From Big Medical Encyclopedia

HEAD (caput). G.'s border passes across the line drawn through the basis of a mandible, the rear edge of its branch, a top of a mastoid, the upper nuchal line, an outside occipital ledge and further through similar anatomic formations of other party. Distinguish brain (cerebral) and front (visceral) G.'s departments, the line between to-rymi is drawn on supraorbital edge of a frontal bone, the upper edge of a malar and zygoma before outside acoustical pass (see. Person , Skull ).

Fig. 1. Scheme of areas of the head: 1 — reg. frontalis; 2 — reg. parietalis; 3 — reg. occipitalis; 4 — reg. mastoidea; 5 — reg. parotideomasseterica; 6 — reg. mentalis; 7 — reg. oris; 8 — reg. buccalis; 9 — reg. nasalis; 10 — reg. orbitalis; 11 — reg. temporalis.

The brain department, in turn, allocates a base of skull (basis cranii) and a calvaria (fornix cranii). Besides, G. is subdivided into areas (fig. 1): frontal (regio frontalis), parietal (regio parietalis), occipital (regio occipitalis), temporal (regio temporalis), orbital (regio orbitalis), nasal (regio nasalis), oral (regio oris), mental (regio mentalis), buccal (regio buccalis), parotid and chewing (regio parotideomasseterica). B of temporal area allocate almost important mastoidal area (regio mastoidea). At vertebrate animals and the person in brain department of G. are located the brain surrounded with a cranium, an acoustic organ and balances. In the front department of G. which is a support of forefronts of digestive and respiratory systems organs of sight, sense of smell and large sialadens lie.

A comparative anatomy

Data of a comparative anatomy show that G. was allocated on the front end of a body of animals for the best orientation in the environment. On G. as on the forefront of a body, sense bodys (sight, hearing, sense of smell) and bodies of capture of food developed. Phylogenetic the most ancient within G. is a basal part — a base of skull. In process of development of a brain younger part G. in the phylogenetic relation — a calvaria, and also the front structures which are transformed under the influence of process of capture of food and its razmelcheniye forms.

Originally the forefront of a body was also correctly segmented, as well as a trunk of the lowest vertebrata. Due to the development of sense bodys and a brain, transformation of branchiate arches primary correct segmentarnost of G. in a most part disappears. At modern fishes the front couple of branchiate mandibular arches lost gills and was transformed to the jaws armed with numerous small teeth. The second couple of branchiate arches (hypoglossal) limits in front the first branchial aperture and at many fishes bears a gill on a back surface. The third and the subsequent couples of branchiate arches, being located in partitions between branchial apertures, bear both on lobbies, and on back surfaces the difficult and plentifully supplied by blood folds — gills. At cyclostomous (lampreys), and also at the lowest cartilaginous fishes (sharks, slopes) branchial apertures open independently outside on each side (at sharks) or from below (at slopes). At chimeras and at all bony fishes the branchiate device is covered outside with a skin fold — the branchiate cover attached to a hypoglossal arch.

At land vertebrate animals the branchiate device is reduced and will be transformed to other bodies. Mandibular branchiate arches form top and bottom jaws, and also a pair hammer and an anvil; from the second couple of branchiate arches small horns of a hypoglossal bone and a stirrup develop. From the third couple of branchiate arches the body and big horns of a hypoglossal bone, a thyroid cartilage of a throat form. From fabric of branchiate arches bodies — a middle ear, acoustical (eustachian) pipes, palatine tonsils, thyroid and epithelial bodies, goitrous gland, language form. In connection with considerably reduced mobility of a body of land vertebrate animals of G. gains ability to the movement. The joint with a backbone develops, the shoulder girdle loses connection with a skull, the cervical department of a backbone having bigger mobility than other its departments develops. Amphibiouses have only one cervical vertebra connected movably to an occipital bone. Reptiles, birds and mammals have a cervical department of a backbone and the neck clearly separates G. from a trunk. Thanks to it receives big mobility. Mammals according to the progressing development of a brain, in particular hemicerebrums, have an increase in volume of brain department of the skull reaching a maximum at the person.

The acoustic organ, a webby labyrinth to-rogo on the origin is the complicated channel of a sideline of fishes, already at cartilaginous fishes opens by means of the endolymphatic channel outside on a dorsal part of the head. The middle ear develops only at land vertebrata. The outside ear appearing at reptiles and birds at mammals is supplemented with a mobile auricle.

Situation and a relative organogeny of sight strongly affects development of a skull. At the highest fishes and reptiles the interorbital partition is formed. The bone eye-socket receives big capacity in development.

G.'s evolution at the highest mammals and the person is connected with progressive development of a brain.

Damages and diseases of soft tissues of the head

Damages of soft tissues of the head can be closed and opened.

Open damages of soft tissues can be fire and not fire. In the Great Patriotic War among total number of the wounds of soft tissues wounded in G. frequency made 54,6% (B. A. Self-currents). Wounds can be bullet and fragmental. At wound of soft tissues the hurting shell can make impact on bones of a skull and a brain energy of side blow. Therefore all wounded with gunshot wounds of soft tissues of G. shall be inspected for the purpose of identification of symptoms of injury of bones of a skull and a brain (the roentgenogram, nevrol, inspection). The vast majority of wounds of soft tissues of G. can be sewn up tightly, hurt and impractical edge of wounds shall be exsected. Thanks to good blood supply of a wound of soft tissues of G., as a rule, heal without complications. The hurt wounds of pilar part G. quite often have linear character and can remind cut wounds. At damage of galea aponeurotica the gaping of a wound is more expressed. All wounds and bruises of a pilar part of a goal - * you can be followed by injury of bones of a skull owing to what at these patients the X-ray analysis of bones of a skull and careful audit of a bottom of a wound are necessary during primary surgical treatment. Wounded in G. with damage of soft tissues need observation since symptoms of damage of a brain can come to light later a nek-swarm time after getting injured (see. Craniocereberal injury). Scalped wounds of the head result more often from disturbance of the accident prevention when long hair are reeled up on the rotating parts of the machine, at the same time soft tissues of G. can be scalped on a big extent, sometimes together with auricles. Treatment — return of a scalp into place (replantation) and fixing by seams. Full engraftment is in rare instances observed, partial is more often.

