Innervation of the skin: nerve endings, Merkel cells, Ruffini's little bodies, Meissner, Pacini. Overview of the innervation of the skin, muscles and organs by area Blood supply and innervation of the skin
The skin has a rich neuro-receptor apparatus. Nerve fibers are represented by branches of the cerebrospinal and autonomic nerves. Cerebrospinal nerve fibers belong to the central nervous system (CNS). They are responsible for different types of sensitivity. Vegetative fibers belong to the autonomic nervous system (sympathetic and parasympathetic) and regulate the work of the glands, blood vessels and muscles of the skin.
Nerve fibers run parallel to the blood and lymphatic vessels, enter the hypodermis, where they form large plexuses. Thinner branches branch off from the plexuses, branching and forming deep dermal plexus. Small branches from them rise to the epidermis and form superficial plexuses located in the papillary layer of the dermis and in the epidermis.
Receptor endings divided into free and not free. Free ones are in the form of naked axial cylinders (devoid of auxiliary glial cells) and end in the epidermis, hair follicles and glands. They are responsible for pain and temperature sensitivity.
Non-free nerve endings are subdivided into unencapsulated and encapsulated, most often called calves.
Non-encapsulated nerve endings include the terminal sections of neurons in the form of disks that form synapses with Merkel cells, performing the function of touch. Localized in the epidermis.
Encapsulated nerve endings are diverse and are different types of mechanoreceptors (slowly and rapidly adapting receptors):
Meissner corpuscles located inside the papillae of the dermis, there are many of them in the skin of the palmar-lateral surfaces of the fingers, lips, genitals;
Krause flasks localized in the dermis, especially a lot of them in the places where the skin transitions to the mucous membranes in the region of the lips, eyelids, external genital organs;
In the lower part of the dermis and the upper part of the hypodermis are localized Ruffini's little body;
In the deep layers of the dermis and hypodermis, mainly in the area of the palms, soles, nipples of the mammary glands, genitals, are located corpuscles of Vater-Pacini;
Genital Dogel's little body are found in the skin of the genitals, providing an increased sensitivity of these areas.
Sensitive innervation of the scalp: 1) the area of the face above the incision of the eyes - the frontal and supraorbital nerves (from the 1st, orbital, branches of the trigeminal nerve), the ear-temporal nerve (from the 3rd, mandibular, branches of the trigeminal nerve), temporomandibular nerve (from the 2nd, maxillary, branches of the trigeminal nerve), a large ear nerve (from the cervical plexus);
2) the area of the face between the incision of the eyes and the incision of the mouth - infraorbital and zygomatic-facial nerves (from the 2nd, maxillary, branches of the trigeminal nerve);
3) the area of the face below the incision of the mouth - the chin nerve (from the 3rd, mandibular, branches of the trigeminal nerve);
4) the occipital region - the large occipital nerve (the posterior branch of the second cervical spinal nerve), the small occipital nerve (from the cervical plexus).
Innervation of the muscles of the head: facial muscles - the facial nerve (VII pair of cranial nerves); chewing muscles - motor branches of the same name to the muscles (from the 3rd, mandibular, branches of the trigeminal nerve).
Language... Sensory innervation: the general sensitivity of the anterior two-thirds is carried out by the lingual nerve (from the 3rd, mandibular, branch of the trigeminal nerve), the gustatory sensitivity of the anterior two-thirds of the tongue is provided by the tympanic string (branch of the facial nerve). The posterior third of the tongue: general sensitivity - the lingopharyngeal nerve (IX pair of cranial nerves) and the vagus nerve (X pair of cranial nerves); gustatory sensitivity of the posterior third of the tongue - the lingopharyngeal nerve.
The innervation of the muscles of the tongue is the hypoglossal nerve (XII pair of cranial nerves).
Mucous membrane of the cheeks... Sensory innervation is the buccal nerve (from the 3rd, mandibular, branches of the trigeminal nerve).
Sky... Sensory innervation - anterior, middle and posterior palatine nerves (from the 2nd, maxillary, branches of the trigeminal nerve).
Innervation of muscles: muscle pulling the palatine curtain - 3rd, mandibular, branch of the trigeminal nerve; the uvula muscle, the palatine curtain lifter, the lingual-palatine and pharyngeal-palatine muscles - the vagus nerve (X pair of cranial nerves).
Salivary glands... The parotid salivary gland receives sensory fibers from the ear-temporal nerve (3rd, mandibular, branch of the trigeminal nerve); parasympathetic fibers - from the lingopharyngeal nerve (IX pair of cranial nerves); sympathetic fibers - from the upper cervical node of the border sympathetic trunk (they reach the gland through the arteries that supply it with blood).
The submandibular and sublingual salivary glands receive sensory fibers from the 3rd branch of the trigeminal nerve, parasympathetic fibers - from the tympanic string from the VII pair of cranial nerves, sympathetic fibers - from the upper node of the cervical part of the border sympathetic trunk (they reach the glands through the arteries that supply them with blood) ...
