Greater foot anserine of the facial nerve name. Greater pes anserine of the facial nerve

Parotid gland (glandula parotis) - large salivary gland irregular shape (Fig. 54, 55). In cross-section it resembles a triangle; its deep part enters the postmaxillary fossa, bounded in front by a branch lower jaw, above by the auditory canal and the temporomandibular joint, behind by the mastoid process with the sternocleidomastoid muscle and below by the fascial septum separating the parotid gland from the submandibular gland. With its anterior edge, the organ extends onto the outer surface of the masticatory muscle.

Rice. 54. Topography of the parotid-masticatory region.
1 - r. temporalis n. facialis; 2 - a. temporalis superficialis; 3 - n. auriculotemporalis; 4 - a. transversa faciei; 5 - glandula parotis; 5 - m. sternocleidomastoideus; 7 - r. colli n. facialis; 8 - r. marginalis mandibulae n. facialis; 9 - a. facialis; 10 - v. facialis; 11 - mm. buccales n. facialis; 12 - ductus parotideus; 13 - r. zygomaticus n. facialis; 14 - m. masseter

Rice. 55. Frontal section of the auditory canal and parotid salivary gland. 1 - eardrum: 2 - styloid process with muscles attached to it; 3 - capsule parotid gland; 4 - parotid gland; 5 - Santorini cracks; 6 - cartilage of the auditory canal; 7 - temporal muscle.

The fascia of the region creates a case for the parotid gland, enveloping it on all sides. WITH outside the fascia is thickened and is described as an aponeurosis. The fascia is thinned in the area adjacent to the peripharyngeal tissue and the cartilaginous part of the auditory canal, which has Santorini fissures. As a result, pus from fascial bed glands are able to break into the peripharyngeal space and into the auditory canal, the latter is more often observed in children. In addition to the fascial cover, the parotid gland is enveloped in a thin capsule, which, together with the fascia inside the organ, gives off spurs, dividing it into lobules. This prevents the spread of the purulent process in the gland itself. The sizes of the parotid gland vary. Sometimes it only slightly overlaps the posterior part of the masticatory muscle, but in some cases it almost reaches its anterior edge, especially when additional lobules of the gland are observed, located along the Stenon’s duct.

The excretory duct of the parotid gland (ductus parotideus) is formed from collecting trunks within the organ. Sometimes these stems form a common duct outside the gland. The duct may not be single. The length of the duct is from 1.5 to 5 cm, the lumen diameter is 2-3 mm. The duct, having passed to the anterior edge of the masticatory muscle, goes into the fatty lump of the cheek, pierces the buccal muscle, runs for 5-6 mm under the mucous membrane and opens into the vestibule of the oral cavity. The projection of the duct onto the skin follows from the tragus auricle to the corner of the mouth or located on the parallel next to the transverse finger below the zygomatic arch. The transverse facial artery runs in the direction of the duct and slightly above it.

The inner part of the parotid gland, located behind the branch of the lower jaw (Fig. 56), is penetrated by the external carotid artery, where it divides into terminal branches: maxillary, posterior auricular and superficial temporal. Outward from carotid artery The external jugular vein is located. Within the gland, the transverse facial and posterior auricular veins flow into the vein.

Rice. 56. Parotid-masticatory region and parapharyngeal space (horizontal cut).
1 - fatty lump of the cheek; 2 - m. buccinator; 3 - upper jaw; 4 - Ch. pterygoideus medialis; 5 - pharynx; 6 - styloid process with muscles attached to it; 7 - a. carotis interna with n. vagus, n. accessorius, n. hypoglossus; 8 - I and II cervical vertebrae; 9 - ganglion cervicalis superior trunci sympathici; 10 - v. jugularis interna n. glossopharyngeus; 11 - parotid salivary gland; 12 - outer leaf of the facial fascia; 13 - lower jaw: 14 - m. masseter The arrow leads to the peripharyngeal space.

