Topography of the fascia and cell spaces of the head

The head is divided according to the conditional division of the skull into two sections - the brain and facial. The dense skin of the frontal-parietal-occipital area, covered with hair, which has a large number of sweat and sebaceous glands, is firmly connected by vertically oriented connective tissue bundles with a suprugular muscle tendon. Due to this, the subcutaneous tissue is divided into a number of cells filled with fat tissue. Therefore, the intradermal arteries passing through here (including the smallest ones), fused with connective tissue bundles, do not subside even with small wounds of the scalp and give abundant bleeding. With the periosteum, the tendinous helmet (supracranial muscle) is weakly fused, so the skin along with the tendon helmet is quite mobile. In the lateral parts of the head, the tendon helmet becomes thinner and extends into the superficial fascia of the temporal region. Under the tendinous helmet of the supracranial muscle, between it and the periosteum, there is a subaphoneurotic fiber 2-3 mm thick, limited by the places of the beginning and attachment of this muscle. Under the periosteum of the bones of the cranial vault lies a thin layer of loose fiber 0.5-1 mm thick, which is divided by seam lines. On the seam lines the periosteum fuses with the bones of the cranial vault.

The skin of the face is thin, contains a large number of sebaceous and sweat glands. A moderately pronounced layer of subcutaneous tissue is present in all parts of the face, except for the back of the nose. The superficial fascia on the face is absent, as mimic muscles are weaved into the skin. At the same time, each facial muscle is covered with its own thin connective tissue fascia and well-expressed subcutaneous adipose tissue, which forms a fat body on children's cheeks, giving a specific round expression to children's faces. The fatty body of the cheek is attached to the anterior edge of the masticatory muscle. It is located in a fairly dense connective tissue capsule, which is fused to the fascial case of the temporal muscle. The fatty body of the cheek has a temporal, ophthalmic and pterygoal processes that can serve as ways of spreading inflammatory processes from the lateral area of the face to the orbit and into the cranial cavity. The temporal process of the fatty body of the cheek penetrates upward and anteriorly, under the fascia of the temporal muscle, the lower part of which descends into the anterolateral sections of the face (into the subculture region). From the fatty body departs into the infundibular fossa, to the lower orbital fissure, its orbital process. The pterygopalon of the fatty body penetrates into the pterygoid-palatine (pterygopalaceous) fossa. The pterygoal process through the lower medial part of the upper orbital gap sometimes enters the cavity of the skull, where it lies against the wall of the intercellular sinus of the hard shell of the brain. The cheek muscle on the outside is covered with the so-called buccal-pharyngeal fascia, where the fascia of the cheek muscle passes into the adventitia of the lateral wall of the pharynx. Between the pterygoid crochet of the sphenoid bone at the top and the lower jaw there is a dense part of this fascia, called the wing-mandibular suture. From the inside, the mucous membrane of the oral cavity is attached to the buccal muscle.

The temporal fascia (fascia temporalis) covering the temporal muscle begins on the lateral surface of the skull, on the temporal line and the tendon helmet. Above the zygomatic arch (3-4 cm above it), the temporal fascia is divided into a superficial plate that attaches to the lateral margin of the zygomatic arch, and a deep fascia that attaches to the medial margin of the zygomatic arch. Between these plates is a small amount of fatty tissue in which the superficial blood vessels and nerves pass (the branches of the ear-temporal nerve and the facial branch are the frontal and cheekbone branches). This fatty interfascial fiber continues down and anterior to the boundaries of the temporal region. Together with the anterior part of the superficial lamina of the temporal fascia, it passes to the outer surface of the zygomatic bone and to the zygomatic muscles.

Between the temporal fascia and the temporal muscle there is a small amount of connective tissue (subfascial tissue) that continues downward under the zygomatic arch into a narrow gap between the temporal and masticatory muscles and passes into the connective tissue between the chewing muscle and the lateral surface of the mandible branch. In this space, enter the chewing artery and the nerve, which go to the chewing muscle, and the same vein leaves. In the interval between the anterior margin of the temporal muscle (under the fascia of the temporal muscle) and the outer wall of the orbit, there is also fatty tissue that communicates with the area of the fatty lump of the cheek.

The fascia masseterica, covering the same muscle and firmly fused with its superficial bundles, is attached at the top to the lateral surface of the malar bone and zygomatic arch, fused with the buccal fascia in front, and behind with a capsule of the parotid gland located in the submandibular fossa. On the lateral surface of the fascia covered by the fascia, the parotid salivary gland passes through the posterior front. The mouth of this duct is located on the mucosa at the level between the first and second upper molars.

The deep cell space of the temporal region is between the temporal muscle and the periosteum in the temporal fossa. In this cell, deep temporal vessels (anterior and posterior deep temporal arteries), which rise from the dorsal fossa, pass.

In the region of the inframammary fossa, which should be considered as a deep area of the face, near the bottom of the temporal and pterygoid muscles is fatty tissue, where the vessels and nerves pass. Accordingly, the location is distinguished by the temporal-pterygoid and inter-winged cellular spaces, which are interconnected. The temporo-pterygoid space, in which the maxillary artery and the venous pterygoid plexus are located, lies between the temporal and lateral pterygoid muscles. A part of the veins of this venous plexus is found in the thickness of the fascia of the lateral pterygoid muscle. The inter-winged cell space occupies a place between the medial and lateral pterygoid muscles covered by their own fascia. Where these muscles touch, fascia form one leaf, called the intercapital fascia. In the inter-winged space, the mandibular nerve and the branches extending from it (mandibular, anuricular-temporal, buccal and lingual nerves) pass. Here also pass the blood vessels that feed the pterygoid muscles and the lower jaw.

Inside the deep region of the face is the ocellophilic cell space of the head. It is bounded from the outside by a fascia-covered medial pterygoid muscle. On the inside there is a lateral wall of the pharynx, behind it are the transverse processes of the upper cervical vertebrae, covered with the pre-faceted fascia and muscles. Muscles that begin on the styloid process (shilohlotochnaya, silo-tongue, shilohozyazychnaya), covered with their own fascia, divide the near-pharyngeal space into the anterior and posterior parts. This muscular-fascial fascicle, originating on the styloid process, is connected to the so-called buccal-pharyngeal fascia. This bundle divides the peripheral space into the anterior and posterior parts, in the scientific literature it is called the silodiaphragm. In the back part of the near-pharyngeal space pass the internal carotid artery, the internal jugular vein and 4 cranial nerves (glossopharyngeal, vagal, accessory and sublingual nerves). There are also lymph nodes located near the internal jugular vein. The front part of the okolothril space is occupied by fatty tissue and small blood vessels.