Professional Documents
Culture Documents
Full download Sobotta Atlas of Anatomy, Vol. 3: Head, Neck and Neuroanatomy (English/Latin)(16th Ed.) 16th Edition Friedrich Paulsen file pdf all chapter on 2024
Full download Sobotta Atlas of Anatomy, Vol. 3: Head, Neck and Neuroanatomy (English/Latin)(16th Ed.) 16th Edition Friedrich Paulsen file pdf all chapter on 2024
3: Head,
Neck and Neuroanatomy
(English/Latin)(16th Ed.) 16th Edition
Friedrich Paulsen
Visit to download the full and correct content document:
https://ebookmass.com/product/sobotta-atlas-of-anatomy-vol-3-head-neck-and-neuro
anatomy-english-latin16th-ed-16th-edition-friedrich-paulsen/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...
https://ebookmass.com/product/sobotta-atlas-of-anatomy-
vol-2-internal-organs-english-latin16th-ed-16th-edition-
friedrich-paulsen/
https://ebookmass.com/product/sobotta-praparieratlas-dissection-
atlas-3rd-edition-friedrich-paulsen/
https://ebookmass.com/product/sobotta-atlas-of-anatomy-
vol-1-general-anatomy-and-musculoskeletal-system-english-
latin16th-ed-16th-edition-friedrich-paulsen/
https://ebookmass.com/product/cunninghams-manual-of-practical-
anatomy-volume-3-head-neck-and-brain-16th-edition-rachel-koshi/
Head, Neck and Dental Anatomy 4th Edition, (Ebook PDF)
https://ebookmass.com/product/head-neck-and-dental-anatomy-4th-
edition-ebook-pdf/
https://ebookmass.com/product/oxford-handbook-of-head-and-neck-
anatomy-1st-edition-van-gijn/
https://ebookmass.com/product/netters-head-and-neck-anatomy-for-
dentistry-3-3rd-edition-neil-s-norton-phd/
https://ebookmass.com/product/illustrated-anatomy-of-the-head-
and-neck-5th-edition-edition-margaret-fehrenbach/
https://ebookmass.com/product/imaging-anatomy-head-and-neck-1st-
edition-philip-r-chapman/
ATLAS OF ANATOMY
ELSEVIER
F. Paulsen, J. Waschke
Atlas of Anatomy
Friedrich Paulsen, Jens Waschke (Eds.)
Atlas of Anatomy
English Version with Latin Nomenclature
16th Edition
ELSEVIER
ELSEVIER This atlas was founded by Johannes Sobotta + ((Sterbekreuz)}. former
Hackerbrucke 6, 80335 Munich, Germany Professor of Anatomy and Director of the Anatomical Institute of the
All business correspondence should be made with: University in Bonn, Germany.
books.cs.mucOelsevier.com
German Editions:
Original Publication 181 Edition: 1904-1907 J. F. LehmannsVerlag, Munich. Germany
Sobotta Atlas dar Anatomie 2~~<~-11 111 Edition: 1913-1944 J. F. Lehmanns Verlag. Munich. Garmany
C Elsevier GmbH, 2017. 12111 Edition: 1948 and following editions
All rights reserved. Urban &Schwarzanb&rg, Munich, Garmany
ISBN 978-3-437-44023-6 13111 Edition: 1953, ed. H. Becher
14111 Edition: 1956, ed. H. Becher
This translation of Sobotta Atlas der Anatomie. 24111 edition by Friedrich
Paulsen and Jens Waschke was undertaken by Elsevier GmbH. 15111 Edition: 1957. ed. H. Becher
16111 Edition: 1967. ed. H. Becher
ISBN 978-Q-7020..5271-2 n·th Edition: 1972, eds. H. Ferner and J. Staubesand
18111 Edition: 1982, eds. H. Ferner and J. Staubesand
All rights reserved 19111 Edition: 1988. ad. J. Staubesand
16111 edition 2018 20111 Edition: 1993, ads. R. Putz and R. Pabst. Urban & Schwarzanberg,
C Elsevier GmbH, Munich. Garmany Munich, Germany
21 91 Edition: 2000, ads. R. Putz and R. Pabst. Urban & Fischer, Munich,
Notice Germany
The translation has been undertaken by Elsevier GmbH at its sole 22nd Edition: 2006. eds. R. Putz and R. Pabst. Urban & Fischer.
responsibility. Munich, Germany
Knowledge and best practice in this field are constantly changing. As 23~ Edition: 2010. ads. F. Paulsen and J. Waschke. Urban & Fischer.
new research an experience broaden our understanding. changes in Elsevier, Munich, Germany
research methods, professional practices, or medical treatment may 24111 Edition: 2017. ads. F. Paulsen and J. Waschk.a, Elsevier, Munich,
become necessary. Germany
Practitioners and researchers must always rely on their own
experience and knowledge in evaluating and using any information, Fi:lrelgn Edlt1ons:
methods, compounds or experiments described herein. Arabic
Because of rapid advances in the medical sciences. in particular,
Chinese
independent verification of diagnoses and drug dosages should be
made. Croatian
To the fullest extent of the law. no responsibility is assumed by Czech
Elsevier, authors, editors or contributors in relation to the translation or English (nomenclature in English or Latin)
for any injury and/or damage to persons or property as a matter of French
products liability. negligence or otherwise, or from any use or Greek
operation of any methods. products. instructions. or ideas contained in Hungarian
the material herein. Indonesian
Italian
Bibliographic Information published by the Deutsche Nationalbibliothek
Japanese
The Deutsche Nationalbibliothek lists this publication in the Deutschan
Nationalbibliografie; detailed bibliographic data is available on the Korean
Internet at http://WWW.d-nb.de/. Polish
Portuguese
Russian
18 19 20 21 22 5 4 3 2 1 Spanish
Turkish
All rights. including translation. are reserved. No part of this publication Ukrainian
may be reproduced or transmitted in any form or by any means.
