sinelnikov vol ii

8/12/2019 Sinelnikov Vol II

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ATLAS OF HUMAN ANATOMY


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P . A C M H E A b H M K O B

ATAAC

AHATOMMM

HEAOBEKA

B TP EX TOMAX

TOM II

Y H E H M E

O B H V T P E H H O C T i l X

M COCVAAX


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R.D.SINELNIKOV

ATLAS

O F

H U M A N

ANATOMY

IN T H R E E V O L U M E S

Volume II

The Science

of the Viscera

and Vessels

Translated from the Russian

by

LudmilaAksenova .M.D.


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Fi r s t pub l i shed 1989

Revised f rom the 1979 Russian edi t ion


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CONTENTS

T H E S C I E N C E O F T H E V I S C E R A ( S P L A N C H N O L -

O G Y ) 9

T he D i ge s ti ve S y s te m ( T h e D i g es ti ve A p p a r a t u s ) . . . 1 2

The Cav i ty o f t he M ou th 12

Th e Lips 12

The Che eks 14

Th e Palate 15

I 'he Musc les of the Pala te and Fauc es 18

T h e T o n g u e 1 9

Th e Mu scl es o f t he To ng ue 21

Th e Skel e t a l (Ex t r i n s i c ) Mu scl es o f t he To ng ue . 21

Th e In t r i n s i c Mu scl es o f t he To ng ue 23

T h e M u c o u s M e m b r a n e o f t h e T o n g u e 2 5

T h e S a li va ry G l a n d s of t h e C a v i ty o f t h e M o u t h . . . 2 5

Th e Paro t i d Gla nd 27

T h e S u b m a n d i b u l a r G l a n d 2 7

T h e S u b l i n g u a l G l a n d 2 7

T h e T e e t h 2 7

T h e D e c i d u o u s T e e t h 2 9

T h e P e r m a n e n t T e e t h 3 2

T he B i t e 38

The Pharynx 38

Th e Muscl es o f t he Pharynx 41

Th e Mu cou s Co at o f t he Phary nx 45

Tin - Oe soph agu s 48

The Abdominal and Pelvic Par ts of the System of Digest ive

Org ans (Ya.R .S inc ln ikov ) 51

Th e S tom ach 51

Th e Sm al l In t es t i ne 59

T h e D u o d e n u m 5 9

T h e R e s p i r a t o r y S y s t e m ( T h e R e s p i r a t o r y A p p a r a t u s ) . 1 1 4

Th e Cavi ty of the No se 114

T h e Larynx 121

T he Car t i l age s o f t he Larynx 126

T he Mus cl es o f t he Larvnx 134

T he M uco us Co al o f t he Larynx 140

T he Cav i ty of the Lary nx 144

T h e T r a c h e a a n d t h e B r o n c h i 1 44

Th e Lungs 146

T h e B r o n c h o p u l m o n a r y S e g m e n t s 1 58

T h e B o u n d a r i e s o f t h e L u n g s I ~ ) H

Th e P l eu ra 160

Developm en t and Age Fea tu res o f t he Resp i ra to ry Sys t em

(Ya.R .S ine ln ikov) 163

T h e U r o g e n i t a l S y s t e m ( T h e U r o g e n i t a l A p p a r a t u s )

(Ya.R .S inc ln ikov) 164

T h e U r i n a r y O r g a n s 1 M

T he Kidn eys 164

T h e U r e t e r s 1 7 6

T h e U r i n a r y B l a d d e r 1 7 8

T h e G e n i t a l O r g a n s 1 7 9

T h e M a l e G e n i t a l O r g a n s 1 7 9

T h e I n t e r n a l M a l e G e n i t a l O r g a n s 1 7 9

T h e T e s t i s 1 7 9

T he Vasa Defere n t i a 183

T h e - S p e r m a t i c C o r d s 1 84

T he Sem inal Ves i c l es 185

T he Pros t a t e 187

T h e B u l b o - u r e t h r a l G l a n d s 1 8 9


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6

C O N T E N T S

Th e Ex terna l Fem ale Ge n i t a l Org ans and Par t s . . 205

Th e Lab i a Majo ra 205

T h e L a b i a M i n o r a 2 0 5

Th e Ves t i bu l e o f t he Vag ina 206

T h e G r e a t e r V c s t i b u la r G l a n d s 2 0 7

Th e C l i t o r i s 207

Th e Bu lb o f t he Ves t i bu l e 20 8

T h e F e m a l e U r e t h r a 2 0 8

The P er i t oneum of t he Cav i ty o f t he Fem ale T ru e Pe lv i s 208

Developm en t and Age Fea tu res o f t he Organs o f t he Uro-

gen i t a l Sys t em (Ya.R .S inc ln ikov) 210

T h e P e r i n e u m 2 1 2

Th e Pelvi c Dia phra gm 212

T he Mus cl es o f t he Pe lv ic Dia phra gm 214

T he Fascia of the M usc les of the T ru e Pelvis . . . 217

T h e U r o g e n i t a l D i a p h r a g m 2 1 7

T h e M u sc le s of t he U r og e ni ta l D i a ph r ag m . . . . 2 1 8

T he Mus cl es o f t he Ex t erna l Gen i t a l Or ga ns . . . 218

T h e M a m m a r y G l a n d 2 1 9

T H E S C I E N C E O F T H E V E S S E L S ( A N G I O L O G Y ) . 2 2 3

Th e B lood Vasc u l ar Sys t em 229

G e n e r a l C i r c u l a t i o n 2 2 9

T h e H e a r t 2 2 9

T he Cav i ty o f t he He ar t 23 4

Th e R igh t At r i um 234

Th e R igh t Ven t r i c l e 237

T he Left At r i um 238

T he Left Ven t r i c l e 240

T he S t ruc tu re o f t he Hea r t 242

Th e Vesse l s o f t he He ar t 248

T he Ar t er i es o f t he He ar t 248

T he Veins o f t he He ar t 248

T h e P e r i c a r d i u m 2 5 3

T he Vesse ls o f t he Lesser C i rcu l a t i on 263

T h e P u l m o n a r y T r u n k 2 6 3

T h e P u l m o n a r y V e i n s 2 6 3

Th e Ar t er i es o f t he Gre a t er C i rcu l a t i on 271

T he Aor t a 271

Th e Asce nd ing Aor t a 271

T he Arc h o f t he Aor t a 271

T h e D e s c e n d i n g A o r ta 2 7 3

T h e D e e p P a l m a r A r c h 3 0 4

T he Ar t er i es o f t he Tr un k 307

T h e D e s c e n d i n g T h o r a c i c A o r t a 3 0 7

T he Vi scera l Branc hes 307

T he Par i e t a l Branc hes 307

T h e A b d o m i n a l A o r t a 3 0 8


T he Vi scera l Bra nch es 310

T he Arte r ies of the Pelvis 321

T h e C o m m o n I l ia c A r t e r y 3 2 1

Th e Ex terna l I l i ac Ar t e ry 321

Th e In t ern a l I l i ac Ar t ery 325

T h e V i s c er a l B r a n c h e s 3 2 5


T h e A r t er ie s o f t h e L o w e r L i m b ( Y a . R .S i n e ln i k o v ) . . . 3 2 8

T h e F e m o r a l A r t e r y 3 2 8

T he Pop l i t ea l Ar t ery 333

T he Pos t er i o r Tib i a l Ar t ery 338

T he Ante r i o r Tib i a l Ar t ery 342

T he Ar t er i a l Netw orks 346

Th e Veins o f t he Gre a t er C i rc u l a t i on 347

T he Sys t em o f t he Supe r io r Vena Cava 347

T h e V e i n s o f t h e T r u n k 3 4 7

T h e S u p e r i o r V e n a C a v a 3 4 7

T he Vena Azygos and t he In fer i o r Vena Hem iazygos 347

T h e I n n o m i n a t e V e i n s 3 5 3

Th e Veins o f t he He ad and Neck 355

T h e E x t e r n a l J u g u l a r V e i n 3 5 5

Th e In t erna l Jug u l ar Vein 358

T h e I n t r a c r a n i a l B r a n c h e s 3 5 8

T h e E x t r a c r a n i a l B r a n c h e s 3 6 4

Th e Veins o f t he Up per Lim b 367

T he Super f ic i a l Veins 367

T h e D e e p V e i n s 3 6 9

Th e Sys t em o f t he In fer i o r Ve na Cav a 375

T h e V e i n s o f t h e T r u n k 3 7 5

Th e In fer i o r Vena Cava 375

Th e Par i e t a l Veins 375

T he Vi scera l Veins 376

T he Sys t em o f t he Por t a l Vein 376

T he Veins of the Pelvis 382

T he Par i e t a l Veins 382


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C O N T E N T S

7

The R igh t Lym phat i c Du ct 402

The Sys tem o f t he Th orac i c Duc t 404

The Abd om ina l Par t o f t he Th orac i c Du ct 404

Th e Lym ph Vesse l s and Gla nd s o f t he Low er Lim b . 404

Th e Super f ic i a l Lym ph Vesse l s 404

Th e De ep Lym ph Vessel s. 406

T h e L y m p h V e s se ls a n d G l a n d s of t h e P elv is . . . 4 0 6

The Lym ph Vesse l s and Glands o f t he Cav i ty o f t he

A b d o m e n 4 1 0

The Lym ph Vesse l s o f t he Kidneys and Suprarena l

Glands 410

T h e I n t e s ti n a l T r u n k 4 1 0

The Lym ph Vesse l s and Glands o f t he Cav i ty o f t he

Thorax 415

Th e Lym ph Vesse l s o f t he Dia phra gm 415

T h e L y mp h V es se ls of t he T h o ra c ic W a ll s . . . . 4 17

T he Lym ph Vesse ls o f t he Lun gs 417

T h e L y m p h V e s s e ls o f t h e O e s o p h a g u s 4 1 9

Th e Lym ph Vesse l s o f t he H ea r t 419

T he Lym ph Vesse l s and Gla nds o f t he He ad and Neck . 419

Th e Lym ph Vesse l s o f t he He ad 421

Th e Lym ph Vesse l s o f t he Neck 423

T he Lym ph Vesse ls and Gla nds o f t he Up per Lim b . 423

Th e Super f ic i a l Lym ph Vesse ls 424

T h e D e e p L y m p h V e s s e ls 4 2 4

T h e L y m ph V esse ls of th e M a m m a ry G l an d . . . . 4 26

T h e S p l e e n 4 2 7

Developm en t and Age Fea tu res o f t he B lood Vascu l ar Sys

t em (Ya.R .S ine ln iko v) 428

Sub jec t Inde x 431


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TH E SCIENCE OF THE

VISCERA

SPLANCHNOLOGY

Splanchnologia


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S p l a n c h n o l o g y (splanchnologia)

1

is the scientific study of the in

ternal organs, or v iscera

{viscera

s .

splanchna).

