What is temporal arteritis. Temporal arteritis symptoms and treatment Symptoms of Horton's disease

Blood vessels are some channels, a kind of pathways through which the body receives the necessary nutrients and atomic oxygen, giving in exchange for excretion in environment waste and simply harmful substances. Unfortunately, the vessels, like other organs, are susceptible to various diseases, for example, one of the most typical angiitis is temporal arteritis in young and old people.

Some of the most common vascular diseases caused by a wide variety of factors (pathogenic agents, age changes tissues, hereditary tendency, aggressive external environment, autoimmune reactions, etc.) are arteritis (angiitis), which are.

There are other names for temporal arteritis - Horton's disease / syndrome, or giant cell, temporal arteritis (according to ICD-10, M31.6 is presented.)

The disease was first officially noted in 1890, and in 1932 the symptoms were described by the American physician W. Horton.

Temporal arteritis is a systemic vascular disease that manifests itself in a massive inflammatory process of all arteries, and the affected cells accumulate in their walls in the form of so-called "granulomas", and blood clots are also formed. As a result, breaking its functionality.

Causes

The causes of temporal arteritis in young people are different. Like other anginitis, it occurs both in the form of an independent pathological process (primary arteritis), the causes of which are not thoroughly determined by science (versions of its occurrence from an infectious factor to a hereditary predisposition), and in the form of a concomitant disease (most often accompanied by a disease such as rheumatic polymyalgyu), as well as as a consequence of other pathological conditions - the so-called secondary arteritis.

In addition, the cause of secondary temporal arteritis is old age, and nervous overload, causing a drop in immunity. Also, many experts consider the intake of large doses of antibiotics to be a provoking agent.

The disease is quite common, affecting on average 19 out of a hundred thousand people.

Pathogenesis

Horton's disease refers to the so-called systemic vasculitis, with a characteristic lesion of all large (6-8 mm in diameter) and less often middle arteries. In this case, the arteries of the upper half of the body are most often inflamed - the head, shoulders, arms, arteries of the eyes, vertebral arteries, and even the aorta.

Patients diagnosed with temporal lobe arteritis are predominantly elderly people over 59 years of age. A particular mass is observed in people over 71 years old. It is noteworthy that there are about four times more women among the cases of men.

The temporal artery is not difficult to detect: it is enough with a slight pressure, to feel a moderate pulsation of the vessel, touch your temple with your fingertips. Affected by this disease, the artery causes a sharp swelling of the temple and scalp itself. The tissues around the inflamed vessel are reddened.

At the initial stages, immune inflammation of the vascular walls of the arteries is observed, since the formation of autoantibody complexes begins in the blood, which attach to the inner surface of the vessels.

The process is accompanied by the release of the so-called inflammatory mediators by the affected cells, which spread from the inflamed vessel to the adjacent tissues.

Temporal arteritis, unlike all other arterial inflammations, responds well to treatment. The main thing is to diagnose the disease on early stages and provide adequate therapy.

Symptoms of temporal arteritis are fairly typical.

The characteristic manifestations of temporal arteritis should alert the doctor at the initial admission of such a patient:

hyperemia of facial tissues, pronounced relief of the vessels of the face;
complaints of local temperature rise;
acute, pulsating, often difficult to bear pain at the site of the affected temple, radiating to the neck and back of the head.
In addition, due to inflammation of the tissues adjacent to the vessel, the patient has a prolapse upper eyelid the affected side of the face.
Objects such patients see blurry, not clearly, complain of "double vision" in the eyes, decreased visual acuity of one (over time, without treatment, the second eye is affected). Deterioration of vision is, as it were, temporary, transient. The patient complains of headache, general weakness and bad mood.
Soreness in the jaw is felt when eating. Also noticeable is increased, abnormal soreness when touching, scratching the scalp, depression and loss of strength (asthenia).

Diagnostics

Temporal arteritis, not detected in the early stages, develops, threatening chronic form... This can lead to complete loss of vision due to a pronounced disturbance of the blood flow supplying the optic nerve. That's why early diagnosis temporal arteritis is extremely important.

In addition to the initial collection of anamnesis, the cardiologist performs the following actions:

general examination, including palpation of the external blood vessels in order to detect their soreness. On examination, the temporal artery may be thickened and hard to the touch. The pulse in the area of inflammation is weak or not felt at all;
measured eye pressure, body temperature.
auscultation is performed using medical devices internal organs(lungs and heart);
produced ultrasound procedure blood vessels;
appointed;
the patient's blood is examined in the laboratory (general and biochemical analyzes). With temporal arteritis, anemia is characteristic. Moreover, in the analyzes it is observed that it reaches 101 mm in 1 hour. In addition, the volume of C-reactive protein synthesized in liver cells and entering the bloodstream during injuries and inflammations is significantly increased.