electronic or mechanical, including photocopying, recording, or any
information storage and retrieval system, with our permission in
writing by the publisher. Details on how to seek permission. further
information about the Publisher's permissions policies and our
arrangements with organizations such as the Copyright Clearance
Canter and the Copyright Licensing Agency, can be found at our
website: www.elsevier.dehechteundlizenzen/
In the preface of the first edition of his atlas in May 1904, Johannes has now come back into fashion- we have simply modernised the con-
Sobotta writes: 'Long-standing experience in cadaver dissection clas- cept. Each picture is thus completed with a short explanatory text to in-
ses has prompted the author to ensure that the illustrations of the peri- troduce the students to the structure depicted and to explain why those
pheral nervous system and the blood vessels depict the relevant struc- particular dissection and depiction methods have been chosen for that
tures in the same way that the student is accustomed to seeing them particular region. The individual chapters have been systematically struc-
on the cadaver, i.e. that they depict the vessels and nerves from the tured to follow today's methods of studying, while various illustrations
same region together. Furthermore, the atlas alternates between pages have been updated or replaced. The majority of these new illustrations
of text and full-page diagrams. The latter contain the key illustrations in have been designed from the point of view of the learner, to make it
the atlas, while the former - in addition to sketches and schematic easier to study the key pathways of blood supply and innervation. We
drawings and legends- contain a brief. concise text to help the student have furthermore revised numerous existing illustrations and reduced
find information quickly when using the book in the dissection hall.' the number of labels, using bold type to facilitate access to the anatomi-
Just as fashions change on a regular basis, so do students' reading and cal content. The numerous clinical practice examples ('Clinical Remarks')
studying habits. The ubiquitousness of multi-media and the ready avail- show the somewhat 'dry' subject of anatomy at its most vibrant best,
ability of information and stimuli are surely the main reasons why these demonstrating to beginners how relevant anatomy is for their subse-
habits are changing at a much faster rate than ever before. Publishers quent professional life and giving them a tantalising taste of their clinical
and publishing houses must stay abreast of these developments and of training to come. Another revised feature is the introductory preface to
students' changing expectations regarding atlases and textbooks they the individual chapters, which sum up the content and the key issues,
wish to use, as well as ensuring the digital availability of the contents. and include a real-life clinical case. In addition, each chapter ends with a
In addition to interviews with students and systematic surveys, a pub- summary of questions which would typically be asked in oral anatomy
lisher can sometimes gauge students' expectations from the textbook exams and exam tests. As in the 23m edition, each chapter contains a
market itself. Detailed textbooks claiming to be completely comprehen- brief introduction to the embryology of each body region.
sive are increasingly being abandoned in favour of textbooks that di-
dactically meet students' educational needs and cover the contents of Readers should please note two things:
their courses and exams - whether they are studying medicine, den- 1. The 241h edition of the Sobotta Atlas cannot replace an explanatory
tistry or biomedical science. Likewise, although the images in atlases textbook.
such as Sobotta have fascinated many generations of doctors and me- 2. No matter how good an educational concept is, students still have to
dical professionals around the world with their precise naturalistic re- put in many hours of intensive studying themselves -a good con-
presentations of real dissections, they are sometimes perceived by cept can but make that knowledge more accessible. Learning anato-
students as being too complicated and too detailed. This realisation re- my is not difficult, but it does take a lot of time; time that is well
quires us to consider how we can build upon the obvious strengths of spent. since everybody- doctor and patient- will benefit from it in
an atlas- which in the course of over 100 years of tradition and 23 the long run. The aim of the 24111 edition of the Sobotta Atlas is not
German editions, has become a benchmark of accuracy and quality- to only to facilitate your study, but also to make the time you spend
meet modern didactic concepts without the overall work losing its studying engaging and interesting, so that the atlas is something you
unique, exclusive characteristic and its originality. will repeatedly want to pick up and consult, both during your medical
For educational reasons, we have maintained the Sobotta's original con- training and your subsequent professional career.
cept and chosen to publish the atlas, as it has been since the first edi-
tion, in three volumes: General Anatomy and Musculoskeletal System Erlangen and Munich, summer of 2017,
(1 ); Internal Organs (2); and Head, Neck and Neuroanatomy (3). And while exactly 113years after the first edition was published
the concept mentioned in the preface of the first edition, i.e. linking the
pictures in the Atlas with an explanatory text, may be old-fashioned, it Friedrich Paulsen and Jsns Waschks
Acknowledgements of the 24th German Edition
The work on the 241~ edition of the Sobotta Atlas has once again been a Special thanks to our team of illustrators Dr Katja Dalkowski, Marie Da-
lot of fun, and this intensive involvement has continued to strengthen vidis, Johannes Habla, Anne-Kathrin Hermanns, Martin Hoffmann, Son-
our sense of pride in the Sobotta. ja Klebe, Jorg Mair and Stephan Winkler, who in addition to updating the
Today, more than ever, an extensive anatomy atlas of the calibre of the existing images also helped us develop a large number of new illustra-
Sobotta requires a lot of teamwork with the coordination of the publi- tions.