The t e rm v i scera i s

app l i ed t o o rgans con t a ined i n t he cav i t i es o f t he body ( t he m ou th ,

t he neck , ches t , abd om en , and pe lv is ) . T he v i scera a re un i t ed i n to

sys t em s , o r app ara tus , acco rd ing t o funct i ona l , t opog raph o-an a-

tom ica l , and genet i c p roper t i es . Each o rgan o f a g iven sys t em has

i t s own speci f ic s t ructure and funct ion but takes par t in accom

pl ishing the general funct ion of the system together wi th i t s o ther

organs.

Th e d iges t i ve sys tem {appaiatus digestoriuss. systems digestorium),

t he r esp i r a to ry sys t em

{apparatus respiratorius

s.

systema respirator-

ium), the u rogen i t a l sys t em

{apparatus urogenitalis

s.

systema urogeni-

tale), and t he endocr ine , o r duc t l ess g l ands (glandulae sine ductibus)

are related to the viscera.

Som e o f t he i n t e rna l o rgans a re r e l a t ed t o var ious sys t em s . For

ins t ance , t he phary nx i s an o rgan o f bo th t he d iges t i ve and t he r e

sp i r a to ry appara tus , whereas t he m ale u re th ra (urethra masculina) is

a par t of the ur inary system and i s related at the same t ime to the

sys t em o f t he gen i t a l o rgans .

Al l the systems of the viscera have a feature in common. Thev

are ho l l ow (cav i t a ry ) o rgans , t ubu l ar o r o f som e o ther shape , wh ich

1

Eng l i sh equ iva l en t s to t he Lat i n t e rm s are g iven acco rd ing t o

the B i rm ingha m Rev i s ion (BR) o f t he Par i s An atom ica l No m e n

c l a tu re (NA) (Bu t t e rw or ths Med ic a l Dic t i ona ry , 1978 , second ed i

t io n , E d i t o r - i n - C h i ' f M a c D o n a l d C r i t c h l c y ) .

a r e li n e d w it h a m u c o u s c o a t , o r m e m b r a n e (tunica mucosa)whic h i s

covered by ep i t he l i um and cons i s t s o f a l am ina p r opr i a m u cosae

a n d l a m i n a m u s c u l a r i s m u c o s a e . W i t h i n t h e m u c o u s c o a t l i e m a n y

d i f f eren t l y shaped g l ands

(glandulae)

secre t i ng m ucus i n to t he cav

i ty of t he o rga ns . Di rec t l y over the m uco us coa l i s t he sub m u co us

coat

(tela submucosa)

a n d n e x t c o m e s t h e m u s c u l a r c o a t

(tunica mus

cularis)

of smooth muscle f ibres. The hol low organs may be covered

on t he ou t s i de by a serous coa t

(tunica serosa)

or adve n t i t i ous coa t

[tunica adventitia s.Jibrosa). Between t he m uscu l ar and serous coa t s

l ies the subserous coat (tela subsero sa).

The l i s t ed coa l s have i nd iv idual m orpho log i ca l f ea tu res i n each

organ, which i s determined by ihe funct ional t rend of the given

system of the viscera.

Besides the hol low organs the system of in ternal organs also

c o n t a i n s o r g a n s o f g l a n d u l a r s t r u c t u r e , g l a n d s (glandulae). T h e s e

are the sal ivary glands, the l iver , the sexual g lands, the duct less

g l a n d s . T h e y a r e f o r m e d o f p a r e n c h y m a

(parenchyma)

which i s a

spec i f i c t i s sue accom pl i sh ing secre to ry and ho rm onal func t i on ,

and o f s t rom a

(stroma).

The s t rom a i s a suppor t i ng t i s sue o f t he

g l and and separa t es i t i n to l obu l es

(lobuli).

Duct l ess ( endocr ine)

g l ands and g l ands wi th duct s ( exocr ine g l ands) a re d i s t i ngu i shed .

Accord ing t o s t ruc tu re , t he l a t t e r a re d iv ided i n to a lveo l ar ( ac i -

n o u s ) ,

tubu l ar , and m ixed a lveo l ar - t ubu l ar g l ands .

I t should be pointed out that the act iv i ty of al l v iscera i s closely

in t er r e l a t ed and t he i r s t udy accord ing t o t he separa t e sys t em s ( ap

para tus ) i s ex t r em ely cond i t i ona l .


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THE DIGESTIVE SYSTEM

(THE DIGESTIVE APPARATUS)

Systema

digestorium

(Apparatusdigestorius)

T h e fi rs t par t of the digest ive system is the cavi ty of the mo uth sm al l in test ine (intestinum tenue), and t he l a rge i n t es t i ne (intestinum

(cavum oris) opening on the face by means of the oral f i ssure (rima crassum) term inat i ng by t he anus . The sa l i vary g l ands , t he li ver (ne

ons).

N e x t c o m e i h e o r o p h a r y n g e a l i s t h m u s

(isthmus fauaum),

th e

pat),

the ga l l b l add er , and t he p anc reas (F ig . 402) a l so be long t o

p h a r y n x , i h e o e s o p h a g u s , t h e s t o m a c h (ventriculus s. gaster), the t he d iges t i ve sys t em .

THE CAVITY OF THE MOUTH

The cav i t y o f t he m ou th

(cavum oris)

(Figs 402, 403, 429) i s the

beginning of the digest ive system. I t i s bounded anter ior ly by the

l ips, super ior ly by the palate, lateral ly by the cheeks, and in ter ior ly

by the tongue and muscles forming the f loor of ihe cavi ty . The cav

i t y o f t he m ou th com m unica t es pos t er i o r l y wi th t he pharynx by

m e a n s o f t h e o r o p h a r y n g e a l i s t h m u s (isthmus jaucium).

The alveolar process of the maxi l la and the alveolar par t of the

mandible wi th the teeth divide the cavi ty of the mouth in to two

par t s : an an l cro l a t e ra l par t , t he ves t i bu l e o f t he m ou th (vestibulum

oris)

and a pos l erom e d ia l pa r t , the cav i ty p rope r o f t he m ou th

(ca

vum orisproprium). When the t ee th a re i n occ lus ion bo th par t s com

m unica t e by m eans o f sm al l spaces be tween t he c rowns o f t he

t ee th and l a rge spaces be tween t he l as t m ax i l l a ry and m and ibu l ar

m o l a r s .


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Palalum durum

Denies

Palaium molle

Cavum oris

Labium infcriu s-A f 5

I

Glandula sublingualis

Pharynx

Lingua

Oesophagus

Hepar

Vesica

fcllea

Ventriculus

(gaster)

Flexura coli

dextra

Colon

ascendens

Valva

ileocaecalis

Caecum

Ductus

pancreaticus

Flexura

duodenojejunalis

Flexura

coli sinis(ra

Jejunum

Colon

dcseendens

Colon

iransversum


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14

T H E C A V IT Y O F T H E M O U T H

Philtrum

Tub e rcul urn

labii supcrioris

Labium su peri us

Palalum durum

Arcus dentalis superior

Palatum molle

Uvula

(palalina)

Commissura

labtorum

Bucca

Isthmus faucium

Labium inferius

Sulcus meniolabialis

Raphe palali

Arcus

palatopharyngeus

Tonsilla palatina

Arcus palatoglossus

Dorsum linguae

Arcus dentalis inferior

403 . Cavity of mouth (cavum oris) and oropharyngeal isthmus (isthmus

faucium); anter ior aspect (V^ .

The surface of the l ips facing the teeth i s smooth, moist , and i s

con t i nuous wi th t he m ucous cover ing o f t he a lveo l ar p rocesses , t he

g u m s (gingivae).

The st ructure of ei ther l ip consist s of three par ts : (a) the cu

o f t he upper l i p (frenulum labii superioris) and t he f r enu lum o f t he

lower l ip (frenulum labii inferioris) (Fig. 408 ) .

The subm ucous l ayer o f t he l i p s con t a ins a g rea t num ber o f

m ucous l ab i a l g l ands (glandulae labiales) (Figs 40 4 A, 40 4 B , 412)


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T H E C A V I T Y O T T H E M O U T H 15

~ L>

4 0 4 A . Labial and buccal glands (glandulae labiales et buccales)

( specimen prepared by E .Kovbas) .

(Photograph of total ly s tained preparat ion of the l ips and

cheeks.)

1upper

lip; 2 lower lip ; 3left c heek ; 4 right cheek .

The m ore o r l ess developed subcu t aneous f a t i s a lways t h i cker

in t he cen t r a l par t s o f t he cheeks . Between t he m asse t er and buc

c ina to r m usc l es i s a l im i t ed accum ula t i on o f f a t known as t he buc

cal pad of fal (carpus adiposum buccae).

A few duct s o f t he m ucous bucca l g l ands (glandulae buccales)

open on t he m ucous m em brane o f t he cheeks ; t he bod i es o f t he

g l ands a re em bedded i n t he subm ucous l ayer and par t l y be tween

the bund l es o f t he bucc ina to r m usc l e . Bucca l g l ands s i t ua t ed i n

the vicini ty of the last molar are cal led molar g lands

(glandulae mo-

lares) .

On the l eve l wi th t he upper second m olar t he m ucous m em

brane o f bo th checks bear s t he paro t i d pap i l l a

(papilla parotidea)

wi th t he open ing o f t he paro t i d duct (ductus parotideus) (Figs 405,


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16 T H E C A V I T Y O F T H E M O U T H

Papilla incisiva

Palatum durum

Plicae palatinae transversae

M. orbicularis oris

Vcstibulum oris

M. buccinator

Ductus paroiideus

M , massetcr

Glandulae palatinae

Arcus

toglossus

onsil la palatina

Arcus

alopharyngeus

M. picrygoidcus

medialis

M. sty lopharyngeus

M . styloglossus

Process us

styloideus

M. stylohyoidcus

A, carolis

intcrna

V. jugularis

in tc rna

M. digastricus

M. sicrnocleido-

maMoidcu*.

M. longissimus capit is

M. constr ic tor

pharyngU superior

Uvula

(palatina)

A. carotis

externa

M edu lla spinalis Dens axis

4 0 5 .