Pharynx... Sensory innervation is the lingopharyngeal nerve (IX pair of cranial nerves) and the vagus nerve (X pair of cranial nerves). Muscle innervation: vagus nerve (X pair of cranial nerves).
Orbital contents... Sensitive innervation of all components of the orbit is carried out by the nerves of the 1st and 2nd branches of the trigeminal nerve.
Innervation of the external muscles of the eyeball: the external rectus muscle of the eye - the abducens nerve (VI pair of cranial nerves); superior oblique muscle of the eye - blocky nerve (IV pair of cranial nerves); the rest of the muscles - the oculomotor nerve (III pair of cranial nerves).
Internal muscles of the eyeball: the muscle that narrows the pupil, the ciliary muscle receives parasympathetic fibers from the Yakubovich nucleus (preganglionic fibers go as part of the oculomotor nerve to the ciliary node, from which postganglionic fibers reach the named muscles). The muscle that dilates the pupil is innervated by sympathetic fibers coming from the cavernous plexus.
Lacrimal gland... Sensory fibers come from the 1st branch of the trigeminal nerve; parasympathetic fibers originate from the superior salivary nucleus (preganglionic fibers in the facial nerve, more precisely, the intermediate nerve, reach the pterygopalatine node, from which postganglionic fibers penetrate the orbit through the infraorbital fissure and innervate the lacrimal gland). Sympathetic fibers come to the gland from the cavernous plexus.
Nasal cavity... General sensitive innervation of the nasal mucosa is carried out by the 1st and 2nd branches of the trigeminal nerve; olfactory sensitivity is due to olfactory filaments (I pair of cranial nerves).
Outer and middle ear... The sensory innervation of the concha is the large ear nerve (cervical plexus), the anterior ear nerves (3rd, mandibular, branch of the trigeminal nerve).
External ear canal and tympanic membrane... Sensitive innervation of the external auditory canal and tympanic membrane is the ear-temporal nerve (from the 3rd, mandibular, branches of the trigeminal nerve).
Tympanic cavity and auditory tube... The sensory innervation of the mucous membrane of the middle ear is the ear-temporal nerve (from the 3rd mandibular, branches of the trigeminal nerve).
Muscles of the middle ear: stapes muscle - facial nerve; muscle pulling the eardrum, 3rd, mandibular, branch of the trigeminal nerve.
Neck
Neck skin: small occipital, large ear, transverse neck and supraclavicular nerves (branches of the cervical plexus).
Muscles of the neck... Superficial muscles of the neck. The subcutaneous muscle of the neck is the cervical branch of the facial nerve; sternocleidomastoid muscle - accessory nerve (XI pair of cranial nerves); neck muscles located below the hyoid bone - neck loop; muscles of the neck located above the hyoid bone: the anterior abdomen of the digastric muscle - the 3rd, mandibular, branch of the trigeminal nerve, the posterior abdomen - the facial nerve, the stylohyoid muscle - the facial nerve, the awl-lingual muscle - the hypoglossal nerve: the stylopharyngeal muscle - lingopharyngeal nerve; sublingual-maxillary muscle - 3rd, mandibular, branch of the trigeminal nerve; chin-lingual, chin-hypoglossal and hypoglossal-lingual muscles - the hypoglossal nerve (XII pair of cranial nerves).
Deep neck muscles- muscle branches of the cervical and brachial plexuses.
Thyroid and parathyroid glands... These glands are innervated by fibers of the vagus nerve and the borderline sympathetic trunk; sensory fibers are obtained from the cervical plexus.
Larynx... Innervation of the laryngeal mucosa: above the glottis - the upper laryngeal nerve (branch of the vagus nerve), below the glottis - the lower laryngeal nerve (branch of the laryngeal age nerve).
Innervation of the muscles of the larynx: the cricoid-thyroid muscle - the superior laryngeal nerve; the remaining muscles of the larynx are the lower laryngeal nerve (branches of the vagus nerve).
Breast
The proper muscles of the chest are innervated by intercostal nerves, the skin of the thoracic region receives sensory fibers mainly from the intercostal nerves, partly due to the branches of the cervical (subclavian region) and brachial (in the lateral regions) plexuses.
Heart... Autonomic innervation: sympathetic - from the cervical part of the borderline trunk (from its three nodes, the upper, middle and lower heart nerves, respectively), parasympathetic - sa account of the vagus nerve (the upper cardiac branch departs from the upper yurtal nerve, the lower cardiac branches - from laryngeal recurrent nerve). Afferent fibers to the heart come as part of the same cardiac branches from the vagus nerve and from the cervical and superior thoracic spinal nerves through the borderline sympathetic trunk.