shing house. The cornerstone of the 24111 edition has been laid by Dr For their help in producing the clinical images. we would also like to
Katja Weimann, who extensively coordinated the project. We are very thank Dr Frank Berger, Institute of Clinical Radiology of Ludwig Maximi-
grateful for her hard work. Also, without the long-standing experience lians University, Munich; Prof. Christopher Bohr, Phoniatrics and
of Dr Andrea Beilmann, who has worked on several previous editions of Paediatric Audiology, ENT Clinic at Friedrich Alexander University,
the Sobotta and has been a true pillar of strength for the Sobotta team, Erlangen/Nurnberg; Dr Eva Louise Bramann. Ophthalmology Clinic at
many things would not have been possible. We would like to thank her Heinrich Heine University, Dusseldorf; Prof. Andreas Dietz, Director of
again most profusely for all her help and support. Benjamin Rempe, the ENT Clinic and Outpatients' Clinic at the University of Leipzig; Prof.
another member of the four-person team behind the 241~ edition of the Gerd Geerling, Ophthalmology Clinic at Heinrich Heine University, D(jssel-
Sobotta. has contributed to Sobotta for the first time. approaching the dorf; Dr Berit Jordan, University Clinic and Outpatients' Clinic for Neu-
task with real passion and enthusiasm. His unique way of motivating rology, Martin Luther University, Halle/Wittenberg; Dr Axel Kleespies.
the team served as a continual source of encouragement and motiva- Surgical Clinic, Ludwig Maximilians University, Munich; Prof. Norbert
tion for the editors. Benjamin: thank you very much. We fondly recall the Kleinsasser, University Clinic for Illnesses of the Ear. Nose and Throat.
monthly conference calls in which Benjamin Rempe and Dr Andrea Bail- Julius Maximilians University, Wurzburg; Dr Hannes Kutta, ENT prac-
mann helped us carefully craft the Sobotta Atlas and, despite their dif- tice, Hamburg-Aitona/Ottensen; Dr Christian Markus, Anaesthesiology
ferent approaches, showing a remarkable gift for intuitively adopting a Clinic, Julius Maximilians University, Wurzburg; Jorg Pekarsky, Institute
uniform working style. Sibylle Hartl coordinated the project in collabora- for Anatomy II, Friedrich Alexander University, Erlangen/Nurnberg; Dr
tion with Dr Andrea Beilmann and was responsible for the entire print Dietrich Stovesandt, Clinic for Diagnostic Radiology, Martin Luther Uni-
production. We are truly grateful to her. Without the tenacity and the versity, Halle/Wittenberg; Prof. Jens Werner, Surgical Clinic, Ludwig
protective hand of Dr Dorothea Hennessen and Rainer Simader, who Maximilians University, Munich; Dr TobiasWicklein, Erlangen. and Prof.
were both in charge of the overall management of the 'Sobotta 241~ Stephan Zierz, Director of the University Clinic and Outpatients' Clinic
edition' project and who never lost faith in their Sobotta team or the for Neurology, Martin Luther University Halle/Wittenberg.
tight schedule, this edition in its present form would not have been Last but not least, we would like to thank our families, who not only
possible. Others whom we are similarly grateful to for their involve- were very gracious and understanding of all the time we devoted to the
ment in the project and their share of its success are: Dr Antje Kronen- 241 ~ edition of the Sobotta, but who also gave us very helpful sugges-
berg (editing), the abavo GmbH team (technical image processing and tions whenever we needed feedback. You have been a true support.
typesetting) and Nicola Kerber (layout design). We would very much like
to thank Dr Ursula Osterkamp-Baust for exhaustively compiling the in- Erlangen and Munich. summer of 2017
dex. Friedrich Paulsen and Jens Waschke
1. List of Abbreviations
Singular: Plural: ~ female
A. Arteria Aa. Arteria a ({ mala Percentages:
Lig. = Ligamentum Ligg. = Ligamenta In the light of the large variation in
M. Musculus Mm. Musculi individual body measurements, the
N. Nervus Nn. NetVi percentages indicating size should
Proc. Processus Procc. = Processus only be taken as approximate
R. Ramus Rr. Rami values.
v. Vena Vv. Venae
Var. = Variation
3. Use of Brackets
I 1: Latin terms in square brackets refer to alternative terms as given in I 1: Round brackets are used in different ways:
the Terminologia Anatomies (1998), e.g. Ren [Nephros). To keep the - for terms also listed in round brackets in the Terminologia Anatomi-
legends short, only those alternative terms have bean added that es, a.g.(M. psoas minor)
differ in the root of the word and are necessary to understand clinical - for terms not included in the official nomenclature but which the
tenns, e.g. nephrology. They are primarily used in figures in which the editors consider important and clinically relevant e.g. (Crista
particular organ or structure plays a central role. zygomaticoalvaolaris)
- to indicate the origin of a given structure, e.g. R. spinalis (A,
vertebral is).