C avity of mouth: hard and soft palate (palatum durum et palatum molle); infer ior

aspect (

5

/

6

) .

(Horizontal section of the head and neck through the level of the first cervical vertebra.)


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TH E CAVITY OF THE MO UTH 17

Plicae palatinae transversae

A. palatina

major

Labium superius

Papilla incisiva

Tunica mucosa palati duri

Glandulae palatinae

Papilla parotidea

M. buccinator

Foramen palatinum

majus

Ductus

parotideus

Tendo m. tensoris

veli palatini

M. levatorve l i

palatini

Pars buccopharyngea

m. constrictoris

pharyngis superioris

M. palatopharyngeus

Tunica mucosa

buccae

M. buccinator

Raphc

pterygomandibularis

M. palatopharyngeus

M. palatoglossus

M. palatoglossus

Arcus palatoglossus

Arcus palatopharyngeus

Tonsilla palatina

M. stylogtossus

M, uvulae

M. longitudinalis superior

Isthmus faucium

M. longitudinal is in ferior

M. verticalis linguae

Septum linguae

M. transversus linguae


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18

T H E C A V I TY O F T H E M O U T H

tongue i s a space by m eans o f wh ich t he cav i t y o f t he m ou th com

mu nica tes wi th the cavi ty of the ph ary nx ; i t is cal led th e o ro ph ar -

yngeal i s t hm us

(isthmus faucium).

A thin t r iangular fold (plica triangularis) o f t h e m u c o u s m e m

brane ar i ses f rom the poster ior surface of the palatoglossal arch.

I t s upper par t i s narrow whi le i t s wide base i s at tached to the la

teral border of the root of the tongue. The tonsi l lar fossa (fossa ton-

sillaris)

is s i tuated be twee n the poste r ior m arg in of the fold and the

pal a topharyngeal a rch ; i t l odges t he t ons i l (tonsilla palatina)

(Figs 40 3, 406) which occ upie s the fossa com plete ly in adul t s .

Under t he m ucous m em brane t he so f t pa l a t e con t a ins an apo-

neurot ic sheet cal led the palat ine aponcurosis , as wel l as some

muscles which play an important role in the act of swal lowing.

The t ons i l (tonsilla palatina) (Figs 403 , 406 , 407 ) is a pai r ed al

m o nd-s hape d s t ruc tu re wh ich var i es in s i ze . T he t ons i ls a re s i t ua t

ed on e i t her s i de be tween t he pa l a tog lossa l and pa l a topharyngeal

arches, in the tonsil lar fossa (fossa tonsillaris). The t ons i l bo rder s l a -

1 . Th e m usc u lu s uvu l ae (F igs 406 , 433) cons i s t s o f two m uscl e

s l i p s converg ing t owards t he m id l i ne o f t he uvu l a l end ing i t a con i

cal shape. T he sl ips ar i se f rom the poster ior nasal spin e (spina nasa-

lis posterior) and f rom the pa l a t i ne apon euro s i s , run t o t he m id l i ne

of the uvula and inter twine to form the raphc.

Act ion: shor tens the uvula by rais ing i t .

Innerva t i on : t he pharyngeal p l exus

(plexus pharyngeus).

Blood supp ly : t he pa l a t i ne a r t e r i es

(arteriae palatinae).

2 . Th e t enso r pa l a t i m usc l e

(musculus tensor veli palatini)

(Fig . 406) i s f lat , t r ian gul ar , and l ies between the m edial p teryg oid

muscle and the levator palat i muscle. I t ar i ses by a wide base f rom

the scaphoid fossa (fossa scaphoidea)of t he sphen o id b one , and t he

car t i l ag inous and m em branous par t and t he m arg in o f t he bony

groove o f t he pharyngo tym pan ic ( aud i t o ry ) t ube t o t he sp ine o f t he

spheno id . I t descen ds and i s con t i nuo us wi th a nar row t end on

which cu rves round t he p t erygo id ham ulus and t he bu r sa on i t and

then sp reads ou t as a wide band o f t end inous f i b res i n t he aponeu

rosis of the sof t palate. Some of the bands are inser ted in to the

t era l l y upon t he buccopharyngeal par t o f t he super io r cons t r i c t o r

m uscl e o f t he pharynx (musculus constrictorpharyngis superior). T h e

m ed ia l su r face o f t he t ons il is uneven and has num ero us round o r

oval openings leading in to the crypts of i t s mat ter ; they are cal led

the tonsi l lar p i t s

(fossulae tonsillares).

Very m any l ym ph nodu l es

(no-

duli lympkatici)

are em be dd ed in the wal ls of the pi t s . T h e latera l

surface of the tonsi l i s covere d w i th a f ibrous c apsu le which i s at

tached to the f ibrous plate of the pharynx.

Normal ly , the tonsi l does not extend beyond the fossa and a

free space cal led the in t ratonsi l lar clef t

(fossa supratonsillaris)

re

mains over i t .

Innerva t i on : t he l esser pa l a t i ne nerve

(nervus palatinus medius

s.

minoris).

Blood supp ly : t he ascend ing pharyngeal , ascend ing pa l a t i ne ,

and t ons i l l a r a r t e r i es (arteriaepharyngea ascendens, palatina ascendens,

ramus tonsillaris arteriae facialis).

The bund l es s t r e t ch downwards , m ed ia l l y and fo rwards and ,

expand ing , en t er t he so f t pa l a t e t o b l end wi th t he bund l es o f t he

con t ra l a t e ra l m usc l e and o f o ther m usc l es . Som e o f t he bund l es

are i n ser t ed i n to t he m idd l e par t o f t he pa l a t i ne aponeuros i s .

Act i on : r a i ses t he so f t pa l a t e , nar rows t he pharyngeal open ing

o f t h e p h a r y n g o t y m p a n i c t u b e .

4.

T h e p a l a t o g l o s s u s m u s c l e (musculuspalatoglossus) (Fig. 40 6) is

narrow and f lat and i s lodged in the palatoglossal arch. I t takes or i

gin f rom the lateral border of the root of the tongue to be as i f a

con t i nua t i on o f t he t r ansver se m uscl e bund l es o f t he t ongue , as

cends , and t e rm inat es i n t he aponeuros i s o f t he so f t pa l a t e .

Act i on : nar rows t he f auces by b r i ng ing t he pa l a tog lossa l a rches

closer to the root of the tongue.

5 .

T h e p a l a t o p h a r y n g e u s m u s c l e

(musculus palatopharyngeus)

s 406, 433) i s f lat and t r iangular and l ies for the most par t in

the palatopharyngeal arch. I t ar i ses by i t s wide base f rom the pos

ter ior wal l of the lower par t of the pharynx and f rom the lamina of

t he t hy ro id car t i lage . T he m uscl e bund l es s t r e t ch t o t he m id l i ne

T H E M U S C L E S O F T H E P A L A T E A N D F A U C E S

T H E T O N G U E 19


18/435

Rima glottidis

Plica vocalis

Plica ve stibularis

Plica aryepiglottica

Incisura inlerarytenoidea

Tuberculum comiculalum

Tuberculum cuneiforme

Recessus piriformis

Epiglottis

Plica glossocpiglottic

lalcralis

Tonsilla palatina

Vallecula epiglottica

Plica glossocpiglottica

mediana

Tonsilla palatina

Folliculi

inguales

:

oramen caecum linguae

Papillae foliatae

Papillae vallatac

Papillae conicae

Papillae filiformes

Sulcus terminalis

Papillae fungiformes

' Corpu s linguae

Dorsum linguae

Sulcus me dianus linguae

Apex linguae

4 0 7 .

Tongue (lingua); s u p e r io r a s p e c t

20

T H E T O i N G U E


19/435

Frenulum labii superioris

Dorsum linguae

Plica fimbriala

Commissura

labiorum

Fades inferior

linguae

Plica sublingualis

Floor of caviiy of mouth

Caruncula

sublingualis

Frenulum

labii infcrioris

Gingiva

Margo linguae

Glandula

ingualis a nterior

N. lingualis

M. longitudinalis

inferior

Frenulum linguae

Glandula

sublingualis

Ductus

submandibularis

Gingiva

4 0 8 .

Cavity of mouth (cavum

oris);

an te r io r a spec t (Vi ) .

|The t ongue i s r a i sed ; a reas o f t he m ucous m em brane are r em oved on t he l e f t ; t he

sub l i ngual g l and

(glandula sublingualis)

and t he an t er i o r l i ngual g l and

(glandula

lingualis anterior) can be seen.]

amen cecum linguae) m ark ing t he c losed t hy rog lossa l duc t (ductus

fold of the muc ou s m em br an e passes sagi t tal ly from the infer ior


20/435

T H E T O N G U E

21

Tunica m ucosa linguae

M. longitudinalis inferior \ Palatum duru m

M. longiiudinalis superior


Glandula lingualis anterior

Septum nasi

Oslium pharyngeum

tubae audirivae

Torus tubarius

Tonsil lapharyngea

Labium superius

Rima oris

labium inferius

M. gcnioglossus

Mandihula

M. geniohyoideus I--*& &..

M. m ylohyoidcus

Corpus ossis hyoidei

Lig. hyoepiglotticum

Lig. thyrohyoideum medianum

Cartilago (hyroidea

Palatum molle

Foramen caecum

linguae

Uvula (palatina)

Ductus lingualis

(remnant of ductus

thyroglossus)

Pharynx

Epiglottis

Cartilago cricoidea

Esophagus

4 0 9 . Vestibule of mouth (vestibulum oris) and cavity of mouth (cavum oris)

22 T H E T O N G U E


21/435

Palatum durum

Lig. siylohyoidcum

M. stylopharyngeus

M. slyloglossus

M. constrictor

pharyngis m cdius

M. hyoglossus

(cut off)

M. chondro-

glossus

Membrana

ihyrohyoidca

M. constrictor

pharyngis inferior

Mandibula

M.gcnioglossus

M. longitudinalis inferior

t>s hyoideum

Lig- thyrohyoideum medianum

Carti lago thyroidea

4 1 0 . Muscles of tongue (musculi linguae), right side;

la te ra l a spec t (Vi ) .

