3 курс / Топографическая анатомия и оперативная хирургия / ТАиОХ голова

Ɂɪɢɬɟɥɶɧɵɣ ɤɚɧɚɥ canalis opticus) ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɫɩɟɪɟɞɢ ɤɧɭɬɪɢ ɭ ɨɫɧɨɜɚ ɧɢɹ ɦɚɥɵɯ ɤɪɵɥɶɟɜ ɤɥɢɧɨɜɢɞɧɨɣ ɤɨɫɬɢ ɑɟɪɟɡ ɧɟɝɨ ɜ ɩɨɥɨɫɬɶ ɝɥɚɡɧɢɰɵ ɩɪɨɯɨɞɹɬ ɡɪɢɬɟɥɶɧɵɣ ɧɟɪɜ n. opticus ± II ɩɚɪɚ ɱɟɪɟɩɧɵɯ ɧɟɪɜɨɜ ɢ ɝɥɚɡɧɚɹ ɚɪɬɟɪɢɹ

ȼɟɪɯɧɹɹ ɝɥɚɡɧɢɱɧɚɹ ɳɟɥɶ fissura orbitalis superior), ɱɟɪɟɡ ɧɟɟ ɩɪɨɯɨɞɹɬ ɜ ɩɨ ɥɨɫɬɶ ɝɥɚɡɧɢɰɵ III-IV-VI ɩɚɪɵ ɢ I ɜɟɬɜɶ V ɩɚɪɵ ɱɟɪɟɩɧɵɯ ɧɟɪɜɨɜ nn. oculomotorius, trochlearis, abducens et nervus ophthalmicus ɢ ɝɥɚɡɧɵɟ ɜɟɧɵ ± vv. ophthalmicae.

Ʉɪɭɝɥɨɟ ɨɬɜɟɪɫɬɢɟ foramen rotundum) ɜɟɞɟɬ ɜ ɤɪɵɥɨ-ɧɟɛɧɭɸ ɹɦɤɭ fossa pterigopalatina ɑɟɪɟɡ ɧɟɝɨ ɩɪɨɯɨɞɢɬ ɜɟɪɯɧɢɣ ɱɟɥɸɫɬɧɨɣ ɧɟɪɜ ± II ɜɟɬɜɶ ɬɪɨɣɧɢɱ ɧɨɝɨ ɧɟɪɜɚ

Ɉɜɚɥɶɧɨɟ ɨɬɜɟɪɫɬɢɟ foramen ovale), ɱɟɪɟɡ ɧɟɝɨ ɩɨɤɢɞɚɟɬ ɩɨɥɨɫɬɶ ɱɟɪɟɩɚ ɧɢɠɧɟɱɟɥɸɫɬɧɨɣ ɧɟɪɜ n. mandibularis ± III ɜɟɬɜɶ ɬɪɨɣɧɢɱɧɨɝɨ ɧɟɪɜɚ ɉɨɫɥɟɞɧɢɣ ɢɞɟɬ ɜɦɟɫɬɟ ɫ ɞɨɛɚɜɨɱɧɨɣ ɚɪɬɟɪɢɚɥɶɧɨɣ ɜɟɬɜɶɸ ɤ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɟ ɢ ɩɨɥɭɥɭɧɧɨɦɭ ɭɡɥɭ ɬɪɨɣɧɢɱɧɨɝɨ ɧɟɪɜɚ ɢ ɫ ɜɟɧɚɦɢ ɫɜɹɡɵɜɚɸɳɢɦɢ ɤɪɵɥɨɜɢɞɧɨɟ ɜɟɧɨɡɧɨɟ ɫɩɥɟɬɟɧɢɟ ɫ ɩɟɳɟɪɢɫɬɵɦ ɫɢɧɭɫɨɦ

Ɉɫɬɢɫɬɨɟ ɨɬɜɟɪɫɬɢɟ foramen spinosum) ± ɩɪɨɩɭɫɤɚɟɬ ɜ ɩɨɥɨɫɬɶ ɱɟɪɟɩɚ ɫɪɟɞɧɸɸ ɦɟɧɢɧɝɟɚɥɶɧɭɸ ɚɪɬɟɪɢɸ ɜɦɟɫɬɟ ɫ ɜɨɡɜɪɚɬɧɨɣ ɜɟɬɜɶɸ ɧɢɠɧɟɱɟɥɸɫɬɧɨɝɨ ɧɟɪɜɚ ɢɧɧɟɪɜɢɪɭɸɳɟɣ ɬɜɟɪɞɭɸ ɦɨɡɝɨɜɭɸ ɨɛɨɥɨɱɤɭ Ɉɬ ɷɬɨɝɨ ɨɬɜɟɪɫɬɢɹ ɩɨ ɜɧɭɬ ɪɟɧɧɟɣ ɩɨɜɟɪɯɧɨɫɬɢ ɱɟɲɭɢ ɜɢɫɨɱɧɨɣ ɤɨɫɬɢ ɪɚɫɯɨɞɹɬɫɹ ɛɨɪɨɡɞɵ ɜ ɤɨɬɨɪɵɯ ɩɪɨ ɯɨɞɹɬ ɫɬɜɨɥ ɢ ɨɫɧɨɜɧɵɟ ɜɟɬɜɢ ɫɪɟɞɧɟɣ ɦɟɧɢɧɝɟɚɥɶɧɨɣ ɚɪɬɟɪɢɢ ɋɪɟɞɧɹɹ ɱɟɪɟɩɧɚɹ ɹɦɤɚ ɫɨɨɛɳɚɟɬɫɹ ɫ ɧɚɪɭɠɧɵɦ ɨɫɧɨɜɚɧɢɟɦ ɱɟɪɟɩɚ ɱɟɪɟɡ ɨɜɚɥɶɧɨɟ ɢ ɨɫɬɢɫɬɨɟ ɨɬ ɜɟɪɫɬɢɹ

Ʉɚɧɚɥ ɫɨɧɧɨɣ ɚɪɬɟɪɢɢ canalis caroticus), ɜ ɧɟɦ ɩɪɨɯɨɞɢɬ ɜɧɭɬɪɟɧɧɹɹ ɫɨɧɧɚɹ ɚɪɬɟɪɢɹ ɜ ɫɨɩɪɨɜɨɠɞɟɧɢɢ ɨɞɧɨɢɦɟɧɧɨɝɨ ɧɟɪɜɧɨɝɨ ɫɩɥɟɬɟɧɢɹ

Ʉɥɢɧɨɜɢɞɧɨ-ɤɚɦɟɧɢɫɬɚɹ ɳɟɥɶ fissura sphenopetrosa), ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɦɟɠɞɭ ɛɨɥɶɲɢɦ ɤɪɵɥɨɦ ɤɥɢɧɨɜɢɞɧɨɣ ɢ ɩɢɪɚɦɢɞɨɣ ɜɢɫɨɱɧɨɣ ɤɨɫɬɟɣ ɡɚɩɨɥɧɟɧɚ ɜɨɥɨɤ ɧɢɫɬɵɦ ɯɪɹɳɨɦ ɱɟɪɟɡ ɤɨɬɨɪɵɣ ɜ ɤɚɧɚɥ ɤɪɵɥɨɜɢɞɧɵɯ ɨɬɪɨɫɬɤɨɜ canalis pterygoideus) ɩɪɨɯɨɞɹɬ ɛɨɥɶɲɨɣ ɤɚɦɟɧɢɫɬɵɣ ɧɟɪɜ n. petrosus major ɢ ɧɟɪɟɞɤɨ ɚɧɚɫɬɨ ɦɨɡ ɫɜɹɡɵɜɚɸɳɢɣ ɤɪɵɥɨɜɢɞɧɨɟ ɜɟɧɨɡɧɨɟ ɫɩɥɟɬɟɧɢɟ ɝɥɭɛɨɤɨɣ ɨɛɥɚɫɬɢ ɥɢɰɚ ɫ ɩɟ ɳɟɪɢɫɬɵɦ ɫɢɧɭɫɨɦ ɑɟɪɟɡ ɪɚɫɳɟɥɢɧɭ ɤɚɧɚɥɚ ɦɚɥɨɝɨ ɤɚɦɟɧɢɫɬɨɝɨ ɧɟɪɜɚ ɩɪɨɯɨɞɢɬ ɨɞɧɨɢɦɟɧɧɵɣ ɧɟɪɜ

ɂɧɮɟɤɰɢɹ ɜ ɫɪɟɞɧɸɸ ɱɟɪɟɩɧɭɸ ɹɦɤɭ ɦɨɠɟɬ ɩɟɪɟɣɬɢ ɢɡ ɝɥɚɡɧɢɰɵ ɩɨ ɝɥɚɡɧɵɦ ɜɟɧɚɦ

Ɂɚɞɧɹɹ ɱɟɪɟɩɧɚɹ ɹɦɤɚ fossa cranii posterior) ɨɬɝɪɚɧɢɱɟɧɚ ɨɬ ɫɪɟɞɧɟɣ ɫɩɢɧɤɨɣ ɬɭɪɟɰɤɨɝɨ ɫɟɞɥɚ dorsum selle ɢ ɜɟɪɯɧɢɦɢ ɤɪɚɹɦɢ ɩɢɪɚɦɢɞ ɜɢɫɨɱɧɵɯ ɤɨ ɫɬɟɣ Ɉɬ ɨɫɬɚɥɶɧɨɣ ɱɚɫɬɢ ɩɨɥɨɫɬɢ ɱɟɪɟɩɚ ɨɧɚ ɨɬɞɟɥɟɧɚ ɧɚɦɟɬɨɦ ɦɨɡɠɟɱɤɚ tentorium cerebelli Ʉɨɫɬɧɭɸ ɨɫɧɨɜɭ ɷɬɨɣ ɹɦɤɢ ɨɛɪɚɡɭɸɬ ɝɥɚɜɧɵɦ ɨɛɪɚɡɨɦ ɡɚɬɵɥɨɱɧɚɹ ɤɨɫɬɶ ɢ ɱɚɫɬɢɱɧɨ ɜ ɩɟɪɟɞɧɟɦ ɨɬɞɟɥɟ ɡɚɞɧɢɟ ɩɨɜɟɪɯɧɨɫɬɢ ɩɢɪɚɦɢɞ ɜɢɫɨɱɧɵɯ ɤɨ ɫɬɟɣ ȼ ɡɚɞɧɟɣ ɱɟɪɟɩɧɨɣ ɹɦɤɟ ɪɚɫɩɨɥɨɠɟɧɵ ɦɨɡɠɟɱɨɤ cerebellum) ɦɨɫɬ pons) ɢ ɩɪɨɞɨɥɝɨɜɚɬɵɣ ɦɨɡɝ medula oblongata ȼ ɧɟɣ ɧɚɯɨɞɹɬɫɹ ɫɥɟɞɭɸɳɢɟ ɨɛɪɚɡɨɜɚɧɢɹ

ȼɧɭɬɪɟɧɧɟɟ ɫɥɭɯɨɜɨɟ ɨɬɜɟɪɫɬɢɟ porus acusticus internus). Ɉɧɨ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɧɚ ɡɚɞɧɟɣ ɩɨɜɟɪɯɧɨɫɬɢ ɩɢɪɚɦɢɞɵ ɑɟɪɟɡ ɷɬɨ ɨɬɜɟɪɫɬɢɟ ɩɪɨɯɨɞɹɬ VII-VIII ɩɚɪɵ ɱɟɪɟɩɧɵɯ ɧɟɪɜɨɜ n. facialis et n.vestibulocochlearis ɩɪɨɦɟɠɭɬɨɱɧɵɣ ɧɟɪɜ n. intermedius) ɢ ɜɟɬɜɶ ɜɧɭɬɪɟɧɧɟɝɨ ɫɥɭɯɨɜɨɝɨ ɩɪɨɯɨɞɚ r. meatus acustici interni) ɫ ɨɞ ɧɨɢɦɟɧɧɨɣ ɜɟɧɨɣ

əɪɟɦɧɨɟ ɨɬɜɟɪɫɬɢɟ for. jugulare). ɑɟɪɟɡ ɩɟɪɟɞɧɸɸ ɱɚɫɬɶ ɟɝɨ ɢɡ ɩɨɥɨɫɬɢ ɱɟ ɪɟɩɚ ɜɵɯɨɞɹɬ ɱɟɪɟɩɧɵɟ ɧɟɪɜɵ ɹɡɵɤɨ-ɝɥɨɬɨɱɧɵɣ n.glossopharyngeus ± IX), ɛɥɭɠ

11

ɞɚɸɳɢɣ n. vagus ± X ɢ ɞɨɛɚɜɨɱɧɵɣ n. accessorius Willis ± XI) Ȼɨɥɟɟ ɲɢɪɨɤɚɹ ɡɚɞɧɹɹ ɱɚɫɬɶ ɹɜɥɹɟɬɫɹ ɦɟɫɬɨɦ ɧɚɱɚɥɚ ɜɧɭɬɪɟɧɧɟɣ ɹɪɟɦɧɨɣ ɜɟɧɵ v. jugularis interna) ɉɨɫɥɟɞɧɹɹ ɫɨɛɢɪɚɟɬ ɜɟɧɨɡɧɭɸ ɤɪɨɜɶ ɢɡ ɜɫɟɯ ɩɚɡɭɯ ɩɨɥɨɫɬɢ ɱɟɪɟɩɚ

Ȼɨɥɶɲɨɟ ɨɬɜɟɪɫɬɢɟ ɡɚɬɵɥɨɱɧɨɣ ɤɨɫɬɢ (for. magnum os occipitale) ɡɚɧɢɦɚɟɬ ɰɟɧɬɪɚɥɶɧɭɸ ɱɚɫɬɶ ɡɚɞɧɟɣ ɱɟɪɟɩɧɨɣ ɹɦɤɢ ɑɟɪɟɡ ɧɟɝɨ ɩɪɨɯɨɞɹɬ ɩɪɨɞɨɥɝɨɜɚɬɵɣ ɦɨɡɝ ɫ ɟɝɨ ɨɛɨɥɨɱɤɚɦɢ ɞɜɟ ɩɨɡɜɨɧɨɱɧɵɟ ɚɪɬɟɪɢɢ a. vertebrales) ɜɟɧɨɡɧɵɟ ɫɩɥɟɬɟ ɧɢɹ ɪɚɫɩɨɥɚɝɚɸɳɢɟɫɹ ɜɧɭɬɪɢ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɢ plexus basilaris et sinus marginalis ɚ ɬɚɤɠɟ ɫɩɢɧɧɨ-ɦɨɡɝɨɜɵɟ ɤɨɪɟɲɤɢ ɞɨɛɚɜɨɱɧɨɝɨ ɧɟɪɜɚ

Ʉɚɧɚɥ ɩɨɞɴɹɡɵɱɧɨɝɨ ɧɟɪɜɚ canalis hypoglossi). ȿɝɨ ɨɬɜɟɪɫɬɢɟ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɩɨɞ ɹɪɟɦɧɵɦ ɛɭɝɨɪɤɨɦ ɑɟɪɟɡ ɤɚɧɚɥ ɩɪɨɯɨɞɢɬ ɩɨɞɴɹɡɵɱɧɵɣ ɧɟɪɜ Q K\SRJORVVXV ±

XII).

