Download Workshop 4

WORKSHOP 4
Topographic anatomy of the temporal part. Cranial cerebral topography. Osteoplastic
and decompressed trepanation of the skull. Topographic anatomy of mastoid process.
Anatomy and technique of antrotomy.
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Identify boundaries of temporal part:
What is located in the subcutaneous cellular tissue of temporal lobe?
How many layers of adipose tissue are there in temporal lobe?
Where is superficial abscess of temporal lobe located?
Identify possible ways of further spread of infection from the temporal lobe?
What incision is used more often to reveal superficial abscesses of the temporal lobe?
What incision is most frequently used to reveal interaponeurotic abscesses of temporal lobe?
What is there in interaponeurotic temporal space?
What is deep temporal cellular space limited by?
What incision is used more frequently to reveal deep temporal abscesses?
What does deep temporal cellular space contain?
What does the osseous basis of temporal lobe contain?
What is particular about the structure of temporal bone?
Which anatomical formation is the temporal muscle tendon attached to?
Identify one of the first signs of the inflamed cellular tissue of deep temporal lobe?
What can be damaged when the temporal abscess is exposed?
What is located in subcutaneous cellular tissue in the area of mastoid process?
Note the front boundary of Shypo triangle?
Identify the back boundary of Shypo triangle:
Identify the upper border of Shypo triangle:
Where can pus penetrate destroying the back wall of antrum mastoideum?
Where can pus penetrate destroying the top wall of antrum mastoideum?
Identify the projection of central slot after Kreinlein scheme?
Where is the column of a.meningea media located according to Kraunlain scheme?
Where is a projection of front branch of a. meningea media determined according to Kronlein scheme?
Identify the projection of lateral (Sylvien) sulcus according to Kronlein scheme:
What foramen does a. meningea media penetrate into the cranial cavity?
What convolution of the brain does the passage of the anterior branch of the middle meningeal artery correspond to?
What convolution of the brain does the passage of the back branch of the middle meningeal artery correspond to?
What is the method of trepanation of the skull called during which a separate cutoaponeurotic piece with a wide basis
and further scalping of it and sawing periosteal isolated pedicle flap?
What tissues compose the first flap at osteoplastic craniotomy by Olivercronie method?
What tissues compose the second flap at osteoplastic craniotomy by Olivercronie method?
What's the inside vessel adjacent to the temporal bone?
What dissections are performed to reveal abscesses of the temporal lobe?
Which of these methods corresponds to decompressed trepanation of the skull?
A patient with an increased intracranial pressure is indicated to perform decompressed trepanation of the skull.
Where is it performed?
A head injury resulted in increased intracranial pressure. In what part of the calvarium is decompressed trepanation
of the skull performed at this localization of the pathologic process?
A patient is indicated to perform trepanation of the mastoid process. Which of the special instruments are used in
craniotomy of mastoid process?
What complications of mastoid process craniotomy can occur in postoperative period, if during the operation there
appeared a violation of front boundary of Shypo triangle?
What complications of mastoid process craniotomy can occur in postoperative period, if during the operation the top
boundary of Shypo triangle was broken?
What complications of mastoid process craniotomy can occur in postoperative period, if during the operation the
posterior boundary of Shypo triangle was broken?
A female patient got a dull injury of the temporal part of the head. She was diagnosed with epidural hematoma.
Indications required osteoplastic craniotomy. What surgical instruments are used to perform craniotomy?