It happens that all these methods still do not allow a confident diagnosis to be made. Then they resort to biopsy of the affected vessel. The procedure is performed under local, local anesthesia. A small fragment of an organ is taken for the purpose of microscopic examination for the presence of affected cells. A biopsy allows you to diagnose the disease with one hundred percent certainty.

They also involve other medical specialists (primarily an ophthalmologist).

Since temporal arteritis in young people can lead to severe, irreversible consequences (stroke due to inflammation of the arteries of the vestibular zone, heart attack, blindness, etc.), even death, treatment of temporal arteritis should be started based on the symptoms that appear.

Treating specialists are usually cardiologists, surgeons and phlebologists.

Basically, such patients are prescribed course (about 12 months, but the treatment may take 2 years) hormonal therapy in the form of rather high doses of anti-inflammatory glucocorticosteroids.

Patients with threatening blindness are prescribed Prednisolone (the so-called pulse therapy). This drug is taken strictly after meals at least three times a day, in total volume up to 61 milligrams.

In some cases, even 61 milligrams of daily intake is ineffective, and the dose is even increased to 92 mg. However, the exact volume medicinal product can only be calculated by the attending specialist.

Prednisone even on initial stage reception causes favorable dynamics: the temperature drops, the patient's appetite and mood improve, the erythrocyte sedimentation rate reaches the norm.

Such a high dose is applied in the first month of treatment, after which it is gradually reduced.

In the event of a threat of serious consequences (for example, in case of individual intolerance to this drug), the patient is initially injected once intravenously with 1 gram of methylprednisolone.

Simultaneously with Prednisolone, patients are prescribed vasodilator and vaso-strengthening medications.

With a complicated course of the disease (the occurrence of aneurysms and thrombosis), as well as ineffectiveness drugs resorting to vascular surgery. Naturally, with an early diagnosis, the prognosis for cure will be more optimistic.

Temporal arteritis (also called giant cell arteritis or Horton's disease) is an ailment characterized by an inflammatory process in the body that occurs mainly during a malfunction immune system... It usually affects the arteries, including those located in the temporal part of the head.

Types of temporal arteritis

Basically in medicine, two types of disease are distinguished:

Primary. It mainly develops in older people as a separate independent disease. Granulomas in this case are not infectious in nature.
Secondary. Such arteritis is a consequence of infectious or viral diseases, which at one time passed in a severe or advanced stage.

When viewed from the developmental side, doctors distinguish:

segmental arteritis- affects certain parts of the body;
focal arteritis- is a holistic mass violation of the functionality of blood vessels.

Causes

Most experts are of the opinion that temporal arteritis occurs through the natural aging of blood vessels in the body. But this is not the only reason why an illness can occur.

The main assumptions about where the disease comes from include:

2. Predisposition to disease through genetic inheritance. In this case, there is a variant of the transmission of arteritis by inheritance from the parents. Cases were also diagnosed when the disease was found in identical twins.

An interesting fact is that temporal arteritis occurs exclusively in people who have White color skin.

3. Autoimmune nature, which manifests itself in the fact that the body begins to fight with itself. As a result, various kinds of pathologies arise. Some of the developmental stages of temporal arteritis may be similar to scleroderma, dermatomyositis, or lupus.

Interesting and useful information about temporal arteritis, the mechanism of its development, possible complications and the consequences, as well as the methods of treatment, can be found in the following video:

Symptoms

According to statistics, most often, temporal arteritis occurs in people aged 60 to 80 years and is accompanied by the following symptoms:

thinning of the skin on the scalp;
functional mobility is impaired lower jaw while chewing food or talking;
muscle pain appears, especially in the shoulder area (it often occurs after physical exertion or in the morning after sleep);
significant;
the appearance of fever or asthenia;
there is malaise, loss of appetite, depression;
sometimes they complain of double vision, and drooping of the upper eyelid.

If you experience any of the symptoms listed above, it is recommended that you immediately consult a doctor, undergo a full examination and consult on all issues.