Ɍɜɟɪɞɚɹ ɦɨɡɝɨɜɚɹ ɨɛɨɥɨɱɤɚ dura mater encephali) ȼɵɫɬɢɥɚɟɬ ɩɨɥɨɫɬɶ ɱɟ ɪɟɩɚ ɢɡɧɭɬɪɢ ɪɵɯɥɨ ɫɜɹɡɚɧɨ ɫ ɤɨɫɬɹɦɢ ɜ ɨɛɥɚɫɬɢ ɫɜɨɞɚ ɝɞɟ ɥɟɝɤɨ ɨɬɫɥɚɢɜɚɟɬɫɹ ɢ ɩɥɨɬɧɨ ɫɪɚɳɟɧɚ ɫ ɜɧɭɬɪɟɧɧɢɦ ɨɫɧɨɜɚɧɢɟɦ ɱɟɪɟɩɚ ɨɫɨɛɟɧɧɨ ɜ ɨɛɥɚɫɬɢ ɲɜɨɜ ɨɬ ɜɟɪɫɬɢɣ ɢ ɛɭɝɨɪɤɨɜ ɓɟɥɶ ɦɟɠɞɭ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɨɣ ɢ ɤɨɫɬɹɦɢ ɱɟɪɟɩɚ ɧɚɡɵɜɚɟɬɫɹ ɷɩɢɞɟɪɚɥɶɧɵɦ ɩɪɨɫɬɪɚɧɫɬɜɨɦ cavum epidurale Ɍɜɟɪɞɚɹ ɦɨɡɝɨɜɚɹ ɨɛɨɥɨɱɤɚ ± ɩɥɨɬɧɚɹ ɮɢɛɪɨɡɧɚɹ ɩɥɚɫɬɢɧɤɚ ɫɨɫɬɨɹɳɚɹ ɢɡ ɞɜɭɯ ɥɢɫɬɤɨɜ Ɉɛɚ ɥɢɫɬɤɚ ɪɚɡɞɟɥɟɧɵ ɩɪɨɫɥɨɣɤɨɣ ɪɵɯɥɨɣ ɫɨɟɞɢɧɢɬɟɥɶɧɨɣ ɬɤɚɧɢ ɢ ɫɪɚɜɧɢɬɟɥɶɧɨ ɥɟɝɤɨ ɪɚɫ ɫɥɚɢɜɚɸɬɫɹ Ɍɜɟɪɞɚɹ ɦɨɡɝɨɜɚɹ ɨɛɨɥɨɱɤɚ ɢɦɟɟɬ ɬɪɢ ɨɬɪɨɫɬɤɚ ɋɟɪɩ ɦɨɡɝɚ falx cerebri ɪɚɫɩɨɥɨɠɟɧ ɜ ɫɚɝɢɬɬɚɥɶɧɨɣ ɩɥɨɫɤɨɫɬɢ ɩɪɨɯɨɞɢɬ ɩɨ ɫɪɟɞɧɟɣ ɥɢɧɢɢ ɫɜɨɞɚ ɱɟ ɪɟɩɚ ɢɥɢ ɧɟɫɤɨɥɶɤɨ ɜɩɪɚɜɨ ɨɬ ɧɟɟ Ɉɧ ɬɹɧɟɬɫɹ ɨɬ ɩɟɬɭɲɢɧɧɨɝɨ ɝɪɟɛɧɹ ɞɨ ɜɧɭɬɪɟɧ ɧɟɝɨ ɡɚɬɵɥɨɱɧɨɝɨ ɛɭɝɪɚ ɪɚɡɞɟɥɹɟɬ ɩɨɥɭɲɚɪɢɹ ɦɨɡɝɚ ɢ ɫɜɨɛɨɞɧɵɦ ɤɪɚɟɦ ɞɨɫɬɢɝɚɟɬ ɦɨɡɨɥɢɫɬɨɝɨ ɬɟɥɚ

ɇɚɦɟɬ ɦɨɡɠɟɱɤɚ tentorium cerebelli ɩɪɟɞɫɬɚɜɥɹɟɬ ɫɨɛɨɣ ɝɨɪɢɡɨɧɬɚɥɶɧɨ ɢɞɭ ɳɭɸ ɩɥɚɫɬɢɧɤɭ ɤɨɬɨɪɚɹ ɫɜɟɪɯɭ ɩɨ ɫɪɟɞɧɟɣ ɥɢɧɢɢ ɫɪɚɫɬɚɟɬɫɹ ɫ ɡɚɞɧɢɦ ɨɬɞɟɥɨɦ ɫɟɪɩɚ ɦɨɡɝɚ ȼ ɷɬɨɦ ɦɟɫɬɟ ɧɚɦɟɬ ɦɨɡɠɟɱɤɚ ɩɪɢɩɨɞɧɢɦɚɟɬɫɹ ɢ ɩɪɢɨɛɪɟɬɚɟɬ ɮɨɪɦɭ ɲɚɬɪɚ ɋɡɚɞɢ ɧɚɦɟɬ ɩɪɢɤɪɟɩɥɹɟɬɫɹ ɤ ɡɚɬɵɥɨɱɧɨɣ ɤɨɫɬɢ ɜ ɨɛɥɚɫɬɢ ɩɨɩɟɪɟɱɧɵɯ ɛɨ ɪɨɡɞ ɫ ɛɨɤɨɜ ± ɤ ɜɟɪɯɧɢɦ ɝɪɚɧɹɦ ɩɢɪɚɦɢɞ ɜɢɫɨɱɧɵɯ ɤɨɫɬɟɣ ɚ ɫɩɟɪɟɞɢ ɞɨɯɨɞɢɬ ɞɨ ɤɥɢɧɨɜɢɞɧɵɯ ɨɬɪɨɫɬɤɨɜ ɨɫɧɨɜɧɨɣ ɤɨɫɬɢ ɉɟɪɟɞɧɢɣ ɤɪɚɣ ɧɚɦɟɬɚ ɜɨɝɧɭɬ ɢ ɨɝɪɚɧɢ ɱɢɜɚɟɬ ɨɬɜɟɪɫɬɢɟ ɱɟɪɟɡ ɤɨɬɨɪɨɟ ɩɪɨɯɨɞɢɬ ɫɬɜɨɥɨɜɚɹ ɱɚɫɬɶ ɦɨɡɝɚ ɇɚɦɟɬ ɦɨɡɠɟɱɤɚ ɨɬɞɟɥɹɟɬ ɡɚɬɵɥɨɱɧɵɟ ɞɨɥɢ ɨɬ ɦɨɡɠɟɱɤɚ

ɋɟɪɩ ɦɨɡɠɟɱɤɚ falx cerebelli ɬɹɧɟɬɫɹ ɩɨ ɫɪɟɞɧɟɣ ɥɢɧɢɢ ɨɬ ɜɧɭɬɪɟɧɧɟɝɨ ɡɚɬɵ ɥɨɱɧɨɝɨ ɛɭɝɪɚ ɞɨ ɡɚɞɧɟɝɨ ɤɪɚɹ ɛɨɥɶɲɨɝɨ ɡɚɬɵɥɨɱɧɨɝɨ ɨɬɜɟɪɫɬɢɹ ɋɜɟɪɯɭ ɨɧ ɫɪɚɫ ɬɚɟɬɫɹ ɫ ɧɢɠɧɟɣ ɩɨɜɟɪɯɧɨɫɬɶɸ ɦɨɡɠɟɱɤɨɜɨɝɨ ɧɚɦɟɬɚ ɋɟɪɩ ɦɨɡɠɟɱɤɚ ɩɪɨɯɨɞɢɬ ɦɟɠɞɭ ɩɨɥɭɲɚɪɢɹɦɢ ɦɨɡɠɟɱɤɚ

ɋɢɧɭɫɵ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɢ Ɉɬɪɨɫɬɤɢ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɢ ɫɨɫɬɨɹɬ ɢɡ ɞɜɭɯ ɥɢɫɬɤɨɜ Ɋɚɫɳɟɩɥɹɹɫɶ ɨɧɢ ɨɛɪɚɡɭɸɬ ɜɟɧɨɡɧɵɟ ɩɚɡɭɯɢ ± ɫɢɧɭɫɵ ɤɨɬɨɪɵɟ ɨɬɜɨɞɹɬ ɤɪɨɜɶ ɨɬ ɝɨɥɨɜɧɨɝɨ ɦɨɡɝɚ ɜɨ ɜɧɭɬɪɟɧɧɸɸ ɹɪɟɦɧɭɸ ɜɟɧɭ ȼɧɭɬ ɪɢɱɟɪɟɩɧɵɟ ɜɟɧɨɡɧɵɟ ɫɢɧɭɫɵ ɦɨɠɧɨ ɩɨɞɪɚɡɞɟɥɢɬɶ ɧɚ ɫɢɧɭɫɵ ɤɪɵɲɢ ɱɟɪɟɩɚɜɟɪɯɧɢɣ ɢ ɧɢɠɧɢɣ ɫɚɝɢɬɬɚɥɶɧɵɟ ɫɢɧɭɫɵ ɩɪɹɦɨɣ ɫɢɧɭɫ ɢ ɫɢɧɭɫɵ ɨɫɧɨɜɚɧɢɹ ɱɟ ɪɟɩɚ ɡɚɬɵɥɨɱɧɵɣ ɩɟɳɟɪɢɫɬɵɟ ɤɚɦɟɧɢɫɬɵɟ ɩɨɩɟɪɟɱɧɵɟ ɫɢɝɦɨɜɢɞɧɵɟ

ȼɟɪɯɧɢɣ ɫɚɝɢɬɬɚɥɶɧɵɣ ɫɢɧɭɫ sinus sagittalis superior ɪɚɫɩɨɥɨɠɟɧ ɜ ɜɟɪɯɧɟɦ ɤɪɚɟ ɫɟɪɩɚ ɦɨɡɝɚ ɩɪɢɤɪɟɩɥɹɸɳɟɦɫɹ ɤ ɨɞɧɨɢɦɟɧɧɨɣ ɛɨɪɨɡɞɟ ɫɜɨɞɚ ɱɟɪɟɩɚ ɨɬ ɩɟ ɬɭɲɢɧɨɝɨ ɝɪɟɛɧɹ ɞɨ ɜɧɭɬɪɟɧɧɟɝɨ ɡɚɬɵɥɨɱɧɨɝɨ ɜɨɡɜɵɲɟɧɢɹ ɪɢɫ 4.7) ɇɢɠɧɢɣ ɫɚ ɝɢɬɬɚɥɶɧɵɣ ɫɢɧɭɫ sinus sagittalis inferior ɩɪɨɯɨɞɢɬ ɩɨ ɧɢɠɧɟɦɭ ɜɨɝɧɭɬɨɦɭ ɤɪɚɸ ɫɟɪɩɚ ɢ ɜɩɚɞɚɟɬ ɜ ɩɪɹɦɨɣ ɫɢɧɭɫ sinus rectus ɤɨɬɨɪɵɣ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɧɚ ɫɬɵɤɟ

12

ɫɟɪɩɚ ɦɨɡɝɚ ɢ ɩɚɥɚɬɤɢ ɦɨɡɠɟɱɤɚ ɗɬɨɬ ɫɢɧɭɫ ɫɨɛɢɪɚɟɬ ɜɟɧɨɡɧɭɸ ɤɪɨɜɶ ɨɬ ɦɨɡɝɚ ɝɥɚɜɧɵɦ ɨɛɪɚɡɨɦ ɱɟɪɟɡ ɛɨɥɶɲɭɸ ɜɟɧɭ ɦɨɡɝɚ

