Subl-Txem-kefis midamo, regio frontoparietooccipitalis

• sazRvrebi: winidan — Tvalbudis zeda kide (margo supraorbitalis),

uknidan —kefis gareTa SemaRleba (protuberantia occipitalis externa) da
qedis zeda xazi (linea nuchae superior), gverdebidan — safeTqlis
zeda xazi (linea temporalis superior).
• kanis umetesi nawili Tmiania, igi sqeli da mkvrivia, mtkiced aris
dakavSirebuli kanqveSa qsovilsa da myesovan abjarTan. Amis gamo
mcired moZravia, Seicavs didi raodenobiT cximisa da oflis
jirkvlebs.
• kanqveSa qsovilSi (I SemaerTebelqsovilovani Sre) didi
raodenobiTaa mkvrivboWkoiani xarixebi da konebi, romlebic kans
myesovan abjarTan akavSireben da romelTa Soris
burTulebismagvari cximovani grovebia. aqvea qalasarqvlis
rbili safarvelis sisxlZarRvebi da nervebi.
• sisxlZarRvTa kedlebi mtkiced aris dakavSirebuli kanqveSa
SemaerTebelqsovilovan firfitasa da xarixebTan, ris gamoc
gadakveTili sisxlZarRvebis sanaTurebi ar viwrovdeba. amiT
aixsneba is, rom qalas rbili safarvelis Wrilobebs sakmaod
Zlieri sisxlis dena axasiaTebs.
• sisxlZarRvebi moTavsebuli arian aponevrozis zeviT da
mimarTuli arian qvevidan zeviT da radialurad. amis gamo Tavis
rbili qsovilebi unda gaikveTos radialuri mimarTulebiT,
radgan am dros naklebad ziandeba sisxlZarRvebi da Wrilobis
SexorcebisaTvis Seiqmneba kargi pirobebi.
Sublis midamos:
• sisxliT amaragebs WaRzeda da Tvalbudis zeda sisxlZarRvebi da
nervebi, romlebic Tvalbudidan gamodian. WaRzeda da Tvalbudis
arteriebi (a. supratrochlearis et a. supraorbitalis) gamoeyofa Tvalbudis
arterias (SigniTa saZile arteriis toti);
• venebi erTvis saxisa da Tvalbudis zeda venebs, romelTagan pirveli
uerTdeba SigniTa sauRle venas, xolo meore — mRvimovan sinuss.
• WaRzeda da Tvalbudis zeda nervebi (n. supratrochlearis et n. supraorbitalis)
gamoeyofa Tvalbudis nervs (n. ophthalmicus).
• Sublis midamos gareTa nawilSi gaivlis saxis nervis totebi,
romlebic qalasarqvlis kunTis Sublis mucels amarageben.
Txemis midamos:
• sisxliT amaragebs safeTqlis zedapiruli arteria (a. temporalis
superficialis) da yuris ukana arteria (a. auricularis posterior). isini
anastomozebiT dakavSirebuli arian Tvalbudis zeda da kefis
arteriebTan. aseve anastomozebiT arian dakavSirebuli erTmaneTTan
xsenebuli arteriebis Tanamgzavri venebi.
