the wound.
Primary surgical processing of maxillofacial wounds.
On the features of the maxillofacial operations, N.Iirogov drew attention.
Surgical treatment of persons and jaws are subjected to different times after injury, with the exception of the mi l k and x injuries of soft fabrics and "holey" fractures upper jaw.
Considering cosmetic considerations, with primary surgical processing Maxillofacial wounds need:
Economic excision of its edges, removing only non-existence of fabrics;
Avoid damage to the nerves, vessels and duct of the parole salivary gland.
Then proceed to processing bone tissue jaws.
At the same time remove the movable free bones, devoid of periosteum, knocked out teeth and others. Education preventing the installation of fragments of jaws in the correct position. Bone fragments, especially large associated with surrounding tissues, are preserved, installed them in the possibly more correct position and secured using various methods.
With wounds large sizespenetrating the oral cavity, and the impossibility of rapprochement and crosslinking of all tissue layers, it is necessary to strive first of all to close it from the mucous membrane, and the wound of the skin brought closer to rare seams.
If there is a large defect of the soft tissues and the rapprochement of the edges of the wound can lead to a significant limitation of mobility lower jaw or narrowing the opening of the mouth, it is more expedient to sew along the edges of the wound mucous membrane with the skin. The resulting defect with smooth smooth scar edges will create favorable conditions for the subsequent plastic closure.
With the wound salun docal We must try to restore his passability, stitching its ends. In case of failure, it is necessary to sew the skin wound tightly, and the wound of the mucous membrane is left open to provide outflow in the anticipation of the oral cavity.
When injured in the main trunk of facial nerve, it is necessary to find ends and bring them off with epinery seams.
In disruption of the integrity of the skin, which cannot be replenished with a simple rapprochement of the edges of the wound, the use of skin plastics is shown (plastic on the oncoming flaps, flap on the leg, leather transplantation).
The imposition of a deaf primary seam in injuries is shown within 36-48 hours after injury.
When processing the wound after 48 hours, the edges should be minimally and be sure to sew the wound. The use of antibiotics allows you to sew the wound tightly after its processing even after 72 hours from the moment of injury.
With tissue defects, guides or situational seams are used, which hold wound flaps in the correct position, not bribing completely edges of the wound.
8-12 days after the injury is shown secondary seamWhen the wound is cleaned and already made with granulations.
Typical cuts on the face with surface and deep phlegmon.
For the treatment of abscesses and phlegmon, it is necessary to create the conditions of pus outflow, which is ensured by opening the purulent focus with the subsequent drainage of it. When carrying out cuts on the face, it is necessary to be strictly guided by anatomical landmarks to avoid possible damage to the branches of the facial nerve, entailing functional disorders and deformity of the face.
As you know, the facial nerve when leaving the ForaMen Stylomastoideum comes into the bed of the near-dry salivary gland and is divided into branches: RR.Temporaalis, going upwards ahead of the ear shell: RR.Zygomatici - heading space-up and swearing through the middle of the zilly arc and reaching the outer corner Elets; RR.Buccalis - passing towards the corner of the mouth and RR.Marginales MandiBuli, passing down and forth along the edge of the lower jaw. Part of the branches goes to the neck area.
The facial nerve conducts motor pulses to the entire mimic muscles, so damage to it under operations leads to severe disfigurement of the face.
Therefore, when opening surface jets, the incision is made through skin covering Based on the topographic anatomical distribution of the main branches of the facial nerve, choosing the most "neutral spaces between them." The radial incisions coming from the outer auditory pass are fan-forming from the ear goat to the outer corner of the eye slit, to the tip of the nose and the corner of the mouth, as well as in parallel to the modulemite edge of 1-1.5 cm below it.
To open the same deep urnets in the area of \u200b\u200bthe face, it is recommended to approach the purulent hearth stub, since the dissection of tissues can be complicated by the injury of vascular and nerve highways.
With the phlegmon of the subordinate region, the incision is made at the proper fold of the mucous membrane of the upper array of the oral cavity and, stupidly spreading the fabrics, penetrate to the bottom of the dog's dahmy. If the pus does not appear, reveal the affection through the skin incisions in the place of the greatest accumulation of pus.