Ɂɚɬɵɥɨɱɧɵɣ ɫɢɧɭɫ sinus occipitalis ɥɟɠɢɬ ɜ ɡɚɞɧɟɣ ɱɟɪɟɩɧɨɣ ɹɦɤɟ ɭ ɨɫɧɨɜɚ ɧɢɹ ɫɟɪɩɚ ɦɨɡɠɟɱɤɚ ɫɨɛɢɪɚɟɬ ɜɟɧɨɡɧɭɸ ɤɪɨɜɶ ɨɬ ɦɨɡɠɟɱɤɚ ɪɢɫ 4.8) ɉɨɩɟɪɟɱ ɧɵɣ ɫɢɧɭɫ sinus transversus) ɩɚɪɧɵɣ ɪɚɫɩɨɥɨɠɟɧ ɜ ɨɞɧɨɢɦɟɧɧɨɣ ɛɨɪɨɡɞɟ ɜ ɦɟɫɬɟ ɩɪɢɤɪɟɩɥɟɧɢɹ ɦɨɡɠɟɱɤɨɜɨɝɨ ɧɚɦɟɬɚ ɇɚ ɩɨɤɪɨɜɵ ɩɪɨɟɰɢɪɭɟɬɫɹ ɩɨ ɜɟɪɯɧɟɣ ɜɵɣ ɧɨɣ ɥɢɧɢɢ ɍ ɫɨɫɰɟɜɢɞɧɨɝɨ ɭɝɥɚ ɬɟɦɟɧɧɨɣ ɤɨɫɬɢ ɨɧ ɤɪɭɬɨ ɩɨɜɨɪɚɱɢɜɚɟɬ ɢ ɩɟɪɟɯɨ ɞɢɬ ɜ ɫɢɝɦɨɜɢɞɧɭɸ ɩɚɡɭɯɭ Ɉɛɚ ɩɨɩɟɪɟɱɧɵɯ ɜɟɪɯɧɢɣ ɫɚɝɢɬɬɚɥɶɧɵɣ ɡɚɬɵɥɨɱɧɵɣ ɢ ɩɪɹɦɨɣ ɫɢɧɭɫɵ ɫɥɢɜɚɸɬɫɹ ɜ ɨɛɥɚɫɬɢ ɜɧɭɬɪɟɧɧɟɝɨ ɡɚɬɵɥɨɱɧɨɝɨ ɛɭɝɪɚ ɗɬɨ ɦɟɫɬɨ ɫɥɢɹɧɢɹ ɧɚɡɵɜɚɟɬɫɹ ɫɢɧɭɫɨɜɵɦ ɫɬɨɤɨɦ confluens sinuum).

ɋɢɝɦɨɜɢɞɧɵɣ ɫɢɧɭɫ sinus sigmoideus ɹɜɥɹɟɬɫɹ ɩɪɹɦɵɦ ɩɪɨɞɨɥɠɟɧɢɟɦ ɩɨɩɟ ɪɟɱɧɨɝɨ ɗɬɨ ɬɨɠɟ ɩɚɪɧɵɣ ɫɢɧɭɫ Ɉɧ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɜ ɛɨɪɨɡɞɟ ɫɢɝɦɨɜɢɞɧɨɝɨ ɫɢɧɭ ɫɚ sul. sinus sigmoidei ɢ ɜ ɨɛɥɚɫɬɢ ɹɪɟɦɧɨɝɨ ɨɬɜɟɪɫɬɢɹ ɩɟɪɟɯɨɞɢɬ ɜɨ ɜɧɭɬɪɟɧɧɸɸ ɹɪɟɦɧɭɸ ɜɟɧɭ

ȼɟɪɯɧɢɣ ɤɚɦɟɧɢɫɬɵɣ ɫɢɧɭɫ sinus petrosus superior) ɩɪɨɯɨɞɢɬ ɜ ɨɞɧɨɢɦɟɧɧɨɣ ɛɨɪɨɡɞɟ ɩɨ ɜɟɪɯɧɟɦɭ ɤɪɚɸ ɩɢɪɚɦɢɞɵ ɜɢɫɨɱɧɨɣ ɤɨɫɬɢ ɜɩɚɞɚɟɬ ɜ ɫɢɝɦɨɜɢɞɧɵɣ ɫɢ ɧɭɫ ɜ ɦɟɫɬɟ ɩɟɪɟɯɨɞɚ ɜ ɧɟɝɨ ɩɨɩɟɪɟɱɧɨɝɨ

ɇɢɠɧɢɣ ɤɚɦɟɧɢɫɬɵɣ ɫɢɧɭɫ sinus petrosus inferior) ɥɟɠɢɬ ɜ ɧɢɠɧɟɣ ɤɚɦɟɧɢɫɬɨɣ ɛɨɪɨɡɞɟ ɭ ɡɚɞɧɟɝɨ ɤɪɚɹ ɩɢɪɚɦɢɞɵ ɜɢɫɨɱɧɨɣ ɤɨɫɬɢ ɜɥɢɜɚɟɬɫɹ ɜ ɫɢɝɦɨɜɢɞɧɭɸ ɩɚɡɭ ɯɭ ɜɛɥɢɡɢ ɜɧɭɬɪɟɧɧɟɣ ɹɪɟɦɧɨɣ ɜɟɧɵ

Ɋɢɫ 4.7. ɋɢɧɭɫɵ ɬɜɟɪɞɨɣ ɦɨɡɝɨ ɜɨɣ ɨɛɨɥɨɱɤɢɩɨ ɇɟɬɬɟɪɭ ɫ ɢɡɦɟɧɟɧɢɹɦɢ

1 ² falx cerebri;

2, 15 ² sinus sagittalis superior; 3 ² sinus sagittalis inferior;

4 ² sinus sphenoparietalis;

5 ² sinus intercavernosi;

6 ² sinus petrosus inferior;

7 ² sinus occipitalis;

8 ² sinus sigmoideus;

9 ² sinus transversus;

10 ² confluens sinuum;

11 ² sinus rectus;

12 ² sinus petrosus superior;

13 ² v. magna cerebri (Galeni);

14 ² tentorium cerebelli.

13

Ɋɢɫ 4.8 ɋɢɧɭɫɵ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱ ɤɢ

ɉɨ ɨɛɟɢɦ ɫɬɨɪɨɧɚɦ ɬɭɪɟɰɤɨɝɨ ɫɟɞɥɚ ɪɚɫɩɨɥɨɠɟɧ ɩɚɪɧɵɣ ɩɟɳɟɪɢɫɬɵɣ ɫɢɧɭɫ (sinus cavernosus) ɪɢɫ 4.9) ɉɪɚɜɵɣ ɢ ɥɟɜɵɣ ɫɢɧɭɫɵ ɫɩɟɪɟɞɢ ɢ ɫɡɚɞɢ ɫɨɟɞɢɧɹɸɬɫɹ ɦɟɠɞɭ ɫɨɛɨɣ ɦɟɠɩɟɳɟɪɢɫɬɵɦɢ ɫɢɧɭɫɚɦɢ sinus intercavernosus anterior et posterior ȼ ɩɟɳɟɪɢɫɬɵɣ ɫɢɧɭɫ ɜɩɚɞɚɸɬ ɝɥɚɡɧɵɟ ɜɟɧɵ vv. ophthalmicae), ɫɜɹɡɵ ɜɚɸɳɢɟ ɷɬɭ ɩɚɡɭɯɭ ɫ ɩɨɜɟɪɯɧɨɫɬɧɵɦɢ ɜɟɧɚɦɢ ɥɢɰɚ ɭɝɥɨɜɚɹ ɜɟɧɚ ± v. jugularis ɢ ɝɥɭɛɨɤɨ ɡɚɥɟɝɚɸɳɢɦ ɤɪɵɥɨɜɢɞɧɵɦ ɜɟɧɨɡɧɵɦ ɫɩɥɟɬɟɧɢɟɦ plexus (venosus) pterygoideus ɉɟɳɟɪɢɫɬɵɣ ɫɢɧɭɫ ɱɟɪɟɡ ɜɟɪɯɧɸɸ ɢ ɧɢɠɧɸɸ ɤɚɦɟɧɢɫɬɵɟ ɩɚɡɭɯɢ ɫɨɨɛ ɳɚɟɬɫɹ ɫ ɫɢɝɦɨɜɢɞɧɵɦ ɫɢɧɭɫɨɦ

ɑɟɪɟɡ ɩɟɳɟɪɢɫɬɵɣ ɫɢɧɭɫ ɩɪɨɯɨɞɹɬ ɜɧɭɬɪɟɧɧɹɹ ɫɨɧɧɚɹ ɚɪɬɟɪɢɹ a. carotis interna) ɢ ɨɬɜɨɞɹɳɢɣ ɧɟɪɜ n. abducens ± VI Ƚɥɚɡɨɞɜɢɝɚɬɟɥɶɧɵɣ n. oculomotorius ± III) ɛɥɨɤɨɜɢɞɧɵɣ n. trochlearis ± IV ɢ ɝɥɚɡɧɨɣ n. ophthalmicus ± I ɜɟɬɜɶ n. trigeminus ɧɟɪɜɵ ɩɪɢɥɟɠɚɬ ɤ ɟɝɨ ɥɚɬɟɪɚɥɶɧɨɣ ɫɬɟɧɤɟ ɉɨɥɭɥɭɧɧɵɣ ɭɡɟɥ ɬɪɨɣɧɢɱɧɨɝɨ ɧɟɪɜɚ gang. semilunare nervi trigemini s. ganglion Gasseri ɩɪɢɥɟɠɢɬ ɤ ɡɚɞɧɟɦɭ ɨɬ ɞɟɥɭ ɩɟɳɟɪɢɫɬɨɝɨ ɫɢɧɭɫɚ Ʉ ɩɟɪɟɞɧɟɦɭ ɟɝɨ ɨɬɞɟɥɭ ɩɨɞɯɨɞɢɬ ɠɢɪɨɜɚɹ ɤɥɟɬɱɚɬɤɚ ɜɵɩɨɥɧɹɸɳɚɹ ɤɪɵɥɨɧɟɛɧɭɸ ɹɦɤɭ ɢ ɹɜɥɹɸɳɚɹɫɹ ɩɪɨɞɨɥɠɟɧɢɟɦ ɠɢɪɨɜɨɝɨ ɤɨɦɤɚ ɳɟɤɢ

14

Ɋɢɫ 4.9. ɉɟɳɟɪɢɫɬɵɣ ɫɢ ɧɭɫ ɮɪɨɧɬɚɥɶɧɵɣ ɫɪɟɡ ɩɨ ɇɟɬɬɟɪɭ ɫ ɢɡɦɟɧɟɧɢɹɦɢ

1 ² a. communicans posterior;

2 ² n. oculomotorius (III ɩɚɪɚ);

3 ² n. troch-learis (IV ɩɚɪɚ);

4 ² n. ophthalmicus (I ɜɟɬɜɶ ɬɪɨɣɧɢɱɧɨɝɨ ɧɟɪɜɚ

5 ² n. maxillaris (II ɜɟɬɜɶ ɬɪɨɣ ɧɢɱɧɨɝɨ ɧɟɪɜɚ

6 ² n. abducens (VI ɩɚɪɚ);

7 ² hypophysis; 8 ² pars nasalis pharyngis; 9 ² sinus sphenoidalis; 10 ² sinus caver-nosus;

11 ² a. carotis interna;

12 ² chiasma opticum.

