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ISSN2079-8334. Ceim медицини та бюлогп. 2018. № 2(64)
просочування, палшоз стшки частини артерш i артерюл. У капiлярах речовини головного мозку спостерталися ознаки стазу i роз'еднання ендотелюциив, в венозних судинах - ознаки застшного повнокров'я. Морфометрично в грут щурiв лшп SHR значення щшьносп нейроглп i нейроглiального шдексу були значуще бшьше, а нейрошв i функцiонуючих капiлярiв -значуще менше в порiвняннi з показниками нормотензiвного контролю, що свiдчить про розвиток патолопчних змiн в ix центральнiй нервовiй системi.
Ключовi слова: артерiальна гiпертензiя, спонтанно-гiпертензивнi щури, головний мозок.
Стаття надшшла 21.12.17р.
DOI 10.26724 / 2079-8334-2018-2-64-119-122 UDC 611.831.1-053.9
arterioles have been revealed. In the brain matter capillaries, there were signs of stasis and separation of endotheliocytes, in the venous vessels - signs of the brain congestion. Morphometrically, in the group of the SHR line rats, the values of neuroglia density and neuroglial index were significantly higher, and the neurons and functioning capillaries were significantly less in comparison with the normotensive control indices, indicating the development of pathological changes in their central nervous system.
Key words: arterial hypertension, spontaneously hypertensive rats, brain.
Рецензент Срошенко Г.А.
MORPHOLOGICAL FEATURES OF THE NERVES IN THE WALLS OF THE NASAL CAVITY AND THOSE OF THE ADJACENT STRUCTURES IN ELDERLY AND SENILE PEOPLE
E-mail: olegb007@i.ua
The purpose of the research was to study syntopical features of the pterygopalatine ganglion, the nerves of the nasal area in order to determine their morphological changes in elderly and senile people. Using a complex of morphological methods of research, 31 specimens of the nasal area of elderly and senile people have been studied. They were carried out on the corpses of people who had died of causes not associated with ENT pathology. In accordance with the Helsinki Declaration of the World Medical Association "Ethical Principles of Medical Investigations involving Human Subjects as a Research Object" (19642000). The study involved the pterygopalatine foramen, the pterygopalatine ganglion, the nerve branches were separated, their course and branches that were traced. Then the posterior nasal branches of the pterygopalatine ganglion were examined. The rates of their branching and their syntopy were identified. The mucous membrane, glands and vessels of the walls of the nasal cavity and adjacent structures are innervated in different ways. For instance, 2-6 branches of the pterygopalatine nerves arise in the pterygopalatine fossa from the median surface of the maxillary nerve at a distance of 1.9-2.4 mm from the foramen rotundum. Some of them enter the pterygopalatine ganglion, and the others adjoin the ganglion and connects to the nerve branches, which arise from the latter. In this age group, on 20 specimens, the ganglion is located in the middle of the pterygopalatine fossa, on 6 of them it is closer to the front wall and on the rest 4 it is closer to the back wall. It is located 1.5-2.0 mm deep more laterally of the pterygopalatine foramen. The projection of the foramen on 25 specimens corresponded to the posterior end of the middle nasal turbinate and on 6 of them to the area between the posterior ends of the middle and upper nasal turbinates. In 11 specimens the ganglion was triangular, in 8-polygonal, 8-oval and in 4 of them it was cone-shaped. The pterygopalatine ganglion gives rise to some nervous branches. The greater palatine nerve, which is located in a large palatine canal, is the longest of them. The lateral upper posterior nasal branches on the 30 specimens arose from the ganglion, and on the 1st one, they branched out from the greater palatine nerve. In the region of the posterior edge of the nasal septum, the nerve branches were topographically located at the point of transition of the anterior wall of the sphenoid sinus to the lower one, which could serve as a benchmark for surgical interventions on the nerves of the nasal cavity walls. The pterygopalatine ganglion in elderly and senile people is of various shape: from from triangular and polygonal to oval or conical. In a certain category of people in the mucous membranes of the nasal cavity and its adjacent structures, the number of small and medium nerve fibers decreases. The posterior edges of the middle and lower nasal turbinates, the transition site of the anterior to the lower wall of the sphenoid sinus, may serve as a benchmark for surgical interventions in the posterior nasal nerves of the pterygopalatine ganglion.
Keywords: pterygopalatine ganglion, nerves of the nasal cavity walls, ontogenesis, human.