The phlegmons of the zilly region are opened through the skin incision at the lower edge of the zilly bone parallel to the zilly arc.
In the phlegmon of the cheeky region, the topography of the main branches of the facial nerve, wall of the duct, according to which the cuts have a radial direction from the ear of the ear to the outer corner of the eye slit, to the wing of the nose, the corner of the mouth.
The cuts from the opposition of the mouth are suitable in cases where the pus is located between the mucous membrane and the penette muscle.
With phlegmons, the cheeks in the M.Masseter region, which are most often the spread of the latter, is opened with a cross-section, which goes from the lower edge of the ear of the ear (2 cm of the key) towards the corner of the mouth. The incision passes between the branches of N.Facialis; They are damaged at such cuts only in rare cases.
War-Yasenetsky for opening phlegmon in the retrondibular region (vapotitis, pararaharyagial phlegmon) recommends that skin cut and fascia in the challenge of the angle of the lower jaw, and deep into the dull way (better with a finger). With such a section, R. coli intersects, which does not cause significant disorders: sometimes R.Marginalis mandibulae may be damaged, which innerves the chin muscles.
The infection from the accommodation of the eye gland can be drained through the incision proposed by Blair (Blair). It begins at the level of the lower edge of the zyloma arc at a distance of 2 cm ahead of the ear goat, heads down the book, behind and at the angle of the lower jaw. The incision penetrates the gland capsule.
Occopter phlegmons with the involvement of the cheekbone lump lump, it is recommended to open the incision starting at 2-3 cm in front of the wing of the nose and continuing in the direction of the ear of the ear on 4-5 cm. The cut should not be taken deep, because here you can damage V.Facialis and Ductus Stenoni . The branches of the facial nerve with such a section are rarely damaged. Most often, in case of occasional phlegmon, it is better to cut the incision through the mucous membrane of the leadership of the mouth at the jaw peel.
The temporal area is distinguished: surface phlegmon located between leather and temporal aponeurosis; median - between aponeurosis and temporal muscle; Deep - under the temporal muscle and spilled, spreading on all mentioned layers.
The main incision at the opening of the surface phlegmon of the template region, is the incision of the bone of the fan-like diverging viscoral branches of the face nerve.
With deep penettees of the temporal area, cuts are carried out radially in the course of muscle fibers and large arterial highways.
With a spilled phlegmon, it is more expedient to incision along the border of the attachment of the temporal muscle and its aponeurosis, in the form of a semicircle.
What remains to be done if the branch of the facial nerve is damaged in the field of the parcel or even in the channel of the pyramid of temporal bone during operations in the middle ear?
In such cases, existing anatomical reserves should be explored and proceed with the restoration operation to eliminate the paralysis of the mimic muscles.
In general, the struggle against the paralysis of the facial nerve is allowed in two ways: the subset to the facial nerve of segments of motor nerves, located near, or mobilizing non-stealized muscles.
Ballens and Karde at the beginning of the twentieth century were offered as the nerves - donors to use N.Accessorius and N.Hypoglossus.
For this purpose, N.Accessorius crossed the exit from under the mouse muscle and stitched the central segment of it with facial nervelying to the periphery from the place of damage. In the same way, n.hypoglossus is sewn with face nerve. However, the intersection of N.Hypoglossus may entail a disorder muscular function Neck and tongue muscles. F.M.Hitrov in 1949 proposed for the nerve plastikalitse nerve N. phrenicus transplant.
Trepanation of the topless sinus (Sinus Maxillaris Highmari).
Nasal cavity has putinous sickleswhich communicate with various nasal strokes.
Over the top nasal sink in the nose cavity opens a sinus wedge-shaped bone (Sinus sphenoidalis).
Upper nasal strokes The rear cells of the labulous bone lability are open, in the middle nasal stroke - the opening of the frontal and topless sinus, the front and middle cells of the labulous dice lattice. A nose-butter canal opens into the bottom nose.