Ɉɬ ɦɨɡɝɚ ɢ ɨɬ ɱɟɪɟɩɚ ɤɪɨɜɶ ɨɬɬɟɤɚɟɬ ɩɨ ɜɧɭɬɪɟɧɧɢɦ ɹɪɟɦɧɵɦ ɢ ɩɨɡɜɨɧɨɱɧɵɦ ɜɟɧɚɦ vv. jugulares internae et vv. vertebrales ɢ ɦɧɨɝɨɱɢɫɥɟɧɧɵɦ ɜɟɧɚɦ ɠɢɪɨɜɨɣ ɤɥɟɬɱɚɬɤɢ ɩɟɪɢɞɭɪɚɥɶɧɨɝɨ ɩɪɨɫɬɪɚɧɫɬɜɚ Ɉɬɬɨɤ ɤɪɨɜɢ ɨɬ ɤɨɫɬɟɣ ɤɪɵɲɢ ɢ ɨɫɧɨɜɚ ɧɢɹ ɱɟɪɟɩɚ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɢ ɩɪɨɢɫɯɨɞɢɬ ɩɨ ɜɟɪɯɧɟɦɭ ɢ ɧɢɠɧɟɦɭ ɫɚ ɝɢɬɬɚɥɶɧɵɦ ɫɢɧɭɫɚɦ ɚ ɬɚɤɠɟ ɩɨ ɡɚɬɵɥɨɱɧɨɦɭ ɜɟɪɯɧɟɦɭ ɢ ɧɢɠɧɟɦɭ ɤɚɦɟɧɢɫɬɨɦɭ ɫɢɧɭɫɚɦ Ɇɟɫɬɨɦ ɫɨɟɞɢɧɟɧɢɹ ɜɟɧɨɡɧɵɯ ɫɢɧɭɫɨɜ ɤɪɵɲɢ ɢ ɨɫɧɨɜɚɧɢɹ ɱɟɪɟɩɚ ɹɜɥɹ ɟɬɫɹ ɫɢɧɭɫɨɜɵɣ ɫɬɨɤ ɤɭɞɚ ɬɚɤɠɟ ɩɨɫɬɭɩɚɟɬ ɜɟɧɨɡɧɚɹ ɤɪɨɜɶ ɨɬ ɦɨɡɝɚ ɱɟɪɟɡ ɛɨɥɶ ɲɭɸ ɦɨɡɝɨɜɭɸ ɜɟɧɭ v. cerebri magni Galeni Ɉɬ ɫɢɧɭɫɨɜɨɝɨ ɫɬɨɤɚ ɨɬɬɨɤ ɩɪɨɢɫɯɨ ɞɢɬ ɜ ɝɨɪɢɡɨɧɬɚɥɶɧɨɦ ɧɚɩɪɚɜɥɟɧɢɢ ɩɨ ɩɨɩɟɪɟɱɧɵɦ ɫɢɧɭɫɚɦ ɤɨɬɨɪɵɟ ɩɟɪɟɯɨɞɹɬ ɫ ɤɚɠɞɨɣ ɫɬɨɪɨɧɵ ɜ ɫɢɝɦɨɜɢɞɧɵɟ ɫɢɧɭɫɵ ɉɨɫɥɟɞɧɢɟ ɩɪɢɧɢɦɚɸɬ ɜ ɫɟɛɹ ɜɟɪɯɧɢɟ ɢ ɧɢɠɧɢɟ ɤɚɦɟɧɢɫɬɵɟ ɫɢɧɭɫɵ ɚ ɜ ɧɢɯ ɜ ɫɜɨɸ ɨɱɟɪɟɞɶ ɜɩɚɞɚɸɬ ɜɟɧɵ Ɍɪɨɥɚɪɚ ɢ Ʌɚɛ ɛɟ ɨɬ ɜɟɪɯɧɟɧɚɪɭɠɧɨɣ ɜɵɩɭɤɥɨɣ ɫɬɨɪɨɧɵ ɩɨɥɭɲɚɪɢɣ ɦɨɡɝɚ ɢ ɢɡ ɜɟɪɯɧɟɝɨ ɫɚɝɢɬ ɬɚɥɶɧɨɝɨ ɫɢɧɭɫɚ ɚ ɬɚɤɠɟ ɨɬ ɛɨɤɨɜɵɯ ɩɟɳɟɪɢɫɬɵɯ ɫɢɧɭɫɨɜ ɉɟɪɟɞɧɢɣ ɦɟɠɩɟɳɟɪɢ ɫɬɵɣ ɫɢɧɭɫ ɩɪɢɧɢɦɚɟɬ ɜ ɫɟɛɹ ɜɟɧɨɡɧɵɟ ɫɢɧɭɫɵ ɦɚɥɵɯ ɤɪɵɥɶɟɜ ɤɪɵɥɨɜɢɞɧɨɣ ɤɨ ɫɬɢ sinus venosus alae parvae ossis sphenoidalis ɢ ɝɥɚɡɧɵɟ ɜɟɧɵ Ɉɫɧɨɜɧɨɣ ɨɬɬɨɤ ɜɫɟɣ ɜɟɧɨɡɧɨɣ ɤɪɨɜɢ ɢɡ ɱɟɪɟɩɚ ɩɪɨɢɫɯɨɞɢɬ ɱɟɪɟɡ ɹɪɟɦɧɨɟ ɨɬɜɟɪɫɬɢɟ ɂɡ ɱɟɪɟɩɚ ɤɪɨɜɶ ɬɚɤɠɟ ɨɬɬɟɤɚɟɬ ɩɨ ɩɨɡɜɨɧɨɱɧɵɦ ɜɟɧɚɦ ɩɨ ɜɟɧɨɡɧɨɦɭ ɷɩɢɞɭɪɚɥɶɧɨɦɭ ɫɩɥɟ ɬɟɧɢɸ ɫɩɢɧɧɨɦɨɡɝɨɜɨɝɨ ɤɚɧɚɥɚ Ȼɨɥɶɲɨɟ ɡɧɚɱɟɧɢɟ ɢɦɟɸɬ ɦɧɨɝɨɱɢɫɥɟɧɧɵɟ ɷɦɢɫ ɫɚɪɧɵɟ ɜɟɧɵ vv. emissariae) ɩɨɫɪɟɞɫɬɜɨɦ ɤɨɬɨɪɵɯ ɫɢɧɭɫɵ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨ ɥɨɱɤɢ ɫɨɨɛɳɚɸɬɫɹ ɫ ɞɢɩɥɨɷɬɢɱɟɫɤɢɦɢ ɢ ɜɧɟɱɟɪɟɩɧɵɦɢ ɜɟɧɚɦɢ Ƚɥɚɜɧɵɟ ɢɡ ɷɦɢɫ ɫɚɪɧɵɯ ɜɟɧ ɬɟɦɟɧɧɚɹ ɷɦɢɫɫɚɪɧɚɹ ɜɟɧɚ v. emissaria parietalis) ± ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɩɨ ɫɬɨɪɨɧɚɦ ɫɚɝɢɬɬɚɥɶɧɨɝɨ ɲɜɚ ɢ ɫɨɨɛɳɚɟɬ ɜɟɧɵ ɫɜɨɞɚ ɱɟɪɟɩɚ ɫ ɜɟɪɯɧɢɦ ɫɚɝɢɬɬɚɥɶ ɧɵɦ ɫɢɧɭɫɨɦ ɡɚɬɵɥɨɱɧɚɹ ɷɦɢɫɫɚɪɧɚɹ ɜɟɧɚ v. emissaria occipitalis) ± ɧɚɯɨɞɢɬɫɹ ɧɚ ɡɚɬɵɥɨɱɧɨɣ ɱɟɲɭɟ ɜ ɨɛɥɚɫɬɢ ɧɚɪɭɠɧɨɝɨ ɡɚɬɵɥɨɱɧɨɝɨ ɜɵɫɬɭɩɚ ɢɥɢ ɩɨ ɫɬɨɪɨɧɚɦ ɟɝɨ ɜ ɨɛɥɚɫɬɢ ɜɟɪɯɧɟɣ ɜɵɣɧɨɣ ɥɢɧɢɢ ɗɬɚ ɜɟɧɚ ɫɨɨɛɳɚɟɬ ɡɚɬɵɥɨɱɧɵɟ ɜɟɧɵ ɫ ɩɨ ɩɟɪɟɱɧɵɦ ɫɢɧɭɫɨɦ ɢɥɢ ɫɢɧɭɫɨɜɵɦ ɫɬɨɤɨɦ ɫɨɫɰɟɜɢɞɧɚɹ ɷɦɢɫɫɚɪɧɚɹ ɜɟɧɚ v. emissaria mastoidea ɢɧɨɝɞɚ ɦɨɠɟɬ ɛɵɬɶ ɩɨ ɧɟɫɤɨɥɶɤɨ ɜɟɧ ɫ ɤɚɠɞɨɣ ɫɬɨɪɨɧɵ ± ɪɚɫɩɨ ɥɚɝɚɟɬɫɹ ɧɚ ɡɚɞɧɟɣ ɩɨɜɟɪɯɧɨɫɬɢ ɫɨɫɰɟɜɢɞɧɨɝɨ ɨɬɪɨɫɬɤɚ ɩɨ ɥɢɧɢɢ ɡɚɬɵɥɨɱɧɨɫɨɫɰɟɜɢɞɧɨɝɨ ɲɜɚ ɢɥɢ ɜɛɥɢɡɢ ɟɝɨ ɋɨɟɞɢɧɹɟɬ ɡɚɬɵɥɨɱɧɵɟ ɜɟɧɵ ɫ ɫɢɝɦɨɜɢɞɧɵɦ ɫɢɧɭɫɨɦ ɦɵɳɟɥɤɨɜɚɹ ɷɦɢɫɫɚɪɧɚɹ ɜɟɧɚ v. emissaria condylaris) ± ɩɪɨɯɨɞɢɬ ɱɟɪɟɡ ɦɵɳɟɥɤɨɜɵɣ ɤɚɧɚɥ canalis condylaris ɉɨɫɪɟɞɫɬɜɨɦ ɷɬɨɣ ɜɟɧɵ ɨɫɭɳɟɫɬɜɥɹɟɬɫɹ ɫɜɹɡɶ ɡɚɬɵɥɨɱɧɵɯ ɢɥɢ ɝɥɭɛɨɤɢɯ ɜɟɧ ɲɟɢ ɫ ɧɢɠɧɟɣ ɱɚɫɬɶɸ ɫɢɝɦɨɜɢɞɧɨɝɨ ɫɢɧɭɫɚ

15

ɷɦɢɫɫɚɪɧɚɹ ɜɟɧɚ ɫɥɟɩɨɝɨ ɨɬɜɟɪɫɬɢɹ v. emissaria foramen caeci) ± ɫɨɟɞɢɧɹɟɬ ɜɟɧɵ ɩɨɞɫɥɢɡɢɫɬɨɝɨ ɫɥɨɹ ɧɨɫɨɜɨɣ ɩɨɥɨɫɬɢ ɫ ɩɟɪɟɞɧɢɦ ɨɬɞɟɥɨɦ ɜɟɪɯɧɟɝɨ ɫɚɝɢɬɬɚɥɶɧɨɝɨ ɫɢɧɭɫɚ

Ʉɪɨɦɟ ɭɤɚɡɚɧɧɵɯ ɜɵɩɭɫɤɧɢɤɨɜ ɫɭɳɟɫɬɜɭɸɬ ɢ ɞɪɭɝɢɟ ɤɨɬɨɪɵɟ ɨɛɪɚɡɭɸɬ ɱɚ ɳɟ ɜɫɟɝɨ ɜɟɧɨɡɧɵɟ ɫɩɥɟɬɟɧɢɹ ɜɟɧɨɡɧɨɟ ɫɩɥɟɬɟɧɢɟ ɨɜɚɥɶɧɨɝɨ ɨɬɜɟɪɫɬɢɹ plexus venosus for. ovalis ɜɟɧɨɡɧɨɟ ɫɩɥɟɬɟɧɢɟ ɩɨɞɴɹɡɵɱɧɨɝɨ ɤɚɧɚɥɚ plexus venosus canalis hypoglossi ɜɟɧɨɡɧɨɟ ɫɩɥɟɬɟɧɢɟ ɫɨɧɧɨɝɨ ɤɚɧɚɥɚ plexus venosus carotis internus)

ɢ ɞɪ ȼɫɟ ɜɧɭɬɪɢɱɟɪɟɩɧɵɟ ɫɢɧɭɫɵ ɫɜɹɡɚɧɵ ɦɟɠɞɭ ɫɨɛɨɣ ɚɧɚɫɬɨɦɨɡɚɦɢ Ɉɫɨɛɟɧɧɨ

ɫɥɟɞɭɟɬ ɨɛɪɚɬɢɬɶ ɜɧɢɦɚɧɢɟ ɧɚ ɩɪɚɤɬɢɱɟɫɤɨɟ ɡɧɚɱɟɧɢɟ ɜɟɧ Ɍɪɨɥɚɪɚ ɢ Ʌɚɛɛɟ ɤɨɬɨ ɪɵɟ ɹɜɥɹɸɬɫɹ ɤɪɭɩɧɵɦɢ ɚɧɚɫɬɨɦɨɡɚɦɢ ɦɟɠɞɭ ɜɟɧɨɡɧɵɦɢ ɫɢɧɭɫɚɦɢ ɤɪɵɲɢ ɱɟɪɟɩɚɜɟɪɯɧɢɣ ɫɚɝɢɬɬɚɥɶɧɵɣ ɫɢɧɭɫ ɢ ɫɢɧɭɫɚɦɢ ɨɫɧɨɜɚɧɢɹ ɱɟɪɟɩɚ ɜɟɪɯɧɢɣ ɤɚɦɟɧɢɫɬɵɣ ɫɢɧɭɫ

Ʉɚɤ ɭɠɟ ɨɬɦɟɱɚɥɨɫɶ ɜɧɭɬɪɢɱɟɪɟɩɧɚɹ ɜɟɧɨɡɧɚɹ ɫɢɫɬɟɦɚ ɫɨɨɛɳɚɟɬɫɹ ɫ ɜɟɧɚɦɢ ɦɹɝɤɢɯ ɩɨɤɪɨɜɨɜ ɤɪɵɲɢ ɱɟɪɟɩɚ ɱɟɪɟɡ ɷɦɢɫɫɚɪɧɵɟ ɜɟɧɵ ɢ ɫɢɫɬɟɦɭ ɝɥɚɡɧɨɣ ɜɟɧɵ ɧɚɱɚɥɶɧɵɟ ɜɟɧɵ ɤɨɬɨɪɨɣ ɧɨɫɨɥɨɛɧɚɹ ɜɟɧɚ ɜɟɧɵ ɜɟɤ v. nasofrontalis, vv. palpebralis ɢ ɞɪ ɫɨɛɢɪɚɸɬ ɤɪɨɜɶ ɢɡ ɦɹɝɤɢɯ ɩɨɤɪɨɜɨɜ ɱɟɪɟɩɚ ɥɨɛɧɨɣ ɨɛɥɚɫɬɢ ɩɨɩɚɞɚ ɸɳɭɸ ɡɚɬɟɦ ɜ ɱɟɪɟɩ ɜ ɛɨɤɨɜɨɣ ɩɟɳɟɪɢɫɬɵɣ ɫɢɧɭɫ