T H E T O N G l ' E

23


22/435

Apex linguae


Tunica mucosa linguae (cut ed ge)


M. genioglossus

Septum linguae

M. genioglossus

M. longitudinalis inferior

M hyoglossus (cut off)

M. hyoglossus


M chondroglossus

Pars chondropharyngea

m. constrictoris

pharyngis m edii

M. styloglossus

Cornu majus ossis hyoidei


Cornu minus ossis hyoidei

M mylohyoideus

M. geniohyoideus

411 . Muscles

of

tongue; inferior aspect (V,)

24

T H E G L A N D S O F T H E C A V I T Y O F T H E M O U T H


23/435

Glandula parotis

M. masseter

Mandibula

M. buccinator

Glandu la paro lis accessoria

Ductus parotideus

Fascia masse terica

et fascia parotidea

Glandulac molares

Glandulae buccales

Glandulaelabiales

M. digastricus

(venter posterior)

M. stylohyoideus

Glandula

submandibularis

Labium superius

Lingua


Labium inferius

Caruncula sublingualis

Ductus sublingualis

major

Ductus sublinguales

minores

Mandibula

M. ge nioglossus

M. digastricus (ven ter ante rior 1

T H E T O N G U E

25


24/435

f rom the septum of the tongue on i t s whole distance and par t ly

penet r a t i ng i t and t e rm inat i ng i n t he m ucous m em brane o f t he

m arg ins and do r sum of t he t ongue .

Act ion : r educes t he t r ansver se d i am eter o f t he t ongue and

makes i t t ransversely convex.

4 . The ver t i ca l m usc l e o f t he t ongue

(musculus verticalis linguae).

Its short muscle fibres l ie in the free part of the tongue between i ts

dorsum and infer ior surface.

Act ion: f lat tens the tongue.

Innerva t i on : a l l t he m uscl es o f t he t ongue are i nnerva t ed by

the t e rm inal b ranches o f t he hypog lossa l nerve (rami UnguaU s nervi

hypoglossi).

Blood supply: al l the muscles of the tongue are suppl ied by the

l i ngual a r t e ry

(arteria lingualis).

T H E M U C O U S M E M B R A N E O F T H E T O N G U E

T h e m u c o u s m e m b r a n e o f t h e t o n g u e

(tunica mucosa linguae)

(Figs 407, 408) i s smooth in the region of the root , infer ior surface

of the body and the t ip , an d roug h on the dorsu m of the ton gu e.

The roughness i s p rod uce d by t he l a rge num be r o f sm al l e l eva t i ons

cal led the l ingual papi l lae (papillae linguales) (Fig. 407) w hich are

divided into four groups.

1. The fi l iform papil lae

(papillae filiformes)

occur on t he who le

body o f t he t ongue and l end i t s m ucous m em brane a ve lve ty ap

pearan ce. These are s t ruc tures com pose d of a conical bo d)

on whose apex are b rush - shaped appendages o f ep i t he l i um

(Fig. 413 A). T he f il iform pap i l lae ar e most p ron ou nc ed in th e

middle of the dorsum of the tongue and in the vicini ty of the

vallate papil lae

(papillae vallatae).

2. The fung i fo rm pap i l l ae (papillae fungiform es), 150 to 20 0 in

num ber , a r e sca t t e red m ain ly on t he do r sum of t he t ongue nearer

t o i ts m arg ins bu t a re r a rer i n i ts m ed ian par t s . Th ey are cone- l i ke

project ions larger than the f i l i form papi l lae and are therefore wel l

de t ec t ab l e am ong t hem . On the m arg ins o f t he t ongue t hey are

very flattened.

3. The va l l a t e pap i l l ae

(papillae vallatae)

are the largest but are

hardly elevated above the surface. There are f rom 7 to 11 of them

arranged at the jun ct i on of the bo dy wi th the root , to the f ront of

and paral lel to the sulcus terminal i s . The cent ral papi l la i s sur

rounded by a r idge and i s immediately in f ront of the foramen cae

cum . Each pap i l l a is com pose d o f a sm al l cy l i nd r i ca l e l eva t i on su r

rounded by a c i r cu l ar g roove aroun d which i s a r i dge o f t he

m u c o u s m e m b r a n e .

4 . The fo l i a l i nguae

(papillae foliatae)

are a r r anged on t he l a

teral par t s (margins) of the tongue. They consist of 5 to 8 folds

which are separated by grooves; the folds run almost ver t ical ly in

The l i ngual g l ands

(glandulae linguales)

(Figs 409 , 412 , 413 A,

413 B) a re g rouped i n to m uc ous , se rous , and m ixed g l an ds . Th e

serous glands are in the region of the val late papi l lae and the fol ia

l i nguae . T he fo ll owing g l ands a re d i s t i ngu i shed i n t he m ucou s an d

m ixed g roups .

( a ) The an t er i o r l i ngual g l and (glandula lingualis anterior) is an

e longat ed s t ruc tu re s i t ua t ed on e i t her s i de o f t he gen iog lossus

muscle near to and to the back of the t ip of the tongue. I t s duct

op en s on the infer ior surface of the tongu e alon g the f imbriated

fold . Besides, these glands may be arranged in smal l groups in the

poster ior par t of the margin of the tongue in the s tyloglossus and

palato glossu s mus cles. T he i r duc ts open in the folds of the folia

l inguae.

(b ) The g l ands o f t he l i ngual t ons i l (glandulae tonsillae lingualis)

f o rm a 4 - 8 - m m t h ic k l a y er u n d e r t h e m u c o u s m e m b r a n e . T h e y o c

cup y the region of the l ingual tonsi l to the epiglot t i s . T he i r d ucts

open in the grooves surrounding the fol l icles and even in the pi t in

the middle of the fol l icle.

Three fo lds fo rm where t he m ucous m em brane passes over

from the root of the tongue to the epiglot t i s . One of them is un

pai red and l ies cent ral ly ; th is i s the glosso-epiglot t ic fold (plicaglos-

soepiglottiea mediana)

(F ig. 407 ) . T he pai r ed fold s t retch es to the la

t e ra l bo rd er o f t he ep ig lo t t is and i s ca l l ed t he phary ngo-e p ig lo t t i c

fold (plica glossotpiglottica latera lis). Between these folds on each

side i s a depression cal led the val lecula epiglot t ica.

I n t h e s u b m u c o s a o f t h e t o n g u e a r e e m b e d d e d a l a r g e a m o u n t

o f l oose connect i ve t i s sue and t end inous bands o f t he i n t r i n s i c

m uscl es o f t he t ongue , wh ich fo rm the aponeuros i s o f t he t ongue

(aponeurosis linguae)

in t he aggregat e .

Vesse l s and nerves pass t h rough t he t ongue .

26

THE GLANDS OF THE TONGUE


25/435

4 1 3 A . Glands of tongue

( s p e c im e n s p r e p a r e d b y

Ya . S in e ln ik o v . )

( P h o t o m i c r o g r a p h . )

(Area o f t o t a l l y s t a ined m ucous m em brane o f t he

root of the tongue.)

1 glands iti the region of the folia linguae

2 gl ands in the r eg io n of the va l la t r pap i l la e

3fi l i fo rm papi l la e

4 g land s in the r eg ion of the roo l o f ihe t ong ue

T H E G L A N D S O F T H E C AV I TY O F T H E M O U T H

27


26/435

T H E P A R O T I D G L A N D

The paro t i d g l and (glandula parotis) (Figs 40 5 , 412) has i he

shape of an i r regular t r ian gle and i s s i tuated on th e lateral surface

of the ram us of the m an dib le a nd the poste r ior b ord er of the

masseter muscle

(musculus masseter).

Infer ior ly i t m ay co me in con

tact wi th the submandibular g land. I t s deeply si tuated par t i s in re

lat ion wi th the s tyloid pro cess , the s tylohyo id an d styloglossus

muscles as wel l as wi th the in terna l carot id ar tery a nd the in te rna l

jugular vein . The gland i s enclosed in the parot id fascia (fascia pa-

rotidea)which gives off processe s pen et r at in g betw een th e lobu les

of the gland.

The paro t i d duct (ductus parotideus) em erges f rom the upper

par t of the anter ior border of the gland and runs almost hor izon-

lal ly , paral lel to the zygomat ic arch, on the lateral surface of the

m asse t er m usc l e ; on r each ing t he an t er i o r bo rder o f t he m uscl e t he

duct passes through the buccal pad of fat (corpus adiposum buccae).

p ierces t he bucc ina to r m usc l e , and opens i n t he ves t i bu l e o f t he

mouth at the level of the upper second molar tooth in the parot id

pap i l l a (papilla parotidea) o n t h e m u c o u s m e m b r a n e o f t h e c h e e k .

An accesso ry paro t i d g l and

(glandula parotis accessona)

vary ing in

sha pe i s s i tuate d alo ng the length of the paro t id d uct (Fig . 412 ) .

T he paro t i d g l and i s pen et r a t e d by t he b ranch es o f t he ex t erna l ca

rot id ar tery , the poster ior facial vein , and smal l branches of the fa

cial nerve.

Inne rva t i on : paro t i d b ranches o f t he au r i c u lo t em pora l nerve

(rami parotidci nervi auriculolemporalis) (ganglion oticum); nerves a t

t endan t t o t he super f i c i a l t em pora l a r t e ry .

B lood supp ly : paro t i d b ranches o f t he super f i c i a l t em pora l and

m ax i l l a ry a r t e r i es

(rami parotidci arteriae temporalis superficialis

e t

maxillaris).

T H E S U B M A N D I B U I - A R G L A N D

T h e s u b m a n d i b u l a r g l a n d

(glandula submandibularis)

(Figs 412,

414) i s s i tuated in the subm axi l lary t r iang le

(trigonum submandibu-

lare) in a fascial she ath formed by the superf icial layer of the d ee p

cervical fascia.

The super io r su r face o f t he g l and com es i n to r e l a t i on wi th i he

m ylohyoid m uscl e , t hen t he g l and cu rves roun d t he pos t er i o r bo r

der of the muscle to l ie on i t s anter ior surface and touches the pos-

terolateral border of the subl ingual g land. Poster ior ly the gland

reaches t he paro t i d g l and and t he m ed ia l p t e rygo id m uscl e . The

s u b m a n d i b u l a r d u c t (ductus submandibularis) passes on the medial

su r face o f t he sub l i ngual g l and fo rward a nd upw ard t o open on t he

sub l i ngual pap i l l a (caruncula sublingualis) (Fig. 408 ) .

I n n e r v a t i o n : t h e c h o r d a t y m p a n i , s u b m a n d i b u l a r g a n g l i o n

(ganglion submandibulare), and nerves a t t endan t t o t he f ac i a l a r t e ry

(arteria facialis).