Complications and consequences

As the walls of the arteries become inflamed and swollen during Horton's disease, the lumen between them begins to narrow. As a result of this process, the transportation of blood becomes difficult and the body does not receive the full amount of oxygen and nutrients. The consequences can be tragic, since cases of the formation of a thrombus (blood clot), which completely blocks the work of the vessel, were often recorded, as a result of which a person could die.

Another dangerous complication temporal arteritis is an aneurysm that protrudes the wall of a vessel, thereby increasing the chances of it ruptured.

Most often, anterior ischemic neuropathy appears, which disrupts blood flow in the arteries, which feeds the optic nerves, through which a person's overall vision decreases or peripheral vision worsens. According to statistics, approximately 30% of people show signs of bilateral vascular lesions, respectively, the same decrease in vision in two eyes.

Occasionally there are:

occlusion of the central artery, which is characterized by a sharp partial or complete loss of vision;
paralysis oculomotor nerve, during which double vision occurs in the eyes and the ability to move the eyeball is lost;
edema of the retina or hemorrhage into it through increased intraocular pressure.

In any case, it is best to undergo prophylactic diagnostics to exclude the presence of temporal arteritis, or to detect it in the early stages, when it is best treated.

Diagnostics

For examination and diagnosis, a person must visit a doctor who will prescribe everything required analyzes and will be able to advise on emerging issues.

The list of examinations that are assigned includes:

Checking up with a neurologist and ophthalmologist.
General clinical and biochemical blood tests, which will indicate the presence or absence of leukocytosis and anemia. They also pay attention to the indicators of the erythrocyte sedimentation rate and the level of C-reactive protein (indicates the quality of the immune system).
USGD for extracranial vessels.
Possible appointment of CT and MRI.
Angiography.

If everything indicates the presence of temporal arteritis, the doctor will order a biopsy, during which a small area is removed temporal artery(about 2.5 cm), after which the laboratory examines this section under a microscope. If the ailment affects the eyes, a biopsy is performed from the side where the affected area is.

Diagnosis of the disease is carried out as soon as possible immediately after you discover the symptoms. This will reduce the risk of developing blindness, as well as take all the necessary measures for treatment on time.

In addition to analyzes, it is often necessary to consult a cardiologist who performs:

1. General examination, including palpation of external bloody vessels. The purpose of such an examination is to establish their soreness. During the examination, the doctor can find out which artery is by touch (hard, thickened, etc.) and make an appropriate conclusion.

It is important to note that the pulse in the affected area is poorly expressed or absent altogether.

2. During the diagnosis, body temperature and eye pressure are measured.

3. Using special medical devices, it is possible to perform auscultation of the lungs and heart.

Treatment

The treating specialists are mainly cardiologists, phlebologists and surgeons. Treatment begins immediately, because if this is not done, there is a high risk of severe irreversible consequences that can directly lead to the death of a person (heart attack, stroke).

After diagnosis, the doctor plans a treatment strategy. The main goal is to block the malfunctioning immune system that damages its own cells in the body. In such cases, glucocorticosteroids are often prescribed.

Therapeutic treatment

It is considered one of the most effective ways... The basis of the technique is hormone therapy, in which the drug Prednisolone and Methylprednisolone are used. It is being treated according to the following scenario:

A person takes Prednisolone 60 mg per day for 2-4 days. Every week, you need to reduce the dosage by 5 mg to reach the 40 mg norm. After that, the dosage is reduced by another 2 mg every week, reaching the 20 mg mark. If suddenly during treatment the disease worsens, it is necessary to increase the dosage until the symptoms are completely eliminated.
Methylprednisolone is taken 1 g intravenously for three days. After that, it is taken orally at 20-30 mg per day.

If a person is sick with an infectious disease or, it is imperative to carry out additional antibiotic therapy.

In the case when the previous scenario is not effective, the doctor prescribes the use of cytostatics (Methotrexate, Azathioprine).

Surgical method

Usually, the operation is prescribed only in cases where the disease proceeds with major complications, as well as against the background of cancer, aneurysms or blood clots. In any case, this is all individually and solely by the decision of the attending physician.

Folk remedies

Doctors always warn that treatment folk remedies may adversely affect the development of the disease, but in any case there is a category of people who use these methods. They have a good effect on improving the quality of the immune system and relieving negative symptoms. Some people combine therapeutic and traditional methods, starting to take decoctions, acupuncture, massage and a number of similar procedures.