The front wall of the gaimor cavity is represented by a thin plate corresponding to Fossa Canina. N.INFRAORBITALIS is located on this wall.
The top wall of the sinuses is at the same time the lower wall of the orbit. In the thickness of the wall there is canalis infraorbitalis with a vascular-nervous beam passing there.
The lower wall of the sinus is represented by an alveolar jaw process, which corresponds to the roots of the 2nd small and front large indigenous tooth.
The inner wall of the sinus arrives to the middle and lower nose. The wall of the lower nasal stroke is solid, but thin. It relatively easily managed to punish the sinus gaymorov.
The rear wall of the sinus is represented by an upper-eyed hill in contact with the picker, where there are N.INFRAORBITALIS, Ganglion Sphenopalatinum, a.maxillaris with its branches. Through this wall can be approached to the Cuttle Pile.
With the delay of the discharge mucosa of the gaimor cavity due to the blockage of its hole (opening in the middle nose) or at various pathological processes (cysts, neoplasms, etc.) It is necessary to create favorable conditions for outflow in the first case, and to disclose the sinus as widely so that it can be removed in the second case.
To create outflow from a gaimor cavity, you can resort to the following methods:
1. Extract a large indigenous tooth or the second small and through his well, a trocar is introduced actually through the channel of the buccal root, breathing the well in the direction upwards, to the middle and the stop.
Through this way, the trocar washed the cavity, and the opening in the well is closed with pins.
2. The curved trocar is pierced side wall Obshads within the lower nasal stroke (Wagner, Mikulich, Lichtan).
In 1869, Wagner for the first time quite admitted by the gaymorov cavity to the maizinsky producing a thin, lateral nasal wall from the middle nasal stroke.
Sheffer first revealed the maxillary cavity from the side of the lower nasal stroke.
3. The maxillary sinus can be opened and through the front wall of the sinuses in the Fossa Caninae area (the deso-Custer method is Spring).
This operation allows you to visually inspect the sinus and, if necessary, scrape the mucous membrane, delete the neoplasm, etc. To do this, pulling up the upper lip, in the transitional fold of the mucous membrane, throughout the second indigenous tooth and a cutter, are cut to the bone. The sprayer is peeped up upwards, exposing the in-depth platform of Fossa Canina, but in such limits, so as not to damage the N.infraorBitalis, leaving 1-2 mm below the lower ordown edge through the formen infraorbitalis. The front wall of the sinuses to the desired size is demolished or milling. In order for the outflow not in the cavity of the protrusion of the mouth, and the front wall to the edge of the Piriformis apertura is flick into the lower nasal stroke. The imposition of seams on the wound and tampony of the gaimor cavity is not necessary.
Topanation of the frontal sinus (Sinus Frontalis) by Killian Killian).
The frontal sinus is located in the thickness of the frontal bone, respectively, the abnormal arcs.
The front wall of the sinus is represented by the above-mentioned hill, the rearly thin and separates the sinus from the front cranial fossa, the lower wall is part of the upper wall of the socket and in the middle line of the body - part of the nose cavity, the inner wall is a partition separating the right and left sinuses. The upper and outer wall is absent.
Indications for the opening of the frontal sinus are made about the accumulation of pus, neoplasms in it, cyst, foreign bodies, etc.
The technique of radical operation on Killiana consists in removing the front and lower walls of the sinuses; In the case of needed, resection of the nasal turn of the upper jaw is joined than access to the lattice bone cells.
Pre-tamponized nasal cavity (rear tamponada). The incision along the length of the eyebrows then descends on the nasal process to the lower end of the nasal bone, penetrates the periosteum (spare N. and a.supraorbitalis).
Stretching the edges of the wound, the periosteum parallel to the upper edge of the orphanage and above it is 5-7 mm; The second incision of the periosteum is carried out along the edge of the orbit. The front wall of the sinuses is demolished or cutter. Delete all partitions of the cavity, the latter scrape with a sharp spoon. Drainage is inserted into the frontal sinus, the end of which is removed into the nose hole. Wound tampony. Seam on the skin.