The paper is a fragment of the planned comprehensive scientific work of the M.H. Turkevych Department of Human Anatomy and the Departments of Anatomy, Topographic Anatomy and Operative Surgery of the Higher State Educational Institution of Ukraine "Bukovinian State Medical University" "Features of morphogenesis and topography of systems and organs in pre and postnatal periods of human ontogenesis", state registration number 0115U002769 (2015-2019).
Recently, considerable attention has been paid to the anatomical changes occurring in the body of elderly and senile people. An increasing share of these people needs medical care. Therefore, the detection of morphological changes in organs of various systems, including the nervous one, is important for both theoretical and practical medicine. At the beginning of the elderly age atrophic processes in the mucous membrane begin. It was atrophied in six specimens (12.48%) [1, 3]. During aging the morphological and functional changes occur in all parts of the respiratory system, including the thorax, airways, pulmonary parenchyma and the vascular system of the small pulmonary circulation [8]. Based on the complex of implemented morphological methods of research, it was found that during the elderly
© A.V. Bambuliak, N.B. Kuzniak, 2018
ISSN2079-8334. Ceim Meduu,UHU ma dio^ii. 2018. № 2(64)
and senile age there are some reverse processes of human ontogenesis and involutional changes occur in the walls of the maxillary sinus [6]. The inervation of the frontal sinus was studied in detail, it was given much attention by the scientists. There is also evidence that the anterior ethmoidal nerve is involved in the inervation of its mucous membrane. The inneration of the frontal sinus, regardless of its form, is provided by the anterior ethmoidal nerve [7, 4, 2]. According to Rybalko T.I., in people with brachycephalic shape of the skull, the pterygopalatine ganglion is located closer to the posterior wall of the fossa of the same name, therefore, the introduction of a needle in its upper parts is more accurate. In people with a dolichocephalic form of the head the ganglion is located closer to the anterior wall, therefore the most precise is the introduction of a needle in the lower parts of the pterygopalatine fossa. When a needle was being introduced, the lateral plate of the pterygoid process of the sphenoid bone remained the main reference point and the place of the injection was the median trago-orbital line. The pterygopalatine nerves are sensory nerves, that connect the maxillary nerve with the pterygopalatine ganglion. These nerves are from 1 to 10 mm long [5]. The analysis of literary sources indicates the disparity of representations about the topography of the nerves of the nasal cavity and its adjacent structures. And the data on the peculiarities of the structure of the nerves in the nasal cavity walls in elderly and senile people are fragmentary, or completely absent.
Purpose of the research is to study syntopical features of the pterygopalatine ganglion, the nerves of the nasal area in order to determine their morphological changes in elderly and senile people.
Material and methods. Using a complex of morphological methods of research, 31 specimens of the nasal area of elderly and senile people have been studied. They were carried out on the corpses of people who had died of causes not associated with ENT pathology. In accordance with the Helsinki Declaration of the World Medical Association "Ethical Principles of Medical Investigations involving Human Subjects as a Research Object" (1964-2000). Studying the nasal area was carried out in the Chernivtsi Regional Forensic Medical Bureau and at the M.H. Turkevych Department of Human Anatomy of the HSEI of Ukraine "Bukovinian State Medical University". The lateral walls of the nose and its adjacent structures were sequentially prepared, starting with their posterior sections by means of surgical instruments. The sphenopalatine foramen and the pterygopalatine ganglion were identified, the nerve branches were prepared, their course and branches were traced. Then the posterior nasal branches of the pterygopalatine ganglion were studied. The rates of their branching out and their syntopy were determined. Similar studies were conducted on the front and horizontal sections of the specimens. In a number of specimens, the mucosa was stripped off for histological examination.
Results of the study and their discussion. Both physiological and morphological changes are known [8] to develop in the central and peripheral nervous systems even under normal conditions of a body vital activity. Therefore, when studying the pathomorphology of the human nervous system, it is always necessary to take into account not only the development of the pathological process, the duration of its course, but also the age factor, because functional-adaptive mechanisms vary with age. The mucous membrane, glands and vessels of the walls of the nasal cavity and its adjacent structures are innervated in various ways. For instance, in the pterygopalatine fossa from the medial surface of the maxillary nerve at a distance of 1.9-2.4 mm from the foramen rotundum, 2-6 branches of the pterygopalatine nerves arise. They are directed down and inward. One part of them enters the pterygopalatine ganglion, and the other one adjoins the ganglion and connects to the nerve branches, which arise from the latter. The pterygopalatine ganglion is one of the important ganglions of the autonomic nervous system, in which the parasympathetic preganglionic nerve fibers end. It is located in the pterygopalatine fossa and is surrounded by the cellular tissue. In this age group in 20 specimens the ganglion is located in the middle of the pterygopalatine fossa, in 6 of them -closer to the anterior wall and in the rest 4- closer to the posterior wall. The pterygopalatine ganglion is located syntopically medially and inferiorly to the maxillary nerve. Surgical manipulations on the pterygopalatine ganglion with external percutaneous access are complex and not always effective. Therefore, we studied the topographic-anatomical ratio of the ganglion and its projection on the lateral wall of the nasal cavity. It is located at a depth of 1.5-2.0 mm laterally of the sphenopalatine foramen. The projection of the foramen on 25 specimens corresponded to the posterior end of the middle nasal turbinate and on 6 of them to the area between the posterior ends of the middle and upper nasal turbinates. The knowledge about the location of the pterygopalatine ganglion is thought to help clinicians to choose the site of the surgical manipulations rationally through the intranasal access. In 11 specimens the ganglion was triangular, in 8-polygonal, 8-oval and in 4 of them it was cone-shaped. When it was triangular, the lateral and medial surfaces, the superior, anterior and posterior edges could be identified. The lower angle was the most acute [3].