The closed damages of soft tissues pilar part G. usually are followed by the expressed hypostasis of fabrics and formation of a hematoma. Treatment usually conservative — a bed rest, locally cold. At large hematomas the puncture with aspiration of the streamed blood can be made (see. Hematoma ).

Inflammatory diseases of soft tissues of the head

Inflammatory diseases of soft tissues of the head are shown in the form of abscesses, furuncles, an anthrax, phlegmons and an erysipelatous inflammation.

Abscesses most often arise because of different damages, especially at the nonperforating wounds put with small splinters. Treatment by the general rules — a section, drainage (see. Abscess ).

Phlegmons have the same reasons of education, as abscesses. The phlegmonous inflammation can arise under skin or under an aponeurosis and is characterized by lack of demarcation that promotes its distribution and formation of purulent zatek. At subgaleal phlegmon inflammatory process can extend to bones of a skull and even to a firm meninx and cause thrombosis of the adjacent site of a sine. Treatment of phlegmon — cuts, sometimes multiple, drainage and prescription of antibiotics by the general rules (see. Phlegmon ).

Furuncles and anthrax On the origin and a wedge, to a current do not differ from furuncles and an anthrax of other localizations. The anthrax sometimes tends to distribution. Distribution of necrotic process to depth of covers of G. is dangerous that can cause a necrosis of an outside plate of a bone of a skull, thrombosis of a venous sine. Treatment of these diseases is conducted by the general rules (see. Anthrax , Furuncle ).

Erysipelatous inflammation on G. results from distribution of erysipelatous process from a neck more often. The disease is followed by a headache, high temperature, oznoba. At an erysipelatous inflammation of pilar part G. puffiness of skin and small morbidity clearly are defined during the pressing, in an initial stage of a disease affected areas can have pale color, bubbles happen seldom, usually very small. G.'s ugly face — a dangerous disease, it can be complicated by phlegmon, meningitis, sepsis. Treatment — antibiotics, locally — greasing by antiseptic solutions.

Owing to a possibility of development of intracranial complications all inflammatory diseases of soft tissues of G. demand careful medical observation. At most of them hospitalization and intensive antibiotic treatment are shown.

Tumors of soft tissues of the head

Tumours of soft tissues of the head are various. Benign tumors are most frequent: lipomas, angiomas, neurofibromas. Quite often the atheromas of the head, externally similar to a tumor, reaching the big sizes, painless, covered with not changed skin, often multiple meet (see. Epidermoid cyst ). Large atheromas should be differentiated with brain hernia. Brain hernias are less dense, contract during the pressing; on the roentgenogram it is possible to find defect in a bone of a skull. The differential diagnosis between an atheroma, a dermoid cyst or a lipoma of special value has no since the diagnosis can be found out at operation. Benign tumors are removed by the general rules.

Fig. 2. The patient with angiomas of soft tissues of the head, neck and bones of a skull.

G.'s (fig. 2) angiomas — benign vascular tumors, can be capillary, shown in the form of small roundish spots of red color; cavernous — in the form of knotty tumors of cyanotic color of various sizes decreasing during the pressing always arise in hypodermic cellulose, but can burgeon (to get) into bones of a skull and to connect to vessels of a meninx. Sometimes on the head are formed lymphangiomas (see). Diagnosis of angiomas is not difficult. Treatment variously depending on the sizes and a form of a new growth (see. Hemangioma ).

The carcinoma cutaneum of the head arises from an epithelium of skin, skin glands and sometimes from an epithelium of hair bulbs. A tumor, being shown in the form of a painless node in the beginning, quickly enough increases and ulcerates; gives metastasises in regional limf. nodes.

Sarcoma of soft tissues of the head arises at young age more often; the tumor develops from connective tissue cells. Treatment by the general rules — beam, surgical or electrosurgical (see. Tumours ).

Bibliography: Zhedenov V. N. A comparative anatomy of primacies (including the person), M., 1962, bibliogr.; Zolotko Yu. L. Atlas of topographical anthropotomy, p.1, Head and neck, M., 1964; To in and N about in V. V. and Yu. M Bomash. Practical guidance on topographical anatomy, M., 1964; The Multivolume guide to surgery, under the editorship of B. V. Petrovsky, t. 3, book 2, page 361, M., 1968, bibliogr.; Napalkov P. N., Smirnov A. V. and Schreiber M. G. Surgical diseases, page 5, L., 1976; Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945, t. 4, p.1, page 256, M., 1949; Paches A. I. Tumors of the head and neck, M., 1971; Severtsev A. N. Collected works, t. 1, M. — L., 1949; Head injury, ed. by W. F. Caveness a. A. E. Walker, Philadelphia — Toronto, 1966; Kent G. Comparative anatomy of the vertebrates, St Louis, 1969, bibliogr.

A. H. Berkutov; I. I. Shmalgauzen, S. S. Mikhaylov (comparative anatomy).