! Identify boundaries of temporal part:
From above and behind – superior temporal line, from below - zygomatic arch, in front - frontal process
of zygomatic bone and zygomatic process of frontal bone
# in front - supraorbital margin of frontal bone, behind – external occipital protuberance and superior
nucheous line, laterally – superior temporal line
From above – the line that meets the continuing zygomatic arch, in front – the line of attachment to the
auricle, from below and laterally – corresponds to the shape of paramastoid process
Boundaries of temporal muscle
! What is located in the subcutaneous cellular tissue of temporal lobe?
m.m. auricularis anterior et superior, a. et v. temporalis superficialis, n. auriculotemporalis, n.
zygomaticotemporalis, a. et v. auricularis posterior, n. occipitalis minor, rr. temporales (n. facialis)
# a., v et n. auricularis posterior, a. et v. occipitalis, n. occipitalis minor, n. occipitalis major
m. auricularis posterior, a. et v. auricularis posterior, n. auricularis magnus, n. occipitalis minor, n.
auriculari posterior, lymphatic vessels and nodes
a., v. et n. supratrochlearis, a., v. et n. supraorbitalis, rr. temporales (n. facialis)
! How many layers of adipose tissue are there in temporal lobe?
five
# four
three
two
! Where is superficial abscess of temporal lobe located?
Between the skin and superficial leaf of temporal aponeurosis
# between temporal aponeurosis and external surface of temporal muscle
Between superficial and deep leaves of temporal aponeurosis
Between periosteum and bone
! Identify possible ways of further spread of infection from the temporal lobe:
Into subtemporal fossa, parotid - masticate part, submasticate space, frontal part, into the orbit,
temporal bone, into the cranial cavity
# into buccal part, temporal-pterygoid and infrapterigoid space, parapharyngeal space, into parotid masticate part
into lateral triangle of the neck, in frontal parietal occipital part, into mastoid process, into cranial cavity
limited by temporal lobe
! What incision is used more often to reveal superficial abscesses of the temporal lobe?
Anterior inclined incision behind the frontal process of zygomatic bone
# arciform incision alongside the lower temporal lines of temporal bone
Horizontal incision over zygomatic arch
posterior vertical incision through mid-inflammatory infiltrate
! What incision is most frequently used to reveal interaponeurotic abscesses of temporal lobe?
horizontal incision over zygomatic arch
# horizontal incision under zygomatic arch
posterior vertical incision through mid-inflammatory infiltrate
Zigzag incision above zygomatic arch
! What is there in interaponeurotic temporal space?
a. et v. temporalis media, n. zygomaticotemporalis
# a. et v. temporalis superficialis, n. auriculotemporalis
v. retromandibularis
ductus parotideus
! What is deep temporal cellular space limited by?
temporal muscle and periosteum
# periosteum and bone
temporal aponeurosis and external surface of the temporal muscle
superficial and deep leaves of temporal aponeurosis
! What incision is used more frequently to reveal deep temporal abscesses?
Arciform incision along the lower temporal lines of temporal bone
# horizontal incision under zygomatic arch
posterior vertical incision through mid-inflammatory infiltrate
two vertical incisions
! What does deep temporal cellular space contain?
a. et v. temporales profundae, deep temporal nerves
# a. et v. temporalis media
a. et v. temporalis superficialis
n. auriculotemporalis
! What does the osseous basis of temporal lobe contain?
A big wing of cuneiform bone, scale of temporal bone, part of the frontal bone, part of the parietal bone
# a small wing of coneiform bone, frontal scale, frontal margin of parietal bone, ethmoid bone
Temporal bone, maxilla, zygomatic bone, mandible
A big wing of cuneiform bone, mastoid process of temporal bone, part of frontal bone
! What is particular about the structure of temporal bone?
Absence of spongy layer – squamous structure
# it contains airway sinus - pneumatic structure
It is composed of spongy and compact layers – diploetic structure
It has got three-layered structure, contains collars
! Which anatomical formation is the temporal muscle tendon attached to?