Colour Chart
Concha nasalis inferior Os occipitale In the newborn the following cranial bones are
..
indicated by only one colour:
Mandibula Os palatinum
- --
Osfrontale Os temporale Os occipitale, Os palatinum
Os lacrimale Os zygomaticum
Os nasale Vomer
Table of Content
Head
Overview................................................... 4
Skeleton and Joints......................................... 9
Muscles.................................................... 47
Topography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Neurovascular Pathways . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Nose....................................................... 68
Mouth and Oral Cavity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Salivary Glands............................................. 110
Eye
Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Skeleton . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Eyelids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Lacrimal Apparatus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Muscles of the Eye.......................................... 141
Topography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Eyeball ..................................................... 154
Visual Pathway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Ear
Overview 166
Outer Ear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
Middle Ear.................................................. 174
Auditory Tube . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Inner Ear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
Hearing and Equilibrium.................................... 192
Neck
Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Pharynx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Larynx ..................................................... 221
Thyroid Gland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Topography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240
Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Topography . . . . . . . . . . . . . . . . . . . . . . . . 56
Neurovascular Pathways . . . . . . . . . . . 62
.... Nose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Overview
The head (Caput) is flexibly connected to the torso (trunk, Truncus) tive tract. Thus, we use our heads both for the food Intake and..,..
via the neck area. This allows us to direct the sensory organs of tial orie11tation. Together with our nose and sinuses, our mouth,
our head towards environmental stimuli without having to move our pharynx and masticatory apparatus significantly contribute to the
whole body. The bony skeleton of the head is the ekull (Cranium). shape of our face. We humans additionally use the oral cavity and its
Its posterior section, called the neurocranium, encloses essential organs for articulation, enabling speech and singing.lhe mime·
parts of the central nervous system (brain), while its front section, 1lc muscl&l, which do not have their own fascia, insert directly into
the viscerocranium. encloses the various major, highly specialised the skin of the head, thus enabling unique facial expressions to aid
organs of sensory perception: the eye (organ of sight), the •r (oF- our communication with the rest of the world.lhe Protuberantia e»
gan of hearing and balance), the no• (organ of smell) and the oral cipitalis extema at the back of the skull, the base of the ears and the
cavity and pharynx (organs of taste). The respiratory tract starts in Mandibula lin order from the back to the front) mark the boundary
the nasal cavity and upper part of the pharynx, while the oral cavity between the head and neck area.
and middle section of the pharynx mark the beginning of the dige~r
Main Topics
After studying this chapter, you should be able to:
• describe the cranial bones and cranial development; • describe the blood supply and inneJVation of the entire nose
• name sutures and fontanelles, including closure; with respect to its clinical relevance;
• describe the basic structure of the skull. its bones and their • demonstrate the olfactory epithelium and how it is connected
positional relationship to each other; to the anterior cranial fossa;
• identify the neurocranium, viscerocranium, internal surface of • describe the location, bony structures and openings of the sinu·
the cranial base and cranial fossae, and be able to explain their ses, and their topographical relationship to other structures;
structure; • explain the embryological development of the oral cavity,
• name the major passageways and structures. foramina, masticatory apparatus. tongue. palate and salivary glands;
fissures and impressions on the inner and outer surfaces of the • describe all structures of the oral cavity, their neurovascular
cranial base; supply, and the routes of nerves and vessels;
• describe the insertion, origin, function and innervation of the • describe the topography and the interrelationship of the
muscles of facial expression; structures and organs to each other and to the neighbouring
• describe the structure, blood supply, lymphatic drainage and regions. and their functions;
innervation of the scalp; • explain the dental development and the detailed structure of
• name and locate key landmarks in the different areas (face, the different teeth, including the different stages of dentition;
lateral facial region), systematically identify them and be able to • describe the structure and function of the Articulatio temporo-
describe the topographic route of neurovascular pathways in the mandibularis, and the location, function, blood supply and
areas, as well as name and visualise in three dimensions the innervation of the masticatory muscles;
anatomical structures deep within the lateral facial region that • outline the structure, location, function, innervation, vascular
are not visible from the outside; supply and lymphatic drainage of the tongue. palate and salivary
• name major topographic features and explain their clinical glands;
relevance; • provide an exact explanation of the blood supply to the Tonsilla
• outline the origin, route and fibre quality, and the innervation palatine;
areas of the twelve cranial nerves 1- chapter 12); • outline the topography of the floor of the mouth including its
• describe the general embryological development of the nose compartments, the muscles involved, and the blood supply,
and sinuses; innervation and lymphatic drainage.
• describe the external structure of the nose, the bony and carti-
laginous structure of the nasal skeleton, and the boundaries of
the nasal cavities and their distension;
2
Clinical Relevance
In order not to lose reference to future everyd8:y clinical life with so many anatomical details, the fotlowing describes a typical esse th8t
shows why the content of this chapter is so important.