Here are some tips for treating temporal arteritis with folk remedies:

To stop development sooner inflammatory process, take herbal tea based on and.
To make it easier, it is recommended to drink one-component decoctions from, leaves of coltsfoot, Siberian elderberry, clover, etc.
An infusion of (pepper) is considered good for headaches.
From the pains that bother you in the temporal lobe, lemon helps, which must be peeled from the zest to the inner white layer. Then the lemon is pressed against the area where pain occurs and hold until a reaction in the form of redness and a desire to scratch appears.

Forecast

Temporal arteritis can be cured, but it is impossible to completely get rid of the disorders that have arisen at the level of the immune system. Competent therapy and treatment methods will help suppress the activity of the disease and inflammatory processes, as well as prevent the development severe complications in sight and stroke.

With the help of steroid therapy, the symptoms of the disease are quickly relieved and laboratory clinical parameters are normalized. After two months of treatment, the indicators and analyzes return to normal and improve, normal blood flow is restored and the lumen of the affected arteries increases.

At the time of taking the necessary measures in a timely manner, the forecast is quite favorable, but in no case can one hope for self-healing.

Prophylaxis

Due to the fact that the causes of the disease are not fully understood, doctors cannot provide practical effective measures for prevention. Despite this, there is a clear connection with the transfer of infectious diseases, so a person should extremely carefully monitor the state of his immune system.

Normalize the daily routine, go to bed on time, take breaks during heavy and active loads.
Monitor your diet, do not eat junk food, drink enough water per day.
Take vitamins, eat fruits and foods that are healthy for the body.
For the slightest signs or suspicion of temporal arteritis, consult a doctor immediately.
Complete rejection of bad habits that affect the work and tone of blood vessels.
Practice moderate physical activity in the form of gymnastics or other simple exercises.
It's great if you temper in the morning. Morning contrast shower has a positive effect not only on the state of health, but also on the mood.
Ventilate the room before going to bed.

Temporal arteritis (video)

An introductory video on temporal arteritis can be viewed below:

Temporal arteritis is a hereditary or post-infectious disease that affects blood vessels and interferes with their functioning. There are several treatment options - therapeutic, surgical and folk. But in any case, you should first undergo diagnostics and only then make a decision on how to proceed.

Next article.

Temporal arteritis - what is it and what is the threat?

Temporal arteritis (giant cell arteritis, Horton's disease) is an inflammatory disease of the middle and large arteries. In general, all arteries of the body are subject to inflammation, but most often the disease affects the arteries of the head and neck. It is this localization of the foci of inflammation that makes the disease very dangerous, because among its complications are impaired blood flow, partial or complete blindness, and even a stroke.

In addition, a characteristic feature of the disease is the formation of granulomas on the walls of blood vessels, which, as a result, can lead to overlap of the lumens of the arteries and thrombosis.

People between the ages of 50 and 70 are most likely to get this disease.

Most often, the disease develops after 50 years, and its peak falls at the age of 70 or more. It is noteworthy that women prevail in the risk group - according to statistics, they suffer from arteritis 3 times more often than men.

But, fortunately, temporal arteritis is successfully treated today, which distinguishes it from other inflammatory diseases of the body. And, nevertheless, it is sometimes vital to have at least a superficial knowledge of the causes, symptoms, methods of diagnosing and treating arteritis.

Causes of temporal arteritis

To date, the exact causes of temporal arteritis are unknown. Nevertheless, it has been established that the natural processes of vascular aging and the concomitant destruction of their walls, as well as genetic predisposition, will play an important role in the development of the disease.

In addition, in some cases, severe infectious diseases, the treatment of which was accompanied by the intake of strong antibiotics. In addition, inflammation can be triggered by certain viruses that enter the body and affect the walls of weakened arteries.

Temporal arteritis - the main symptoms

The first alarming symptom that cannot be ignored is the sudden onset of sharp pain in the temples and irradiation pain in the tongue, neck and even shoulders.

Throbbing pain in the temples may be the first symptom of temporal lobe arthritis.

A clear sign of developing temporal arteritis is a throbbing pain in the temples. Moreover, simultaneously with the pain symptom, a pronounced pulsation of the temporal artery can be felt on palpation.

Very often, pain attacks are accompanied by partial or complete loss of vision, which can last from several minutes to many hours. In this case it comes already about the progressive inflammation of the arteries and damage to the eye vessels.

In addition, secondary symptoms may also indicate inflammation of the temporal arteries, among which the following should be noted:

Temporal arteritis (giant cell arteritis)

Temporal arteritis, also known as giant cell arteritis, is an inflammatory disease of the middle-caliber arteries that supply blood to the head, eyes, and optic nerves. Place your fingers firmly on your temple and you will feel a very pronounced pulsation. This is the pulsating temporal artery. The disease usually affects people over the age of 60 and is manifested by swelling and soreness of the vessels of the temple and scalp. Women suffer from this disease 4 times more often than men.