Thymus... The autonomic innervation is carried out by the branches of the vagus nerve and the border sympathetic trunk, sensory fibers come from the cervical spinal nodes along the branches of the border sympathetic trunk.
Esophagus... Sensory innervation is the vagus and glossopharyngeal nerves and afferent fibers of the thoracic spinal nerves. The striated muscles of its upper section receive motor somatic fibers from the vagus nerve, the smooth muscles of the lower section have autonomic innervation: from the border sympathetic trunk and the vagus nerve.
Lungs... Autonomic innervation: due to the branches of the border sympathetic trunk and the vagus nerve.
Stomach
The skin of the anterior and lateral surface of the abdomen receives innervation from the 6-12th intercostal nerves, the ilio-hypogastric and ilio-inguinal nerves. The lateral and anterior abdominal muscles are innervated by the same nerves as the skin. The posterior abdominal muscles and the iliopsoas muscle receive motor fibers from the lumbar plexus.
The abdominal organs have autonomic innervation: parasympathetic, sympathetic and afferent. All these fibers reach the organs through the plexus on the vessels that supply them with blood. The parasympathetic fibers of the abdominal organs are obtained from two sources: the vagus and pelvic nerves. The vagus nerves, entering the abdominal cavity, form the anterior and posterior chords on the stomach and then enter the solar plexus, and from there through the vessels to the liver, pancreas, kidneys, adrenal glands, stomach and small intestine. To the large intestine and the pelvic organs, parasympathetic fibers come from the sacral spinal cord, through the pelvic nerves and the hypogastric plexus.
Sympathetic fibers to the organs of the abdominal cavity and pelvis are part of the visceral branches of the borderline sympathetic trunk (the largest of them are the celiac nerves), solar, lower mesenteric and hypogastric plexuses.
Afferent fibers (processes of cells of the spinal nodes) reach organs in the same ways as sympathetic fibers (through the borderline sympathetic trunk and its branches).
Back
The skin of this area is innervated by the posterior branches of all spinal nerves, excluding the 2nd cervical. Innervation of the superficial muscles: the broadest muscle - the thoracic-spinal nerve (from the brachial plexus); trapezius muscle - accessory nerve (XI pair): scapula levator and rhomboid muscle - spinal nerve of the scapula (from the brachial plexus); upper and lower dentate muscles - intercostal nerves. Innervation of deep muscles: muscles of the occipito-vertebral group - along the zatomial nerve (posterior branch of the 1st cervical spinal nerve); rib lifters - intercostal nerves; the rest of the deep muscles of the back are the posterior branches of the cervical, thoracic and lumbar spinal nerves.
Upper limb
Shoulder area... Innervation of the skin: Above the deltoid muscle, the skin is innervated by the supraclavicular nerves (from the cervical plexus) and the deltoid nerves (from the brachial plexus).
Muscle innervation: deltoid and small round muscles - deltoid nerve (from the posterior bundle of the brachial plexus), supraspinatus and infraspinatus muscles - the suprascapular nerve (from the supraclavicular part of the brachial plexus), subscapularis muscle - the subscapularis nerves (from the supraclavicular part of the brachial plexus), large and small pectoral muscles - the anterior pectoral nerves (from the supraclavicular part of the brachial plexus), the broadest muscle of the back and the large round muscle - the thoracic-spinal nerve (from the supraclavicular part of the brachial plexus), the anterior serratus muscle - the long pectoral nerve (from the supraclavicular part of the brachial plexus), subclavian muscle - the subclavian nerve (from the supraclavicular part of the brachial plexus).
Shoulder... Innervation of the skin: the medial surface is the medial cutaneous nerve of the shoulder (from the medial bundle of the brachial plexus), the lateral surface is the lateral cutaneous nerve of the shoulder (branch of the axillary nerve), the posterior surface of the shoulder is the posterior cutaneous nerve of the shoulder (branch of the radial nerve).
Muscle innervation: anterior group - the musculocutaneous nerve (from the lateral bundle of the brachial plexus); the posterior group - the radial nerve (from the posterior bundle of the brachial plexus).
Forearm... Innervation of the skin: the anterior surface - the medial cutaneous nerve of the forearm (from the medial bundle of the brachial plexus) and the lateral cutaneous nerve of the forearm (a branch of the musculocutaneous nerve); the posterior surface is the posterior cutaneous nerve of the forearm (a branch of the radial nerve).
Muscle innervation: posterior group - deep branch of the radial nerve; anterior group: the carpal-ulnar flexor and the medial half of the deep flexor of the fingers - the ulnar nerve; the rest of the muscles of the anterior group of the forearm are the median nerve.
Brush... Innervation of the skin: the skin of the palm in the area of 3 1/2 fingers (starting with the thumb) - branches of the median nerve; the area of the remaining 1 1/2 fingers - branches of the ulnar nerve; rear of the hand: skin of 2 1/2 fingers (starting with the thumb) - the radial nerve; the skin of the remaining 2 1/2 fingers is the ulnar nerve. The branches of the median nerve extend to the rear of the middle and nail phalanges of the II and III fingers.