Within the parotid gland there are superficial and deep lymph nodes. The first collect lymph from the skin of the face, auricle, external auditory canal and tympanic cavity; the second - with soft palate, posterior half of the nasal cavity. Lymph flows into the nodes under the sternocleidomastoid muscle, near the internal jugular vein. Inflammation of deep lymph nodes located in the thickness of the gland, creates clinical picture mumps (pseudo-mumps).

The facial nerve passes through the thickness of the parotid gland, innervating the facial muscles. The nerve, emerging from the stylomastoid foramen, descends slightly downwards and, turning sharply upward, following under the earlobe, enters the thickness of the parotid gland. In the thickness of the gland it forms a plexus, and outside it forms a large crow's foot (pes anserinus major) (Fig. 57). The position of the main branches of the nerve is relatively constant. The starting point for the projection of the branches is the root of the earlobe.

Rice. 57. Topography of branches facial nerve.
1 - n. facialis; 2 - m. temporalis; 3 - r. zygomatici; 4 - r. buccalis; 5 - r. marginalis mandibulae; 6 - r. colli; 7 - n. auricularis posterior; 3 - plexus parotideus.

The temporal branches (rami temporales) are directed to the upper edge of the orbit; innervate the frontalis muscle and the orbicularis orbitalis muscle. The zygomatic branches (rami zygomatici) follow the zygomatic bone and further to the orbital zone; innervate the zygomatic muscle and the orbicularis orbital muscle. The buccal branches (rami buccales) are directed towards the mouth area; innervate the muscles of the mouth. The marginal branch of the jaw (ramus marginalis mandibulae) runs along the edge of the lower jaw; innervates muscles lower lip. The cervical branch (ramus colli) follows behind the angle of the lower jaw and goes to the neck to m. platisma. The listed branches of the facial nerve are most often represented on the face by two to three trunks. O. S. Semenova identifies a nerve structure with multiple connections and an isolated course of nerve trunks. Given the position of the branches of the facial nerve, it is recommended to make incisions on the face according to the principle of diverging rays with the earlobe as the starting point and taking into account the position of the main nerve trunks.

The front part of the area is occupied by m. masseter Under the masticatory muscle there is a layer of loose fiber where purulent processes can develop, often of odontogenic origin (Fig. 58).

Rice. 58. Topography of the space under the masticatory muscle.
1 - m. masseter; 2 - n. massetericus and a. masseterica; 3 - a. and v. temporalis superficialis; 4 - n. auriculotemporalis; 5 - glandula parotis; 6 - m. sternocleidomastoideus; 7 - a. facialis; 8 - v. facialis; 9 - a. buccinatoria with m. buccinator; 10 - ductus parotideus.

Directly in front of this muscle, a. facialis et v. facialis. Both vessels above the edge of the jaw slope towards the corner of the oral fissure. The superficial position of the artery on the bone allows you to palpate at the edge of the jaw and masticatory muscle to feel its pulse impulses.

(pes anserinus minor)
the set of branches of the infraorbital nerve immediately after its exit from the infraorbital foramen.

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Paw- paws, w. 1. Reduce-caress. to paw in 1, 2, 3 and 6 values. 2. A trace from an animal paw (hunting). 3. Skin, fur taken from someone’s paw. animal. Fur coat with hare's feet. Crow's feet -........
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Paw- -And; pl. genus. -ok, dat. -pkam; and.
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Artery Iliac Minor- (a. iliaca parva) see List of anat. terms.
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Vein Mesenteric Small- (v. mesenterica parva) see List of anat. terms.
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Vein azygos, Lesser Superior- (v. azygos minor superior) cm. vol. 1, List of anat. terms.
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Vein Legs Subcutaneous Small- (v. saphena parva, PNA, BNA, JNA) see List of anat. terms.
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Vein of the Heart Small- (v. cordis parva, PNA, BNA, JNA) see List of anat. terms.
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Crow's Foot Large— (pes anserinus major) see List of anat. terms.
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Crow's Foot Deep- (pes anserinus profundus) a set of diverging bundles of the semimembranosus tendon located at the medial edge of the tibia under the superficial pes anserine.
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Crow's Foot Small- (pes anserinus miror) a set of branches of the infraorbital nerve immediately after its exit from the infraorbital foramen.
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Crow's Foot Superficial- (pes anserinus superficialis) triangular aponeurosis of the sartorius, gracilis and semitendinosus muscles, located at the medial edge of the tibia.
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Entente Lesser- in 1920-38 a bloc of Czechoslovakia, Romania and Yugoslavia; the main link in the French-supported system of military-political alliances in Europe in the 1920-30s.