Blood supply: the facial and l ingual ar ter ies (arteriae facialis et

Ungualis).

T H E S U B L I N G U A L G L A N D

The sub l i ngual g l and (glandula sublingualis) (Figs 408 , 412 ,

414) i s s i t ua t ed im m ed ia t e ly be low the m u cou s m e m bra ne o f t he

f loor of the cavi ty of the mouth on the mylohyoid muscle

(musculus

mylohyoideus) la t era l t o t he gen iohyo id m us cl e (musculus geniohyoi-

deus),

the gen iog lossus m uscl e (musculus genioglossus), and t he hyo-

glossus muscle

(musculus hyoglossus).

T he an t er i o r end o f t he g l a nd

duct s , t here i s som et im es a p r i nc ipa l sub l i ngual duc t (ductus sublin

gualis major); i t s t retches on the medial surface of the gland and

opens on t he sub l i ngual pap i l l a e i t her i ndependen t ly o r a l ongs ide

t h e s u b m a n d i b u l a r d u c t .

I n n e r v a t i o n : t h e c h o r d a t y m p a n i , s u b m a n d i b u l a r g a n g l i o n

(ganglion submandibulare),

and nerves a t t endan t t o t he f ac i a l a r t e ry

28

T H E T E E T H


27/435

Glandulac palalinae

Palatum durum

Velum palatinum (palatum mollc)

Arcus palatoglossus

Tonsilla pa latina

Ductus sublinguales

minores

Caruncula sublingu

Duc tus siiblingual

M. gcnioglossus

Glandula sublingualis

Platysma

Ductus submandibularis

M. mylohyoideus

M. geniohyoideus

Glandula submandibularis


414.

Glands of

cavity

ofmouth,right side;

medial aspect (

4

/

s

).

The t ee th o f a hum an erup t i n two per iods . The dec iduous , o r

mi lk , teeth (denies decidui) erupt in the f i rs t per iod, the permanent

g u m s (gingivae) ( the m ucous m em brane o f t he cav i t y o f t he m ou th

which covers the alveolar process of the maxi l la and the alveolar

T H E T E E T H 2 9


28/435

Dens m olaris III (dens serotinus)

De ns molaris II

Dens mo

Denies molares f111

Juga alveolaria

Denies

premo lares I, II

Processus alveolaris

maxillae

Denscaninus

Dentes ineisivi

(laieralisel medialis)

Pars alveolaris

mandibulae

premolaris

Dens premolaris I

Dens incisivus lateralis

Dens ineisivus medialis

415. Maxillary and

mandibular

teeth, permanent

(dentes permanentes)

Q l

x

).

30

THE TEETH


29/435

F.namelum

Corona dentis /

Collum (cervix) dentis

Radix denlis

Canalis radicis denlis

Apex radicis dentis

Foramen apicis denlis

4 1 6 .

Permanent single-root tooth ( r e p r e s e n t e d

s e m i s c h e m a t i c a l l y ) .

(Vert ical sect ion.)

Enamelum

Corona dentis \

Collum (cervix) dentis

Radix dentis

Dentinum

- Cavum co ronale

Ce men turn

THK ITKTH

31


30/435

Dens incisivus medialis


Denscaninus

De ns mo l a hs I

Dens molaris II

Dens molaris I pcrmanens (b ud )

4 1 8 .

Deciduous maxillary teeth of 4-year-old

child;

infer ior

aspec t (

4

/

3

) .

Alveolus dcntis molaris 1,

permanens

Tubercula (coronae) dentis

Denies

32

T H E T E E T H


31/435

^ TT

^

1 0

8

j *

B

4 2 0 . Deciduous teeth (denies decidui) of right side.

A m a x i l l a r y t e e t h ; B m a n d i b u l a r t e e th

1medial incisor, veslibular (facial) surface

2 medial incisor, culling edge

3 lateral incisor , veslibular (facial) surface

4lateral incisor, cutting edge

5canine tooth, vestibular (facial) surface

6canine tooth, culling edge

76rst mola r, veslibula r (facial) surface

8 first molar , occlusal surface

9second molar, veslibular (facial) surface

10second molar, occlusal surface

r a ther sho r t . T he re a re no p rem olar s am ong t he dec iduou s j aw. Each ha l f o f t he m and ib l e has 2 i nc i so r s , 1 can ine , 0 p rem o-

teeth . lars , 2 mo lars; 10 leeth on ihe wh ole jaw .

THE TEETH

33


32/435

Dentes prem olares

Sinus maxillaris

Denies molares

Canalis mandibulae

Dens caninus superior

Dens incisivus superior

lateralis


mcdialis

Facies vestibularis

(facialis)

Dens incisivus inferior

medialis

De ns incisivus inferior

lateralis

Dens caninus inferior

Dentes pre molares

Foramen mentale

Denies molares

34

T H E T E E T H


33/435

Dens caninus superior

Processus palau nus maxillae /

D e

^

t e s

P ' elares

Dens incisivus superior lateralis


med ial is

Fad es m cdialis

Facieslingualis

Dens incisivus

inferior medialrs

Canalis m andibulae

(opened)

Denies molares

Dens incisivus

inferior lateralis

Dentes premolares

Dens caninus inferior

4 2 2 . Permanent m axillary and ma ndibular teeth of right side; media l a spec t (V, )

{The i nner t ab l e o f t he a lveo l ar p rocesses i s r em oved ; t he m and ibu l ar cana l i s opened . )

THE TEETH

r>


34/435

Foram en incisivum

7-9 years

7-10 years

9-1 4 years \

Processus palatinus

maxillae


Margo jncisivus


Dens caninus

Dens prem olaris 1

Dens premolaris11

Densmolaris 1

10-14 yeais

Fades contacius

F-ides occlusalis

Dens molaris II

Dens m olaris III

iensserot imis)

Foramen palatinum majus

Sulura palarina transversa

Suiura palatina median'a

Foramen palatinum minus

Lamina horizontalis ossis palatini

4 2 3 .

Permanent maxillary teeth; in f e r io r a s p e c t Ql\)

(The t ime of tooth erupt ion i s indicated on the lef t s ide of the drawing.)

tween the ends of the cut t ing edge. The l ingual surface bears at the

neck a well p rono unc ed t uberc l e wh ich i s con t i nu ous wi th a l on g i

tudinal elevat ion passing to the mesial angle of the cut t ing edge.

The t uberc l e i s no t p ronounced on t he l ower can ine t oo th . The

cut t ing edge i s formed of two segments meet ing at an angle; the

cont iguous surface i s t r iangular . A canine tooth has a s ingle root ,

which i s com pres sed on th e s ides and has longi tud inal groov es on

the distal surface. The root apex i s s l ight ly incl ined distal ly ( later-

ally).

s ingle root , that of the up pe r f irst prem olar s i s b i fur cate . T he root

of the lower teeth i s conical , the root of the upper teeth i s s l ight ly

com presse d an t eropo s t er i o r l y and has long i t ud ina l g rooves on t he

an t er i o r and pos t er i o r su r faces . The upper f i r s t p rem olar con t a ins

two canal s i n i t s roo t , one bucca l and t he o ther l i ngual .

T h e m o l a r t e e t h (denies molares) (Figs 42 1-4 28 ) , 12 i n nu m

ber , are set d is tal of the premolars , 3 on each side of each jaw. The

l as t m o lar i s ca l l ed t he dens se ro t i nus (wi sdom to o th ) . T he crown

is cubic.

36

T H E T E E T H


35/435

Fades vestibulalis

(facial is)

Dens m olaris III

(densserotinus)

Dens m olaris II

Fades occlusalis

Dens m olaris I

Dens premolaris II

Dens prem olaris I

Dens caninus

Facies vestibulalis (facialis) I De ns incisivus lateralis


4 2 4 .

Permanent mandibular teeth;

s u p e r io r a s p e c t

Ql\).

are at the buccal edge and two, at the l ingual edge. Only the f i rs t

molar has f ive cusps, three of which are at the buccal edge. The

In nerva t i on : t he m a x i l l a ry t ee th a re i nnerv a t ed by t he sup er io r

den t a l nerves

(ncrvi alveolares superiores),

an t er i o r , m idd l e , an d pos

THE TEETH


36/435

l i

4 2 5 . Permanent teeth (deniesperm anen tes) of right side (

x

/

x

)

Amaxillary teeth, l ingual surface

B m and ibu la r tee th , l ingua l sur face.

1

m e d i a l i n c i s o r

2 l a t e r a l i n c i s o r

3 c a n i n e

4 fi rs t p re mo l ar

5

s e c o n d p r e m o l a r

6 f i r s ! m o l a r

7 s e c o n d m o l a r

8

t h i r d m o l a r

J

A)

:J8

T H E T E E T H


37/435

V >

B

8

4 2 7 .

Pe rmanent teeth of right side

(

l

/ j ) .

A

m a x i l l a r y t e e th ; B m a n d i b u l a r t e e th

(Sect ion of eac h tooth i s m ad e in the di rect io n f rom the vest ibule of the m ou th to the

tongue . )

1medial inc isor

2 la te ra l inc iso r

3 c a n i n e

4 f ir st p re mo la r

5 s e c o n d p r c m o l a r

6 first m ola r

7

second mola r

8 third mo la r

T H E B I T E

Tin- term bite indicates the relationship

between

the superior

den t a l a r ch farcus dentalis superior) and t he i n fer i o r d en t a l a r ch (or-

cus dentalis inferior)

when t he t ee th a re b rough t t oge ther i n to occ lu

s i o n ( F i g s 4 1 5 , 4 2 1 , 4 2 2 ) .

In occlus ion th e teeth of on e jaw c om e in co nta ct wi th thei r fel

l ows o f t he o ther j aw; each m ax i l l a ry t oo th a l so com es i n con t ac t

wi th the tooth set lateral ly of the fel low mandibular tooth; each

tooth standing medial ly of the fel low tooth .

C o n t a c t i n g c o r r e s p o n d i n g t e e t h a r e c a l le d p r i n c i p a l a n t a g o n

i s t s , t ee th com ing par t l y i n con t ac t wi th noncor respond ing t ee th

are known as accesso ry an t agon i s t s . Th e l ower m ed ia l i nc i so r s and

the m ax i l l a ry t h i rd m olar s have no accesso ry an t agon i s t s .