Some nerve branches arise from the pterygopalatine ganglion. The largest of them is the greater
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palatine nerve, which is located in the greater palatine canal. The lateral superior posterior nasal branches in 30 specimens arose from the ganglion, in 1 specimen they branched out from the greater palatine nerve. The first ones entered the mucous membrane of the lateral wall of the nasal cavity through the sphenopalatine foramen and headed to the rear ends of the upper and middle nasal turbinates, where they branched out. Their nerve fibers were traced in the mucous membrane of the upper and middle nasal turbinates, the upper and, partly, the middle nasal passages, as well as the cells of the ethmoid bone.
The lateral lower posterior nasal nerves arose from the greater palatine nerve, penetrated through the anterior wall of the greater palatine canal in the region of the posterior end of the lower nasal turbinate and spread in the mucous membrane of the middle nasal passage, maxillary sinus, lower nasal turbinate and the lower nasal passage. Some branches of the pterygopalatine ganglion (medial posterior nasal ones) also penetrated into the the mucous membrane of the nasal septum through the sphenopalatine foramen. Some of them entered the mucous membrane of the sphenoid sinus, which branched out and inervated the mucous membrane of the latter. In the region of the posterior edge of the nasal septum, the nerve branches were topographically located at the point of transition of the anterior wall of the sphenoid sinus to the lower one, which could serve as a benchmark for surgical interventions on the nerve walls of the nasal cavity.
Most of the branches had a straight line. The largest nervous branch (the nasopalatine nerve) was directed downward, branching out into small branches in the mucous membrane of the nasal septum, thus ensuring its innervation. The main trunk of the nasopalatine nerve penetrated into the oral cavity through the incisive foramen. Its end fibers were found in the mucous membrane of the anterior part of the hard palate. All major trunks of nerves in diameter from 0,3 to 0,6 mm were in the deep layer of the mucous membrane near the periosteum and the perichondrium. They were divided into secondary and tertiary branches 0.1-0.3 mm in diameter, which were in contact with each other. In the mucous membrane of the walls of the nasal cavity, two nerve plexuses are found - the greater loopy plexus (located in the deep layers of the mucous membrane) and the lesser one (located in its superficial layers). It should be noted that in places of thickening of the mucous membrane (the anterior part of the nasal septum, free edges of the lower and middle nasal turbinates), the nerve fibers were almost perpendicularly directed to the epithelial lining. Another source of innervation of the walls of the nasal cavity and its adjacent structures is the anterior and posterior ethmoidal nerves, as well as an additional innervation, especially of the ethmoid labyrinth, with the nerves that are derivatives of the nasociliary nerve.
1. The pterygopalatine ganglion in elderly and senile people is of various shape: from from triangular and polygonal to oval or conical.
2. In a certain category of people in the mucous membranes of the nasal cavity and its adjacent structures, the number of small and medium nerve fibers decreases.
3. The posterior edges of the middle and lower nasal turbinates, the transition site of the anterior to the lower wall of the sphenoid sinus, may serve as a benchmark for surgical interventions in the posterior nasal nerves of the pterygopalatine ganglion.
Prospects for further research. They involve studying the blood supply and the lymph outflow in the walls of the nasal cavity in elderly and senile people.