Le to C and I N 6.
Subject: Operations on the head area (continued). Treanation of the maternity process. Primary-surgical processing of maxillofacial wounds. Typical cuts on the face with surface and deep phlegmon.
Trepanation of the gaimor and frontal sinuses.
Trepanation of a mastoid process (Antrotomia) - Schwartz operation, radical trepanation of a mastoid process (Mastoidotomia) - operation rod.
The tripanation of the deputyid process was first made to be carried out in the same time and later a Prussian military doctor I c with e r about m (1776). This operation, however, did not get distribution, since their technique was insufficiently thought out.
In 1873, the first testimony for the opening A N T R U M M A S T O I D E U M with purulent inflammation of the middle ear.
Operational interference on the mastoid process and the drum cavity is entirely related to the region of about t and and and and. These include measures in the propagation of purulent inflammation from the cavity of the middle ear on the cells of the mastoid process, and further - to the cavity of the middle and rear cranial pits and S I N U S T R a n s V E R S U s. Accordingly, this is being taken: a) an opening of K L E T O to a depositous process Operation W in A R C E - W T A N to E (Trepanatio Processus Mastoidei); b) the opening of the village and the middle ear (Antrectomia et Atticotomia); c) Opening Sinus Transversus at all its length before Bulbi v.jugularis inclusive.
The operation in this small area requires accurate orientation in the topographic features of it - mainly this applies to the location of S I N U S S I G M O I D E A, the direction of the channel N.F A C I A L I S and the degree of propagation of the cells of the maternity process. In the circumstances specified for the technique, circumstances are focused on the triangle sh and p about. Mr.: S P E R E D and - the rear edge of the outer hearing aid with an ust of the hearing hole on it, located above the hearing hole (Spina Suprameatum H Enle), with the CRISTA MASTOIDEA , S in the e p x - horizontal line, which is a continuation of the Zoomy Arc.
The practical value of the triangle W and p about is also in the fact that within its limits the trepanitative hole is superimposed: Z A D H I is its wall corresponds to the position of SINUS SIGMOIDEA, in E R X N I - the temporal share of the brain, p e p D N I - Channel N.Facialis. The testimony of the prepanation of the deputyid process is: acute purulent inflammation of the cells of the mastoid process (purulent mastoid), chronic inflammation of the middle ear.
This operation is the evacuation of purulent exudate, removal of granulation from the aircraft cavities of the mastoid process with inflammatory processes in it and the drainage of the resulting cavity. T e x n and to a: arcuate cut dissect soft fabrics with periosteum, retreating to 1 cm for a star from the attachment line of the ear shell. The periosteum is peeling to the sides and expose the outer surface of the presenter process. Within the triangle of ships with the help of chisels and hammers remove the cortical layer. The trepanitative opening is gradually expanding, running deep into. Perhaps, it is necessary to widely open the main cell of the mastoid process (Antrum Mastoideum) and all adjacent cells containing pus.
At the opening of a n T R u m M A S T O i D E U, the granulation of the cavity is scattered, and the bone wound is grunted, the skin wound is not sewn.
In cases of propagation of the purulent process from the cells of the maternity process on the middle ear through (Aditus ad Antrum), another opening of the cavity of the middle ear is added to the trepanation of the mining process, mainly the upper part of it is the RESESSUSUS EPITYMPANICI. As a result, one common cavity is obtained from R e C E S S s, a d i t U S and A n T R u m. Apply 2-3 silk seams, and drainage is introduced into the lower corner of the wound. Primary surgical processing of maxillofacial wounds. On the features of maxillofacial operations, N. I. Pirogov drew attention.
Surgical treatment is subject to wounds of the face and jaws in different times after injury, with the exception of the mi l to the wounds of the soft fabrics of the face and the "divers of the upper jaw.
Given the cosmetic considerations, with primary surgical processing of maxillofacial wounds, it is necessary:
Economic excision of its edges, removing only non-existence of fabrics;
Avoid damage to the nerves, vessels and duct of the parole salivary gland. Then proceed to processing the jaw tissue.