• Txemis midamos venebi erTvis safeTqlis zedapirul venas (v. temporalis
superficialis)
• safeTqlis zedapiruli arteriis totebs Tan sdevs yur-safeTqlis
nervis (n. auriculotemporalis) totebi.
kefis midamos:
• sisxliT amaragebs yuris ukana da kefis arteriebi (a. auricularis posterior
et a. occipitalis) (gareTa saZile arteriis totebi).
• arteriebis Tanamgzavri venebi gareTa sauRle venas erTvis.
• inervacias axorcielebs kefis mcire nervi (n. occipitalis minor) (kisris
wnulis toti) da kefis didi nervi (n. occipitalis major) (kisris II nervis
ukana toti).
limfuri ZarRvebi
• Sublisa da nawilobriv Txemis midamodan ixsneba yba-yuris zedapirul
da Rrma kvanZebSi (nodi lymphatici parotidei superficiales et profundi), Txemis
midamos ukana nawilidan — yuris ukana limfur kvanZebSi (nodi lymphatici
retrumandibulares) da kefis midamodan — kefis limfur kvanZebSi (nodi
limphatici occipitales). am limfuri kvanZebis gamomtani ZarRvebis kisris
Rrma limfur kvanZebSi ixsneba.
kanqveSa qsovilis qveS mdebareobs qalasarqvlis kunTi
(m.epicranius), romelic Seicavs Sublis mucels (venter frontalis),
kefis mucels (venter occipitalis) da myesovan abjars (galea
aponeurotica).
• myesovani abjris qveS cximiT Raribi Txeli, faSari
SemaerTebelqsovilovani Canafenia (II
SemaerTebelqsovilovani Sre), ris gamoc myesovani
abjari ZvlisazrdelasTan mtkiced ar aris
dakavSirebuli. myesovani abjris mtkice kavSiri kanTan
da susti kavSiri ZvlisazrdelasTan ganapirobebs
qalasarqvlis areSi skalpirebuli Wrilobis
ganviTarebis SesaZleblobas.
• qalas skalpirebuli Wrilobebi drouli qirurgiuli
damuSavebis Semdeg kargad xorcdeba, rac rbili
qsovilebis kargi vaskulizaciiT aixsneba.
• qalasarqvlis Zvlisazrdela, anu perikraniumi
dakavSirebulia ZvlebTan faSari SemaerTebeli qsovilis
Txeli feniT (III SemaerTebelqsovilovani Sre), ris
gamoc Zvlisazrdelas acla qalasarqvelidan Zneli ar
aris. igi mtkiced aris fiqsirebuli Zvalze mxolod
qalas Zvlebis nakerebis gaswvriv. ZvlisazrdelaSi
gaivlis Zvlis gareTa firfitis mkvebavi sisxlZarRvebi,
amitom operaciis dros perikraniumi SeZlebisdagvarad
unda davzogoT.
 qalasarqvlis rbili safarvelis SemaerTebelqsovilovani
Sreebis sxvadasxvanari agebuleba ganapirobebs am SreebSi
paTologiuri procesebis gavrcelebis Taviseburebas:

• kanqveSa qsovilSi sisxlCaqceva (kopi) da Cirqovani

kera, Cveulebriv, SemosazRvrulia, vinaidan procesis
gavrcelebas aq ewinaaRmdegeba kanisa da myesovani abjris
urTierTdamakavSirebeli SemaerTebelqsovilovani xarixebi.

• myesovan abjarsa da Zvlisazrdelas Soris ganviTarebuli

igive movlenebi ki advilad vrceldeba da zogjer mTel
Subl-Txem-kefis midamos moicavs.

• periosteumis qveS lokalizebuli hematoma Tu

Cirqovani kera Cveulebriv, erTi Zvlis farglebiT
moisazRvreba, vinaidan maT gavrcelebas xels uSlis
nakerebis gaswvriv ZvalTan mtkiced dakavSirebuli
Zvlisazrdela.

• qalasarqvlis SigniTa zedapiri Zvlisazrdelas nacvlad

dafarulia tvinis magari garsiT.
qalasarqvlis Sreebi: 1_kanqveSa qsovili, 2_kanqveSa sisxlZarRvebi,
3_kani, 4_SemaerTebelqsovilovani konebi da xarixebi,
5_aponevrozisqveSa SemaerTebeli qsovili, 6_myesovani abjari,
7_Zvlisazrdelas qveS mdebare SemaerTebeli qsovili, 8_Zvali,
9_qselisebri garsis granulaciebi, 10_epiduruli sivrce,
11_subduruli sivrce, 12_ qselisebri garsi, 13_rbili garsi, 14_venuri
sinusi, 15_tvinis qerqi, 16_qselqveSa sivrce, 17_tvinis magari garsi,
18_Zvlisazrdela, 19_di ploes vena da gamosaSvebi venebi.
qalasarqvlis Zvlebi Sedgeba gareTa da SigniTa kompaqturi firfitebisagan
(lamina externa et lamina interna), romelTa Soris mdebareobs Rrublisebri nivTiereba,
anu diploe (diploe). SigniTa Sres minisebr firfitasac (lamina vitrea) uwodeben.
qalas travmis dros igi SedarebiT ufro advilad, xSirad da farTo farglebSi
ziandeba, vidre gareTa firfita. aris SemTxvevebi, roca gareTa firfita mTelia,
xolo SigniTa firfita dazianebuli. qalasarqveli yvelaze ufro Txelia
safeTqlis Zvlis qicvis areSi. Sublis midamos qveda nawilSi Zvlis sisqeSi
lorwovani garsiT gamofenili Sublis wiaRebi mdebareobs
• Rrublisebr nivTierebaSi moTavsebulia diploes arxebi
(canales diploici), romlebSic diploes venebi (vv. diploicae)
gaivlis. isini, erTi mxriv, dakavSirebuli arian
qalasarqvlis rbili safarvelis venebTan da meore
mxriv, tvinis magari garsis venur sinusebTan. es kavSiri
upiratesad xorcieldeba gamosaSvebi venebiT (vv.
emissariae). arsebobs ramdenime gamosaSvebi vena,
romelTagan mudmivobiT gamoirCeva dvrilisebri
gamosaSvebi vena (v. emissaria mastoidea); igi dvrilisebr
xvrelSi gaivlis da kefis venas tvinis magari garsis
sigmoidur sinusTan akavSirebs. xSirad gvxvdeba agreTve
Txemis gamosaSvebi vena (v. emissaria parietalis), romelic
safeTqlis zedapirul venas tvinis magari garsis zeda
sagitalur sinusTan akavSirebs. aRsaniSnavia agreTve
kefis gamosaSvebi vena (v. emissaria occipitalis), romelic
kefis venas ganiv sinusTan da sinusebis SerTulTan
akavSirebs, da rokis gamosaSvebi vena (v. emissaria
condilaris), romelic kisris Rrma venur wnuls (plexus
venosus cervicalis profundus) da xerxemlis gareTa venur
wnuls (plexus venosus vertebralis externus) sigmoidur sinusTan
akavSirebs.
• qalasarqvlis safarvel SreebSi ganviTarebuli
anTebiTi procesi gamosaSvebi venebiT SeiZleba venur
sinusebze, tvinis garsebsa da TviT tvinzec gavrceldes.
 safeTqlis midamo, regio temporalis
sazRvrebi: winidan _Sublis Zvlis yrimalis morCi da yvrimalis
Zvlis Sublis morCi, zevidan da uknidan _safeTqlis zeda xazi,
qvevidan _ yvrimalis rkali.
safeTqlis midamo (sqema): 1_kani, 2_kanqveSa qsovili,