The main danger of temporal arteritis is loss of vision, although with a long course of the disease, other arteries are also involved in the process. This disease is potentially dangerous to vision, but if it is started in a timely manner correct treatment this can be avoided. The danger lies in the fact that blood does not pass well through the inflamed arteries to the eyes and optic nerves, therefore, without treatment, the nerve cells of the retina and optic nerve die.

Signs (symptoms)

Patients with temporal arteritis usually begin to complain of vision in one eye, but half of them notice symptoms in the double eye after a few days without treatment.

Headache

Scalp soreness when touched (such as scratching)

Pain in the temple (may be unbearable)

Temporal arteritis

Temporal (giant cell) arteritis is a rather rare systemic vascular disease, the main manifestations of which are signs of vascular lesions in the basin of the external and internal carotid arteries and, very rarely, arterial trunks extending directly from the aortic arch.

This disease in the overwhelming majority of cases is detected in patients of a rather old age (in persons who have not yet turned 50 years old, only isolated cases of the disease are diagnosed). When studying the features of temporal arteritis, it was found that very often the symptoms of this disease occur along with manifestations of polymyalgia rheumatica. Most often, the first manifestations of the disease are found in women aged 60-70 years.

Causes of temporal arteritis

Despite the numerous studies that were carried out after the first description of the manifestations of temporal arteritis by American rheumatologists Horton, Magath and Brown in 1932, they have not been reliably established. It is generally accepted that for some time before the first signs of the disease, the patient could come into contact with various viruses, bacteria, including mycobacterium tuberculosis. Also, the possible influence of heredity is not denied - in those regions of the world where the population has entered into family marriages for a long time, the number of cases is much higher than in the population as a whole (the largest number of cases was detected in the Scandinavian countries of Europe and the northern states of the United States).

The impact of factors is also considered proven. external environment, under the influence of which disorders in the activity of the immune system of the patient's body develop - an increase in the sensitivity (sensitization) of the body becomes the starting point in the development of the autoimmune process.

Its main foci are concentrated in the vascular wall of the arteries of medium and small caliber. As a result of these processes, the normal blood flow is hampered, the phenomena of dystrophy and ischemia develop in the tissues that are located behind the site of the vascular lesion.

Most often, the inflammatory process in the vascular wall with giant cell arteritis affects the arteries of the head, but in exceptional cases, with rapid progression of inflammation, damage is possible coronary arteries, vessels of the kidneys, intestines - parietal blood clots can form in them, causing a progressive narrowing of the lumen of the blood vessel.

Temporal arteritis symptoms

In the overwhelming majority of cases, the development of pronounced inflammation of the arteries is preceded by a rather long prodromal period (the stage of precursors of the disease), which specialists - rheumatologists and angiologists call polymyalgia rheumatica. It is characterized by pronounced general weakness, deterioration of health, the appearance of a constant subfebrile condition (the temperature does not rise above 37, 70C), which is often accompanied by sweating in the evening and at night. In the same period, unpleasant sensations or pains in the muscles and joints of the whole body may occur, which become the cause of insomnia in patients, and with the addition of nausea and lack of appetite, the patient's weight loss rapidly begins to progress. The duration of the stage of prodromal phenomena can vary from several weeks to several months, and an inverse relationship between the duration and severity of the symptoms of polymyalgia rheumatica and the severity of the temporal arteritis itself has been reliably established (the shorter the stage of precursors, the more severe the actual vascular lesion proceeds).

The most characteristic and difficult subjectively tolerated symptom becomes headache... Most often, it concentrates in the temporal region, but can spread to the frontal and parietal zones, and very rarely to the back of the head. The pain can be aching or throbbing, and almost always it occurs spontaneously - the patient does not feel the precursors of an attack (unlike migraine). The unpleasant sensations in the overwhelming majority of cases intensify at night, quickly acquire the character of intolerable, and within a few hours after the onset of the attack, you can see the kind of scalp dense and inflamed, sharply painful when trying to palpate the strand - the affected artery.

In cases where the process affects the arteries supplying the area of the face with blood, the patient may experience "intermittent claudication" of the tongue, chewing and very rarely - facial muscles face, this greatly complicates the patient's normal communication (difficulty in speaking) and nutrition (prolonged chewing of food causes sharp pain in the muscles of the face).