Facial Paralysis
Case Study Further Development
In the summer. a 22-year'-Oid trainee visits his GP stating that for se- An outpatient follow-up examination four weeks later confirms that
veral days now he has had increasing problems moving the right side his facial movements are perfectly symmetrical again.
of his face and has had problems when trying to drink. In addition,
saliva has been constantly dripping from the corner of his mouth. Dissection Lab
He also has the feeling that he hears more loudly on the right side. Look out for the following branches of the N. facialis: N. petrosus
Otherwise, the patient appears to be healthy. He did not have any major, Chorda tympani and N. stapedius.
recent fever, headaches. painful limbs, a bout of flu or a tick bite. His
medical history is nonnal. The young man is not on any medication
and does not take drugs. He only drinks alcohol occasionally and in Back In the Clrnlc
moderate limits: he does not smoke. His family medical history is Although the patient's facial (mimetic) muscles are becoming in-
also normal. creasingly mobile during his cortisone treatment. he has noticed
that his right aye always waters when he is eating, so he goes to
visit his GP again. The doctor tells him that this scxalled crocodile
Result of Examination tears syndrome is also referred to as gustatory hyperlacrimation. This
The first impression of the patient's face as he comes into the exami- harmless irritation syndrome occasionally occurs in the regenera-
nation room immediately indicates facial pa~alysis as a diagnosis. The tive processes after a facial paralysis. Affected patients experience
right side of his face is visibly 'drooping' {-+ F~g. a}. The nasolabial fold increased lacrimation (shedding of tears) on one side when eating.
on the right side has disappeared. When requested. the patient cannot Because the regenerating pa~asympathetic gustatory nerve fibres
fi'CMIIl, smile or whistle a tune, nor biCNV out his cheek on the right side. are growing into the lacrimal gland (Glandula lacrimalis), this results
His attempts to close his eyes result in lagophthalmos (his right eye in faulty misconnection and misrouting of the nerve fibres. If the
remains open} and in BELL:s phenomenon. patient suffers with strong subjective symptoms, Botox injections
can be attempted as a treatment option.
BELI:s phenomenon: the eyeball automlltically
Q turns upwsrds when closing the eyelid. As the tid
cannot be closed, only the white sclera of the eye
remains visible.
The doctor tests the facial nerve sensitivity by brushing the patient's
cheek; however, this is intact. Because the patient cannot frown on the
affected side, the doctor comes to a preliminary diagnosis: idiopathic
{no identified cause! peripheral ~nfranuclear) facial pa~alysis.
Diagnostic Procedure
The ENT specialist conducts an audiometry, which shCNVs no evi-
dence of hearing loss. To exclude other more serious causes (a. g. a
tumour}, he oroers a cranial MRI, blood tests, an electroneurography
{ENoG) and an electromyography (EMG}. The blood test results a~e all
normal; therefore zoster oticus, a herpes simplex infection and bor-
reliosis can all be ruled out. The ENoG and EMG reveal no signs of
major nerve damage. After examination by a neurologist. neurological
symptoms can also be ruled out. The MRI shows a slight swelling of
the N. facialis lVII] inside the bony canal.
Diagnosis
Idiopathic, right-sided peripheral facial paralysis.
In up to 70% of all cases a peripheral fscial para-
Q lysis is idiopathic.
Treatment
An outpatient treatment with cortisone infusion quickly shows re-
sults; the facial movements have already begun to retum to normal Flg.a Left: patient •• Men dulfng examination; centn:r.: patient
by the third day. The forehead branch is the only part of the nerve still when aabel to wrinkle his forehead; right: patient when aslced
not working at this stage. to Cl018 In eye. [T887J
3
Overview
"'C
ca
Q)
:::r: Reglo orbital!&
Reglo temporal!&
Reglo lnfratemporalls
Reglo lnfraorbltalls
Ragio buccalia
Trtgonum submandlbulare
Trigonum caroticum
,.
.
'
-i---:<-->:----T------ Trigonum mu&QJiare
'· ••·! : (omCJCrachaala)
Fig. 8.1 Raglone of ttle head and neck. Raglonas capltl8 at colll; • Regie infraorbitalis
frontal view. IJ803l • Regie zygomatica
The head is conventionally subdivided into the following topographic • Regie oralis
regions: • Regie buccalis
• Regio frontalis • Regie mentalis
• Regio temporal is • Regie parietalis
• Regie orbitalis • Regie occipitalis
• Regio nasalis • Regio parotideomasseterica
Reglo parletalls
Ragio lamporaliB
Reglo auricularis
Reglo occipitalis
I Reglo cervlcalls
Fossa aupraclavicularis major lateralls
{Trlgooum omoclavlculare)
Fig. 8.2 Regions ofttle head and neck, Regiones capitis et colli; • Regio cervicalis anterior, consisting of the Trigonum submandibula-
lateral view. IJB03[ re, Trigonum caroticum and Trigonum musculara [omotracheale)
The neck is conventionally subdivided into the following topographic • Regio stemocleidomastoidea with Fossa supraclavicularis minor
regions: • Regio cervicalis lateralis with Trigonum omoclaviculare
• Regio cervicalis posterior
4
Regions of the Head and Neck 0
Reglo lnfraorbltalls
Reglo parotldeomaseeterlca
Trigonum eubmentale
Trigonum submandlbulare
Trigonum carWcum
Fig. 8.3 Regions of the head and neck. Regiones capitis et eolli;
anterolateral view. [J803]
Regia psriatalis X
,.
•'
I
RsgiD auricularis
•
l', ',
\: ~
__.,__J .. ''
1/
carvicalis lataralis---7'-- . '.
'
'.
RagiD '
,
,./. ,,
.