Tibia- long, thin bone located on the outside lower limb four- and two-legged vertebrates, including humans. It articulates with the TIBIUM bone........

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Gland Vestibular Small- (g. vestibularis minor, PNA, BNA, JNA) see Small vestibular gland.
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Gland vestibular minor— see Small vestibular gland.
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Hysteria Little Charcot- see Charcot minor hysteria.
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Anatomy. The nucleus of the facial nerve lies deep in the posterior parts of the pons, at its border with the medulla oblongata. The axons of the cells of this nucleus, before leaving the pons, bend around the nucleus of the abducens nerve, which is located directly under the IV ventricle (Fig. 89). Next, the fibers of the facial nerve go in the ventral direction (some of the fibers may move to the other side, making a partial crossover; due to this variation, the mild weakness of the muscles and the upper half of the face appears to be explained when central paralysis, (see below) and exit in the lateral sections of the pons, at its junction with the medulla oblongata, between the pons and the overhanging cerebellar hemisphere, i.e. in a place called cerebellopontine angle.

Next to the facial nerve in the cerebellopontine angle is the VIII nerve, from the trunk of which a tumor often develops - a neuroma, which usually compresses the facial nerve. The facial nerve enters together with the auditory nerve into the internal auditory canal of the temporal bone and soon penetrates through the opening at the base of the meatus acusticus into the fallopian canal. Here it forms a knee, that is, it passes from a horizontal direction to a vertical one, and through the stylomastoid foramen it leaves the skull, penetrates the parotid gland and is divided into a number of terminal branches (“large crow’s foot” - pes anserinus major) (Fig. 90).

The other part of the facial nerve is n. intermedius (Some authors consider this part of the facial nerve to be an independent XIII pair, the cranial, intermediate nerve (nervus intermedius)- consists of sensory fibers of the parotid region, gustatory and salivary vegetative fibers Taste fibers are associated with crank joint(gangl. geniculi), lying in the place of the fallopian canal where the facial nerve forms the knee. The dendrites of the cells of the geniculate ganglion as part of the chordae tympani carry taste stimuli from the anterior two-thirds of the tongue, passing the initial part of the path with the lingual nerve - n. lingualis. The axons of these cells, going along with the motor part of the facial nerve, enter the cerebellopontine angle in brain stem, where they end in the nucleus of the solitary tract (gustatory) - nucleus tractus solitarii, where taste fibers and IX pairs (glossopharyngeal nerve) arrive (see Fig. 89).

Secretory salivary fibers emerge from the salivary nucleus (nucleus salivatorius), common with the glossopharyngeal nerve, travel in the fallopian canal along with the motor portion of the facial nerve and leave it as part of the same chordae tympani. They innervate the submandibular and sublingual salivary glands(glandulae submaxillaris et sublingualis) (Fig. 85 and 91).

Secretory lacrimal fibers also come from the VII nerve. They leave the fallopian canal as part of the greater petrosal nerve (n. petrosus major) and, switching to the gangl. pterygopalatinum (Fig. 92 and 132), with a branch of the trigeminal nerve (n. lacrimalis) reach the lacrimal gland. When these fibers are damaged, there is no lacrimation and dry eye (xerophthalmia) is noted. Slightly below the origin of the greater petrosal nerve, it separates from the facial nerve and leaves the fallopian canal n. stapedius to the stapes muscle, when tense, the stapes moves out of the oval end of the labyrinth, thereby providing the best audibility. Damage to this muscle causes some hearing loss and at the same time gives the perception of sounds an unpleasant, irritating character. The so-called auditory dysesthesia, which was named hyperacusis(hyperakusis).

