SUBMAXILLARY AREA

From Big Medical Encyclopedia

SUBMAXILLARY AREA [trigonum submandibulare (PNA), regio submandibularis (JNA), regio submaxillaris (BNA), synonym: submaxillary triangle, submaxillary pole, hypoglossal and maxillary triangle] — the pair anatomic area of triangular shape located in front area of a neck over a hypoglossal bone.

Anatomy

Fig. 1. Diagrammatic representation of borders of submaxillary area and areas of a neck, adjacent to it: 1 — fossa retromandibularis, 2 — side area of the person, 3 — submaxillary area, 4 — trigonum submentale, 5 — a sleepy triangle, 6 — a lopatochnotrakhealny triangle, 7 — grudinoklyuchichno-mastoidal area (the solid line designated borders of submaxillary area, by a dashed line — areas of a neck).

From above submaxillary area (submandibular triangle, T.; trigonum subman-dibulare) is limited to edge of a mandible (mandibula), on each side — two paunches of a biventral muscle (m. digastricus). To the item of the lake it is well available to a research at the head (fig. 1) which is thrown back and turned aside. From above P. of the lake borders on areas of the person — mental, buccal and parotid and chewing (regiones mentalis, buccalis et parotideomasseterica); from below — with triangles of a neck — trigonum submentale in front and sleepy (trigonum carotieum) behind; above and behind proceeds in fossa retromandibularis.

Fig. 2. The diagrammatic representation of topography of submaxillary area (the head is thrown back back, an anterior aspect): 1 — the bed of submaxillary gland covered by a superficial plate of a cervical fascia, 2 — v. submentalis, 3 — a maxillary hypoglossal nerve, 4 — a. submentalis, 5 — a maxillary and hypoglossal muscle, 6 — trigonum submentale cellulose, 7 — a front abdomen of a biventral muscle, 8 — a mandible, 9 — a facial artery, 10 — a facial vein, 11 — submaxillary gland.
Hypoglossal area, hypoglossal gland, submaxillary area, submaxillary gland. Fig. 1. Topography of submaxillary and hypoglossal areas (the right half of a mandible is removed, skin and muscles are delayed). Fig. 2. Topography of hypoglossal area (language is lifted, a part of his mucous membrane is removed). Fig. 3. Topography of submaxillary area (the hypodermic muscle of a neck and a superficial plate of a cervical fascia are removed): 1 — language, 2 — a peredneyazychny sialaden, 3 — a deep artery of language, 4 — a submandibular channel, 5 — hypoglossal gland, 6 — the mandible (is partially removed), 7 — a maxillary and hypoglossal muscle, 8 — a mental hypoglossal muscle, 9 — submandibular gland, 10 — a facial artery, 11 — a facial vein, 12 — podjyazychno - a lingual muscle, 13 — a submaxillary lymph node, 14 — an upper root of a cervical loop, 15 — a breast - klyuchichno - a mastoidal muscle, 16 — a zanizhnechelyustny vein, 17 — an internal jugular vein, 18 — an internal carotid artery, 19 — an outside carotid artery, 20 — deep cervical lymph nodes, 21 — a hypoglossal nerve, 22 — a back abdomen of a biventral muscle, 23 — a shilopodjyazychny muscle, 24 — a parotid gland, 25 — a masseter, 26 — a deep vein of language, 27 \the branch of a mandible (is partially removed) with U-2014\, 28 — a lingual nerve, 29 — hypoglossal nipples, 30 — a hypoglossal fold, 31 — a bridle of language, 32 — a front abdomen biventral - muscles, 33 — a hypodermic muscle of a neck, 34 — a superficial plate of a cervical fascia, 35 — the basis of a mandible, 36 — a regional branch of a mandible of a facial nerve.