--..... '
-~- .!--
5
Overview
"'C
ca
Q)
:::r:
a b
a b cd e1 g h
Fig. 8.5a and b Facial morphometry and proportions; frontal b If perfectly symmetrical, the face can be divided by vertical lines into
view; vertical proportions. IJ8031 five equal parts. These lines run along the outer edge of the auricles
a In ideally proportioned faces. the midline of the face runs directly (a. hl. and pass through the lateral (b. g) and medial (d. e) corners of
through the glabella (Gil. the bridge of the nose (Dorsum nasi, DN). the eyes. The corners of the mouth (c. f) generally align vertically with
the tip of the nose (Apex nasi, ANI, the philtrum (Ph) and the soft the medial rim of the iris.
tissue of the pogonion (Pg'). The centre of the dental arch (Medietas Based on: Radlanski, R. J./Wesker, K. H.: Das Gesicht. Bildatlas klini-
dentium, MD) also aligns with this midline. sche Anatomie. 2. Auflage. KVM, 2012
Tri
1/a
Gl
pp
,,2 ,,3
Sn
st ,,2 ,,3
Me'
F'~g. 8.68 and b Facial morphometry and proportions; frontal view ed into thirds by the line where the upper lip and lower lip meet (St).
Ia) and lateral view lb); transverse proportions. (J803] One third is located above the line between the two lips, while the chin
If perfectly symmetrical, the face can be divided by horizontal lines into region tal:es up the lower two thirds. The transverse mid-pupillary line
three equal parts. Equal distances between the hairline (trichion, Tri) and (PP) can also be used for orientation if both eyes are exactly at the same
the glabella (Gil, between the glabella and the subnasion (Sn), and be- height.
tween the subnasion and the chin (Menton, Me') allow the division into Based on: Radlanski, R. J./Wesker, K. H.: Des Gesicht. Bildatlas klini-
the upper face. micfface and lower face. The lower face is further divid- sche Anatomie. 2. Auflage. KVM, 2012
6
Face 0
Abbreviation Meuuring Point Explanation
Sn subnasale
'
. '
''
..
.. .''
'
' ''
.
' :
Fig. 1.8 'Rinslon lines of the akin of the face; frontal view from the
right side. [J803)
Arry facial surgical operations involving incisions in the skin must pay
attention to the tension lines, which are created by the direction of the
collagen fibrils and the position of the mimetic muscles. Incisions along
these lines and wrinkles are the best option as they reduce the tension
in the skin to a minimum, and thus minimise the scar formation.
Based on: Radlanski, R. J./Wesker, K. H.: Das Gesicht. Bildatlas klini-
sche Anatomie. 2. Auflage. KVM, 2012
7
Overview
0 Face
"'C
ca
Q)
:::r:
Palpebramalar
pit
'1"-truugh'
Nasolabial
fold
Marionette fold
=mantolabial fold
Labiomental
fold
Fig, 8.9 Ageing of th• face; frontal view. [J8031 process, which is slow but inexorable, has a visible effect on the skin:
Increasing age brings complex changes not only to the skin of the face. more and more wrinkles are formed. and gravity forces make the skin
but to all other tissues such as bone. muscle or subcutaneous fat d&- and the subcutaneous connective tissue sag. This is particularly evident
posits (subcutaneous fat compartments) as well. This is due to ageing on the eyelids and at the corners of the mouth.
processes that are specific to each region of the face, and progress at Based on: Radlansk:i, R. J./VVeskar, K. H.: Das Gesicht. Bildatlas klini-
very different rates depending on the individual. They can be influenced sche Anatomie. 2. Auflage. KVM, 2012
by many environmental factors (e.g. UV radiation, smoking). The ageing
8
Skeleton and Joints
Skull 0
Os frontala, SqUIIITia frorrtslls
Foramen ••IIOitJitllll•
Os frontala, Proc. zygomallcua c_-----¥1'-itll- Ma"go supraorbltlllls
~;llljtr~T- Naslan
10..,.,--.:111~---ir-- Oe .......
FIBBura orbllaiiB superior
Su1ura intamiiii8JiB
Fig. 8.10 Skull. Cranium; frontal view. orbit. Laterally, the Proc. zygomaticus meets the Proc. frontalis of the
From bottom to top: the lower jaw (Mandibula). the two halvas of the Os zygomaticum. Both form the lateral margin of the orbit.
upper jaw (Maxillae). the nasal bones (Ossa nasalis) between the upper The Os zygomaticum constitutes the major part of the lateral and lower
jaw and orbit (Orbital and, above the Orbita, the Os frontale. margins of the orbit.
The Os frontale consists of four parts (-+Fig. 8.29). Above the upper The nasal bone (Os nasalel connects with the Os frontale at the fronto-
margin of each orbit (Margo supraorbitalis) the protruding Arcus super- nasal suture on both sides, while the internasal suture connects the
ciliaris (superciliary arch) can be felt. A continuation of the Os frontale two nose bones themselves.
extends medially downwards to form in part the medial margin of the
I Clinical Remarks
Central midfaca fractures occur most frequently as a result of traf- mid-orbital floor, possibly involving the Os ethmoidale, the anteri-
fic accidents. They are categorised according toLE FORT(-+ Fig. or cranial base and/or the Os nasale
8.11) as: • LE FORT Ill: complete disjunction fracture of the facial slceleton
• LE FORT 1: isolated disjunction fracture of the Proc. alvaolaris from the neurocranium
• LE FORT II: disjunction fracture of the maxilla in the area of the
9
Skeleton and Joints
0 Cranial Bones
"'C
ca
Q)
:::r: Ma.da, Proo. frontalis
Sutura sphanofrontalla
Sulura sphanoparlalaiiB
08 spllanoldala,---+...,_+-
Aia major
Mqo infraorbitalill
08 ethmoid'*'
Septum naal
c.eum { Vomer
Forarnan mantale
Fig. 8.12 Cranial bona, Ossa cnnii; frontal view; for colour chart Below this is the Proc. alveolaris, which forms the lower edge of the
seep. VIII. upper jaw and holds the teeth.