Clinic. With the peripheral type of paralysis of the facial muscles (regardless of whether this will be due to damage to the nucleus of the facial nerve, fibers running in the pons, or due to the nerve trunk itself), the entire half of the face is motionless: the skin of the forehead does not gather in folds, the eye does not close , the corner of the mouth is lowered, the nasolabial fold is smoothed. The patient cannot bare his teeth or pout

cheeks, whistle, close your eyes, frown. The asymmetry is also visible in calm state(Fig. 93). The corneal and brow reflexes are lost.

To establish the strength of the orbicularis oculi muscle, the patient is asked to close his eyes tightly, and the doctor tries to lift upper eyelid, determining the resistance force. To determine the strength of the orbicularis oris muscle, the patient is asked to puff out his cheeks, and the doctor presses on them. When this muscle on the affected side is weak, air escapes from the corner of the mouth.

At first, the patient feels awkward when talking or eating; food and saliva on the paralyzed side pour out of the mouth. When you try to close your eyes, you get a non-closing, “hare” eye (lagophthalmos), where, as normally, there is a synergistic upward and outward rotation of the eyeball, but here the iris goes under the upper eyelid, and the sclera does not close ( symptom - Bell phenomenon) (see Fig. 131, a, b, c)

Topical diagnosis. Based on the listed additional symptoms, caused by damage to fibers running together with motor fibers n. facialis, you can approximately determine the location of damage to the facial nerve. Thus, during a process in the brain stem that involves the nucleus of the facial nerve or its radicular fibers, the pyramidal tract often suffers, which gives a picture of alternating hemiplegia (Millard-Hübler palsy), sometimes with simultaneous damage to the abducens nerve on the side of the paralysis of the facial muscles (Fauville palsy) .

Damage to the facial nerve at its exit from the cerebellopontine angle is usually combined with damage to the auditory nerve, i.e., with deafness. Paralysis of the facial muscles in these cases is accompanied by dry eyes, sometimes impaired taste in the anterior two-thirds of the tongue, sometimes dryness of the latter and dry mouth (xerostomia).

Damage to the facial nerve in the fallopian canal up to its knee, i.e., above the origin of the greater petrosal nerve, causes, simultaneously with facial paralysis, dry eye, disorder of taste and salivation, and hyperacusis.

Lesion in the fallopian canal below the origin of the greater petrosal nerve, but above the n. stapedii, gives, in addition to facial paralysis, taste disorder, salivation and hyperacusis, but instead of dry eye, increased lacrimation will be observed here, since due to poor pressure of the lower eyelid, the tear flows out without getting into the lacrimal sac.

When the VII nerve is damaged in the fallopian canal below the origin of n. stapedii, but above the exit of the chordae tympani, facial paralysis, lacrimation, taste disorder and salivation are noted.

Finally, damage to the facial nerve in the bony canal below the origin of the chordae tympani or at the exit from the stylomastoid foramen causes facial paralysis with lacrimation without noted associated disorders. An electromyographic study of facial muscles can help judge the degree of damage to the facial nerve.

Bilateral damage to the facial nerve, diplegia facialis, can also be observed (with polyneuritis, basilar meningitis, fracture of the bones of the base of the skull). Neuritis of the facial nerve may be accompanied by pain in mastoid process or in front of the auricle, obviously due to anastomoses with the fibers of the trigeminal nerve.

Long-term unilateral paralysis of the facial muscles, and sometimes more recent cases, may be accompanied by the development of contracture of the paralyzed muscles, which, upon superficial examination, sometimes leads to the erroneous conclusion about muscle paresis not on the diseased, but on the healthy half of the face.