In about half of patients, in the absence of adequate treatment, temporal arteritis begins to rapidly progress, and after 30-40 days visual impairment may appear, the cause of the development of chimes is ischemic damage to the optic nerve or thrombosis of the central retinal artery. In this case, the likelihood of irreversible blindness is high - the cause of it early development becomes atrophy of the optic nerve.

When the main arteries are involved in the process, changes develop, the area of distribution of which coincides with the zones of blood supply. That is why, when the arteries of the brain are involved in the process, signs of acute cerebrovascular accident or discirculatory encephalopathy with a predominance of mental disorders may appear. With changes in the coronary arteries, the appearance of angina pectoris and its subsequent progression to myocardial infarction is inevitable; with damage to the aorta, a characteristic clinical picture aneurysms of its arch, with damage to the arteries of the kidneys or intestines, chronic renal failure or attacks of "abdominal toad", respectively.

Diagnosis of the disease

To establish or confirm the diagnosis, it is necessary to perform a clinical analysis of blood and urine, the changes of which are similar to the manifestations of other autoimmune diseases - anemia, a sharp increase in ESR, and traces of protein in the urine are found. V biochemical analysis blood shows signs of an active inflammatory process, changes in the coagulogram. An accurate diagnosis can be made only after a histological examination of a piece of the temporal artery wall obtained by performing a percutaneous biopsy.

Temporal arteritis treatment

Effective treatment of temporal arteritis is impossible without the appointment of glucocorticoid (steroid) hormones, which are used first in an overwhelming dose, and then the daily amount of the drug is very slowly and gradually decreases.

In some cases, it is also necessary to prescribe immunosuppressants - these drugs are needed when there is a threat of blindness or when signs of generalization of the process are detected (without treatment, patients in this case rarely live more than 6 months). It is important to remember that with temporal arteritis, a reliable indicator of improvement is not a change in the patient's well-being, but the dynamics of laboratory parameters, therefore, the dose of hormones is selected based on the severity of nonspecific laboratory parameters of inflammation (ESR, C-reactive protein).

In addition, in case of severe disorders of blood clotting processes, anticoagulants of direct and indirect action, antiplatelet drugs are prescribed. To improve the general condition of the patient, symptomatic (eliminating individual manifestations of the disease) and metabolic therapy are prescribed - antianginal drugs for angina pectoris and abdominal toad, vitamins.

Disease prevention

Primary prevention of temporal arteritis is very difficult, because there is no established cause of the development of the disease. Secondary prevention (prevention of exacerbation) consists in the life-long prescription of steroid hormones and immunosuppressants.