Muscle innervation. The abductor muscle of the thumb, opposing the thumb, the superficial head of the short flexor of the thumb, the first and second vermiform muscles are innervated by the branches of the median nerve; and the rest of the hand muscles - by the deep branch of the ulnar nerve.
Lower limb
Pelvis... Cutaneous innervation of the gluteal region, the upper floor of the skin of the gluteal region is innervated by the superior cutaneous gluteal nerves (posterior branches of the three upper lumbar spinal nerves), the middle floor - by the middle cutaneous gluteal nerves (posterior branches of the three superior sacral spinal nerves) and the lower floor - by the lower cutaneous gluteal nerves ( branches of the posterior cutaneous nerve of the thigh).
Innervation of the pelvic muscles: gluteus maximus muscle - lower gluteal nerve (sacral plexus); the tensor of the wide fascia, the middle and small gluteal muscles - the superior gluteal nerve (sacral plexus); internal, obturator, twin and square muscles - the muscular branches of the sacral plexus; external obturator muscle - obturator nerve (lumbar plexus).
Innervation of the thigh skin: anterior surface - anterior cutaneous nerves of the thigh (femoral nerve); lateral surface - lateral cutaneous nerve of the thigh (lumbar plexus); the medial surface is the obturator nerve (lumbar plexus) and the femoral genital nerve (lumbar plexus); the posterior surface is the posterior cutaneous nerve of the thigh (sacral plexus).
Innervation of the thigh muscles: anterior group - the femoral nerve (lumbar plexus); medial group - obturator nerve (lumbar plexus) (the adductor major muscle additionally receives motor fibers from the sciatic nerve); the posterior group is the sciatic nerve (sacral plexus).
Shin... Innervation of the skin: the posterior surface of the lower leg skin - lateral (branch of the common peroneal nerve) and medial (branch of the tibial) cutaneous nerves of the lower leg; lateral surface - lateral cutaneous nerve of the leg; the medial surface is the saphenous nerve (branch of the femoral nerve).
Muscle innervation: anterior group - deep peroneal nerve (a branch of the common peroneal nerve); lateral group - superficial peroneal nerve (branch of the common peroneal nerve); the posterior group is the tibial nerve (a branch of the sciatic nerve).
Foot... Innervation of the skin: most of the skin on the dorsum of the foot is the branches of the superficial peroneal nerve; area of the 1st interdigital space - deep peroneal nerve; lateral edge of the foot - cutaneous nerve of the leg; the medial edge of the foot is the saphenous nerve.
On the sole, the skin in the area of 3 1/2 fingers (starting from the big one) is innervated by the medial plantar nerve (branch of the tibial nerve), the rest of the skin of the sole (the area of the last 1 1/2 fingers) - by the lateral plantar nerve (branch of the tibial nerve).
Innervation of muscles: muscles of the dorsum of the foot - deep peroneal nerve, sole muscles - medial and lateral plantar nerves.
Facial skin includes sweat and sebaceous glands, hair, muscle fibers, nerve endings, blood and lymph vessels. Its structure has its own characteristics, the knowledge of which is especially important for surgeons. At the same time, it will be interesting for an ordinary person to get acquainted with these features. Facial injuries are also possible in everyday life, especially in car collisions. After car accidents, it is often the person who suffers. Frightening bleeding occurs, which frightens both the patient himself and those close to him.
Nevertheless, it is precisely the structural features of the facial skin, its muscles, innervation and blood supply that allow us to hope for a successful outcome with timely professional surgical assistance. Next, we will consider the methods of providing first aid before the arrival of doctors for facial injuries. Accidentally read, maybe even not remembered text, in a critical situation will pop up in memory and will help to avoid mistakes in car accidents and other injuries.
Not so few people in our country, in addition to doctors, have primary medical training with the skills to provide first aid. These are pharmacists, nurses, nurses, police officers and employees of the Ministry of Emergency Situations, a medical officer after urgent service, sorry if someone has forgotten. In acute injuries, there are the main principles of first surgical aid, they allow you to save life and avoid dangerous consequences for the victim. Don't be intimidated by special medical terms. Even a simple presentation of the basic features of the structure of the body and its physiology helps in difficult times. At the same time, awareness of the threat of complications during exacerbation of surgical dental diseases will help make the right decision.
The outer layer of the skin forms a multinucleated squamous keratinizing epithelium, which adheres tightly to the underlying layer in the skin itself. The latter consists of two not clearly demarcated layers - subepithelial papillary and reticular. The papillary layer consists of loose connective tissue, which contains blood vessels and nerve endings that determine the sensitivity of the skin.