When t he t ee th a re i n occ lus ion t he m ax i l l a ry i nc i so r s par t l y

over l ap t he m a nd ibu l ar i nc i so r s and j u t ou t over t hem as a

T H E T E E T H 3 9


38/435

15 13

1 1

3

U

8

5

3 > | * *

15

13

11

B

4 2 8 .

Permanent teeth of right side (

l

/\).

A ma xil lary teeth;

B

m and ibu la r t eeth

1medial

incisor, vestibular (facial) surface

2medial incisor, cutting edge

3 lateral inciso r, vestibula r (facial) surface

4lateral incisor, cutting edge

5canine, vestibular (facial) surface

6canine, cutting edge

7first prem olar , vestibula r (facial) surface

8first pre mo lar, occlusa l surface

9second prem olar. vestibular (facial) surface

10second p rem olar. occlusal surface

11first molar, vestibular (facial) surface

12fint molar, occlusal surface

13 secon d m olar, vestibular (facial) surface

14second molar, occlusal surface

15third molar, vestibular (facial) surface

16

third molar, occlusal surface

40

T H E P H A R Y N X


39/435

Sinus frontalis

Concha nasalis media

Concha nasalis inferior

Palatum durum

Velum palatinum

Concha nasalis superior

Concha nasalis suprema

Apcrtura sinus sphenoidalis

Sinus sphenoidalis

Cavum oris

Vestibulum oris

M, genioglossus

M. geniohyoideus

M. mylohyoide


Sulcus nasalis p osterior

Plica salpingopalaiina

Oslium pharyngeum

(ubac

Tonsil lapharyngea

Recessus pharyngeus

Torus tubarius

Arcus atlantis

Pars nasalis pharyngis

Plica salpingopharynge a

Uvula (palatina)

Arcus palatoglossus

Tonsilla palatina

Arcus palatopharyngeus

Pars oralis pharyngis

Epiglottis

Pars laryngea pharyngis

Cartilago cricoidea

Cavum laryngis

Cartilago thyroidca

Esophagus

Trachea

T H E P H A R Y N X

41


40/435

rotid gland; poster ior ly i t i s bo un de d by the pre ver te bral fascia.

Each l a t e ra l per i pharyngeal space con t a ins t he i n t e rna l j ugu l ar

vein and the in ternal carot id ar tery which are embedded in areolar

tissue.

Three par t s a re d i s t i ngu i shed i n t he cav i t y o f t he pharynx : an

upper , nasa l par t o f t he pharynx (pars nasalis pharyngis), a m idd l e ,

oral par t of the pharynx (parsoralispharyngis), and a l ower , l a ryn -

geal par t of the pharynx (pars laryngca pharyngis).

The upper par t o f t he pharynx i s s i t ua t ed be tween t he pharyn-

gcal fornix

(fornix pharyngis)

a nd t he sof t pa l a t e . T he two pos t er i o r

aper tures of the nose

(choanae)

com m u nica t i ng w i th t he cav i ty o f

the nose open into the f ront of the nasal par t . On the lateral wal l

o f each nasa l par t i s a funnel - shape d pha ryng eal ope n in g o f the

p h a r y n g o t y m p a n i c t u b e

(ostium pharyngeum tubae auditivae)

th rough

which i t com m unica t es wi th t he cav i t y o f t he m idd l e ear . These

openings are on a level wi th the at tachment of the poster ior end of

the infer ior nasal co nch a.

The m idd l e par t o f t he pharynx ex t ends f rom the so f t pa l a t e t o

the in let of the larynx. The poster ior wal l of th is par t corresponds

to the th i rd cervical ver tebra. During swal lowing i t i s separated

from the upper par t by the sof t palate which takes a hor izontal po

si t ion. On the anter ior wal l of th is par t i s the oropharyngeal i s th

m us

(isthmus faucium)

by m e ans o f wh ich i t com m u nica t es wi th t he

cavi ty of the mouth.

The l ower par t o f t he pharynx s t r e t ches beh ind t he l a rynx f rom

the level of i t s in let to the infer ior border of the cr icoid car t i lage at

whose l eve l i t i s con t i nuous wi th t he oesophagus . The pos t er i o r

wal l of the lower par t corresponds to the four th , f i f th , and sixth

1 . Th e super io r cons t r i c t o r m u sc l e o f t he pha ryn x

(musculus

constrictorpharyngis superior)

(Figs 43 0-4 33 ) i s a qua dra ng u l a r shee t .

I t ar i ses f rom several areas according to which the fol lowing four

par ts (or muscles) are dist inguished in i t :

( a) t he p t erygop haryn gea l pa r t o f t he super io r cons t r i c t o r

m uscl e o f t he pharynx (pars pterygopkaryngea rnusculi constrictoris

pharyngis svperioris) ar i s i ng from the p t erygo id ham ulus an d m ed ia l

pterygoid plate;

(b ) t he buc cop hary nge al par t o f t he supe r io r cons t r i c t o r m u s

c l e o f t he pharynx

(pars buccopharyngea rnusculiconstrictorispharyngis

cervical ver tebrae. On the anter ior wal l i s the in let of the larynx

(aditus laryngis) th rough which t he l a ryngeal par t o f t he pharynx

com m unica t es wi th t he cav i t y o f t he l a rynx (cavum laryngis).

The wal l o f t he pharynx cons i s t s o f t h ree coa t s : an adven t i t i ous

(connect i ve- t i s sue) coa t

(tunica adventitia),

a m u s c u l a r c o a t

(tunica

muscularis), a n d a m u c o u s c o a t , o r m e m b r a n e (tunica mucosa).

B e t w e e n t h e m u s c u l a r a n d m u c o u s c o a ts is t h e s u b m u c o u s c o a t

(tela submucosa) which i s cha racte r ized by the presenc e of f ibrous

t i s sue . T he ad ven t i t i ous ( connect i ve- t i s sue) coa t o f t he pha ryn x

(tunica adventitia pharyngis)

i s a con t i n ua t i on o f t he bucco phar yn

geal fascia (fascia buccopharyngea) cover ing t he bucc ina to r m usc l e

and i s i n t u rn con t i nuous wi th t he adven t i t i ous coa t o f t he oeso

phagus . Between t he adven t i t i ous coa t o f t he pharynx and t he ad

joining organs i s a layer of loose connect ive t i ssue which i s espe

c i a l l y developed be tween t he pos t er i o r wal l o f t he pharynx and t he

prev er teb ral fascia. I t i s cal led here the ret ro pha ryn gea l areolar tis

sue and f i l l s the ret rovisceral space (spatium retrovisceraU).

T h e m u s c u l a r c o a t o f t h e p h a r y n x

(tunica muscularis pharyngis),

or the muscular layer , i s formed of f ive layers of s t r iated muscles.

Three o f t hem are m uscl es cons t r i c t i ng t he pharynx (rnusculi con-

strictores pharyngis)

and > t re t ch ing t r ansver sa l l y , and two are m us

c l es r a i s i ng t he pharynx and pass ing l ong i t ud ina l l y . The t h ree

pai r s o f cons t r i c t o r s o f t he pharynx m eet pos t er i o r l y on t he m id -

l ine and par t ly pass over to the cont ralateral s ide and inter lace

wi th a l ong i t ud ina l connect i ve- t i s sue band ar i s i ng f rom the phar

yngeal t uberc l e

(tuberculum pharyngeum)

and ca l l ed t he r ap he o f the

p h a r y n x (raphe pharyngis).

muscle does not reach the base of the skul l and the area of the

pharyngeal wal l devo id o f t he m uscu l ar coa t cons i s t s o f a t h i ck

ened subm uco us f r am ework o f t he pha rynx ca l l ed t he pharyn go-

basi lar fascia (fascia pharyngobasilaris).

2. The m idd l e cons t r i c t o r m usc l e o f t he pharynx (musculus con

strictor pharyngis medius)

(Figs 43 0- 43 2) c ons i s t s o f t he fo ll owing

two par t s (o r m usc l es ) :

( a) t he cho ndr oph ary nge al par t o f t he m id d l e cons t r i c t o r m us

c l e o f t he pharynx (pars chondropharyngea rnusculiconstrictorispharyn

gis medii) ar ises f rom the lesser horn of the hyoid bone;

THE MUSCLES OF THE PH RYNX

42

THE PHARYNX


41/435

Tuber maxillae

Ductus parotideus

Lamina lateralis processus pterygoidei

Hamulus pterygoidcus

M. tensor veli palalini

M. levalor veli palatini

Fascia

pharyngobasilaris

Pars pterygopharyngea

m. constrictoris pharyngis superioris

M. constrictor pharyngis superior

Pars buccopharyngca m . constrictor

pharyngis superior

Raphc ptcrygornandibularis

Pars mylopharyngea

m. constrictoris pharyngis supe rioris ' '.;

M. stylopharyngeus

M, constrictor pharyngis m edius

Pars glossopharyngea

m. constrictoris pharyngis superioris

Pars chondropharyngca &''

m. constrictoris pharyngis med

Pars ceratopharyngea

m. constrictoris pharyngis mcdii

Lamina prevencbralis

Membrana thyrohyoidea

Pars thyropharyngea

m. constrictoris pharyngis

inferioris

M. constrictor pharyngis

inferior

Pars cricopharyngea

m. constrictoris

pharyngis inferioris

M. zygomaticus m ajor

M. buccinator

M, styloglossus

M. depressor anguli oris

WM. mylohyoideus

M. hyoglossus

M. digastricus (venter anterior)


M.cricothyroideus

T H E P H A R Y N X 4 i


42/435

M. lensor

veli palatini

Lamina lalcralis

processus pierygoidei

M. levatorveli palatini

M. constrictor pharyngis superior

Tuber maxillae

Raphe pierygomandibularis

M.styloglossus

M. buccinaior

inferioris

Esophagus

M. stylopharyngeus

Lig. stylohyoideum

Pars chondropharyngca

m. consirictor pharyngis m edius

M. constrictor pharyngis m edius

Pars ceratopharyngea

Membrana thvrohvoidca

Pars thyropharyngea

m. c onstrictorispharyngis

inferioris

Mau

M. constrictor

pharyngis inferior

Pars cricopharyngca

m. constrictoris

pharyngis

Cartilago thyroidca

M. cricothyroideus (pars recta)

M.cricothyroideus (parsobliqua)

Maxil la

Lingua

M. longitudinalis

inferior

M. genioglossus

Mandibula

44

T H E P H A R Y N X


43/435

M. pterygoideus

lateralis

Raphe pharyngis

M. pterygoideus m cdialis

Cornu majus ossis hyoidei

M. petropharyngeus

(inconstant)

M. stylopharyngeus

Lig. stylomandibulare

M. slylohyoideus


medius

M. constrictor pharyngis inferior


inferior (cut off)

- M. palatopharyngeus

Esophagus

T H E P H A R Y N X 4 5


44/435

v

Cho anae M. leva tor vcli palaiii

M. pterygoideus lateralis

M. levaior veli palatini x

M. pterygoideus mcdialis -

M. uvulae _

M. salpingopharyngeu

Radix linguae

Glandulae palatinae

M. tensor veli palatini

M. digastricus

(venter posterior)

M. stylopharyngeus

M. stylohyoideus

M. palatopharyngeus

M. stylopharyngeus

Aditus laryngis

Incisura interarytenoidca

Epiglottis

Cartilago ericoidea

Tunica m uscularis esophagi

(stratum circulare)

M. arytenoidcus obliquus

M. arytenoideus transversus

M. cricoarytenoideus posterior

Tunica muscularis esophagi

(stratum longitudinalc)

433. Miiscles of pharynx;

medial aspect (

3

/4).