Paralysis of facial muscles is observed not only when the nucleus or trunk of the facial nerve is damaged, but also when the cortical-nuclear connections are lost. In these cases, paralysis of the facial muscles is limited to damage to only the lower half of the face and is usually combined with hemiplegia. The eye closes completely and the forehead wrinkles well (sometimes there is slight weakness when closing the eye and wrinkling the forehead), but the teeth on this side cannot be bared and the mouth twists in the healthy direction. This is the so-called central type of paralysis(or paresis) of facial muscles is explained by the fact that the upper cell group of the nucleus of the facial nerve has bilateral cortical innervation, while the lower one is connected only with the opposite hemisphere (Fig. 94).

One-way connections with the cerebral cortex provide more differentiated isolated contractions, while bilateral connections exist where the muscles on the right and left usually act simultaneously. So, when chewing, the masticatory muscles on both sides contract. Most people cannot wrinkle their forehead only on the right or only on the left; many cannot close one or the other eye alternately. Both always contract at the same time vocal cords, both halves of the soft palate.

With central paralysis of the facial muscles, as opposed to its peripheral paralysis, there will be no qualitative changes in electrical excitability and electromyographic changes in the muscles; the corneal and superciliary reflexes do not disappear.

There have been cases of increased mechanical excitability of the facial nerve, which leads to convulsive contractions of the facial muscles when tapping with a hammer 1.5-2 cm below the zygomatic arch at the site of the superficial location of the facial nerve and its “large crow's foot” ( Chvostek's sign). This symptom is especially pronounced in tetany.

Facial nerve- mixed, mainly motor, it contains specific fibers taste sensitivity and motor autonomic fibers. The latter are the roots of the intermediate nerve (p. intermedius), closely adjacent to the trunk of the facial nerve.

Cortical motor facial nerve analyzer located in the lower parts of the anterior central gyrus. From here the fibers pass as part of the cortico-muscular pathway through white matter cerebral hemispheres, then through the knee of the internal capsule they enter the cerebral peduncles and lie together with the pyramidal tract at their base. In the area of ​​the suture of the bridge, immediately in front of the nuclei of the facial nerve, the central fibers cross. Moreover, the dorsal part of the nucleus, from which the upper part of the face is innervated, receives bilateral cortical innervation, the ventral part, associated with the muscles of the lower half of the face, from the opposite hemisphere.

Facial nerve nucleus located in the ventral part of the tegmentum of the medullary pons at its border with the medulla oblongata. In the nucleus of the facial nerve there is a somatotopic projection of the facial muscles - certain muscles are associated with certain groups of cells. Thus, the dorsal part of the nucleus innervates the frontalis muscle, the corrugator muscle, and the orbicularis oculi muscle; lateral subgroup of the ventral part of the nucleus - the muscles of the chin; middle - lip muscles. The axons of the listed cell groups form the intracerebral part of the root of the VII pair. They are directed posteriorly and inwardly to the bottom of the fourth ventricle, pass some distance under it, then turn laterally and ventrally, describing a loop of the facial nerve. At the bottom of the ventricle, this place corresponds to an elevation - the tubercle of the facial nerve. Inside the loop of the facial nerve is the nucleus of the abducens nerve.

Then the facial nerve fibers pass through the thickness of the pons and emerge from the substance of the brain at the pontocerebellar angle. The auditory and intermediate nerves are adjacent to the extramedullary part of the facial nerve root. Together with auditory nerve The facial nerve enters the internal auditory foramen of the temporal bone, from which it enters the canal of the facial nerve, where it passes along with the intermediate nerve. The facial nerve canal first has a horizontal, then vertical direction. At the place of transition from the horizontal to the vertical part there is the second knee of the facial nerve with the ganglion geniculum located here. The facial nerve exits the pyramid of the temporal bone through the stylomastoid foramen, from where it goes to the parotid gland, before entering it it gives off the deep auricular nerve, nerves to the stylohyoid and digastric muscles.
Posterior auricular nerve innervates the auricular muscles, the occipital muscle, anastomoses with the greater and lesser occipital nerves, the auricular branch of the vagus nerve.

