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_4453_Библиотеки_им_академика_М_И_Перельмана
.pdf
230
https://t.me/medicina_free
A. Chorda tympani
B. Manubrium of the malleus
C. Long process of the incus
S.-s. Huang et al.
Fig. 9.5 Stapedius muscle and tensor tympani muscle removed (right)
The chorda tympani is a branch given off by the facial nerve in the
lower half of the mastoid segment, usually 6mm or so before the facial
nerve reaches the stylomastoid foramen. The chorda tympani runs up
and forward to pass through its posterior canaliculus into the middle ear
space. It leaves the canaliculus above the tympanic ring, crossing forward through the tympanic cavity between the manubrium of the mal-
A. Head of the malleus
B. Stapes
leus and the long process of the incus and leaves the tympanic cavity via
its anterior canaliculus (medial part of the petrotympanic ssure) in the
anterior wall of the tympanic cavity to enter the infratemporal fossa.
Gustatory bers of the chorda tympani transmit taste stimuli from the
anterior 2/3 of the tongue, while its parasympathetic bers innervate the
sublingual and submandibular glands
Fig. 9.6 Incus removed (right)
The head of the malleus and the body of the incus articulate at the
incudomalleal joint. The short process of the incus resides in the incu-
dal fossa. The end of the long process of the incus is called the lenticular process and forms the incudostapedial joint with the head of the
stapes
9 Stereoscopic Virtual Anatomy ofTemporal Bone
https://t.me/medicina_free
A. Promontory
B. Stapes
C. Round window
Fig. 9.7 Malleus removed (right)
When the malleus is removed, the full course of tympanic segment and geniculate ganglion of the facial nerve are exposed
231
Fig. 9.8 Stapes removed (right)
The entire ossicular chain is eliminated when the stapes is removed.
The part protruding from the basal turn of the cochlea into the tympanic
A. Basal turn of the cochlea
B. Geniculate ganglion of the
facial nerve
C. Tympanic (horizontal)
segment of the facial nerve
cavity is called the promontory. The small depression posterior-superior
to the promontory is the oval window, and the structure posterior to the
promontory is the round window
232
https://t.me/medicina_free
A. Ampulla of the lateral
semicircular canal
B. Ampulla of the superior
semicircular canal
C. Utricle
D. Common crus
E. Ampulla of the posterior
semicircular canal
F. Saccule
G. Cochlear duct
H. Endolymphatic duct and the
endolymphatic sac
S.-s. Huang et al.
Fig. 9.9 Bony semicircular canals and vestibule removed (right)
The labyrinthine component of the inner ear is divided into the osseous
labyrinth and the membranous labyrinth. Once the osseous semicircular
canals and the bony wall of the vestibule are removed, the membranous
labyrinth, including the saccule and utricle, are exposed. The cochlear
A. Nerve terminal distributed
to the ampullae of the
superior and lateral
semicircular canals
B. Macula of the utricle
C. Macula of the saccule
D. Nerve terminal distributed
to the ampulla of the
posterior semicircular canal
duct is also called the scala media, and it nests between the scala vestibuli and scala tympani. The J-shaped endolymphatic duct (the long
limb is adjacent to the endolymphatic sac, while the short limb is in
proximity with the vestibule) sits deep to the common crus, connecting
the endolymphatic sac to the saccule and utricle
Fig. 9.10 Membranous labyrinth removed (right)
After removing the membranous labyrinth, the vestibular nerve endings, which innervate the membranous labyrinth, can be observed. The
superior vestibular nerve endings dominate the ampullae of the superior
and lateral semicircular canal as well as the macula of the utricle, and
the inferior vestibular nerve endings innervate the posterior semicircular canal and the macula of the saccule
9 Stereoscopic Virtual Anatomy ofTemporal Bone
https://t.me/medicina_free
233
A. Mastoid segment of the facial
nerve
B. Pyramidal segment of the
facial nerve
C. Horizontal segment of the
facial nerve
D. Geniculate ganglion
E. Labyrinthine segment of the
facial nerve
F. IAC segment of the facial
nerve
Fig. 9.11 Vestibular nerve removed (right)
The labyrinthine segment and internal auditory canal (IAC) segment of
the facial nerve is located in front of the vestibular nerve. When the latter is removed, the full course of the facial nerve is exposed. The anatomical structures that can be helpful inlocating the facial nerve include
the digastric ridge, stylomastoid foramen, short process of the incus,
eminence of the lateral semicircular canal, pyramidal eminence, oval
window, cochleariform process, anterior epitympanic recess, sinus tympani, GSPN, eminence of the superior semicircular canal, horizon crest,
vertical crest, nervus intermedius, vestibulocochlear nerve, anterior
inferior cerebellar artery, and labyrinthine artery
A. Scala vestibuli
B. Scala tympani
C. Round window
D. Cochlear aqueduct
E. Cochlear nerve
F. Top of the jugular bulb
G. Internal carotid artery (ICA)
Fig. 9.12 Facial nerve removed (right)
After removing the facial nerve, inside the IAC, we can see the cochlear
nerve extending into the canal of the modiolus. The cochlear aqueduct
runs a long distance, its internal opening is medial and inferior to the
round window, and the external opening is medial to the jugular bulb.
