Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4399_Библиотеки_им_академика_М_И_Перельмана
.pdf
Figure 9–14
https://t.me/med1917
196
Figure 9–15
https://t.me/med1917
197
Figure 9–16
https://t.me/med1917
198
Figure 9–17
https://t.me/med1917
199
Figure 9–18
https://t.me/med1917
200
9. Complete Temporal Bone Study 201
https://t.me/med1917
recess leading to the mastoid air cell system, and the
pyramidal process. Again anteriorly, the relationship
between the cochlea, the carotid artery canal, and the
bony Eustachian tube—being traversed superiorly by
the tesnor tympani muscle—is seen.
FIGURE 9–20
The umbo, the point of the inferior end of the manubrium of malleus, which is the depressed, approximate
center of the tympanic membrane, is seen here. Only
the basal turn of the cochlea is visible. The basal turn
is at the level referred to as the cochlear hook. A portion of the distal end of the endolymphatic duct is now
in view.
FIGURE 9–21
The pyramidal eminence that is located anterior to facial canal and nerve contains the stapedial muscle and
tendon. Antero-medial to the facial nerve is called the
sinus tympani. This sinus is bounded anterolaterally
by the pyramidal eminence and the facial nerve and
medially by the bony labyrinth. It may harbor irrever sible pathologic tissues such as cholesteatoma and granulation tissue. The extent of the sinus is variable.
FIGURE 9–22
Further inferiorly the scala tympani ends blindly at
the round window membrane, which older anatomy
texts refer to as the “secondary tympanic membrane.”
The carotid artery, which is seen anteriorly, can rarely
be dehiscent. Close observation at the time of myringotomy will prevent inadvertent injury to this major
vessel. The previously described surgical access to the
singular nerve coming from the posterior semicircular
canal ampulla is demonstrated here. The corresponding CT scan delineates the round window membrane
by the air-fluid interface seen in the posterior portion
of the ear, and the proximity of the round window
niche to the posterior canal ampulla.
FIGURE 9–23
This sequentially inferior histologic section through the
temporal bone now shows us the cochlear aqueduct. It
emanates from the scala tympani just inside the round
window and is speculated to be a communicating link
between the perilymph and the cerebrospinal fluid. In
this image, there is a microfracture in between the round
window niche area and ampullated posterior semicircular canal. This is the most common location for microfractures observed in the ear and clinically it does not
Figure 9–19a
https://t.me/med1917
202
Figure 9–19b
https://t.me/med1917
203
Figure 9–20
https://t.me/med1917
204
Figure 9–21
https://t.me/med1917
205
Соседние файлы в папке Библиотека им академика М.И. Перельмана