Ɉɬ ɦɹɝɤɢɯ ɩɨɤɪɨɜɨɜ ɤɪɵɲɢ ɢ ɛɨɤɨɜɨɣ ɩɨɜɟɪɯɧɨɫɬɢ ɱɟɪɟɩɚ ɤɪɨɜɶ ɨɬɬɟɤɚɟɬ ɜ ɡɚɧɢɠɧɟɱɟɥɸɫɬɧɭɸ ɜɟɧɭ ɚ ɨɬ ɡɚɬɵɥɨɱɧɨɣ ɨɛɥɚɫɬɢ ± ɜ ɡɚɬɵɥɨɱɧɵɟ ɜɟɧɵ ɋ ɷɬɢɦɢ ɜɟɧɚɦɢ ɢɦɟɸɬɫɹ ɨɛɢɥɶɧɵɟ ɚɧɚɫɬɨɦɨɡɵ ɜɧɭɬɪɢɱɟɪɟɩɧɵɯ ɜɟɧ

ɉɪɢ ɜɨɫɩɚɥɢɬɟɥɶɧɵɯ ɩɪɨɰɟɫɫɚɯ ɜ ɨɛɥɚɫɬɢ ɦɹɝɤɢɯ ɩɨɤɪɨɜɨɜ ɱɟɪɟɩɚ ɧɚ ɥɢɰɟ ɢɥɢ ɡɚɬɵɥɤɟ ɢɧɮɟɤɰɢɹ ɦɨɠɟɬ ɩɪɨɧɢɤɚɬɶ ɱɟɪɟɡ ɫɢɫɬɟɦɭ ɨɩɢɫɚɧɧɵɯ ɚɧɚɫɬɨɦɨɡɨɜ ɜɧɭɬɪɶ ɱɟɪɟɩɚ ɨɫɨɛɟɧɧɨ ɱɟɪɟɡ ɫɢɫɬɟɦɵ ɝɥɚɡɧɵɯ ɢ ɷɦɢɫɫɚɪɧɵɯ ɜɟɧ ɢ ɜɵɡɵɜɚɬɶ ɹɜɥɟɧɢɹ ɦɟɧɢɧɝɢɬɚ ɢɥɢ ɚɛɫɰɟɫɫɚ ɜ ɨɛɥɚɫɬɢ ɨɫɧɨɜɚɧɢɹ ɢɥɢ ɤɪɵɲɢ ɱɟɪɟɩɚ Ɋɚɫɩɪɨ ɫɬɪɚɧɟɧɢɟ ɢɧɮɟɤɰɢɢ ɩɨ ɜɟɪɯɧɟɣ ɢ ɧɢɠɧɟɣ ɝɥɚɡɧɵɦ ɜɟɧɚɦ ɜɧɭɬɪɶ ɱɟɪɟɩɚ ɤ ɩɟɳɟ ɪɢɫɬɨɦɭ ɫɢɧɭɫɭ ɦɨɠɟɬ ɩɪɢɜɨɞɢɬ ɤ ɜɨɡɧɢɤɧɨɜɟɧɢɸ ɝɧɨɣɧɢɤɨɜ ɫɪɟɞɧɟɣ ɱɟɪɟɩɧɨɣ ɹɦɤɢ ɩɨɪɚɠɟɧɢɸ ɝɥɚɡɧɵɯ ɧɟɪɜɨɜ Ɋɚɫɫɬɪɨɣɫɬɜɨ ɮɭɧɤɰɢɢ ɩɨɫɥɟɞɧɢɯ ɢɦɟɟɬ ɨɩɪɟ ɞɟɥɟɧɧɨɟ ɞɢɚɝɧɨɫɬɢɱɟɫɤɨɟ ɡɧɚɱɟɧɢɟ

ɉɨɞ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɨɣ ɧɚɯɨɞɢɬɫɹ ɩɚɭɬɢɧɧɚɹ ɨɛɨɥɨɱɤɚ ɝɨɥɨɜɧɨɝɨ ɦɨɡɝɚ (arachnoidea encephali Ɉɧɚ ɨɬɞɟɥɹɟɬɫɹ ɨɬ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɢ ɳɟ ɥɟɜɢɞɧɵɦ ɫɭɛɞɭɪɚɥɶɧɵɦ ɩɪɨɫɬɪɚɧɫɬɜɨɦ ɉɚɭɬɢɧɧɚɹ ɨɛɨɥɨɱɤɚ ɨɛɪɚɡɭɟɬ ɜɵɪɨ ɫɬɵ ɩɪɨɧɢɤɚɸɳɢɟ ɜ ɬɜɟɪɞɭɸ ɦɨɡɝɨɜɭɸ ɨɛɨɥɨɱɤɭ ɢ ɜɟɧɨɡɧɵɟ ɩɚɡɭɯɢ ɗɬɢ ɜɵɪɨ ɫɬɵ ɧɚɡɵɜɚɸɬ ɝɪɚɧɭɥɹɰɢɹɦɢ ɩɚɭɬɢɧɧɨɣ ɨɛɨɥɨɱɤɢ granulationes arachnoidalis).

Ɇɹɝɤɚɹ ɨɛɨɥɨɱɤɚ ɝɨɥɨɜɧɨɝɨ ɦɨɡɝɚ (pia mater encephali ɫɨɞɟɪɠɢɬ ɛɨɥɶɲɨɟ ɤɨɥɢɱɟɫɬɜɨ ɤɪɨɜɟɧɨɫɧɵɯ ɫɨɫɭɞɨɜ ɢ ɩɪɢɥɟɠɢɬ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨ ɤ ɦɨɡɝɭ Ɇɟɠɞɭ ɦɹɝɤɨɣ ɢ ɩɚɭɬɢɧɧɨɣ ɨɛɨɥɨɱɤɚɦɢ ɧɚɯɨɞɢɬɫɹ ɳɟɥɟɜɢɞɧɨɟ ɩɨɞɩɚɭɬɢɧɧɨɟ ɫɭɛɚɪɚɯ ɧɨɢɞɚɥɶɧɨɟ ɩɪɨɫɬɪɚɧɫɬɜɨ

ɑɟɪɟɩɧɨ-ɦɨɡɝɨɜɚɹ ɬɨɩɨɝɪɚɮɢɹ ȼ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɮɨɪɦɵ ɱɟɪɟɩɚ ɦɟɧɹɟɬɫɹ ɪɚɫɩɨɥɨɠɟɧɢɟ ɢ ɫɨɨɬɧɨɲɟɧɢɟ ɦɨɡɝɚ ɟɝɨ ɛɨɪɨɡɞ ɢɡɜɢɥɢɧ ɰɢɫɬɟɪɧ ɫɨɫɭɞɨɜ ɚ ɬɚɤɠɟ ɪɚɡɥɢɱɧɵɯ ɤɨɫɬɧɵɯ ɨɛɪɚɡɨɜɚɧɢɣ ɨɬɜɟɪɫɬɢɣ ɧɚ ɜɧɭɬɪɟɧɧɟɣ ɢ ɧɚɪɭɠɧɨɣ ɩɨ ɜɟɪɯɧɨɫɬɢ ɨɫɧɨɜɚɧɢɹ ɱɟɪɟɩɚ

ɉɪɨɟɤɰɢɹ ɰɟɧɬɪɚɥɶɧɨɣ ɥɚɬɟɪɚɥɶɧɨɣ ɬɟɦɟɧɧɨ-ɡɚɬɵɥɨɱɧɨɣ ɛɨɪɨɡɞ ɢɡɜɢɥɢɧ ɦɨɡɝɚ ɢ ɤɪɭɩɧɵɯ ɫɨɫɭɞɨɜ ɧɚ ɧɚɪɭɠɧɭɸ ɩɨɜɟɪɯɧɨɫɬɶ ɱɟɪɟɩɚ ɫ ɭɱɟɬɨɦ ɟɝɨ ɮɨɪɦɵ ɨɩɪɟɞɟɥɹɟɬɫɹ ɩɨ ɫɯɟɦɟ Ʉɪɟɧɥɟɣɧɚ Kronlein ɉɨ ɷɬɨɣ ɫɯɟɦɟ ɧɚ ɤɨɠɧɵɯ ɩɨɤɪɨɜɚɯ ɝɨɥɨɜɵ ɩɪɨɜɨɞɢɬɫɹ ɲɟɫɬɶ ɨɫɧɨɜɧɵɯ ɥɢɧɢɣ ɫɚɝɢɬɬɚɥɶɧɚɹ ɥɢɧɢɹ ɢɞɭɳɚɹ ɩɨ ɯɨɞɭ

16

ɫɬɪɟɥɨɜɢɞɧɨɝɨ ɲɜɚ - ɩɪɨɜɨɞɢɬɫɹ ɨɬ ɩɟɪɟɧɨɫɢɰɵ glabella ɤ ɧɚɪɭɠɧɨɦɭ ɜɵɫɬɭɩɭ ɧɢɠɧɹɹ ɝɨɪɢɡɨɧɬɚɥɶɧɚɹ ɥɢɧɢɹ ± ɱɟɪɟɡ ɧɢɠɧɢɣ ɤɪɚɣ ɝɥɚɡɧɢɰɵ ɢ ɜɟɪɯɧɢɣ ɤɪɚɣ ɧɚɪɭɠɧɨɝɨ ɫɥɭɯɨɜɨɝɨ ɩɪɨɯɨɞɚ ɜɟɪɯɧɹɹ ɝɨɪɢɡɨɧɬɚɥɶɧɚɹ ɥɢɧɢɹ ± ɩɚɪɚɥɥɟɥɶɧɨ ɧɢɠɧɟɣ ɩɨ ɜɟɪɯɧɟɦɭ ɤɪɚɸ ɝɥɚɡɧɢɰɵ ɩɟɪɟɞɧɹɹ ɜɟɪɬɢɤɚɥɶɧɚɹ ɥɢɧɢɹ ± ɩɨ ɫɟɪɟɞɢɧɟ ɫɤɭɥɨɜɨɣ ɞɭɝɢ ɩɟɪɩɟɧɞɢɤɭɥɹɪɧɨ ɝɨɪɢɡɨɧɬɚɥɶɧɵɦ ɥɢɧɢɢɹɦ ɫɪɟɞɧɹɹ ɜɟɪɬɢɤɚɥɶɧɚɹ ɥɢɧɢɹ ± ɱɟɪɟɡ ɫɟɪɟɞɢɧɭ ɫɭɫɬɚɜɧɨɣ ɝɨɥɨɜɤɢ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ ɡɚɞɧɹɹ ɜɟɪɬɢɤɚɥɶɧɚɹ ɥɢɧɢɹ ± ɱɟɪɟɡ ɡɚɞɧɸɸ ɝɪɚɧɢɰɭ ɨɫɧɨɜɚɧɢɹ ɫɨɫɰɟɜɢɞɧɨɝɨ ɨɬɪɨɫɬɤɚ ɩɟɪɩɟɧɞɢɤɭ ɥɹɪɧɨ ɝɨɪɢɡɨɧɬɚɥɶɧɵɦ ɞɨ ɩɟɪɟɫɟɱɟɧɢɹ ɫ ɫɚɝɢɬɬɚɥɶɧɨɣ ɥɢɧɢɟɣ

Ɉɫɧɨɜɧɨɣ ɫɬɜɨɥ ɫɪɟɞɧɟɣ ɦɟɧɢɧɝɟɚɥɶɧɨɣ ɚɪɬɟɪɢɢ ɩɪɨɟɰɢɪɭɟɬɫɹ ɜ ɬɨɱɤɟ ɩɟɪɟ ɫɟɱɟɧɢɹ ɩɟɪɟɞɧɟɣ ɜɟɪɬɢɤɚɥɶɧɨɣ ɥɢɧɢɢ ɫ ɧɢɠɧɟɣ ɝɨɪɢɡɨɧɬɚɥɶɧɨɣ ɢɥɢ ɭ ɜɟɪɯɧɟɝɨ ɤɪɚɹ ɫɟɪɟɞɢɧɵ ɫɤɭɥɨɜɨɣ ɞɭɝɢ

ɉɟɪɟɞɧɹɹ ɜɟɬɜɶ ɚɪɬɟɪɢɢ ɨɩɪɟɞɟɥɹɟɬɫɹ ɜ ɬɨɱɤɟ ɩɟɪɟɫɟɱɟɧɢɹ ɜɟɪɯɧɟɣ ɝɨɪɢɡɨɧ ɬɚɥɶɧɨɣ ɢ ɩɟɪɟɞɧɟɣ ɜɟɪɬɢɤɚɥɶɧɨɣ ɥɢɧɢɣ ɚ ɡɚɞɧɹɹ ɜɟɬɜɶ ± ɧɚ ɦɟɫɬɟ ɩɟɪɟɫɟɱɟɧɢɹ ɜɟɪɯɧɟɣ ɝɨɪɢɡɨɧɬɚɥɶɧɨɣ ɫ ɡɚɞɧɟɣ ɜɟɪɬɢɤɚɥɶɧɨɣ ɥɢɧɢɟɣ