On the face, the papillae are low and even, so the skin on the face is thin and smooth. The scars on it are clearly visible. However, experienced surgeons achieve amazing aesthetic results by connecting the edges of the wound with intradermal sutures and masking the sutures in the anatomical folds.
Collagen, denser, skeleton fibers and elastic elastic and reticular fibers, as well as cellular elements, lie in the papillary layer, then it passes into a denser mesh layer, which is characterized by a large number of collagen and elastic fibers and a relatively small number of cellular elements.
The presence of elastic and collagen fibers of the connective part of the skin of the face determines the ability of the skin to stretch during facial expressions and conversation, and a large number of elastic fibers in the mesh layer creates constant physiological tension of the skin, which decreases with age. These lines also define the areas of the face, cuts and information of the edges of the wound are made relative to them. It is because of the presence of elastic fibers that facial injuries look so frightening - the edges of the wound diverge to the sides. At the same time, the face regains its appearance after the correct edges are closed and the sutures are applied.
The reticular layer passes into the mobile connective tissue, which differs from the skin by its significant thickness and loose arrangement of fibrous tissue bundles, as well as by the lesser development of subcutaneous adipose tissue (in comparison with other parts of the body).
Subcutaneous adipose tissue forms an elastic lining, is a plastic support layer that softens mechanical stress from the outside. In the region of the superciliary arches and eyebrows, the subcutaneous layer is a direct continuation of the tissue of the aponeurosis of the skull, but is devoid of a characteristic cellular structure. With the transition to the eyelids and nose, the subcutaneous fat layer acquires the character of a delicate connective tissue.
This structure of the subcutaneous layer in some areas of the face contributes to the rapid spread of hemorrhages, edema, and inflammatory processes along the length. An example of this is boxers during fights. Facial edema and hepatomas reach significant sizes, especially in those who neglect protective mouthguards.
The ways of penetration of pus from the primary focus are known both by maxillofacial surgeons and ordinary dentists. Such conditions are formidable complications, life-threatening, and yet their root cause may be a complication of caries - exacerbation of chronic periodontitis or sometimes a festering hematoma.
The cheek part of the face is rich in fatty tissue. The fatty body of the cheek, isolated from the surrounding tissue by a thin fascia, runs along the anterior edge of the masseter muscle. In the area of the upper and lower lips, the subcutaneous fatty tissue is much less developed, mainly these formations are formed by the circular muscle of the mouth.
A large number of striated muscle fibers ends in the skin of the face, which together make up the facial muscles of the face. A feature of facial muscles is their attachment at one end to the inert skeleton of the face, the other is woven into the connective tissue structures of the skin itself, which determines the mobility of the skin under the action of facial muscles.
In the places of the greatest accumulation of muscle fibers, elastic fibers are especially developed. In the areas of connection of the elastic network with under the epithelial layer, depressions are formed on the skin. Their sequential arrangement leads to the formation of skin grooves and folds, which are the guiding lines along which it is recommended to make incisions when cutting out and matching skin flaps. The scar located along the folds, due to the constant contraction of the facial muscles of the face, quickly stretches in length, becomes thinner and becomes little noticeable.
As a result of the constant contraction of the facial muscles, the elastic frame of the skin wears out, tears of elastic fibers are formed, characteristic wrinkles of the face appear, and the contractility of the skin decreases. The contractility of the facial skin is lower than the contractility of the skin of other parts of the body. This ability of the structure of the skin of the face is of great importance in skin grafting. When it is necessary to decide which part of the body skin is most suitable in terms of its structure for the full replacement of soft tissue defects, the surgeon must take these areas into account.
Mimic muscles determine the individual characteristics and expressiveness of the face, emotions inherent in a person, and also carry out the movement of the lips, eyelids, nostrils.
Blood supply to the soft tissues of the face Arteries and veins of the head
Anatomy and topography of the temporal and facial regions
The passage of blood vessels in the soft tissues of the face has its own characteristics. It is carried out by a powerful highway - the system of the external carotid artery, as well as through the ophthalmic artery, by some branches of the internal carotid artery, then splits into the facial, superficial temporal and other arteries. An extensive network of blood vessels and powerful blood flow allows an always open face to withstand the most severe environmental factors. In case of injuries and damage to one vessel, the blood supply is duplicated through the flow of blood from another line. All arteries are paired.
The main arterial trunk of the anterior part of the face arteria facialis is the facial artery.
It anastomoses (connects) with the frontal arteries and on its way gives many branches to the surrounding tissues, of which the largest are the chin, superior and inferior labial arteries. 
Cranial topography diagram
The largest diameter of the arteries is at the sites of attachment of the facial muscles of the skin. Smaller arteries are evenly distributed throughout the skin. In places of the greatest mobility of the skin, the arteries and veins are more tortuous. In most cases, the arteries and veins run parallel.