To the branch and coronoid process of mandibular
# to cervical mandibular
to zygomatic process of maxilla
to condylar process
! Identify one of the first signs of the inflamed cellular tissue of deep temporal lobe:
trismus
# lagophthalmos
dysphagia
rigidity of occipital muscles
! What can be damaged when the temporal abscess is exposed?
rr temporales n. facialis, rr zygomatici n. facialis, a. et v. temporalis superficialis, n. auriculotemporalis,
deep temporal vessels and nerves
# a., v. et n. supratrochlearis, a., v. et n. supraorbitalis, rr. temporales (n. facialis)
a., v et n. auricularis posterior, a. et v. occipitalis, n. occipitalis minor, n. occipitalis major
m. auricularis posterior, a. et v. auricularis posterior, n. auricularis magnus, n. occipitalis minor, n.
auricularis
posterior, lymphatic vessels and nodes
! What is located in subcutaneous cellular tissue in the area of mastoid process?
m. auricularis posterior, a. et v. auricularis posterior, n. auricularis magnus, n. occipitalis minor, n.
auricularis
posterior, lymphatic vessels and nodes
# m.m. auricularis anterior et superior, a. et v. temporalis superficialis, n. auriculotemporalis, n.
zygomaticotemporalis, a. et v. auricularis posterior, n. occipitalis minor, rr. temporales (n. facialis)
a., v et n. auricularis posterior, a. et v. occipitalis, n. occipitalis minor, n. occipitalis major
et v. temporalis superficialis, n. auriculotemporalis
! Note the front boundary of Shypo triangle?
vertical line carried on the back edge of external auditory passage from the apex of mastoid process via
spina suprameatum
# crista mastoidea
horizontal line which is a continuation of zygomatic arch
crista supramastoidea
! Identify the back boundary of Shypo triangle:
crista mastoidea
# horizontal line of the extended zygomatic arch
vertical line carried on the back edge of external auditory passage from the apex of mastoid process via
spina suprameatum
supramastoid crest
! Identify the upper border of Shypo triangle?
horizontal line which is a continuation of zygomatic arch
# crista mastoidea
vertical line carried on the back edge of external auditory passage from the apex of mastoid process via
spina suprameatum
porus acusticus externus
! Where can pus penetrate destroying the back wall of antrum mastoideum?
into sinus sigmoideus
# into middle cranial fossa
into posterior cranial fossa
into the cavity of middle ear
! Where can pus penetrate destroying the top wall of antrum mastoideum?
into middle cranial fossa
# into sinus sigmoideus
into posterior cranial fossa
into the cavity of middle ear
! Identify the projection of central slot after Kreinlein scheme:
from crossing point of back vertical line with sagittal line to the point of crossing of front vertical line with
the upper horizontal line
# from the point of crossing of back vertical line with the top horizontal line to the point of crossing of
front vertical line with the lower horizontal line
from crossing point of the upper front vertical line with the top horizontal line to the crossing point of
back vertical line with lower horizontal line
from crossing point with the front vertykali sahitalnoyu lines to the point of crossing the front vertykali
bottom
horyzontallyu
! Where is the column of a.meningea media located according to Kraunlain scheme?
On crossing of lower horizontal line and front vertical line
# on crossing of top horizontal line and front vertical line
On crossing of lower horizontal line and middle vertical line
On crossing of lower horizontal line and back vertical line
! Where is a projection of front branch of a. meningea media determined according to Kronlein scheme?
Crossing of upper horizontal line and front vertical line
# crossing of the lower middle horizontal line and middle vertical line
Crossing of lower back horizontal line and back vertical line
On the bissectix of the angle formed by the projection of central sulcus and top horizontal line
! Identify the projection of lateral (Sylvien) sulcus according to Kronlein scheme:
Bissecrix of the angle formed by the projection of central fissure and horizontal line
# crossing of the upper front horizontal line and front vertical line
Crossing of lower horizontal line and middle vertical line
Crossing of lower horizontal line and back vertical line
! What foramen does a. meningea media penetrate into the cranial cavity?
via foramen spinosum
# via foramen rotundum
via foramen ovale
via foramen lacerum
! What convolution of the brain does the passage of the anterior branch of the middle meningeal artery
correspond to?
Precentral convolution
# postcentral convolution
Angular convolution
Top temporal convolution
! What convolution of the brain does the passage of the back branch of the middle meningeal artery
correspond to?