Superficial temporal artery, atemporalis superficialis. One or two terminal branches of the external carotid artery. Together with the ear-temporal nerve, they go in front of auricle... Rice. A, B.
A branch of the parotid gland, ramus parotideus. It supplies blood to the gland of the same name. Rice. A.
The transverse artery of the face, a. transversa faciei (facialis). Passes below the zygomatic arch under the fascia of the parotid gland towards the cheek. Rice. A.
Anterior ear branches, rami auriculares anteriores. Numerous branches to the auricle and external auditory canal. Rice. A.
Oculocular artery, azygomati-coorbitalis. Passes above the zygomatic arch to the lateral edge of the orbit. Rice. A.
Middle temporal artery, a. temporalis media. It departs above the zygomatic arch and supplies the muscle of the same name with blood. Rice. A.
Frontal branch, ramus frontalis. Anterior branch of the superficial temporal artery. Anastomoses with the vessel of the same name on the opposite side, the supraorbital and supra-block arteries (branches of the internal carotid artery). Rice. A.
Parietal branch, ramus parietalis. Posterior branch of the superficial temporal artery. Anastomoses with the branch of the same name on the opposite side, the posterior ear and occipital arteries. Rice. A.
Maxillary artery, a. maxillaris. A large terminal branch of the external carotid artery. It begins below the temporomandibular joint, passes from the outer or inner side of the lateral pterygoid muscle and branches in the pterygo-palatine fossa. Rice. A, B.
Deep ear artery, aauricularis profunda. Goes back and up to the temporomandibular joint, ear canal and eardrum. Rice. B.
Anterior tympanic artery, a. tympanica anterior. Accompanied by chorda tympani, it enters the tympanic cavity through the stony-tympanic fissure. Rice. B.
Inferior alveolar artery, a alveolaris inferior. It passes between the medial pterygoid muscle and the ramus of the mandible. In canalis, the mandibulae continues up to the chin foramen. Rice. B.
Dental branches, rami demotes. Are directed to the roots of the teeth. Rice. B. 13a Peri-toothed branches, rami peridentales.
Maxillofacial branch, ramus mylohyoideus. It begins in front of the opening of the lower jaw and with n.mylohioideus lies in the groove of the same name. Anastomoses with a.submentalis. Rice. B.
Chin ramus, ramus mentalis. The terminal branch of the inferior alveolar artery. Provides blood to the chin. Rice. B.
Middle meningeal artery, a. teningea media. It passes medially from the pterygoideus lat and enters the middle cranial fossa through the spinous foramen, where it branches into terminal branches. Rice. B, C.
Accessory branch, ramus accessorius. It starts from the middle meningeal or maxillary artery and supplies blood auditory tube, pterygoid muscles. Penetrates into the skull through the foramen ovale and branches in the hard shell around the ganglion mgeminale.
Rocky branch, ramus petrosus. It starts from the middle meningeal artery in the cranial cavity. Through the cleft of the canal of the large stony nerve, it anastomoses with the styloid artery. Rice. V.
Superior tympanic artery, a. tympanica superior. Lies next to a stony branch and, together with n.petrosus minor, penetrates the tympanic cavity. Rice. V.
Frontal branch, ramus frontalis. Large terminal branch of the middle meningeal artery. Inside the skull lies in a bony groove or canal at the edge of the lesser wings of the sphenoid bone. Rice. V.
Parietal branch, ramus parietalis. It supplies the posterior part of the dura mater in the cranial vault. Rice. V.
Orbital branch, ramus orbitalis. Passes through the top orbital fissure to the lacrimal gland. Rice. V.
Anastomotic branch [[with lacrimal artery]], ramus anastomoricus []. Rice. B. 23a Pterygoid meningeal artery, apterygomeningea. It starts from the maxillary or middle meningeal arteries and enters the skull through the foramen ovale. It supplies blood to the muscle that tenses the palatine curtain, the pterygoid muscles, the auditory tube, the dura mater and the trigeminal ganglion.
Chewing artery, a. masseterica. It passes over the notch of the lower jaw and supplies the muscle of the same name. Rice. B.
Anterior deep temporal artery, and temporalis profunda anterior. Goes up and enters the temporalis muscle. Rice. B. 25a Posterior temporal artery, a. temporalis profundae anterior.
Pterygoid branches, rami pterygoidei. They supply blood to the pterygoid muscles. Rice. B.
Buccal artery, a. buccalis. Passes along the buccal muscle forward and downward. Provides blood to the cheek and gums. Rice. B.
Posterior superior alveolar artery, a. alveolaris superior posterior. Its branches enter the alveolar canals and supply blood to the upper molars, gums and mucous membrane maxillary sinus... Rice. B.
Dental branches, rami dentales. Head to the roots of the molars upper jaw... Rice. B. 29a Peri-toothed branches, rami peridentales.

2931 0

General and microsurgical anatomy

As you know, in soft tissues the scalp can be divided into the following five main layers: skin with hairline; subcutaneous fatty tissue; an aponeurotic helmet, continuing into the temporal region in the form of a superficial temporoparietal fascia; loose connective tissue and pericranium (Fig. 21.1.1).

Rice. 21.1.1. Cross-sectional diagram of tissues at the level of the temporal fossa.
1 - tendon helmet; 2 - the temporal bone; 3 - periosteum; 4 - loose connective tissue layer; 5 - fascia of the temporal splint; 6 - temporal muscle; 7 - temporoparietal fascia; 8 - superficial temporal vessels; 9 - leather; 10 - subcutaneous fatty tissue

The temporo-parietal fascia (superficial) starts from the arch of the zygomatic bone, is located above the fascia of the superficial temporal muscle and is a continuation of the superficial musculo-aponeurotic system that supports the facial muscles (including the frontal and occipital).

The temporoparietal fascia is separated from the deep fascia covering the temporal muscle by a loose layer connective tissue, which is most pronounced anteriorly and above the auricle, and becomes thinner towards the periphery.

Vessels. Nutrition of the skin of the temporoparietal region is provided by the superficial temporal vascular bundle, which is the terminal branch of the external carotid bundle and leaves the upper part of the parotid salivary gland 1.5 cm anterior to the tragus of the auricle.