It is the presence of a large number of vascular anastomoses that makes it possible to widely use the soft tissues of the face when replacing defects. Taking into account the direction of the main arterial trunks as well as their combinations with venous lymphatic vessels makes it possible for various defects of the soft tissues of the face to use skin grafts taken in certain directions, if possible without disturbing their blood circulation.
The venous system is well developed in the soft tissues of the face. The veins of the face are widely anastomosed, connected to each other, as well as to the veins of the orbit. The veins of the middle ear and nose are connected to the veins of the base of the skull and to the superior sagittal sinus, through the veins of the orbit with the dura mater. The veins of the face are arranged in two layers with the exception of the veins of the forehead. The venous network is expressed in the area of the wings of the nose and lips. In the event of purulent inflammatory processes on the face, increased vascularization and anastomosis can act as an aggravating factor in the course of the disease. A breakthrough of the infection into the vessels of the face or along these vessels leads to damage to the orbit and the cerebral part of the head, which is practically a sentence. That is why dentistry is such a developed field of medicine.... Complications of caries - periodontitis, periostitis, abscess and phlegmon sometimes lead to lightning death of the patient. Here a hand with phlegmonous lesion can be amputated in critical situations, but the person will remain alive. And the infected cavernous sinus does not give us this opportunity.
Lymphatic system of the face Vessels of the lymphatic system
The extensive lymphatic network and the lymph node barrier determine the lymph circulation of the facial tissues and in many ways distinguishes the maxillofacial region from other areas. Almost every area of the face has its own group of regional lymph nodes - powerful analytical laboratories and producers of local immunity factors. Also, each section of the mucous membrane of the nasopharynx and oral cavity has its own accumulation of lymphoid tissue.
The lymphatic system forms two networks in the skin of the face - superficial and deep.
The connection of superficial and deep veins with the meninges
The superficial lymphatic network is finely looped and located under the papillary layer of the skin itself. A deep looped net lies in the reticular corium layer.
In view of the characteristic attachment of the facial muscles of the facial skin and the absence of fascia on the face, the lymphatic vessels of the facial skin have their own characteristics.
Arising from a deep capillary network, they form a plexus in the superficial layers of the subcutaneous fatty tissue. Larger abducting lymphatic vessels are directed to regional lymph nodes located on top of the facial muscles, or to the deep layers of subcutaneous fat, passing under several facial muscles.
The main lymphatic collectors in the form of large lymphatic vessels penetrating under the muscles or their fascia, as a rule, join along the main arterial and venous trunks and follow them to regional lymph nodes, which are divided into three sections.
Innervation of soft tissues of the face Nerve trunks of the face
The innervation of the face is carried out by the facial nerve and
The facial nerve leaves the corresponding bone canal and enters the tissue of the parotid gland, splits into numerous branches that form the plexus parotideus nerve plexus. Fan-shaped diverging branches of the facial nerve go to all facial muscles and provide their contraction. There is a certain individual variability in the structure of the facial nerve, but in general, these are two types of structure. But in any case, the main branches of the facial nerve are present.
- Marginal ramus of the lower jaw
- Buccal branch
- Zygomatic branch
- Temporal branch
These branches are fan-shaped according to the basic principle - from the tragus of the ear (where the nerve begins on the face) to the corner of the mouth, along the lower edge of the lower jaw, to the tip of the nose and to the outer corner of the eye.
Trauma to the branches of the facial nerve leads to paralysis of the facial muscles. To avoid damage to the branches of the facial nerve, deep cuts on the face are made only relative to the lines connecting the ear with the outer corner of the palpebral fissure, the tip of the nose, the corner of the mouth and parallel to the edge of the lower jaw, retreating one and a half to two cm higher from it. Surgeons know these lines by heart; a layman may not need this information. But you never know what knowledge is required in life. Suppose, in addition to acute injuries, there are also chronic ones. The facial nerve, before beginning to innervate the face, passes through the temporomandibular joint and the parotid gland. In both regions, problems and inflammatory processes are possible, mainly associated with the teeth. As luck would have it, the facial nerve is mixed, and is responsible for both facial muscles and sensitivity in the oral cavity and facial areas. Moreover, it also communicates with other nerves through nerve nodes.
People perceive problems with teeth as something commonplace and everyday, as an annoying hindrance. But problems with facial expressions and disorders of taste cannot but disturb, or rather, lead to panic.
And this is where the problems begin. It is very, very difficult to identify the source of the problem even for a qualified and experienced dentist surgeon. The innervation of the head is too complex, in which many nerves and plexuses are involved.
But even this is not sad. People with impaired sensitivity and facial expressions often turn to a neurologist. He prescribes treatment based on his baggage of knowledge and his pharmacological arsenal, most often these are severe highly specialized drugs with psychotropic side effects. People are treated for years to no avail. Meanwhile, the root cause of the disease, bad teeth, may not be eliminated, therefore, the treatment will be ineffective.
This problem takes place. For those interested, here's some background information.