Upon exit from the ear gland or in its thickness the facial nerve breaks up into its terminal branches. The parotid plexus forms the so-called greater crow's foot.
Terminal branches of the facial nerve form many anastomoses with each other, as well as with the sensory endings of the trigeminal nerve.
In the vertical part of the canal, the stapes nerve departs from the facial nerve, innervating the muscle of the same name.

Intermediate nerve contains sensory fibers that conduct taste sensitivity from the anterior 2/3 of the tongue, and motor parasympathetic secretory fibers. The central motor analyzer of the intermediate nerve is located in the superior frontal and orbital gyri, in the autonomic centers of the hypothalamus. From here, preganglionic lacrimal and salivary effector fibers begin, which end on the cells of the superior salivary nucleus (nucl. salivatorius superior), located near the nucleus of the facial nerve. Postganglionic fibers form the motor part of the intermediate nerve. In the area of ​​the ganglion geniculum, salivary fibers depart from the intermediate nerve in the form of a large stony superficial nerve (n. petrosus superfacialis major). The greater petrosal nerve lies in a special groove on the roof of the pyramid of the temporal bone. It leaves the cranial cavity through the lacerated foramen and enters the pterygoid canal (canalis pterygoideus). Here it is joined by the sympathetic nerve - the deep stony nerve (n. petrosus profundus) from the plexus of the internal carotid artery.

After its merger with big petrosal nerve a common trunk is formed, which is called the Vidian nerve. Parasympathetic fibers of the Vidian nerve are interrupted in the pterygopalatine ganglion (g. sphenopalatinum). Lacrimal postganglionic fibers from this node pass along with the zygomatic nerve and reach the lacrimal gland through its anastomosis with the lacrimal nerve. Branches also extend from the pterygopalatine node to the glands of the nasal cavity and mouth.

Salivatory preganglionic fibers depart from the intermediate nerve in the vertical part of the facial nerve canal as part of the chorda tympani (chorda tympani). The chorda tympani crosses the tympanic cavity, exits it through the petrotympanic fissure (fissura pterigotympanica) and, passing between the medial and lateral pterygoid muscles, joins the lingual nerve (n. lingualis). Preganglionic salivary fibers end in the submandibular and sublingual nodes, from where postganglionic fibers begin, heading to the submandibular and sublingual glands.

Specific taste cells sensitivity of the intermediate nerve embedded in the crankshaft, have a T-shaped structure. The dendrites of these cells are part of the chorda tympani and, connecting with the lingual nerve, reach the mucous membrane of the anterior two-thirds of the tongue, ending with taste buds. The axons of the taste cells of the geniculate ganglion first run in the common trunk of the facial nerve, then in the internal auditory canal they depart from it, forming a separate trunk located next to the auditory and facial nerves. They enter the brain substance in the region of the cerebellopontine angle, ending in the taste nucleus of the solitary tract (nucl. tractus solitarii). Nucl. tractus solitarii is located in the dorsolateral part of the tegmentum along its entire length medulla oblongata. The second gustatory neurons move to the opposite side and join the medial lemniscus, ending in the ventral and medial nuclei of the thalamus.

Here it is third gustatory pathway neuron. The axons of the third gustatory neuron, leaving the thalamus opticum, are directed through the posterior sections rear thigh internal capsule to the cortical taste analyzer. It is believed that the cortical taste analyzer is located in the medial wall of the inferior horn lateral ventricle(hippocampus) and the opercular area under the Sylvian fissure. It is suggested that the opercular region creates an idea of ​​the taste of food and its other qualities - temperature, consistency. The limbic taste center forms emotional coloring taste perception.

Large crow's foot (pes anserinus major) see List of anat. terms.

Large medical dictionary. 2000 .

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