46

I M F . P H A R Y N X


45/435

Choanac

Clivus Toru s tubarius

Recess us pharyngeus

W.'F.

V. jugularis intcrn a

A, carotisinlerna

N.vagus

Septum nasi

Plica salpingopharyngea

Pars nasalis pharyngis

Pars oralis pharyngis

Epiglottis

Arcus palatopharyngcus

Tonsilla palatina

Radix linguae

M. stylohyoideus

Ostium

pharyngcum tubae

Velum palatinum

Pars laryngea pharyngis

Aditus laryngis

Plica n. laryngei

Recessus piriformis

Plica pharyngoepigloltica

Plica aryepiglotlica

Tunica mucosa

esophagi

Esophagus

Trachea

THE PHARYNX 47


46/435

4 3 5 A . Pharyngeal glands (specimen prepared by

V. Malishevskaya) .

(Pho tomic rograph . )

(Group of g lands f rom total ly s tained wal l of whole pharynx.)

4 8 T H E O E S O P H A G U S

pingopharyngea). A shor t salpingopalat ine fold (plica salpingopala-


47/435

tinaj

stretches from the second fold to the soft palate.

Pos teriorly of the lub al eleva tion is a sma ll cavity called the re

cess of the pharynx (recessuspharyngeus).

In the lower pan of the pharynx i s a fossa s i tuated between the

medial surface of the thyroid car t i lage of the larynx and the ary-

epiglott ic fold (plica

aryepiglottica);

it is called the piriform fossa

(re-

cessus piriformis). In the region of this fossa, above the superior lar-

yngeal nerve

(nervus laryngeus superior)

pass ing here , t he m u cou s

m em brane fo rm s t he fo ld o f t he l a ryngeal nerve (plica nervi laryn-

8*)-

T h e m u c o u s p h a r y n g e a l g l a n d s

(glandulae pharyngeae)

(Figs 43 5 A, 435 B) of var iou s s ize and shape w hich are em bed ded

in (he submucous coat open on the surface of the mucous coat .

THE OESOPHAGUS

T h e o e s o p h a g u s (esophagus)(Figs 436 , 437) has t he appe aranc e

of a tube co nne ct ing the phary nx wi th the s tom ach . In an adul t the

junct i on be tween t he pharynx and t he oesophagus co r responds t o

the level of the sixth cervical vertebra or the inferior border of the

cr icoid car t i lage. T he jun ct io n wi th the s toma ch i s projected o n a

level wi th the eleventh thoracic ver tebra. In the newborn the be

ginning of the oesophagus is on a level with the fourth or fifth cer

vical ver tebra whi le the end i s on a level wi th the eleve nth thora cic

ver t eb ra . The se bou ndar i e s m ay a l t e r in a li v ing hu m a n whe n he

f l ings back his head or takes a deep breath , and in a person wi th

gast roptosis .

The oesophagus i s 10 to 16 cm in length in the newborn, 20 cm

by the age of 2 years , and up to 25 cm in an adu l t .

A smal l par t of the oesophagus i s s i tuated in the region of the

neck, af ter which i t descends through the in let of the thorax

(aper-

tura thoracis superior)into the tho raci c cavity, pass es in i t , and then

l eaves il t h rough t he oesophagea l op en ing o f t he d i aphra gm

(hiatus

esophageusdiaphragmatis) to enter the cavi ty of the abdomen and to

be cont inuous wi th the cardiac por t ion of the s tomach. In view of

this , the fol lowing three par ts are dist inguished: the cervical par t

o f t he oesophagus (parscervicalis esophagi),the tho racic pa r t of the

o e s o p h a g u s (parsthoracica esophagi),and t he ab dom inal pa r t o f t he

o e s o p h a g u s (pars abdominalis esophagi).

The cervical par t of the oesophagus st retches f rom the level of

Pharynx (pars laryngea)

~^ ' Upp er constriction of oesophag us

Pars cervicalis

Middle (aortic) constriction

of oesophagus

Pars ihoracica

Pars abdominalis

Lower constriction of oesophagus

Diafragm;

Pars cardiaca

T H E O E S O P H A G U S 4 9


48/435

4 3 7 .

Oesophagus; right side

rad iograph) .

1upper cons t r i c t ion

2 anter ior medias t inum

3 l o w e r c o n s t r i c t i o n

the lef t and in the region of the th i rd and four th ver tebrae occu

4 dome o f d i aph ragm

5 s t e r n u m

6

ma mmary g l and

The oesophagus com es i n to r e l a t i on wi th a ser i es o f o rgans .

-,()

T H E O E S O P H A G U S


49/435

It

1^

r

*

fcr

1

438A. Oesophageal

glands

( specimen prepared by

F.Zinovyeva) .

(Photomicrograph. )

(Group of g lands f rom total ly s tained wal l

o f who le oesophagus . )

4 3 8 B .

Oesophageal

gland

( specimen prepared by

F.Zinovyeva) .


(Gl and i solated f rom total ly s tained wal l of

who le oesophagus . )

The l ower t h i rd o f t he oesophagus com es i n con t ac t wi th an

area o f t he per i card ium cor respond ing t o t he l e f t a t r i um and l e f t

ven t r i c l e , t hen runs downwards , cu rv ing sp i r a l l y abou t t he ao r t a ,

and c on t i nue s as t he abdom inal p ar t wh ich i s covered i n f ron t by

an area of the left lobe of the l iver.

The wal l o f t he oesophagus cons i s t s o f t h ree coa t s : m ucous ,

a n d t h e m u c o u s o e s o p h a g e a l g l a n d s

(giandulae esophageae)

(F igs 438 A, 438 B) , whose du ct s ope n on t he su r face o f t he m u

cous coat , and occasional lymph fol l icles .

T h e m u s c u l a r c o a t o f t h e o e s o p h a g u s (tunica muscularis esophagi)

cons ist s of two layers: an inn er , ci rcular and a n outer , lo ngi tu dina l

l ayer . Vascu l ar and nerve ne tworks a re l odged i n t he l oose connec

T H E S T O M A C H

51

coal of the s tomach. A poorly-developed longi tudinal layer ly ing

o ther o rgans s i t ua t ed around i t i n t he pos t er i o r m ed ias t i num . The


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inner ly of the ci rcular layer can be seen at p laces along the length

of the oesophagus.

The m uscu l ar coa t o f t he oesophagus g ives o f f p rocesses wh ich

as s li p s connect i t to t he ad jo in ing o rga ns . Wh er e t he oesop hagu s

passes through the diaphragm i t s muscle f ibres are closely jo ined

to those of the diaphragm as a resul t of which a ci rcular muscle re

sem bl ing a sph inc t er fo rm s around t he oesophagus .

The adven t i t i ous coa t o f t he oesophagus (tunica adoentitia eso

phagi) is formed of loose connect ive t i ssue containing a few elast ic

f ibres. By me ans of th is coat the oes oph agu s i s at ta ch ed to the

T h e s t o m a c h

{ventrieulus

s.

gaster)

(Figs 43 9-4 43 ) i s s i t ua t ed i n

the upp er lef t (%) and r ight (%) par ts of the ab do m ina l cav i ty . I t s

long axis pass es do wn wa rds from left to right an d from ba ck to

front , almost in the f rontal p lane. The shape and size of the s to

mach are qui te var iable and are determined by the degree of i t s

f i l l ing, the funct ional condi t ion of the musculature of i t s wal l s

(cont ract ion, relaxat ion) , d is tent ion of the large and smal l in tes

t ine, and other factors .

The shape of the s tomach also changes wi th age. I t i s usual ly

compared to a retor t p laced upside down wi th the wide lef t par t s i

t ua t ed under t he d i aphragm and t he nar row par t , under t he l i ver .

The l eng th o f t he s t om ach a long i t s l ong ax i s m easu res 21 -25 cm

on the average. I t s capaci ty reaches 3 l i t res .

The s t om ach has severa l par t s : t he card i ac po r t i on , t he fundus ,

the body, and the pylor ic por t ion.

The card i ac po r t i on o f t he s t om ach , o r card i a (parscardiaca ven-

triculi)beg ins by an open in g t h rou gh wh ich t he oeso phag us com

municates wi th the s tomach; th is i s the cardiac or i f ice

(ostium cardi-

acum).

Th e par t of the s tom ach in close vicini ty to the or i fice i s the

cardiac por t ion.

Immediately to the lef t of the cardiac por t ion i s a convex par t

ca l l ed t he fundus o f t he s t om ach {fundus s.Jornix ventriculi). T h e

m ain vesse l s supp ly ing b lood t o t he oesophagus , l ym ph vesse l s

dra inin g the oes oph age al wal ls , as wel l as nerves form ing plexuse s

pass wi th in t he adven t i t i ous coa t .

Inncrva t i on : t he oesophageal p l exus

(plexus esophagei).

Blood supply: in the cervical par tthe infer ior thyroid ar ter y

(arteria tkyroidea inferior); in the thora cic pa r t the oeso phag eal

and b ronch i a l a r t e r i es

(arteriae esopkageae

e t

bronchiales);

in the ab

dom inal par t the l ef t gas t ri c and ph re n i c a r t e r i es (arteriae gastrica

sinistra

et

phrenica inferior).