Temporal part
# precentral convolution
Postcentral convolution
Parietal part
! What is the method of trepanation of the skull called during which a separate cutoaponeurotic piece
with a wide basis and further scalping of it and sawing periosteal isolated pedicle flap?
Osteoplastic craniotomy by Olivercrone method
# osseous plastic craniotomy by Vagner-Volff method
Osteoplastic craniotomy by Kushing method
Decompressive craniotomy by Olivercronie method
! What tissues compose the first flap at osteoplastic craniotomy by Olivercronie method?
Skin, subcutaneous cellular tissue, aponeurosis
# skin, subcutaneous cellular tissue, aponeurosis, subaponeurotic cellular tissue, periosteum, bone
Skin, subcutaneous cellular tissue, muscle, periosteum, bone
Skin, subcutaneous cellular tissue
! What tissues compose the second flap at osteoplastic craniotomy by Olivercronie method?
Muscle, periosteum, bone
#skin, subcutaneous cellular tissue, aponeurosis
Skin, subcutaneous cellular tissue, aponeurosis, subaponeurotic cellular tissue, muscle, periosteum, bone
Skin, subcutaneous cellular tissue
! What's the inside vessel adjacent to the temporal bone?
a.meningia media
# temporalis profunda
a.cerebri media
a.cerebri anterior
! What dissections are performed to reveal abscesses of the temporal lobe?
front sloping dissection, back vertical dissection, horizontal dissection over zygomatic arch
# two vertical dissections, horizontal dissection under zygomatic arch
intraoral
On the upper or lower edge of the orbit
Zigzag dissection above zygomatic arch
! Which of these methods corresponds to decompressive trepanation of the skull?
Cushing’s technique
# Vagner-Volff’s technique
Olivercronie’s technique
Bogaert’s technique
! A patient with an increased intracranial pressure is indicated to perform decompressive trepanation of
the skull. Where is it performed?
In the right temporal part
# in the right parietal part
In the left parietal part
In the right and left occipital parts
! A head injury resulted in increased intracranial pressure. In what part of the calvarium is decompressive
trepanation of the skull performed at this localization of the pathologic process?
Directly above the focus of the pathological process
#in the left temporal part
In the occipital part of symmetrical opposite region
In the right parietal part
! A patient is indicated to perform trepanation of the mastoid process. Which of the special Instruments
are used in craniotomy of mastoid process?
Voyachek chisel or gouge
#Liston’s forceps
Dahlgren’s forceps
Doyen’s forceps
! What complications of mastoid process craniotomy can occur in postoperative period, if during the
operation there appeared a violation of front boundary of Shypo triangle?
Peripheral paralysis of n. facialis on the side of the operation
# Central paralysis of n. facialis on the opposite side of the operation
Damage of the internal ear
Damage of sigmoid sinus and its hemorrhage
! What complications of mastoid process craniotomy can occur in postoperative period, if during the
operation the top boundary of Shypo triangle was broken?
Infection of the cranial cavity
#peripheral paralysis of n. facialis on the side of the operation
Central paralysis of n. facialis on the opposite side
Central paralysis of n. facialis on the operational side
! What complications of mastoid process craniotomy can occur in postoperative period, if during the
operation the posterior boundary of Shypo triangle was broken?
Damage of sigmoid sinus and its hemorrhage
#peripheral paralysis of n. facialis on the operational side
Infection of the cranial cavity
Damage of the internal ear
! A female patient got a dull injury of the temporal part of the head. She was diagnosed with epidural
hematoma. Indications required osteoplastic craniotomy. What surgical instruments are used to perform
craniotomy?
Common surgical instruments, trephine, bone cutter, electrocoagulator, Dalhren’s forceps, Palenov’s
conductor, Gigli’s wire cutter
#common surgical instruments, trephine, bone cutter, electrocoagulator, dissecting blade saw
Common surgical instruments, trephine, bone cutter, electrocoagulator, arc sawing
Common surgical instruments, trephine, bone cutters, electrocoagulator, Dalhren’s forceps