ɉɪɨɟɤɰɢɹ ɰɟɧɬɪɚɥɶɧɨɣ ɛɨɪɨɡɞɵ sulcus centralis ɨɩɪɟɞɟɥɹɟɬɫɹ ɥɢɧɢɟɣ ɩɪɨɜɟ ɞɟɧɧɨɣ ɢɡ ɬɨɱɤɢ ɩɟɪɟɫɟɱɟɧɢɹ ɩɟɪɟɞɧɟɣ ɜɟɪɬɢɤɚɥɶɧɨɣ ɫ ɜɟɪɯɧɟɣ ɝɨɪɢɡɨɧɬɚɥɶɧɨɣ ɞɨ ɬɨɱɤɢ ɩɟɪɟɫɟɱɟɧɢɹ ɡɚɞɧɟɣ ɜɟɪɬɢɤɚɥɶɧɨɣ ɫ ɫɚɝɢɬɬɚɥɶɧɨɣ ɥɢɧɢɟɣ Ȼɨɪɨɡɞɚ ɫɨɨɬ ɜɟɬɫɬɜɭɟɬ ɨɬɪɟɡɤɭ ɷɬɨɣ ɥɢɧɢɢ ɦɟɠɞɭ ɫɪɟɞɧɟɣ ɢ ɡɚɞɧɟɣ ɜɟɪɬɢɤɚɥɶɧɵɦɢ ɥɢɧɢɹɦɢ Ʌɚɬɟɪɚɥɶɧɚɹ ɛɨɪɨɡɞɚ sul. lateralis ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɩɨ ɛɢɫɫɟɤɬɪɢɫɟ ɭɝɥɚ ɨɛɪɚɡɨɜɚɧ ɧɨɝɨ ɩɪɨɟɤɰɢɨɧɧɨɣ ɥɢɧɢɟɣ ɰɟɧɬɪɚɥɶɧɨɣ ɛɨɪɨɡɞɵ ɢ ɜɟɪɯɧɟɣ ɝɨɪɢɡɨɧɬɚɥɶɧɨɣ ɧɚ ɭɱɚɫɬɤɟ ɦɟɠɞɭ ɩɟɪɟɞɧɟɣ ɢ ɡɚɞɧɟɣ ɜɟɪɬɢɤɚɥɶɧɵɦɢ ɥɢɧɢɹɦɢ

ȿɫɥɢ ɭɱɚɫɬɨɤ ɫɚɝɢɬɬɚɥɶɧɨɣ ɥɢɧɢɢ ɡɚɤɥɸɱɟɧɧɵɣ ɦɟɠɞɭ ɬɨɱɤɚɦɢ ɩɟɪɟɫɟɱɟɧɢɹ ɟɟ ɫ ɩɪɨɟɤɰɢɨɧɧɨɣ ɥɢɧɢɟɣ ɋɢɥɶɜɢɟɜɨɣ ɛɨɪɨɡɞɵ ɢ ɜɟɪɯɧɟɣ ɝɨɪɢɡɨɧɬɚɥɶɧɨɣ ɥɢɧɢ ɟɣ ɪɚɡɞɟɥɢɬɶ ɧɚ ɬɪɢ ɪɚɜɧɵɟ ɱɚɫɬɢ ɬɨ ɧɚ ɝɪɚɧɢɰɵ ɜɟɪɯɧɟɣ ɬɪɟɬɢ ɫɨ ɫɪɟɞɧɟɣ ɛɭɞɟɬ ɩɪɨɟɰɢɪɨɜɚɬɶɫɹ ɬɟɦɟɧɧɨ-ɡɚɬɵɥɨɱɧɚɹ ɛɨɪɨɡɞɚ

ɋɢɧɭɫɵ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɢ ɩɪɨɟɰɢɪɭɸɬɫɹ ɫɥɟɞɭɸɳɢɦ ɨɛɪɚɡɨɦ ɜɟɪɯɧɢɣ ɫɚɝɢɬɬɚɥɶɧɵɣ ɫɢɧɭɫ ± ɩɨ ɫɚɝɢɬɬɚɥɶɧɨɣ ɥɢɧɢɢ ɩɨɩɟɪɟɱɧɵɣ ɫɢɧɭɫ ± ɩɨ ɜɟɪɯɧɟɣ ɜɵɣɧɨɣ ɥɢɧɢɢ ɫɢɝɦɨɜɢɞɧɵɣ ɫɢɧɭɫ ± ɩɨɡɚɞɢ ɫɨɫɰɟɜɢɞɧɨɝɨ ɝɪɟɛɧɹ ɫɢ ɧɭɫɧɵɣ ɫɬɨɤ ± ɭ ɧɚɪɭɠɧɨɝɨ ɡɚɬɵɥɨɱɧɨɝɨ ɜɵɫɬɭɩɚ

ɋ ɋ Ȼɪɸɫɨɜɚ ɞɨɩɨɥɧɢɥɚ ɫɯɟɦɭ Ʉɪɟɧɥɟɣɧɚ ɬɪɟɬɶɟɣ ɝɨɪɢɡɨɧɬɚɥɶɧɨɣ ɥɢɧɢɟɣ ɩɪɨɯɨɞɹɳɟɣ ɩɚɪɚɥɥɟɥɶɧɨ ɭɤɚɡɚɧɧɵɦ ɝɨɪɢɡɨɧɬɚɥɶɧɵɦ ɥɢɧɢɟɦ ɱɟɪɟɡ ɬɨɱɤɭ ɩɟɪɟɫɟ ɱɟɧɢɹ ɡɚɞɧɟɣ ɜɟɪɬɢɤɚɥɶɧɨɣ ɫ ɩɪɨɟɤɰɢɨɧɧɨɣ ɥɢɧɢɟɣ ɥɚɬɟɪɚɥɶɧɨɣ ɛɨɪɨɡɞɵ ɗɬɨ ɞɚ ɟɬ ɜɨɡɦɨɠɧɨɫɬɶ ɨɩɪɟɞɟɥɢɬɶ ɩɪɨɟɤɰɢɸ ɫɨɫɭɞɨɜ ɝɨɥɨɜɧɨɝɨ ɦɨɡɝɚ ȼɧɭɬɪɟɧɧɹɹ ɫɨɧ ɧɚɹ ɚɪɬɟɪɢɹ ɩɪɢ ɜɵɯɨɞɟ ɢɡ ɨɛɥɚɫɬɢ ɩɟɳɟɪɢɫɬɨɝɨ ɫɢɧɭɫɚ ɩɨ ɷɬɨɣ ɫɢɧɭɫɟ ɩɪɨɟɰɢ ɪɭɟɬɫɹ ɜ ɩɟɪɟɞɧɟɧɢɠɧɟɦ ɱɟɬɵɪɟɯɭɝɨɥɶɧɢɤɟ ɚ ɩɟɪɟɞɧɹɹ ɦɨɡɝɨɜɚɹ ɚɪɬɟɪɢɹ ɫɨɜɩɚɞɚ ɟɬ ɫ ɜɟɪɯɧɟɣ ɝɨɪɢɡɨɧɬɚɥɶɧɨɣ ɥɢɧɢɟɣ

ɅɂɐȿȼɈɃ ɈɌȾȿɅ ȽɈɅɈȼɕ

Ɉɛɥɚɫɬɢ ɥɢɰɚ (regiones faciei) ɉɪɟɞɫɬɚɜɥɟɧɚ ɩɟɪɟɞɧɟɣ ɢ ɛɨɤɨɜɨɣ ɨɛɥɚɫɬɹɦɢ (reg. facialis anterior et lateralis ɉɟɪɟɞɧɹɹ ɨɛɥɚɫɬɶ ɥɢɰɚ ɜɤɥɸɱɚɟɬ ɨɛɥɚɫɬɢ: ɝɥɚɡɧɢ ɰɵ (reg. orbitalis), ɩɨɞɝɥɚɡɧɢɱɧɚɹ (reg. Infraorbitalis), ɧɨɫɚ (reg. nasalis) ɪɬɚ (reg. oralis) ɢ ɩɪɢɦɵɤɚɸɳɭɸ ɤ ɧɟɣ ɩɨɞɛɨɪɨɞɨɱɧɭɸ ɨɛɥɚɫɬɶ ( reg. mentalis) ɗɬɢ ɨɛɥɚɫɬɢ ɜɦɟɫɬɟ ɫ ɩɪɢɦɵɤɚɸɳɢɦɢ ɤ ɧɢɦ ɱɚɫɬɹɦɢ ɥɢɰɚ ɨɩɢɫɵɜɚɸɬɫɹ ɤɚɤ ɨɬɞɟɥɶɧɵɟ ɜ ɭɱɟɛ ɧɢɤɚɯ ɩɨ ɫɬɨɦɚɬɨɥɨɝɢɢ ɝɥɚɡɧɵɦ ɢ ɅɈɊ-ɛɨɥɟɡɧɹɦ ȼɫɹ ɨɫɬɚɥɶɧɚɹ ɱɚɫɬɶ ɥɢɰɚ ɨɬɧɨ ɫɢɬɫɹ ɤ ɛɨɤɨɜɨɣ ɨɛɥɚɫɬɢ ɜ ɤɨɬɨɪɭɸ ɜɯɨɞɢɬ ɳɟɱɧɚɹ reg. buccalis) ɢ ɨɤɨɥɨɭɲɧɨ-

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ɠɟɜɚɬɟɥɶɧɚɹ regio parotideomasseterica) ɪɢɫ ȼ ɩɨɫɥɟɞɧɟɣ ɞɥɹ ɭɞɨɛɫɬɜɚ ɢɡɭ ɱɟɧɢɹ ɨɬɞɟɥɶɧɨ ɪɚɫɫɦɚɬɪɢɜɚɸɬ ɝɥɭɛɨɤɭɸ ɨɛɥɚɫɬɶ ɥɢɰɚ reg. facialis profunda).

ɋɥɨɢ Ʉɨɠɚ ɥɢɰɚ ɬɨɧɤɚ ɢ ɩɨɞɜɢɠɧɚ ȼ ɩɨɞɤɨɠɧɨɣ ɤɥɟɬɱɚɬɤɟ ɤɨɥɢɱɟɫɬɜɨ ɤɨɬɨɪɨɣ

ɦɨɠɟɬ ɪɟɡɤɨ ɢɡɦɟɧɹɬɶɫɹ ɭ ɨɞɧɨɝɨ ɢ ɬɨɝɨ ɠɟ ɱɟɥɨɜɟɤɚ ɡɚɥɨɠɟɧɵ ɦɢɦɢɱɟɫɤɢɟ ɦɵɲɰɵ ɫɨɫɭɞɵ ɧɟɪɜɵ ɢ ɩɪɨɬɨɤ ɨɤɨɥɨɭɲɧɨɣ ɠɟɥɟɡɵ

ɂɧɧɟɪɜɚɰɢɹ ɤɨɠɢ ɥɢɰɚ ɨɫɭɳɟɫɬɜɥɹɟɬɫɹ ɩɪɟɢɦɭɳɟɫɬɜɟɧɧɨ ɤɨɧɟɱɧɵɦɢ ɜɟɬ ɜɹɦɢ ɜɫɟɯ ɬɪɟɯ ɫɬɜɨɥɨɜ ɬɪɨɣɧɢɱɧɨɝɨ ɧɟɪɜɚ ɜ ɦɟɧɶɲɟɣ ɫɬɟɩɟɧɢ ± ɜɟɬɜɹɦɢ ɲɟɣɧɨɝɨ ɫɩɥɟɬɟɧɢɹ ɜ ɱɚɫɬɧɨɫɬɢ ɛɨɥɶɲɢɦ ɭɲɧɵɦ ɧɟɪɜɨɦ ȼɟɬɜɢ ɬɪɨɣɧɢɱɧɨɝɨ ɧɟɪɜɚ ɞɥɹ ɤɨɠɢ ɥɢɰɚ ɜɵɯɨɞɹɬ ɢɡ ɤɨɫɬɧɵɯ ɤɚɧɚɥɨɜ ɨɬɜɟɪɫɬɢɹ ɤɨɬɨɪɵɯ ɪɚɫɩɨɥɨɠɟɧɵ ɧɚ ɨɞ ɧɨɣ ɜɟɪɬɢɤɚɥɶɧɨɣ ɥɢɧɢɢ ɧɚɞɝɥɚɡɧɢɱɧɨɟ ɨɬɜɟɪɫɬɢɟ for. supraorbitale ɞɥɹ ɧɚɞɝɥɚɡ ɧɢɱɧɨɝɨ ɧɟɪɜɚ n. supraorbitalis ɢɡ I ɜɟɬɜɢ ɬɪɨɣɧɢɱɧɨɝɨ ɧɟɪɜɚ ɩɨɞɝɥɚɡɧɢɱɧɨɟ ɨɬ ɜɟɪɫɬɢɟ for. infraorbitale) ɞɥɹ ɩɨɞɝɥɚɡɧɢɱɧɨɝɨ ɧɟɪɜɚ (n. infraorbitalis ɢɡ II ɜɟɬɜɢ ɬɪɨɣɧɢɱɧɨɝɨ ɧɟɪɜɚ ɢ ɩɨɞɛɨɪɨɞɨɱɧɨɟ ɨɬɜɟɪɫɬɢɟ for. mentale ɞɥɹ ɩɨɞɛɨɪɨɞɨɱɧɨɝɨ ɧɟɪɜɚ n.mentalis ɢɡ III ɜɟɬɜɢ ɬɪɨɣɧɢɱɧɨɝɨ ɧɟɪɜɚ Ɇɟɠɞɭ ɜɟɬɜɹɦɢ ɬɪɨɣɧɢɱɧɨɝɨ ɢ ɥɢɰɟɜɨɝɨ ɧɟɪɜɨɜ ɧɚ ɥɢɰɟ ɨɛɪɚɡɭɸɬɫɹ ɫɜɹɡɢ ɂɧɧɟɪɜɚɰɢɹ ɫɥɢɡɢɫɬɵɯ ɨɛɨɥɨɱɟɤ ɨɫɭ ɳɟɫɬɜɥɹɟɬɫɹ ɜɫɟɦɢ ɬɪɟɦɹ ɜɟɬɜɹɦɢ ɬɪɨɣɧɢɱɧɨɝɨ ɢ ɹɡɵɤɨɝɥɨɬɨɱɧɵɦ ɧɟɪɜɚɦɢ