3_zedapiruli fascia, 4_yvrimalis rkali, 5_safeTqlis
aponevrozi, 6_fasciaTaSorisi sivrce, 7_SemaerTebeli
qsovili, 8_safeTqlis kunTi, 9_Zvlisazrdela,
10_safeTqlis Zvali.
kani:
ukana nawilSi iseTivea, rogoric Subl-Txem-kefis
midamoSi, wina nawilSi ki Txeli da moZravia.
kanqveSa qsovili (I SemaerTebelqsovilovani Sre):
SedarebiT sustad aris ganviTarebuli. mis sisqeSi
arcTu iSviaTad gvxvdeba yuris zeda kunTi.
zedapiruli fascia myesovani abjris gagrZelebaa. igi
qveviT saxis kanqveSa qsovilSi ikargeba
safeTqlis zedapiruli arteria (gareTa saZile arteriis
saboloo toti), gaivlis yba-yuris jirkvalSi. jirkvlis
kafsulidan gamosvlis Semdeg ki gadauvlis yvrimalis
rkals da iyofa Sublis da Txemis totebad romlebic
anastomozebiT mezobel arteriebs ukavSirdebian.
yuris niJaris ukan, kanqveSa qsovilSi, yuris ukana
arteriis totebi gaivlis.
safeTqlis zedapiruli vena qveda ybis ukana venas (v.
retromandibularis) erTvis.
yur-safeTqlis nervi gamoeyofa qveda ybis nervs, safeTqlis
zedapirul arteriasTan erTad yba-yuris jirkvalSi
gaivlis da safeTqlis midamoSi itoteba. yba-yuris
jirkvlis sisqeSi igi totiT ukavSirdeba saxis nervs.
• safeTqlis fascia safeTqlis zeda xazidan iwyeba, qveda nawilSi
zedapirul da Rrma furclebad iyofa da yvrimalis rkals umagrdeba. mis
or furcels Soris moTavsebulia cximovani SemaerTebeli qsovili (II
SemaerTebelqsovilovani Sre). safeTqlis fascia dakavSirebulia safeT-
qlis midamos Zvlovan sazRvrebTan da safeTqlis fososTan erTad qmnis
Zvalfasciur sivrces, romelSic safeTqlis kunTi mdebareobs. yvrimalis
rkalis zemoT safeTqlis fasciaSi gaivlis da safeTqlis kunTSi
totiandeba safeTqlis Sua arteria (a. temporalis media) (safeTqlis
zedapiruli arteriis toti)
• safeTqlis kunTi iwyeba safeTqlis qveda xazidan (linea temporalis inferior), safeTqlis
forakidan (planum temporale) da safeTqlis fasciidan, umagrdeba qveda ybis
gvirgvinisebr morCsa da qveda ybis totis wina kides. safeTqlis kunTsa da
safeTqlis fascias Soris qveda nawilSi cximovani SemaerTebeli qsovilia (III
SemaerTebelqsovilovani Sre), romelic qveviT loyis cximovan baliSs
ukavSirdeba. safeTqlis kunTsa da safeTqlis Zvlis qicvs Soris gaivlis
safeTqlis Rrma sisxlZarRvebi da nervebi.
• safeTqlis kunTs sisxliT amaragebs
safeTqlis Rrma arteriebi (aa. temporales
profundae) (Sua meningealur arteriis
totebi).
• safeTqlis Rrma venebi (vv. temporales
profundae) erTvis frTisebr wnuls (plexus
pterigoideus).
• safeTqlis Rrma nervebi (nn. temporales
profundae) qveda ybis nervs gamoeyofa,
anervebs safeTqlis kunTs.
• safeTqlis midamos zedapiruli Sreebis
limfuri ZarRvebi ixsneba yuris wina da
ukana limfur kvanZebSi, xolo Rrma
Sreebis limfuri ZarRvebi _ yba-yuris
limfur kvanZebSi.
• safeTqlis forakis Semqmneli Zvlebis SigniTa
zedapirze gaivlis Sua meningealuri arteria (a.meningea
media). igi zeda ybis arteriidan (a. maxillaris) gamodis,
wvetiani xvreliT (foramen spinosum) qalas RruSi Sedis da
safeTqlis Zvlis qicvsa da tvinis magar garss Soris
wina da ukana totebad iyofa. arteria da misi totebi
mtkiced aris dakavSirebuli magar garsTan. Zvalze isini
qmnian arteriul Rarebs (sulci arteriosi). arterias Tan sdevs
ori vena. SemTxvevaTa naxevarSi arteriis wina toti
dasawyisSi gaivlis 0,5-2sm sigrZis Zvlovan arxSi.
