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_4501_Библиотеки_им_академика_М_И_Перельмана
.pdf
20 ■ ANATOMY OF THE TEMPORAL BONE WITH SURGICAL IMPLICATIONS
Figure 33
The facial nerve and its geniculate ganglion lie beneath the
dura of the middle cranial fossa. The facial, vestibular, and
cochlear nerve trunks are seen in the internal auditory canal.
Figure 32
The middle and apical turns of the cochlea are emerging as the
middle ear space narrows. The falciform crest and its
relationship to the cochlear and facial nerves are seen, as well
as the labyrinthine segment of the facial nerve.
CHAPTER 1: SERIAL PHOTOGRAPHS OF SECTIONS OF THE TEMPORAL BONE ■ 21
Figure 34
The protympanum diminishes in size anteriorly. The lesser
superficial petrosal nerve (LSPN) in its superior tympanic
canaliculus lies just superior to the tensor tympani muscle. All
three turns of the cochlea and the helicotrema are seen.
Figure 35
The tensor tympani muscle lies in its semicanal just medial
to the osseous part of the eustachian tube.
22 ■ ANATOMY OF THE TEMPORAL BONE WITH SURGICAL IMPLICATIONS
Figure 37
The internal auditory canal opens to the posterior cranial fossa.
The pericarotid and peritubal areas are well pneumatized.
Figure 36
Progressing anteromedially, only the anterior aspect of the basal
turn of the cochlea remains.
CHAPTER 1: SERIAL PHOTOGRAPHS OF SECTIONS OF THE TEMPORAL BONE ■ 23
HORIZONTAL THREE-DIMENSIONAL PHOTOGRAPHS
OF CELLOIDIN-IMPREGNATED TEMPORAL BONES
The paired images appearing in Figures 38 to 51 are stereoscopic counterparts of the accompanying, labeled photograph. The photograph is
presented only to aid in identifying the anatomic structures featured in the
stereo views. The stereo photographs were made with a Donaldson camera
from celloidin blocks during the process of sectioning. They show the threedimensional anatomy of the temporal bone in the horizontal plane. Figures
38 to 44 show a sequence of views from superior to inferior; Figures 45 to 51
show selected views of particular anatomic interest.
In order to appreciate the three-dimensional effect, it is important to
concentrate on the paired images and have them fully occupy your field of
vision. In addition, the plane of your eyes must remain parallel to the plane
of the page. Then “defocus” your eyes and allow the images to fuse.
Alternatively, looking “through” or “beyond” the images without focusing
on them enables perception of the three-dimensional effect. We believe that
these stereo views will facilitate the comprehension of ear anatomy in its
three-dimensional aspect, and aid in understanding of the two-dimensional
photographs in this book.
24 ■ ANATOMY OF THE TEMPORAL BONE WITH SURGICAL IMPLICATIONS
Figure 39
At a deeper level, we see the genu of the facial
nerve. It is an important landmark in the middle
cranial fossa approach to the internal auditory
canal. The vertical crest (also known as “Bill’s
bar”) separates the facial nerve anteriorly from
the superior vestibular nerve posteriorly. The
lateral and posterior canals are both visible. The
lateral part of the internal auditory canal is
narrower than the midportion, with the cochlea
located anteriorly and the ampulla of the superior canal located posteriorly. The short process
of the incus is tethered to the walls of the incudal fossa by the posterior incudal ligament.
(Comparable to Fig. 4 on p. 7.)
Figure 38
There is a large anterior epitympanic recess
which opens into the mesotympanum inferiorly.
The epitympanum narrows posteriorly to the
aditus which in turn communicates with the
mastoid air cell system. The crista is seen on the
lateral wall of the ampulla of the superior canal
(female, age 72 yr). (Comparable to Fig. 2 on p. 6.)
CHAPTER 1: SERIAL PHOTOGRAPHS OF SECTIONS OF THE TEMPORAL BONE ■ 25
Figure 40
Prussak’s recess is seen lateral to the head and
neck of the malleus. The incus articulates with
the stapes by means of the lenticular process. The
facial nerve is seen in its tympanic (horizontal)
segment. The basal turn of the cochlea is
exposed. The superior division of the vestibular
nerve and its utricular branch are evident. The
otoconial surface of the macula of the utricle
faces medially and posteriorly. (Comparable to
Fig. 5 on p. 7.)