Ⱦɜɢɝɚɬɟɥɶɧɵɟ ɧɟɪɜɵ ɨɬɧɨɫɹɬɫɹ ɤ ɞɜɭɦ ɫɢɫɬɟɦɚɦ ɥɢɰɟɜɨɝɨ ɢ III ɜɟɬɜɢ ɬɪɨɣ ɧɢɱɧɨɝɨ ɧɟɪɜɨɜ ɉɟɪɜɵɣ ɫɧɚɛɠɚɟɬ ɦɢɦɢɱɟɫɤɭɸ ɜɬɨɪɨɣ ± ɠɟɜɚɬɟɥɶɧɭɸ ɦɭɫɤɭɥɚ ɬɭɪɭ Ʉɪɨɜɨɫɧɚɛɠɟɧɢɟ ɥɢɰɚ ɨɫɭɳɟɫɬɜɥɹɟɬɫɹ ɝɥɚɜɧɵɦ ɨɛɪɚɡɨɦ ɫɢɫɬɟɦɨɣ ɧɚɪɭɠɧɨɣ ɫɨɧɧɨɣ ɚɪɬɟɪɢɢ ɱɟɪɟɡ ɟɟ ɜɟɬɜɢ ɩɨɜɟɪɯɧɨɫɬɧɭɸ ɜɢɫɨɱɧɭɸ ɜɟɪɯɧɸɸ ɱɟɥɸɫɬɧɭɸ ɢ ɥɢɰɟɜɭɸ ɚɪɬɟɪɢɢ Ʉɪɨɦɟ ɬɨɝɨ ɜ ɤɪɨɜɨɫɧɚɛɠɟɧɢɢ ɥɢɰɚ ɩɪɢɧɢɦɚɟɬ ɭɱɚɫɬɢɟ ɢ ɝɥɚɡ ɧɚɹ ɚɪɬɟɪɢɹ ɢɡ ɜɧɭɬɪɟɧɧɟɣ ɫɨɧɧɨɣ ɚɪɬɟɪɢɢ

ɋɨɫɭɞɵ ɥɢɰɚ ɨɛɪɚɡɭɸɬ ɨɛɢɥɶɧɭɸ ɫɟɬɶ ɫ ɪɚɡɜɢɬɵɦɢ ɚɧɚɫɬɨɦɨɡɚɦɢ ɱɟɦ ɨɛɟɫ ɩɟɱɢɜɚɟɬɫɹ ɯɨɪɨɲɟɟ ɤɪɨɜɨɫɧɚɛɠɟɧɢɟ ɦɹɝɤɢɯ ɬɤɚɧɟɣ а. Ʌɢɰɟɜɚɹ ɚɪɬɟɪɢɹ ɤɪɨɜɨɫɧɚɛɠɚɟɬ ɩɨɤɪɨɜɵ ɥɢɰɚ ɢ ɦɢɦɢɱɟɫɤɭɸ ɦɭɫɤɭɥɚɬɭɪɭ ɢ

ɚɧɚɫɬɨɦɨɡɢɪɭɟɬ ɫ ɞɪɭɝɢɦɢ ɜɟɬɜɹɦɢ ɢɡ ɫɢɫɬɟɦɵ ɧɚɪɭɠɧɨɣ ɫɨɧɧɨɣ ɚɪɬɟɪɢɢ ɩɨɩɟ ɪɟɱɧɚɹ ɚɪɬɟɪɢɹ ɥɢɰɚ ɢɡ ɩɨɜɟɪɯɧɨɫɬɧɨɣ ɜɢɫɨɱɧɨɣ ɚɪɬɟɪɢɢ ɩɨɞɝɥɚɡɧɢɱɧɚɹ ɚɪɬɟɪɢɹ ɢɡ ɜɟɪɯɧɟɱɟɥɸɫɬɧɨɣ ɫ ɜɟɬɜɹɦɢ ɢɡ ɫɢɫɬɟɦɵ ɜɧɭɬɪɟɧɧɟɣ ɫɨɧɧɨɣ ɚɪɬɟɪɢɢ ɤɨɧɟɱ ɧɵɟ ɜɟɬɜɢ ɝɥɚɡɧɨɣ ɚɪɬɟɪɢɢ ± ɥɨɛɧɚɹ ɚɪɬɟɪɢɹ ɞɨɪɡɚɥɶɧɚɹ ɚɪɬɟɪɢɹ ɧɨɫɚ ɚ ɬɚɤɠɟ ɫ ɨɞɧɨɢɦɟɧɧɵɦɢ ɚɪɬɟɪɢɹɦɢ ɩɪɨɬɢɜɨɩɨɥɨɠɧɨɣ ɫɬɨɪɨɧɵ

ȼɟɪɯɧɟɱɟɥɸɫɬɧɚɹ ɚɪɬɟɪɢɹ ɜɬɨɪɚɹ ɤɨɧɟɱɧɚɹ ɜɟɬɜɶ ɧɚɪɭɠɧɨɣ ɫɨɧɧɨɣ ɚɪɬɟɪɢɢ

ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɜ ɝɥɭɛɨɤɨɣ ɨɛɥɚɫɬɢ ɥɢɰɚ ɢ ɫɧɚɛɠɚɟɬ ɤɪɨɜɶɸ ɝɥɚɜɧɵɦ ɨɛɪɚɡɨɦ ɠɟ ɜɚɬɟɥɶɧɵɣ ɚɩɩɚɪɚɬ ɬ ɟ ɜɟɪɯɧɸɸ ɢ ɧɢɠɧɸɸ ɱɟɥɸɫɬɢ ɫ ɢɯ ɚɥɶɜɟɨɥɹɪɧɵɦɢ ɨɬɪɨɫɬ ɤɚɦɢ ɢ ɡɭɛɚɦɢ ɢ ɜɫɟ ɠɟɜɚɬɟɥɶɧɵɟ ɦɵɲɰɵ

ȼɟɧɵ ɥɢɰɚ ɨɛɪɚɡɭɸɬ ɞɜɟ ɫɟɬɢ ɩɨɜɟɪɯɧɨɫɬɧɭɸ ɢ ɝɥɭɛɨɤɭɸ ɉɟɪɜɚɹ ɫɨɫɬɨɢɬ ɢɡ ɥɢɰɟɜɨɣ ɜɟɧɵ ɢ ɟɟ ɜɟɬɜɟɣ Ƚɥɭɛɨɤɚɹ ɜɟɧɨɡɧɚɹ ɫɟɬɶ ɩɪɟɞɫɬɚɜɥɟɧɚ ɤɪɵɥɨɜɢɞɧɵɦ ɫɩɥɟɬɟɧɢɟɦ ɢ ɛɨɥɟɟ ɦɟɥɤɢɦɢ ɫɩɥɟɬɟɧɢɹɦɢ ɡɚɥɨɠɟɧɧɵɦɢ ɜ ɬɨɥɳɟ ɦɵɲɰ ɢ ɦɟ ɠɦɵɲɟɱɧɨɣ ɤɥɟɬɱɚɬɤɟ ɝɥɭɛɨɤɨɣ ɨɛɥɚɫɬɢ ɥɢɰɚ ɗɬɢ ɜɟɧɨɡɧɵɟ ɫɩɥɟɬɟɧɢɹ ɫɜɹɡɚɧɵ ɱɟɪɟɡ ɝɥɭɛɨɤɭɸ ɜɟɧɭ ɥɢɰɚ ɫ ɩɨɜɟɪɯɧɨɫɬɧɵɦɢ ɜɟɧɚɦɢ ȼɚɠɧɨɟ ɩɪɚɤɬɢɱɟɫɤɨɟ ɡɧɚ ɱɟɧɢɟ ɢɦɟɸɬ ɫɜɹɡɢ ɤɪɵɥɨɜɢɞɧɨɝɨ ɫɩɥɟɬɟɧɢɹ ɫ ɩɟɳɟɪɢɫɬɵɦ ɫɢɧɭɫɨɦ ɬɜɟɪɞɨɣ ɦɨɡ ɝɨɜɨɣ ɨɛɨɥɨɱɤɢ ɩɨɫɪɟɞɫɬɜɨɦ ɷɦɢɫɫɚɪɧɵɯ ɜɟɧ ɜɟɧɨɡɧɵɟ ɫɩɥɟɬɟɧɢɹ ɨɜɚɥɶɧɨɝɨ ɢ ɪɜɚɧɨɝɨ ɨɬɜɟɪɫɬɢɣ (foraminis ovalis, emissarium foraminis laceri ɩɨɫɪɟɞɫɬɜɨɦ ɜɟɧ ɝɥɚɡɧɢɰɵ ɩɪɢɱɟɦ ɲɢɪɨɤɢɣ ɚɧɚɫɬɨɦɨɡ ɦɟɠɞɭ ɧɢɠɧɟɣ ɝɥɚɡɧɨɣ ɜɟɧɨɣ ɢ ɤɪɵɥɨɜɢɞ ɧɵɦ ɫɩɥɟɬɟɧɢɟɦ ɩɪɨɯɨɞɢɬ ɱɟɪɟɡ ɧɢɠɧɸɸ ɝɥɚɡɧɭɸ ɳɟɥɶ

18

ȼ ɪɚɡɥɢɱɧɵɯ ɨɛɥɚɫɬɹɯ ɥɢɰɚ ɢɦɟɸɬɫɹ ɳɟɥɢ ɢɥɢ ɩɪɨɫɬɪɚɧɫɬɜɚ ɫɨɞɟɪɠɚɳɢɟ ɜ ɛɨɥɶɲɟɣ ɢɥɢ ɦɟɧɶɲɟɣ ɫɬɟɩɟɧɢ ɠɢɪɨɜɭɸ ɢ ɪɵɯɥɭɸ ɤɥɟɬɱɚɬɤɭ ɤɨɬɨɪɚɹ ɤɨɧɰɟɧ ɬɪɢɪɭɟɬɫɹ ɩɪɟɢɦɭɳɟɫɬɜɟɧɧɨ ɜɨɤɪɭɝ ɫɨɫɭɞɢɫɬɨ-ɧɟɪɜɧɵɯ ɩɭɱɤɨɜ ɋɪɟɞɢ ɤɥɟɬɱɚɬɨɱ ɧɵɯ ɩɪɨɫɬɪɚɧɫɬɜ ɧɚɢɛɨɥɶɲɟɟ ɩɪɚɤɬɢɱɟɫɤɨɟ ɡɧɚɱɟɧɢɟ ɢɦɟɸɬ ɜɢɫɨɱɧɨɤɪɵɥɨɜɢɞɧɵɣ ɢ ɦɟɠɤɪɵɥɨɜɢɞɧɵɣ ɩɪɨɦɟɠɭɬɤɢ ɦɟɠɱɟɥɸɫɬɧɨɣ ɨɛɥɚɫɬɢ ɨɤɨɥɨɭɲ ɧɨɣ ɢ ɩɚɪɚɮɚɪɢɧɝɟɚɥɶɧɨɟ ɩɪɨɫɬɪɚɧɫɬɜɨ ɚ ɬɚɤɠɟ ɤɥɟɬɱɚɬɨɱɧɵɟ ɩɪɨɦɟɠɭɬɤɢ ɞɧɚ ɪɨɬɨɜɨɣ ɩɨɥɨɫɬɢ

Ȼɨɤɨɜɚɹ ɨɛɥɚɫɬɶ (regio facialis lateralis).

Ƚɪɚɧɢɰɵ

ɫɜɟɪɯɭ ± ɜɟɪɯɧɢɣ ɤɪɚɣ ɫɤɭɥɨɜɨɣ ɞɭɝɢ ɞɨ ɧɚɪɭɠɧɨɝɨ ɫɥɭɯɨɜɨɝɨ ɩɪɨɯɨɞɚ ɢ ɧɢɠɧɢɣ ɤɪɚɣ ɝɥɚɡɧɢɰɵ

ɫɧɢɡɭ ± ɧɢɠɧɢɣ ɤɪɚɣ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ ɫɩɟɪɟɞɢ ± ɧɨɫɨɳɟɱɧɚɹ ɢ ɧɨɫɨɝɭɛɧɚɹ ɫɤɥɚɞɤɢ ɭɝɨɥ ɪɨɬɨɜɨɣ ɳɟɥɢ ɫɡɚɞɢ ± ɤɪɚɣ ɜɟɬɜɢ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ

Ʌɢɧɢɟɣ ɩɪɨɜɟɞɟɧɧɨɣ ɭ ɩɟɪɟɞɧɟɝɨ ɤɪɚɹ ɠɟɜɚɬɟɥɶɧɨɣ ɦɵɲɰɵ m. masseter), ɩɨɜɟɪɯɧɨɫɬɧɚɹ ɛɨɤɨɜɚɹ ɨɛɥɚɫɬɶ ɥɢɰɚ ɞɟɥɢɬɫɹ ɧɚ ɪɚɫɩɨɥɨɠɟɧɧɭɸ ɤɩɟɪɟɞɢ ɨɬ ɷɬɨɣ ɦɵɲɰɵ ɳɟɱɧɭɸ ɢ ɨɤɨɥɨɭɲɧɨ-ɠɟɜɚɬɟɥɶɧɭɸ ɪɢɫ Ʉɧɭɬɪɢ ɨɬ ɜɟɬɜɢ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ ɧɚɯɨɞɢɬɫɹ ɝɥɭɛɨɤɚɹ ɨɛɥɚɫɬɶ ɥɢɰɚ

ɓɟɱɧɚɹ ɨɛɥɚɫɬɶ (regio buccalis)

Ƚɪɚɧɢɰɵ

ȼɟɪɯɧɹɹ ² ɫɤɭɥɨɜɚɹ ɞɭɝɚ; ɧɢɠɧɹɹ ² ɧɢɠɧɢɣ ɤɪɚɣ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ;

ɩɟɪɟɞɧɹɹ ² ɜɟɪɬɢɤɚɥɶɧɚɹ ɥɢɧɢɹ ɩɪɨɜɟɞɟɧɧɚɹ ɨɬ ɧɚɪɭɠɧɨɝɨ ɭɝɥɚ ɝɥɚɡɚ ɤ ɭɝɥɭ ɪɬɚ; ɡɚɞɧɹɹ ² ɩɚɥɶɩɢɪɭɟɦɵɣ ɩɟɪɟɞɧɢɣ ɤɪɚɣ ɠɟɜɚɬɟɥɶɧɨɣ ɦɵɲɰɵ ɪɢɫ .