The upper jaw or maxillary bone (Maxilla) is located between the orbit The lowar jaw oder mandible (Mandlbula) consists of the Corpus and
and the oral cavity. The maxilla forms part of the lower and the medial Rami mandibulae, both of which converge at the Angulus mandibulae.
margins of the orbit and borders laterally on the Os zygomaticum. The The Corpus mandibulae holds the teeth. Underneath that is the Basis
Proc. frontalis of the maxilla connects with the Os frontal e. In the body mandibulae, the protrusion at the midline of the Protuberantia mentalis.
of the maxilla, below the lower orbital margin, is the Foramen infraorbi- Please note the Foramen mentale as well.
tale. There is a bony projection in the midline, the Spina nasalis anterior.
I Clinical Remarks
Frllcblras of the 0. na•ale or other bone/cartilage af ttle no•a The nasal septum and Conchae nasales can also be fractured as a
are among the most common fractures in the facial area. We dis- result. Fractures of the bone/cartilage of the nose are typical injuries
tinguish between closed and open nasal fractures; in the latter, the resulting from violent physical disputes, car accidents, martial arts
bone is exposed as a result of injury to the skin and soft tissue. such as karate and boxing, and a variety of team sports.
10
Cranial Bones 0
Os ternporala, Pars squamosa
Sutura ~Ilea
Sutura fTontolacriiT'Biill
Butum ocapilnmlllloidea
Spine. nMB~ia
Os ~e. Proc. rneatoldeus
Sutura ternpomzygornatlca
Protubanlntia mentalis
Fig. 8.13 Cranial bones. Oaa cranii; lateral view; for colour chart
seep. VIII
The lateral view displays parts of the Ossa frontal e. parietale, occipital e.
sphenoidale and temporale, parts of the viscerocrenium (Os nasale, Os CAMP&I's pl.,e
lacrimale, Maxilla and Os zygomaticum) and the lateral aspect of the
lower jaw (Mandibulal.
Within the viscerocranium, the 0. nasale borders the Os frontale cra-
nially and the maxilla posteriorly. The upper part of the Os lacrimale
forms the Fossa sacci lacrimalis between the maxilla and the Os eth-
moidale. The Proc. alveolaris of the maxilla contains the upper teeth.
Medially, the maxilla connects with the Os frontale and laterally with
the Os zygomaticum. At the front there is a bony projection, the
Spina nasalis anterior. The Os zygomaticum gives the cheek area its
contour.
The head of the Mandibula (Caput mandibulae) articulates with the tem- Fig. 8.14 Planes of reference ofttle Jaw.
poral bone in the Articulatio temporomandibularis. FRANKFORT horizontal plane (line): between the lo-
The upper frontal aspect of the Os frontal• connects with the parietal wer edge of the orbit and the upper edge of the Meatus
bone (Os parietal e) and the sphenoidal bone (Os sphenoidal e) along the acusticus extemus
Suture coronal is. The Os parietale borders the occipital bone (Os occipi- CAMPER's plane: between the lowest point of the Spi-
ta lei along the Sutura lambdoidea. The Pars squamosa of the Os tempo- na nasalis anterior and the highest point of the Meatus
rals forms the major part of the lateral wall of the skull. acusticus extemus
The Os temporale and Os zygomaticum form the Arcus zygomaticus, Occlusal plane: runs parallel to the CAMPER's plane
which bridges the Fossa temporalis. Tragus plane: between the medial angle of the eye and
the tragus
11
Another random document with
no related content on Scribd:
III.
Kokoonpano.
Rakas Äiti!
Terveisiä täältä pääkaupungista kaikilta ja hyvää voimista
toivotan Teille, hyvä Äiti, ja pyydän ettette unohtaisi minua, vaan
antaisitte Latolan Ellin kirjoittaa muutaman rivin voimisistanne ja
kotipuolen kuulumisista. Tiedättekös, kun täällä on semmoiset
kansanopistokurssit, joissa oppineet miehet ja naiset puhuvat
opettavaista ja hyödyllistä, ja väliin lauletaan. Sitte täällä on
kelkkamäki, laitettu jäälle puutelineitten avulla, ja siellä lasketaan ja
se maksaa 5 penniä kerta. Ja toverit ovat kunnon tyttöjä, keittäjä on
vähän hienonlainen ja pitää hiuksensa päälaella kuin herrasväki.
Olen ollut teaatterissakin ja siellä vasta ihmeitä näkee, yksikin piika
hoasteli ihan sitä meijän puolen puhheen tyylii. Ja kaikki siellä
näytetään niinkuin olisi tapahtunut. Emäntä on oikein semmoinen
ihminen, että niitä saa etsimällä etsiä. Se pitää hyvän järjestyksen,
niin että jokainen tietää tehtävänsä. Sitte meillä on vielä iltakurssit,
joissa opetetaan laskemaan ja kirjoittamaan. Keittäjä tuhraa
hajuvettä vaatteisiinsa ja käy mielellään ulkona
promeneeraamassa, kun vaan saa aikaa. Olen usein
maatapannessani Teitä muistanut, jotta kuinkahan siellä
Kaatamossakin jaksetaan. Ja meitä on neljä tyttöä samassa
paikassa: keittäjä, keittäjän apulainen, lapsenhoitaja ja minä, joka
olen sisäkkö. Mutta kyllä keittäjäkin on pohjaltaan hyvä tyttö. Ja
akateemiassa on hirmuinen valaskalan luuranko, ainakin 20 syltä
pitkä. Herra on myös ystävällinen ja puhutteleekin niin kauniisti,
että oikein hyvältä tuntuu. Täällä on paljon tyttöjä huonoilla jäljillä.