Most often, the veins are located posteriorly and deeper than the artery. The artery and vein lie in the subcutaneous fatty tissue on the temporoparietal fascia and are divided into two (anterior and posterior) branches, and sometimes a larger number of branches, approximately 7 cm above the upper edge of the tragus (Fig. 21.1.2).

Rice. 21.1.2. The branching diagram of the superficial temporal artery.

The diameter of the artery is slightly less than the diameter of the veins and ranges from 1.8 to 2.2 mm, the length of the vascular pedicle is up to 4-5 cm.

Nerves. Together with the vessels, the cutaneous parietal-pubic nerve passes over the superficial fascia, and the branches of the facial (motor) nerve pass under the fascia (Fig. 21.1.3).

Rice. 21.1.3. Location of the temporal-cutaneous nerve (1) and branches of the facial nerve (2).

Pickup and transplant options. Fascial temporoparietal flap

The fascial temporoparietal flap is most commonly used in surgery. Its advantages include a relatively large size (up to 17 x 14 cm), a small uniform thickness and good blood supply with a relatively large diameter of the supplying vessels.

The fascial flap is taken from the preauricular T-shaped access within the scalp. The vascular bundle is easily identified in the subcutaneous adipose tissue anterior to the superior edge of the auricle.

After that, the skin with fiber is dissected, dissecting the tissue under hair follicles... The latter circumstance, as you know, is very important in the prevention of focal alopecia.

As the distance from the base of the flap increases, it becomes more difficult to isolate the fascia due to its increasingly dense connection with the skin by fibrous bridges.

When isolating the anterior section of a complex of tissues, it is advisable to use a neurostimulator to identify and maintain the anatomical continuity of the frontal branches of the facial nerve. The auricoparietal cutaneous nerve may be included in the flap.

The successful use of a fascial flap for plastics of defects of the hand, forearm, foot, ankle joint and other areas is described.

The temporoparietal complex of tissues can be used as a strip with the isolation of fragments of the fascia on the branches of the superficial temporal artery. This feature is especially important in plastics of hand and finger tissue defects.

One of the advantages of the temporo-parietal fascial flap is the possibility of preparing a two-layer graft from two folded fascia sections, one of the surfaces of which can be previously closed with a split skin graft.

The flap may include the skin, the periosteum (outside of the temporalis muscle attachment site), and the outer cortical plate of the parietal bone.

The disadvantages of the flap include the possibility of the subsequent development of focal alopecia and the risk of damage to the superficial branches of the facial nerve. The possibility of expansion of the postoperative scar due to tension on the suture line during closure of the donor defect was noted. In this regard, this tissue complex is recommended to be used mainly in women. In men with short hairstyles, it is preferable to use the fascial parascapular tissue complex.

Fascial skin flaps

Retroauricular flap including scalp. This tissue complex can be transplanted into the posterior branch of the superficial temporal artery. The flap is located behind the auricle, and part of its skin is hairy. Thus, its transplant allows the formation of the border of the hairline.

Indications for surgery are past injuries or operations, the results of which were focal baldness on the hairline in the temporal region.

Taking a flap. The superficial temporal vessels are found anterior to the auricle and isolated in the distal direction, keeping the branches going to the flap.

The veins draining the flap may run together or posterior to the superficial temporal artery. In the first case, the veins and artery run together inside the superficial fascia over the deep fascia.

When the veins are located to the side and posterior of the artery, they can pass in the subcutaneous fat above the auricle. In this case, this area (without skin) should be included in the flap. The flap is then removed behind the ear downward, passing under the superficial fascia.

If the posterior venous branch is not defined or it is located too high, then a phased (delayed) flap formation is advisable.

If venous drainage from the flap is insufficient, the posterior ear vein may be used to provide adequate venous drainage.

It is important to note that when choosing a donor zone, it is necessary to take into account the location of the border and the direction of hair growth, which must correspond to the characteristics of the damaged zone.

Preauricular cartilaginous skin flap. Includes an area of skin anterior to the upper third of the auricle and the pedicle of the curl of the auricle with the skin covering it. These fabrics allow you to perfectly shape the wing of the nose and the dome of the tip of the nose. The flap is isolated on the superficial temporal vessels. Closing the donor defect may require relocation of the curl to reduce the cosmetic defect.

Other flaps can be formed on the branches of the superficial temporal artery. On the posterior branch of the latter, an occipito-parietal flap can be distinguished, the central axis of which is located in the anteroposterior direction approximately 7 cm above the tragus of the auricle.

IN AND. Arkhangelsky, V.F. Kirillov