1. Boychuk OM, Makar BH. Budova i syntopiya reshitchastoyi kistky u lyudey litnyoho ta starechoho viku. Klinichna ta eksperymentalna patolohiya. 2013; 2 (44): 21-24. [in Ukrainian]
2. Voronenko YuV, Shekera OH, Stadnyuk LA. Aktualni pytannya herontolohiyi i heriatriyi u praktytsi simeynoho likarya. Kyiv: Kafedra terapiyi i heriatriyi NMAPO imeni P.L. Shupyka. 2015; 530 s. . [in Ukrainian]
3. Horbachenko OB, Shvets AI, Polovyk OYu, Rozhnov VH, Marchenko VYu. Rol antropometrychnykh pokaznykiv cherepa pry vybori likuvannya hanhlionitiv vushnoho vuzla. Visnyk problem biolohiyi i medytsyny. 2015; 2(4): 247-249. [in Ukrainian]
4. Makar BH. Stanovlennya i topohrafo-anatomichni vzayemovidnoshennya stinok nosa iz sumizhnymy strukturamy v postnatalnomu ontohenezi lyudyny: avtoref. dys. na zdobuttya naukovoho stupenya d.med.n. Kharkiv, 2004; 36 s. [in Ukrainian]
5. Petrova LG, Merkulova YeP, Chekan VL. Perelom kostey nosa. Minsk: BelMAPO. 2014; 24 s. [in Russian]
6. Pivtorak VI, Bulko MP. Klinichna anatomiya triychastoho ta lytsyovoho nerviv. Vehetatyvni vuzly lytsya. Mistseve znebolennya: navchalnyi posibnyk dlya stud. vyshch. med. navch. zakladiv. Vinnytsya: Nova knyha. 2012; 136 s. [in Ukrainian]
7. Protsak TV, Hayina NI. Topohrafo-anatomichni osoblyvosti verkhnyoshchelepnykh pazukh u lyudey litnyoho ta starechoho periodiv ontohenezu. Naukovyi visnyk mizhnarodnoho humanitarnoho universytetu. 2014; 7: 34-36. [in Ukrainian]
8. Sinelnikov RD, Sinelnikov YaR, Sinelnikov AYa. Atlas anatomii cheloveka. 4 v. Moskva: Novaya volna. 2016; 312 s. [in Russian]
2079-8334. Свт медицини та бюлоги. 2018. № 2(64)
МОРФОЛОГ1ЧН1 ОСОБЛИВОСТ1 НЕРВ1В СТ1НОК НОСОВО1 ПОРОЖНИНИ I СУМ1ЖНИХ СТРУКТУР У ЛЮДЕЙ ПОХИЛОГО ТА СТАРЕЧОГО В1КУ Бамбуляк А.В., Кузняк Н.Б., Бойчук О.М., Лопушняк Л.Я. Мета роботи - вивчити синтошчш особливостi крило-пiднебiнного вузла, нервiв носово! дiлянки з метою визначення !х морфологiчних змiн у людей похилого та старечого вку. Комплексом морфолопчних методiв дослiдження вивчено 31 препарат носово! дiлянки людей похилого та старечого вку, яю виконувались на трупному матерiалi людей, померлих вщ причин не пов'язаних з ЛОР-патолопею. Вiдповiдно до Гельсшсько! деклараци Всесвтьо! медично! асощаци "Етичш принципи медичних дослiджень за участю людини як об'екта дослщження" (1964-2000 рр.) визначали клино-пiднебiнний отвiр, крило-пiднебiнний вузол, вiдпрепаровували нервовi плки, простежували !х хiд i плки, яю вiдгалужувалися вiд них. Далi дослiджували заднi носовi плки крило-шднебшного вузла. Виявляли рiвнi !х вщходження та синтопiю. Слизова оболонка, залози i судини стiнок носово! порожнини та сумiжних з ними структур шнервуються рiзними шляхами. Так, у кршю-шднебшнш ямцi вiд присередньо! поверхш верхньощелепного нерва на вiдстанi 1,9-2,4 мм вщ круглого отвору беруть початок 2-6 гшок крилопiднебiнних нервiв. Одна частина з них вступае у крило-шднебшний вузол, а друга прилягае до вузла i з'еднуеться з нервовими плками, яю починаються вiд останнього. У данiй вковш групi на 20-ти препаратах вузол розмщений посерединi крило-шднебшно! ямки, на 6-ми - ближче до передньо! стшки i на 4-ти - ближче до задньо! стшки. Вiн знаходиться на глибиш 1,5-2,0 мм латеральнiше клино-пiднебiнного отвору. Проекщя отвору на 25-и препаратах вщповщала задньому юнцю середньо! носово! раковини i на 6-и - д^нщ мiж заднiми юнцями середньо! та верхньо! носових раковин. На 11-ти препаратах вузол мав трикутну форму, 8-и -багатокутну, 8-и - овальну i 4-и - конусоподiбну. Вiд крило-пiднебiнного вузла беруть початок окремi нервовi гiлки. Найбшьшою iз них е великий шднебшний нерв, який розташований у великому шднебшному каналi. Бiчнi верхнi задш носовi гiлки на 30-и препаратах починались вщ вузла, а на 1-му - вщходили вiд великого шднебшного нерва. У дiлянцi заднього краю носово! перегородки нервовi плки топографiчно знаходились у мiсцi переходу передньо! стшки клиноподiбно!' пазухи у нижню, що може бути орiентиром для хiрургiчних втручань на нервах стшок носово! порожнини. Висновки. Крило-шднебшний вузол у людей похилого i старечого вку мае рiзноманiтну форму: вщ трикутно! i багатокутно! до овально! або конусоподiбноl'. У визначено! категори людей у слизовiй стшок носово! порожнини i сумiжних з ними структур зменшуеться юльюсть дрiбних i середнiх нервових волокон. Задш кра! середньо! та нижньо! носових раковин, мюце переходу передньо! у нижню стшку клиноподiбно!' пазухи можуть бути орiентиром для хiрургiчних втручань на задшх носових нервах крило-шднебшного вузла.