"Emergency care in neurostomatology".
Who will be able to overcome this publication about syndromes of lesions of the cranial nerve systems, especially the autonomic divisions, write to the corporate mail of the site.
Deep face area
The sensitive innervation of the face is complex. It involves sensitive trunks and all three branches of the trigeminal nerve, as well as the branches of the cervical plexus. The rich innervation and blood supply of the face allows multiple duplication of innervation and blood circulation of each part of the head, promotes tissue stability in case of injuries, and accelerates the healing of injuries on the face. Even extensive head injuries will heal in most cases. At the same time, if the disease does arise, it creates certain difficulties in diagnosis and treatment. Over the past 20 years, the problem of innervation has become urgent again, which is associated with the massive use of implants for dental prosthetics. No matter how the examination is carried out before implantation operation, but statistically, injuries or compression of the nerve trunks during the installation of implants occur, and this suggests that anatomy as a science should continue to develop, revealing cases of anatomical variability and atypism.
As for facial injuries, it's amazing what situations happen in life. Wanting only the best, people sometimes make serious mistakes when providing first aid. At the same time, the correct solutions have long been described, you just need to know and implement them. But more on that in our next article.
Circulatory and lymphatic skin systems. The arteries that nourish the skin form a wide-mesh network under the hypodermis, which is called the fascial network. Small branches branch off from this network, dividing and anastomosing with each other, forming a subdermal arterial network. From the subdermal arterial network, the branching and anastomosing vessels go up in the forward and oblique directions, and on the border between the papillae and the reticular layer of the dermis, a superficial vascular plexus is formed from them. From this plexus originate arterioles, which form terminal arteriolar arcades of looped structure in the dermal papilla. The density of papillary capillaries in the skin corresponds to the density of the papillae and is different in different areas of the body, varying within the range of 16-66 capillaries per 1 mm of skin. Hair follicles, sweat and sebaceous glands are equipped with vessels extending horizontally from the deep vascular plexus. The venous system begins with postcapillary venules, which form four venous plexuses in the papillary layer and subcutaneous fatty tissue, repeating the course of arterial vessels. A characteristic feature of intradermal vessels is a high degree of anastomosis between vessels of the same type and of different types. Glomuses, or arteriovenous glomerular anastomoses, are often found in the skin - short connections of arterioles and venules without capillaries. They are involved in the regulation of body temperature, maintain the level of interstitial tension, which is necessary for the functioning of capillaries, muscles and nerve endings.
The lymphatic vessels of the skin are represented by capillaries that form two networks located above the superficial and deep vascular plexuses. The lymphatic networks anastomose with each other, have a valve system and, passing through the subcutaneous fatty tissue, on the border with the aponeurosis and muscle fascia form a wide-loop plexus - plexus lymphaticus cutaneus.
Innervation of the skin. The receptor function of the skin is of particular importance. The skin serves as a barrier between the environment and the internal environment and perceives all types of irritations. The skin is innervated by the central and autonomic nervous systems and is a sensitive receptor field. In addition to the usual nerve endings in the form of treelike branches, glomeruli that innervate the sebaceous and sweat glands, hair follicles and blood vessels, the skin has a kind of nerve apparatus in the form of so-called encapsulated bodies and nerve endings. The main nerve plexus of the skin lies in the deep sections of the subcutaneous fatty tissue. Rising from it to the surface, the nerve branches approach the appendages of the skin and form a superficial nerve plexus in the lower part of the papillary layer. Branches branch off from it into the papillae and epidermis in the form of axial cylinders. In the epidermis, they penetrate to the granular layer, lose the myelin sheath and end in a simple sharpening or thickening. In addition to free nerve endings, there are also special nerve formations in the skin that perceive various irritations. Encapsulated tactile bodies (Meissner's bodies) are involved in the functions of touch. The feeling of coldness is perceived with the help of Krause flasks, the feeling of warmth is perceived with the participation of Ruffini's bodies, the position of the body in space, the sensation of pressure is perceived by lamellar bodies (Vater-Pachini bodies). Feelings of pain, itching and burning are perceived by free nerve endings located in the epidermis. The tactile bodies are located in the papillae and consist of a thin connective tissue capsule containing special receptor cells. A soft nerve fiber in the form of a myelin-free axial cylinder, ending in a thickening in the form of a meniscus, adjacent to the receptor cells, approaches them through the lower pole of the capsule. Krause end flasks are located under the papillae. Their elongated oval shape is directed towards the papillae with the upper pole. In the upper pole of the connective tissue capsule, there is a myelin-free nerve cylinder ending in a glomerulus. Ruffini's bodies are located in the deep parts of the dermis and the upper part of the subcutaneous fatty tissue. They represent a connective tissue capsule in which the end of the nerve axial cylinder is divided into numerous branches. Lamellar bodies are located in the subcutaneous fatty tissue, have a capsular structure. The skin also contains many autonomic nerve fibers located along the surface of all vessels, including capillaries. They regulate the functional activity of the vascular plexus and thereby influence the physiological processes in the epidermis, dermis and subcutaneous adipose tissue.