• Sua meningealuri arteriis orive mTavari toti Tavis
tvinis qerqis mniSvnelovan areSi mdebareobs. wina toti
_ safeTqlis wilis areSi. aRniSnuli monacemebis
gaTvaliswineba aucilebelia eqstraduruli (epiduruli)
hematomis dadgenisTvis. qalas tramvis niadagze
meningealuri arteriis dazianebis Sedegad
ganviTarebuli eqstraduruli hematoma TandaTanobiT
aSorebs magar garss Zvlisagan da awveba tvins, rac
gadaudebel operaciul Carevas (trepanacias) saWiroebs.
 dvrilisebri morCis midamo, regio mastoidea
sazRvrebi: winidan da uknidan dvrilisebri morCis Sesabamisi
kideebi, zevidan _ yvrimalis rkalis doneze gavlebuli
horizontaluri xazi.
• kani Txeli da moZravia.
• kanqveSa qsovilSi mdebareobs:
1. yuris ukana kunTis (m. auricularis posterior) konebi;
2. yuris ukana arteria (a, auricularis posterior).
3. yuris ukana nervi (n. auricularis posterior) (saxis nervis
toti) da yuris didi nervis (n. auricularis magnus) ukana
toti.
• fascia myesovani abjris gagrZelebaa.
• yuris ukana limfuri kvanZebi (nodi lymphatici retroauriculares)
mdebareobs fasciis qveS an zemoT. isini limfas krefen
Txemisa da kefis midamoebidan, yuris niJaris ukana
zedapiridan, gareTa sasmeni xvrelidan da dafis Rrudan.
• dvrilisebr morCs umagrdeba mkerd-laviw-dvrilisebri
kunTi (m. sternocleidomasodeus), Tavis ugrZesi kunTi (m.
longissimus capitis) da Tavis salmunis kunTi (m. splenius capitis).
misgan iwyeba ormucela kunTi (m. digastricus).
• Zvlisazrdela mtkiced aris dakavSirebuli ZvalTan,
gansakuTrebiT im adgilebSi, sadac dvrilisebr morCs
kunTebi umagrdeba.
dvrilisebri morCis
zedapirze aRiniSneba
samkuTxa foraki,
romelsac satrepanacio,
anu Si pos samkuTxedi
ewodeba. igi zevidan
SemosazRvrulia
yvrimalis rkalis
doneze gavlebuli
horizontaluri xaziT,
winidan _ gareTa
sasmeni xvrelis ukana
kidiT da yuris
Sesavlis zeda wvetiT
(spina suprameatum),
uknidan _ dvrilisebri
morCis ukana kidiT.
dvrilisebri morCis
Cirqovani anTebisa da
Sua yuris qronikuli
anTebis dros
trepanacia am
samkuTxedis farglebSi
xorcieldeba.
• safeTqlis Zvlis dvrilisebri morCi Seicavs lorwovani garsiT
gamofenil Zvlovan ujredebs (cellulae mastoideae), romelTagan yvelaze
didi moculobisaa dvrilisebri mRvime (antrum mastoideum). igi
satrepanacio (Sipos) samkuTxedis farglebSi mdebareobs da mRvimis
SesavliT (aditus ad antrum) dakavSirebulia dafis RrusTan (cavum tympani).
dvrilisebri mRvime proecirdeba satrepanacio samkuTxedis zeda
nawilSi. igi Zvlis zedapiridan 1,5-2mm-is siRrmeze mdebareobs.
dafis Rru moTavsebulia safeTqlis Zvlis kldovan nawilSi _
dafis apksa da SigniTa yurs Soris; aqvs eqvsi kedeli _zeda,
qveda, SigniTa, gareTa, wina da ukana; Seicavs sasmen Zvlebs _
CaquCs, grdemlsa da uzangs. igi sasmeni luliT (tuba auditiva)
dakavSirebulia cxvirxaxasTan, xolo qalas Rrusgan
gayofilia dafis sarqvliT (tegmen tympani).
• praqtikuli TvalsazrisiT sayuradReboa:
1. satrepanacio samkuTxedis ukana kidis
gaswvriv qalas RruSi magari garsis
sigmoiduri sinusia, romelic
dvrilisebri mRvimisgan gayofilia
Zvlis sakmaod sqeli feniT.
2. samkuTxedis wina kidis gaswvriv
dvrilisebri morCis farglebSi
mdebareobs saxis nervis arxi, romelSic
saxis nervi gaivlis,
3. samkuTxedis zeda kidis zemoT Tavis
tvinis safeTqlis wilia.