P.'s skin of the lake thin, at men is partially covered with hair, spliced with a hypodermic muscle of a neck (platysma). Under skin there pass small arteries and veins. Cervical branch of a facial nerve (of colli n. facialis) and branchings of a cross nerve of a neck (n. transversus colli) probodat a hypodermic muscle of a neck, innervating it and skin of a neck. Under this muscle the considerable accumulations of hypodermic cellulose causing existence of a so-called double chin can be located. A superficial plate of a cervical fascia in P. of the lake, having departed from a hypoglossal bone, it is split on more dense superficial and thinner deep plates which form a fascial bag (capsule) of submaxillary gland (saccus gl. submandibularis) and vaginas biventral and shilopodjya loud muscles (fig. 2). Behind a corner of a mandible both plates merge in thickened tyazh again — a shilonizhnechelyustny sheaf (lig. stylomandibulare), edges P. separates the lake from a zanizhnechelyustny pole. In a superficial plate of a cervical fascia there passes the facial vein (v. facialis). Between superficial and deep plates, except submaxillary gland (see), are located a facial artery (a. facialis) with departing from it podpodborodoch-ache an artery (a. submentalis), and also a submental vein (v. submentalis), a maxillary hypoglossal nerve (n. mylohyoideus), limf, nodes and cellulose (tsvetn. fig. 3). The deep plate also covers the muscles forming P.'s bottom of the lake — maxillary and hypoglossal and hypoglossal and lingual (mm. mylohyoideus et hyoglossus), an also lingual vein (v. lingualis), hypoglossal and lingual nerves (nn. hypoglossus et lingualis), lying on an outer surface of a hypoglossal and lingual muscle. To an inner surface of a hypoglossal and lingual muscle the facial artery (a. lingualis) prilezhit. In the depth of P. of the lake, its top, has Pirogov's triangle limited from below (behind) to a sinew of a biventral muscle, from above a hypoglossal nerve, in front the rear edge of a maxillary and hypoglossal muscle.

Cellulose P. of the lake is reported through a crack between maxillary and hypoglossal and hypoglossal and lingual muscles with cellulose of a mouth floor (see. Roth, oral cavity ) and peripharyngeal space; on the course front arteries and veins it is reported with cellulose of side area of the person and a sleepy triangle. On cellulose inflammatory processes of submaxillary area can pass on person (see) and in deep parts necks (see).

Blood supply of skin and P.'s muscles of the lake is carried out by branches of a facial artery, is preferential under - a mental artery; deep muscles are krovosnabzhat by also lingual artery (a. lingualis). Venous outflow happens on the veins of the same name. The lymph gathers in submaxillary (Submandibular, T.) and deep cervical limf, nodes (nodi lymphatici submandibulares et seg-vicales profundi).

P.'s skin of the lake the cross nerve of a neck from a cervical plexus, a muscle — craniocereberal innervates (cranial, T.) nerves: trigeminal (n. trigeminus) — a front abdomen biventral and a maxillary and hypoglossal muscle, front — a hypodermic muscle of a neck, a back abdomen biventral and a shilopodjyazychny muscle; a hypoglossal nerve — hypoglossal and lingual and shiloyazychny muscles.

Pathology

In P. the lake observe inflammatory processes (see. Lymphadenitis , Phlegmon ), benign and malignant tumors and their metastasises are found, there can be bleedings from a facial artery at injuries, diseases of submaxillary gland — sialadenitis (see), a sialolithic disease (see. Sialolithiasis ).

At inspection of the patient concerning various patol, processes in P. lakes, except poll and survey, make a palpation of area index and anonymous fingers the quiet sliding movements. At the same time it is possible to define the infiltrate, a tumor and also increased and condensed limf. nodes. At an arrangement patol, the center in deep departments of P. of the lake conjoined manipulation when the index finger is placed in hypoglossal area is most reasonable, and index and anonymous fingers of other hand palpate P. of the lake. In the presence of phlegmon, abscess, cystous education in P. the lake can palpatorno define fluctuation.

At diseases submaxillary gland (see) in addition use sialografiya (see).

At purulent processes in P. lakes, napr, at phlegmon, do a section 2 — 3 cm lower than edge of a body of the mandible and parallel to it not to damage a facial nerve (a regional branch of a mandible). At such section it must be kept in mind that near submaxillary gland the facial artery is located, to-ruyu it is necessary to bypass or tie up. For the purpose of creation of good outflow of exudate the fascia needs to cut, the lakes covering P.

At distribution of inflammatory purulent processes of P. of the lake on the cellulose surrounding a neurovascular bunch of a neck, the section is done not only in submaxillary area, but also along a first line grudino - a clavicular and mastoidal muscle. The similar section is made during removal of tumors of P. of the lake, a salivary stone from submaxillary gland, at an operative measure apropos hron, a sialadenitis of this gland, and also during removal limf. node.



Bibliography: Bir A., Brown G. and Kummel. Operational surgery, the lane with it., t. 2, the p. 2, page 15, M. — L., 1930; Evdokimov A. I. had to - Pashayev N. Sh. Topographical anatomy of an oral cavity, M. — JI., 1930; Zolotko Yu. JI. Atlas of topographical anthropotomy, p.1, page 118, 171, M., 1964; Nekrasov G. M. Lymph nodes of a neck and head, Smolensk, 1938; The Guide to surgical stomatology, under the editorship of A. I. Evdokimov, page 162, M., 1972.


V. I. Zausayev; V. S. Speransky (annate.).

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