Function of the skin.
2-interaction of the organism and the environment. Wednesday.
Thermoregulatory function the skin is carried out both due to changes in blood circulation in the blood vessels, and due to the evaporation of sweat from the surface of the skin. These processes are regulated by the sympathetic nervous system.
Secretory function the skin is carried out by the sebaceous and sweat glands. Their activity is regulated not only by the nervous system, but also by the hormones of the endocrine glands.
The secretion of the sebaceous and sweat glands maintains the physiological state of the skin, has a bactericidal effect. The glands also secrete various toxic substances, that is, they perform excretory function. Many fat and water soluble chemicals can be absorbed through the skin.
Exchange function the skin consists in its regulating effect on the metabolism in the body and the synthesis of certain chemical compounds (melanin, keratin, vitamin D, etc.). The skin contains a large number of enzymes involved in protein, fat and carbohydrate metabolism.
The role of the skin in water and mineral metabolism is significant.
Receptor function the skin is carried out due to the richest innervation and the presence in it of various terminal nerve endings. There are three types of skin sensitivity: tactile, temperature and pain. Tactile sensations are perceived by Meissner's bodies and Vater-Pacini lamellar bodies, Merkel's tactile cells, as well as free nerve endings. For the perception of the feeling of cold, the little bodies (flasks) of Krause serve, the heat - the bodies of Ruffi-ni. Pain sensations are perceived by free, non-encapsulated nerve endings that are located in the epidermis, dermis and around the hair follicles.
The skin of the body is the border between the external world and the internal environment. The total area of the skin is about 1.5-2 sq. m.
The skin in the body has certain:
The skin has a three-layer structure:
- The integumentary layer is the epidermis.
- The middle layer is the dermis (skin itself).
- Deep layer of subcutaneous fatty tissue -.
The dermis has 2 layers: superficial papillary and deep reticular layers... The papillae of the superficial layer of the dermis protrude into the bottom. In the grooves between the papillae, there are loops of blood capillaries and sensory nerve endings. Together with the nerve endings of the deep reticular layer of the dermis, they are receptors that perceive various stimuli.
Nerve plexuses of the skin
The skin of the body is innervated by the branches of the spinal nerves of the somatic nervous system. In addition to the sensory and motor nerve fibers of the spinal nerves, the skin also contains secretory and sympathetic fibers vegetative part of the nervous system.
Nerve trunks entering the skin, form plexuses in the hypodermis- subcutaneous fat layer. From the deep nerve plexus of the hypodermis, many nerve trunks depart into the dermis, forming new plexuses there. These nerve plexuses subcutaneous tissue and dermis give twigs to all structural elements of the skin: hair follicles, muscles, blood vessels, sebaceous and sweat glands. Autonomic nerve fibers entwine blood vessels, regulate their tone, providing tissue nutrition.
Sensory (afferent) nerves are present in the dermis free nerve endings or specialized terminal structures - receptors.
Free sensitive endings are located in the papillae of the dermis, protruding from below into the epidermis. They perceive the feeling of pain.
Specialized receptors perceive tactile (touch), temperature, vibration stimuli. Terminal nerve structures have a complex structure. Differences in structure indicate the perception by each type of nerve endings of a separate type of irritation: cold, mechanical, vibration, heat.
Tactile Meissner corpuscles oval are located in the papillae of the dermis and are surrounded by a fibrous membrane. Maximum number of tactile bodies have toe pads, palms and soles of the feet... These receptors perceive tactile sensations - touch.
Merkel discs, or tactile menisci, are located in the lower layer of the epidermis. Their structure includes epithelial cells and sensory nerve endings... They are also designed to sense touch, creating areas of increased sensitivity in the red border of the lips. Accumulations of a large number of nerves on the palms and soles are surrounded by subcutaneous fat and dense connective tissue - this is tactile rollers.
The effect of cold is perceived Krause flasks... Heat perception is provided by work calf ruffini... In the hypodermis there are large (up to 4 mm) lamellar bodies of Vater-Pacini oval shape. They transmit information to the brain about the degree of pressure on the skin. Their work allows a person to respond to vibration.
In 1 sq. see leather available about 300 sensitive nerve endings... They are connected by sensory (afferent) nerve fibers with centers in the spinal cord and brain and serve for the skin to perform its function of the organ of touch... The effects of environmental factors are perceived by skin receptors, and the nerve trunks transmit the received signal to the central nervous system. In the central sections of the analyzers, the signals are analyzed and a response is generated. By motor (efferent) nerve fibers, the command is transmitted to the periphery for execution - sweating, changes in the lumen of blood vessels, muscle contraction.