Ɋɢɫ Ɉɛɥɚɫɬɢ ɝɨɥɨɜɵ ɢ ɲɟɢ

ɋɥɨɢ

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Ʉɨɠɚ ɬɨɧɤɚ ɫɨɞɟɪɠɢɬ ɛɨɥɶɲɨɟ ɤɨɥɢɱɟɫɬɜɨ ɩɨɬɨɜɵɯ ɢ ɫɚɥɶɧɵɯ ɠɟɥɟɡ ɩɪɨɱ ɧɨ ɫɪɚɳɟɧɚ ɫ ɯɨɪɨɲɨ ɪɚɡɜɢɬɵɦ ɫɥɨɟɦ ɩɨɞɤɨɠɧɨɣ ɠɢɪɨɜɨɣ ɤɥɟɬɱɚɬɤɢ ɢ ɦɢɦɢɱɟ ɫɤɢɦɢ ɦɵɲɰɚɦɢ ɍ ɦɭɠɱɢɧ ɜ ɧɢɠɧɟɦ ɨɬɞɟɥɟ ɢɦɟɟɬɫɹ ɜɨɥɨɫɹɧɨɣ ɩɨɤɪɨɜ ɂɧ ɧɟɪɜɢɪɭɟɬɫɹ ɤɨɠɚ ɜɟɬɜɹɦɢ ɬɪɨɣɧɢɱɧɨɝɨ ɧɟɪɜɚ

ɉɨɞɤɨɠɧɚɹ ɤɥɟɬɱɚɬɤɚ ɪɚɡɜɢɬɚ ɯɨɪɨɲɨ ɨɫɨɛɟɧɧɨ ɭ ɞɟɬɟɣ ɢ ɠɟɧɳɢɧ ɉɨ ɜɟɪɯɧɨɫɬɧɚɹ ɮɚɫɰɢɹ ɪɚɡɞɟɥɹɟɬ ɟɟ ɧɚ ɞɜɚ ɫɥɨɹ ɩɨɜɟɪɯɧɨɫɬɧɵɣ ɩɪɨɱɧɨ ɫɜɹɡɚɧɧɵɣ ɫ ɤɨɠɟɣ ɢ ɝɥɭɛɨɤɢɣ ȼ ɩɨɫɥɟɞɧɟɦ ɫɥɨɟ ɧɚɯɨɞɹɬɫɹ ɦɢɦɢɱɟɫɤɢɟ ɦɵɲɰɵ ɫɨɫɭɞɵ ɢ ɧɟɪɜɵ Ɇɢɦɢɱɟɫɤɢɟ ɦɵɲɰɵ ɧɚɱɢɧɚɸɳɢɟɫɹ ɧɚ ɤɨɫɬɹɯ ɥɢɰɟɜɨɝɨ ɱɟɪɟɩɚ ɜ ɳɟɱɧɨɣ ɨɛɥɚɫɬɢ ɪɚɫɩɨɥɨɠɟɧɵ ɧɚ ɪɚɡɥɢɱɧɵɯ ɭɪɨɜɧɹɯ ɢɯ ɪɚɡɞɟɥɹɟɬ ɤɥɟɬɱɚɬɤɚ ɜ ɜɢɞɟ ɦɟɠ ɮɚɫɰɢɚɥɶɧɵɯ ɤɥɟɬɱɚɬɨɱɧɵɯ ɫɥɨɟɜ

Ɇɢɦɢɱɟɫɤɢɟ ɦɵɲɰɵ ɥɢɰɚ ɦɵɲɰɚ ɩɨɞɧɢɦɚɸɳɚɹ ɜɟɪɯɧɸɸ ɝɭɛɭ m. levator labii superioris ɦɚɥɚɹ ɢ ɛɨɥɶɲɚɹ ɫɤɭɥɨɜɵɟ ɦɵɲɰɵ m. zygomaticus major et minor ɳɟɱɧɚɹ ɦɵɲɰɚ m. buccinator ɤɪɭɝɨɜɚɹ ɦɵɲɰɚ ɪɬɚ m. orbicularis oris), ɦɵɲɰɚ ɨɩɭɫɤɚɸɳɚɹ ɧɢɠɧɸɸ ɝɭɛɭ (m. depressor labii inferioris), ɦɵɲɰɚ, ɨɩɭɫɤɚ ɸɳɚɹ ɭɝɨɥ ɪɬɚ (m. depressor anguli oris) ɢ ɞɪ. ɂɧɧɟɪɜɢɪɭɸɬɫɹ ɜɟɬɜɹɦɢ ɥɢɰɟɜɨɝɨ ɧɟɪɜɚ ɪɢɫ 4.11).

ɀɢɪɨɜɨɟ ɬɟɥɨ ɳɟɤɢ corpus adiposum buccae) ɜ ɳɟɱɧɨɣ ɨɛɥɚɫɬɢ ɪɚɫɩɨɥɚɝɚ ɟɬɫɹ ɩɪɢɦɵɤɚɹ ɤ ɩɟɪɟɞɧɟɦɭ ɤɪɚɸ ɠɟɜɚɬɟɥɶɧɨɣ ɦɵɲɰɵ Ɉɧɨ ɡɚɤɥɸɱɟɧɨ ɜ ɞɨɜɨɥɶ ɧɨ ɩɥɨɬɧɭɸ ɮɚɫɰɢɚɥɶɧɭɸ ɤɚɩɫɭɥɭ ɤɨɬɨɪɚɹ ɨɬɞɟɥɹɟɬ ɟɝɨ ɨɬ ɩɨɞɤɨɠɧɨɣ ɤɥɟɬɱɚɬɤɢ ɢ ɦɢɦɢɱɟɫɤɢɯ ɦɵɲɰ ɜ ɬɨɦ ɱɢɫɥɟ ɢ ɨɬ ɳɟɱɧɨɣ ɦɵɲɰɵ ɪɚɫɩɨɥɨɠɟɧɧɨɣ ɜ ɝɥɭɛɢɧɟ Ɉɬ ɠɢɪɨɜɨɝɨ ɬɟɥɚ ɳɟɤɢ ɨɬɯɨɞɹɬ ɨɬɪɨɫɬɤɢ ɜ ɩɨɞɜɢɫɨɱɧɭɸ ɜɢɫɨɱɧɭɸ ɢ ɤɪɵɥɨɜɢɞ ɧɨ-ɧɟɛɧɵɟ ɹɦɤɢ

ȼ ɝɥɭɛɨɤɨɦ ɫɥɨɟ ɩɨɞɤɨɠɧɨɣ ɤɥɟɬɱɚɬɤɢ ɩɨɞ ɩɨɜɟɪɯɧɨɫɬɧɵɦ ɫɥɨɟɦ ɦɢɦɢɱɟ ɫɤɨɣ ɦɭɫɤɭɥɚɬɭɪɵ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɥɢɰɟɜɚɹ ɚɪɬɟɪɢɹ a. facialis ɪɢɫ 4.12) Ɉɧɚ ɨɬɯɨ ɞɢɬ ɨɬ ɧɚɪɭɠɧɨɣ ɫɨɧɧɨɣ ɚɪɬɟɪɢɢ ɩɪɨɯɨɞɢɬ ɜ ɩɨɞɧɢɠɧɟɱɟɥɸɫɬɧɨɣ ɬɪɟɭɝɨɥɶɧɢɤ ɩɨɡɚɞɢ ɩɨɞɧɢɠɧɟɱɟɥɸɫɬɧɨɣ ɠɟɥɟɡɵ ɢ ɨɝɢɛɚɹ ɧɢɠɧɢɣ ɤɪɚɣ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ ɜɵ ɯɨɞɢɬ ɜ ɳɟɱɧɭɸ ɨɛɥɚɫɬɶ Ɂɞɟɫɶ ɜɧɢɡɭ ɭ ɩɟɪɟɞɧɟɝɨ ɤɪɚɹ ɠɟɜɚɬɟɥɶɧɨɣ ɦɵɲɰɵ ɥɟɝ ɤɨ ɩɪɨɳɭɩɵɜɚɟɬɫɹ ɟɟ ɩɭɥɶɫɚɰɢɹ ȼ ɞɚɥɶɧɟɣɲɟɦ ɚɪɬɟɪɢɹ ɥɨɠɢɬɫɹ ɧɚ ɧɚɪɭɠɧɭɸ ɩɨɜɟɪɯɧɨɫɬɶ ɳɟɱɧɨɣ ɦɵɲɰɵ ɢ ɧɚɩɪɚɜɥɹɟɬɫɹ ɤ ɜɧɭɬɪɟɧɧɟɦɭ ɭɝɥɭ ɝɥɚɡɚ ɝɞɟ ɧɚɡɵ ɜɚɟɬɫɹ ɭɠɟ ɭɝɥɨɜɨɣ ɚɪɬɟɪɢɟɣ a. angularis ɉɨɫɥɟɞɧɹɹ ɚɧɚɫɬɨɦɨɡɢɪɭɟɬ ɫ ɤɨɧɟɱɧɵ ɦɢ ɜɟɬɜɹɦɢ ɝɥɚɡɧɨɣ ɚɪɬɟɪɢɢ ɢɡ ɜɧɭɬɪɟɧɧɟɣ ɫɨɧɧɨɣ ɚɪɬɟɪɢɢ

ɇɚ ɩɭɬɢ ɥɢɰɟɜɚɹ ɚɪɬɟɪɢɹ ɞɚɟɬ ɜɟɬɜɢ ɜɨɫɯɨɞɹɳɚɹ ɧɟɛɧɚɹ ɚɪɬɟɪɢɹ a. palatina ascendens ɩɨ ɛɨɤɨɜɨɣ ɫɬɟɧɤɟ ɝɥɨɬɤɢ ɧɚɩɪɚɜɥɹɟɬɫɹ ɤɜɟɪɯɭ ɢ ɞɨɫɬɢɝɚɟɬ ɦɹɝɤɨɝɨ ɧɟɛɚ ɦɢɧɞɚɥɢɤɨɜɚɹ ɚɪɬɟɪɢɹ a. tonsillaris) ± ɬɨɧɟɧɶɤɢɣ ɫɨɫɭɞ ɫɧɚɛɠɚɸɳɢɣ ɤɪɨ ɜɶɸ ɧɟɛɧɭɸ ɦɢɧɞɚɥɢɧɭ tonsilla palatina) ɩɨɞɩɨɞɛɨɪɨɞɨɱɧɚɹ ɚɪɬɟɪɢɹ a. submentalis) ± ɫɧɚɛɠɚɟɬ ɤɪɨɜɶɸ ɩɨɞɛɨɪɨɞɨɱɧɭɸ ɨɛɥɚɫɬɶ ɧɢɠɧɹɹ ɝɭɛɧɚɹ ɚɪɬɟɪɢɹ a. labialis inferior) ± ɫɧɚɛɠɚɟɬ ɤɪɨɜɶɸ ɨɛɥɚɫɬɶ ɧɢɠɧɟɣ ɝɭɛɵ ɜɟɪɯɧɹɹ ɝɭɛɧɚɹ ɚɪɬɟɪɢɹ a. labialis superior) ± ɚɧɚɥɨɝɢɱɧɵɣ ɫɨɫɭɞ ɫɧɚɛɠɚɸɳɢɣ ɤɪɨɜɶɸ ɜɟɪɯɧɸɸ ɝɭɛɭ ɭɝɥɨ ɜɚɹ ɚɪɬɟɪɢɹ a. angularis ɚɧɚɫɬɨɦɨɡɢɪɭɟɬ ɫ ɞɨɪɫɚɥɶɧɨɣ ɚɪɬɟɪɢɟɣ ɧɨɫɚ a. dorsalis nasi ɢɡ ɫɢɫɬɟɦɵ ɝɥɚɡɧɨɣ ɚɪɬɟɪɢɢ ɤɨɬɨɪɚɹ ɨɬɯɨɞɢɬ ɢɡ ɜɧɭɬɪɟɧɧɟɣ ɫɨɧɧɨɣ ɚɪɬɟɪɢɢ

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