Figure 41
The external auditory canal (EAC) is widely
opened and lies in the same plane as the internal
auditory canal. The posterior pouch of von Tröltsch
occupies the interval between the posterior malleal
fold and the tympanic membrane. The facial nerve
is seen in the beginning of its mastoid (vertical) segment. Normally, the anterior crus of the stapes is
straight and the posterior crus is curved, as seen
here. All three turns of the cochlea are seen. Note
that the apex of the cochlea points laterally, anteriorly, and inferiorly, and lies medial to the cochleariform process. The saccular branch of the inferior
vestibular nerve passes to the cribrose area. The
tensor tympani muscle and tendon are fully
exposed. (Comparable to Fig. 11 on p. 9.)
26 ■ ANATOMY OF THE TEMPORAL BONE WITH SURGICAL IMPLICATIONS
Figure 42
The conical shape of the pars tensa is evident.
The stapedius tendon attaches to the head of the
stapes. The promontory of the cochlea lies fully
exposed. The posterior ampullary nerve traverses
the singular canal on its way to the ampulla of the
posterior canal. There is a small arachnoid cyst
causing slight displacement but no atrophy of the
cochlear nerve bundles in the internal auditory
canal. (Comparable to Fig. 14 on p. 10.)
Figure 43
The manubrium of the malleus is visible in the
region of the umbo. The protympanum and hypotympanum are seen. The facial recess lies lateral and
the sinus tympani lies medial to the facial nerve.
The hook portion of the cochlea is located near the
ampulla of the posterior canal. Note the crista of the
posterior canal. (Comparable to Fig. 15 on p. 11.)
CHAPTER 1: SERIAL PHOTOGRAPHS OF SECTIONS OF THE TEMPORAL BONE ■ 27
Figure 44
The basal turn of the cochlea and round window
are seen. The protympanum leads to the tympanic orifice of the bony part of the eustachian
tube. (Comparable to Fig. 19 on p. 12.)
Figure 45
There is extensive pneumatization of the temporal bone. The posterosuperior cell tract leads to
the pneumatized petrous apex. The subarcuate
tract passes through the arch of the superior
canal, also leading to the petrous apex. Note that
the semicircular duct hugs the outer wall of the
bony canal (female, age 67yr).
28 ■ ANATOMY OF THE TEMPORAL BONE WITH SURGICAL IMPLICATIONS
Figure 46
This view shows Koerner’s (petrosquamosal)
septum which marks the junction of the lateral
or squamous part and the medial or petrous part
of the mastoid. The crista of the lateral canal and
the ampullated end of the superior canal are
visualized (male, age 67yr).
Figure 47
The anterior inferior cerebellar artery loops
deeply into the internal auditory canal. The facial
nerve is seen in the internal auditory canal and in
its tympanic segment. The superior division of
the vestibular nerve and its utricular branch, as
well as the utricular macula are seen (male, age
87yr).
CHAPTER 1: SERIAL PHOTOGRAPHS OF SECTIONS OF THE TEMPORAL BONE ■ 29
Figure 48
The cochlear nerve and the inferior division of
the vestibular nerve with its two branches, the
posterior ampullary and saccular nerves, are
seen. The inferior utricular crest marks the
boundary between the nonampullated end of
the lateral semicircular duct and the utricle. The
modiolus, osseous spiral lamina, limbus, organ
of Corti, and spiral ligament can be seen. The
saccule narrows inferiorly to the ductus
reuniens (female, age 68yr).
Figure 49
This is the right ear of a 62-yr-old man who
underwent stapedectomy for otosclerosis 2yr
before death. A gelfoam-wire prosthesis was
implanted and attached to the incus. Hearing
was improved. The prosthesis is partially
enveloped in fibrous tissue. The ductus reuniens
is seen passing from the saccule to the cochlear
duct.
Соседние файлы в папке Библиотека им академика М.И. Перельмана