The internal carotid artery sits close to the cochlea, with its vertical segment joining the horizontal segment beneath the cochlea
234
https://t.me/medicina_free
A. Scala vestibuli
B. Scala tympani
C. Round window
D. Cochlear aqueduct
Fig. 9.13 Round window (right)
The round window is a blind terminal of the scala tympani, sealed by a
membrane inside the round window niche. The medial end of the
cochlear aqueduct opens medial and inferior to the round window
S.-s. Huang et al.
9 Stereoscopic Virtual Anatomy ofTemporal Bone
https://t.me/medicina_free
Virtual Anatomy: Retro Auricular Approach
De-junZhang
235
A. Inferior wall of the EAC
B. Umbo
C. Malleal stria
D. Malleal lateral process
(prominence)
Fig. 9.14 Tympanic membrane (right)
The umbo (the tip of manubrium), posterior malleal stria, and malleal prominence (the lateral process of malleus) can be seen through the EAC
236
https://t.me/medicina_free
S.-s. Huang et al.
A. Inferior wall of the EAC
B. Manubrium (handle of
malleus)
C. Posterior-superior wall of
the EAC
D. Basal turn of the cochlea
Fig. 9.15 Removed tympanic membrane (right)
The head and neck of the malleus and most of the incus covered by the
posterosuperior wall of the EAC (tympanic scutum) can be observed
A. Anterior wall of the EAC
B. Ty mpanic orifice of the
Eustachian tube
C. Internal carotid artery
D. Tensor tympani muscle
E. Handle of malleus
(manubrium)
through the reconstructed bony canal. It is necessary to remove part of
the lateral wall of the epitympanum when performing the transcanal
approach to explore the epitympanum
Fig. 9.16 Anterior tympanic cavity (right)
The Tensor tympani muscle (located in the semicanal for the tensor
tympani muscle), the tympanic orice of the Eustachian tube, and the
internal carotid artery (surrounded by its bony wall) can be seen through
the anterior tympanic cavity
9 Stereoscopic Virtual Anatomy ofTemporal Bone
https://t.me/medicina_free
A. Tensor tympani muscle
B. Cochleariform process
C. Lateral process of the
malleus
D. Long process of the incus
E. Stapes
F. Chorda tympani
237
Fig. 9.17 Superior tympanic cavity (right)
The tensor tympani tendon attaches to the upper part of the handle of
malleus after it emerges from the cochleariform process. The cochleariform process is anteroinferior to the tympanic segment of the facial
nerve. The tympanic segment of the facial nerve runs superior to the
stapes and the oval window. The chorda tympani, emerging from the
posterosuperior wall of the tympanic cavity, crosses the tympanic cavity between the long process of the incus and the manubrium
A. Basal turn of the cochlea
B. Round window
C. Long process of the incus
D. Stapes
Fig. 9.18 Posterior tympanic cavity (right)
Observed through the posterior tympanic cavity: the basal turn of the
cochlea, the posterosuperior part of the promontory, the oval window,
and the round window, which lies in the depression seen posteriorly.
The oval window is sealed by the stapes footplate and annular ligament.
The round window lies deep within the round window niche and cannot
be observed easily
238
https://t.me/medicina_free
S.-s. Huang et al.
A. Inferior wall of the EAC
B. Roof of the jugular bulb
Fig. 9.19 Inferior tympanic cavity (right)
The inferior tympanic cavity is separated by an irregular bony wall
from the jugular bulb postero- inferiorly. The inferior wall of the tympanum is also called the jugular wall. In some cases, the jugular wall is
dehiscent. When the high- or nger-like jugular bulb protrudes into the
middle ear cavity through the dehiscence of the jugular wall, it can
cause pulsatile tinnitus or conductive hearing loss. The jugular body, a
chemoreceptor similar to the carotid body, is located at the dome of the
jugular bulb. Glomus jugulare tumors arise from this chemoreceptor
9 Stereoscopic Virtual Anatomy ofTemporal Bone
https://t.me/medicina_free
Virtual Anatomy: Middle Cranial Fossa
Approach
Xiao-hongLi
A. Tympanic membrane
B. Ossicular chain
C. Bony wall of EAC
D. Bony part of Eustachian tube
E. Tensor tympani muscle
F. Temporal bone (anterior
petrous apex)
239
Fig. 9.20 General view of the temporal bone (right)
A superior view of the components in the temporal bone via a middle cranial fossa approach
Соседние файлы в папке Библиотека им академика М.И. Перельмана