Ключовi слова: крило-пiднебiнний вузол, нерви стшок носа, онтогенез, людина.
Стаття надшшла 24.12.17р.
МОРФОЛОГИЧЕСКИЕ ОСОБЕННОСТИ НЕРВОВ СТЕНОК НОСОВОЙ ПОЛОСТИ И СМЕЖНЫХ СТРУКТУР У ЛЮДЕЙ ПОЖИЛОГО
И СТАРЧЕСКОГО ВОЗРАСТА Бамбуляк А.В., Кузняк Н.Б., Бойчук О.М., Лопушняк Л.Я. Цель работы - изучить синтопические особенности крыло-небного узла, нервов носового участка с целью определения их морфологических изменений у людей пожилого и старческого возраста.. Комплексом морфологических методов исследования изучен 31 препарат носового участка людей пожилого и старческого возраста, которые выполнялись на трупном материале людей, умерших от причин, не связанных с ЛОР-патологией. Согласно Хельсинкской декларации Всемирной медицинской ассоциации "Этические принципы медицинских исследований с участием человека в качестве объекта исследования" (19642000 гг.) определяли клино-небное отверстие, крыло-небный узел, препарировали нервные ветви, прослеживали их ход и ветви, ответвляющиеся от них. Далее исследовали задние носовые ветви крыло-небного узла. Выявляли уровни их отхождения и синтопию. Слизистая оболочка, железы и сосуды стенок носовой полости и смежных с ними структур иннервируются различными путями. Так, в крыло-небной ямке от медиальной поверхности верхнечелюстного нерва на расстоянии 1,9-2,4 мм от круглого отверстия берут начало 2-6 ветвей крылонебных нервов. Одна часть из них поступает в крыло-небный узел, а вторая прилегает к узлу и соединяется с нервными ветвями, которые начинаются от последнего. В данной возрастной группе на 20-ти препаратах узел расположен посередине крыло-небной ямки, на 6-й - ближе к передней стенке и на 4-й - ближе к задней стенке. Он находится на глубине 1,5-2,0 мм латеральнее клино-небного отверстия. Проекция отверстия на 25-и препаратах отвечала заднему концу средней носовой раковины и на 6-м - участке между задними концами средней и верхней носовых раковин. На 11-ти препаратах узел имел треугольную форму, 8-и -многоугольную, 8-и - овальную и 4-х - конусовидную. От крыло-небного узла берут начало отдельные нервные ветви. Наибольшей из них является большой небный нерв, расположенный в большом небном канале. Боковые верхние задние носовые ветви на 30-и препаратах начинались от узла, а на 1-м - отходили от большого небного нерва. В области заднего края носовой перегородки нервные ветви топографически находились в месте перехода передней стенки клиновидной пазухи в нижнюю, что может быть ориентиром для хирургических вмешательств на нервах стенок носовой полости Выводы. Крыло-небный узел у людей пожилых и старческого возраста имеет разнообразную форму: от треугольной и многоугольной до овальной или конусовидной. У определенной категории людей в слизистой стенок носовой полости и смежных с ними структур уменьшается количество мелких и средних нервных волокон. Задние края средней и нижней носовых раковин, место перехода передней в нижнюю стенку клиновидной пазухи могут быть ориентиром для хирургических вмешательств на задних носовых нервах крыло-небного узла.
Ключевые слова: крыло-небный узел, нервы стенок носа, онтогенез, человек.
Рецензент Пронша О.М.