Mutta professorit ja muut korkeasti oppineet sanovat että mekin
olemme yhtä hyviä isänmaan lapsia kuin kaikki muut, ettemme me
ole vaan piikoja ja »piikoja». Ja herra on pankin virkamies.
Tiedättekös kun tapasin Aholan Tanun kelkkamäessä, ja se on nyt
aliupseeri ja voisi olla vaikka rovastin nimipäivillä, niin on kohtelias
ja pulska, että minäkin olen ollut hänen seurassaan. Eikä täällä
rouva räiski ja roiski niinkuin nimismiehen rouva siellä kotona,
vaikka on piikoja yhtä paljon kuin nimismiehessä ja pappilassa
yhteensä. En ole Teille kirjoittanut, vaikka on jo kulunut kaksi
kuukautta kun läksin kotoa, joka oli minulta hyvin pahasti tehty.
Tiedättekös millä jäljillä se Mäkelän Tiina on sieltä Valtimon
kulmalta, jonka hyvin tunnette, minä näin sen kerran kadulla
humalassa. Niin että kyllä täällä niin hyvää huolta pidetään kaikista,
ettei olisi voinut arvatakkaan. Ja on niin hauska olla oppineitten ja
viisasten ihmisten seurassa. Ei ole ihmekään että olette ollut
huolissanne, kun aina niin hellästi seuraatte lastenne askeleita.
Kyllä paikka on harvinaisen hyvä ja kyllä täällä on nuorella tytöllä
niin paljon viettelyksiä ja täällä on niin paljon huvituksia. Ja
kansanopistokursseissa keskustellaan kuinka tulee säästää palkat
oman kodin perustamista varten ja vanhanpäivän varaksi. Vaan
meidän rouva tietääkin kaikki, lakanasta parsineulaan asti. Ja täällä
täytyy tietää kenen kanssa seurustelee. Sanoitte kotoa lähteissäni:
»pidä, lapseni, Jumala silmäisi edessä!» En ole sitä
unhottanutkaan, vaan päivä päivältä yhä paremmin oppinut
ymmärtämään hyvien neuvojenne arvon. Mutta kyllä se valaskala
oli niin suuri, ettei oikein uskoisikaan, sen vatsaan mahtuisi vaikka
kymmenen Joonasta. Eikä nyt muuta kuin hyvästi vaan ja terveisiä
kaikille ja voikaa hyvin.
Oma tyttärenne
Aliina.
Mutta sitä voin heti Teille vakuuttaa, rakas Äiti, ettei ole mitään
huolen syytä. Kaikki on mennyt paremmin kuin siellä kotona
osasimme aavistaakaan.
Rouva taas on semmoinen, että niitä saa etsimällä etsiä. Hän nyt
tietää kaikki, mitä talossa on, lakanasta parsineulaan asti. Eikä hän
räiski ja roiski, niinkuin nimismiehen rouva siellä kotipitäjässä. Kyllä
tässä meidän talossa jokainen tietää tehtävänsä, vaikka onkin
piikoja yhtä paljo kuin nimismiehessä ja pappilassa yhteensä.
Entäs sitte teaaiterissä! Siellä vasta suu auki jää. Kaikki näytetään
niinkuin elämässä tapahtuu. Annappas kun muutamassa
kappaleessa —
Kuopion takana taisi olla sen nimi — piikatyttö hoasteli ihan »sitä
meijän puolen puhheen tyylii», jotta multa kesken kaiken pääsi hörä
nauru.
Olen nyt kertonut Teille, rakas Äiti, yhtä ja toista elämästäni täällä
pääkaupungissa. Niinkuin näette, olen olooni hyvin tyytyväinen.
Sanoitte lähteissäni: »pidä, lapseni, Jumala silmäisi edessä!» Ne
sanat eivät ole koskaan unohtuneet, vaan olen tullut päivä päivältä
yhä selvemmin niiden merkitystä käsittämään sekä huomaamaan
että kun niin tekee, silloin seuraa onni ja tyytyväisyys ja levollisen
omantunnon rauha. Vasta nyt olen tullut oikein käsittämään
antamienne neuvojen suuren arvon elämän monimutkaisella
polulla.
Oma tyttärenne
Aliina.
Mikään ryhmä ei saa olla liian ahdas eikä tarpeettomia ryhmiä saa
asettaa.
Johdanto.
Käsittely.
Loppulause.
Loppulause ei saa olla pitkä. Joskus riittää lause tai pari, onpa
toisinaan niinkin, ettei erikoista loppulausetta kaivata ensinkään,
se vaan tuntuisi liialliselta, etsityltä. Loppulauseen, milloin
semmoinen on, tulee koskea koko esitystä eikä ainoastaan sen
osaa ja siirtymisen käsittelystä loppulauseeseen tulee tapahtua
luontevasti.
Ainekeräys- ja jäsennysnäyte.
Otsake.
Esittäminen.
Esityksen hallitseminen.