The card i ac po r t i on , fundus , and body m ake up t ha t par t o f

t he s t om ach which s t r e t ch es dow nw ards and t o t he r i gh t; t he py

lor ic por t io n i s the par t which i s d i rec ted upw ard s and to the r ight

at an angle to the body of the s tom ac h. At the jun ct i on w i th the

pylor ic ant rum the body forms the lowest par t of the cavi ty of the

s tom ach .

T he descr ibed shape o f t he s t om ach i s enc oun t ered m ore f r e

que n t l y du r i ng X- ray exam inat i on and i s com pare d t o t he shape o f

a f i sh-hook; another shape that can be seen on X-ray examinat ion

is that of a horn, in which case the body of the s tomach l ies almost

t r ansver se ly wh i l e t he py lo r i c par t i s i t s con t i nua t i o n w i thou t angu-

lat ion.

The surface of the s tomach facing the f ront i s the anter ior wal l

o f t he s t om ach

(paries anterior ventriculi),

that facing the back i s the

pos t er i o r wal l o f t he s t om ach

(paries posterior ventriculi).

T h e u p p e r

bor der o f t he s t om ac h a t t he j un c t i on o f the an t er i o r and pos t er i o r

wal ls is con cav e, sho r ter , and forms the lesser curva iur e of the s to

m a c h

(curvatura ventriculi minor).

The l ower bo rder fo rm ing t he

lower jun ct i on of the wal ls of the s to ma ch i s con vex and longe r

and i s t he g rea t er cu rva tu re o f t he s t om ach

(curvatura ventriculi ma

jor).

At the junct ion of the body of the s tomach wi th the pylor ic

T H E A B D O M I N A L A N D P E L V I C P A R T S O F T H E S Y S TE M O F D I G E S T I V E

O R G A N S

THE STOMACH

52 T H E S T O M A C H


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4 3 9 . Stomach ( r a d i o g r a p h ) .

1fmid us of s tom ach

2 l e s s e r c u r v a t u r e o f s t o m a c h

3 p e a t e r c u r v a t u r e o f s t o m a c h

I b ody of s tom ach ( co nt ro l m ed ium be tw een fo ld*, o f

m u c o u s c o a t o f s t o m a c h )

5 u p p e r e x t r e m i t y o f s t o m a c h

6 per is ta ls i s wave

i

p y l o r u s

8 * - d u o d e n a l b u l b

^^iliac crest

X I I T h

twe lf th thorac ic ve r te bra

ILfirst lumbar %crtcbr


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us (paries an terior)

Esophagus (pars arxlominalis)

Pars superior duodcni

Tunica

museulan~

duodeni

Pars /

descendens"

duodeni

Curvatura

veniriculi major

Junction of peritoneum

with omentum majus

Tunica muscularis ventriculi

Antrum pyloricum

54

T H E S T O M A C H


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(stratum longitudinale)

Duodenum (pars superior)

Stratum circular?

T H E S T O M A C H

55


(stratum circularc)

Fundus vciitriculi


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Stratum circulars

M. sphincter pylo ri I

56 T H E S T O M A C H


55/435

Fundus ventriculi

Tunica m uscularis esophagi

t Incisuracardiaca

Tunica mucosa esophagi

Ostium cardiacum

M. sphincter pylori

Ostium pyloricum

Plicae gasiricae

Tunica mucosa

ventriculi

Telasubmucosa

ventriculi

Tunica muscularis ventriculi

THE STOMACH 57


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II

58 TH E STOMACH


57/435

fc** f f f tM|

T H E S M A L L I N T E S T I N E

59

The m ucous coa l o f t he s t om ach has i t s own l am ina m uscu l a-

r is mucosae and i s sepa rated f rom ihe m us cu lar coa l by a well de

lowest point ( lower pole) of the greater curvature in a hook-l ike

shape and ver t ical posi t ion of the s tomach descends to the level of


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veloped loose submucous coat (tela submucosa);these two coa t s a re

responsible for the formation of ihe folds.

Th e mucou s coat of ihe s tom ach i s d ivided in to sma l l , I to

6 mm in diameter , gast r ic areas (areae gastricae) (Fig. 444) on which

are smal l 0 .2 m m wide pi t s cal led g ast r ic fo veolae (foveolae gastri

cac).T he foveolae are sur rou nd ed by vi l lous folds (plicae villosae)

which are most pronouced in the region of the pylorus. One or two

ducts of the gast r ic g lands open in each foveola. Gast r ic g lands

proper

(glandulae gastricae propriae)

occur r i ng i n t he r eg ion o f t he

fundus and body and con sist ing of chief an d pa r ietal cel l s , an d p y-

loric glands

(glandulae pyloricae),

consist ing of chief cel l s alone, are

d i s t i ngu i shed . Gas t r i c l ym phat i c nodu l es

(folliculi lymphatici gas-

trid)

are em bedded i n t he m ucous coa t (p redom inan t l y i n t he py -

loric portion).

Topography o f i he s t om ach . The g rea t er pan o f t he s t om ach i s

si tuated to the lef t of the midplane of the body, occupying the lef t

hypochondr i c and ep igas t r i c r eg ions .

Skeletopical ly , the ent ry in to the s tomach i s lo the lef t of the

ver tebral column on a level wi th the tenlh or eleventh thoracic ver

tebra; the exit is to the right of the vertebral column on a level

wi th the twel f th thoracic or f i rs t lumbar ver tebra.

The upper (ver t i ca l i n a ho rn - shaped s t om ach) par t o f t he

lesser curvature s t retches along the lef l border of the ver tebral co

lumn, the lower par t crosses the ver tebral column from lef t to

right.

The poster ior wal l of the s tomach in the region of the fundus i s

in relat ion wi th the spleen; the other par ts of ihe poster ior wal l ad

join organs s i tuated at the back of the abdomen: ihe lef t supra

renal g land, the upper end of the lef t k idney, the pancreas, the

aor ta and the vessels ar i s ing f rom i t .

The s t om a ch i s d i sp l aced du r ing r esp i r a t i on and w hen t he ad

jacent hol low organs ( the t ransverse colon) are f i l led . The cardiac

and py lo r i c po r t i ons o f t he s l om ach are l ess m ob i l e , i he o ther po r

t ions a re d i s t i ngu i shed by cons iderab l e ab i l i ty t o d i sp l ace . Th e

a l i ne d rawn be tween t he i l i ac sp ines (linea biiliaca) a n d s o m e t i m e s

lies below it .

T h e fu ndu s of the s tom ach i s below the do m e of the left hal f of

t he d i aphragm . The l esser cu rva tu re and upper po r t i on o f t he an

ter ior wal l are in relat ion wi th the infer ior surface of the lef t lobe

of the l iver. T he an tero infe r ior su rface of the body and pylor ic

por t i on ad jo in t he cos t a l par t o f t he d i aphragm and t he an t er i o r

abdom inal wal l co r respond ing t o t he ep igas t r i um . The l e f t par t o f

the greater curvature i s related to the visceral surface of the spleen;

the oth er par ts , s t re tch ing to the r ight, a re in relat ion wi th the

t r ansver se co lon .

I f t he s t om ach i s ho rn - sha ped and i t s pos i t i on i s m o re h o r i zon

tal , the grea ter curv atu re l ies on a level wi th a line conn ec t ing the

ends of the tenth r ibs or on a level wi th the umbi l icus.

The age f ea tu res o f t he shape and pos i t i on o f t he s t om ach are

as fol lows: the convexi ty of the fundus and greater curvature of the

s tom ach o f a newborn are l ess p ronounced , wh i l e t he shape o f t he

stomach i s almost cyl indr ical ; the posi t ion i s almost ver t ical , the

capac i t y r each es 150 cm

3

but increases very rapidly in ihe f i rs t days

of l i fe. T he s tom ach of infants i s pe ar- sha pe d an d si tua ted at a

higher level because i t i s usual ly displaced by the inf lated in test i

na l l oops . La t er i he s l om ach g radual l y t akes a m ore ho r i zon t a l po

s i t i on . T he s t om ach o f i n fan t s i s a lm os t com ple t e ly covered by t he

liver.

Innervat ion: the lef t gast r ic (coel iac) p lexus (plexus gastrici, s.ce-

liacus).

Blood su pply : the r ight and left gast r ic ar ter ies (arteriae gastricae

dextra et sinistra) pass to the lesser curvature; the r ighl and lef t gas-

t ro -ep ip lo i c a r t e r i es (arteriae gastroep iploicae dextra et sinistra) a p

p roach t he g rea t er cu rva tu re ; t he fundus i s supp l i ed by t he shor t

gas t r i c a r t e r i es (arteriae gastricae breves)from the sp lenic ar tery (arte-

ria lienalis).

T he l ym ph is d ra in ed f rom the wal ls of the s l om ac h i n to t he

reg ional l ym ph nodes s i t ua t ed on t he l esser and g rea t er cu rva tu res .

THE SMALL INTESTINE

The sm al l i n t es t i ne (intestinum tenue) (Figs 445-449 , 475) i s ges t i ve t r ac t ; i t s m esen t er i c par t occup i es a lm os t t he who le l ower

60

T H E S M A L L I N T E S T I N E

A- intestinalis


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V. intestinalis

Nodi lymphatici

Tela suhmucosa Tunica mucosa

Tunica muscularis

(stratum circularc)

Tun ica mu-scularis

L (stratum longitudinale)

4 4 5 .

Small intestine (intestinum tenue) (V

2

).

(Loop of mesentcr ic par t of . smal l in test ine. )

i l turns to the lef t and at f i rs t passes almost hor izontal ly crossing

the infer ior vena cava in f ront , then ascends obl iquely in f ront of

odeni inferior)

fo rm s where t he second pa r t i s con t i nuou s wi th t he

th i rd pa r t ; a sharper d uod eno j e junal f lexure

(fUxura duodenojejuna-

I I I !. S M A I . I . I N T I . M I M .

61


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4 4 6 A . Duodenal glands (specimen prepared by

L. Lom akina ) .


(Group of g lands f rom total ly s tained duodenal wal l . )

62

T H E S M A L L IN T E S T I N E


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Mesenterium

A. intestinalis

Tunica muscu lar is

(stratum

longitudinale)

Plicae circulares

447.

Mucous

coat

of

small intestine

(

]

/\).

(Segm en t o f t he j e j u num , open ed fo r a g rea t er pa n o f it s l eng th ; t he serou :

coat i s par t ly removed; the longi tudinal layer of the muscular coat can be

seen.)

Folliculi lymphatici aggregati

Folliculi lymphatici solitarii

T H E S M A L

sinelnikov vol ii

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