Intermediate part of the lip. Lips - WomanWiki - women's encyclopedia. Excerpt characterizing Lips

In technology, lips or sponges are longitudinal projections on the edges of some tools and devices that serve to capture and hold workpieces, just as the lips of the mouth serve to capture food. Vices, pliers, and round nose pliers are supplied with jaws.

Structure

The outer, visible surface of the lips is covered with skin, which passes into the mucous membrane of their back surface, facing the teeth - it is covered with a mucous membrane, smooth, moist and passes into the mucous membrane of the alveolar processes - into the surface of the gums.

The structure of each lip is divided into three parts: cutaneous, intermediate and mucous.

• skin part, pars cutanea, has the structure of the skin. Covered with stratified squamous keratinizing epithelium, contains sebaceous and sweat glands, as well as hair;
• intermediate part, pars intermedia, a pink area, also has skin, but the stratum corneum is preserved only in the outer zone, where it becomes thin and transparent. The junction of the skin and the mucous membrane - the red border - is replete with translucent blood vessels, which determine the red color of the edge of the lip, and contains a large number of nerve endings, making the red edge of the lip very sensitive.
• mucous part, pars mucosa, occupying the posterior surface of the lips, is covered with stratified squamous non-keratinizing epithelium. The ducts of the salivary glands open here

The thickness of the lips is formed by: predominantly the orbicularis oris muscle, loose connective tissue, skin and mucous membrane.

When the mucous membrane of the lips passes into the gums, two median vertical folds are formed, called frenulum of the upper lip And frenulum of the lower lip.

The superior and inferior labial arteries, the mental artery (aa. labiales, superior et inferior, mentalis).

Anthropological aspect

In anthropology, lips are distinguished by thickness, direction and contour of the upper lip, and the width of the oral opening. By thickness, lips are divided into thin, medium, thick, and swollen. The upper lip can protrude forward (procheilia), have a vertical profile (orthocheilia), or, less commonly, recede back (opistocheilia). The thickest (swollen) lips and procheilia are characteristic of the equatorial (Negro-Australoid) race. Caucasians are characterized by orthocheilia. The thinnest lips are found among some peoples in Northern Europe and Asia. The upper lip can have a different contour - concave, straight, convex. The latter is especially characteristic of the pygmies of Central Africa and the Semang (Malacca Peninsula). The height and profile of the upper lip, the thickness of the lips and the width of the mouth also vary depending on age and gender. With age, the thickness of the lips (after 25 years) and procheilia decrease, the height of the upper lip and the width of the mouth increase.

Physiology

Participation in meals

Participation in facial expressions

Participation in sound production

Being the last barrier on the path of air exhaled through the oral cavity, the lips participate in the formation of speech sounds and are an important part of the articulatory apparatus - the human speech organs.

Due to the great mobility of the lower jaw relative to the upper, the lower lip is one of the active organs of speech along with the tongue and soft palate. The upper lip is a passive organ of speech due to its less mobility.

Air flows through the lips when pronouncing all speech sounds, but they play the most important role when pronouncing labial consonants and rounded vowels.

Consonant sounds are formed when the flow of exhaled air overcomes an obstacle in the oral cavity. Consonants are called labial (labial) if the lips serve as a barrier.

Labial consonants

Labial consonants are divided into two categories according to which organ serves as a passive organ paired with the active lower lip. If the barrier to air is formed by the contact of the lower lip with the upper lip, then the resulting consonant sounds will be labiolabial (bilabial, bilabial), and if the lower lip touches the upper teeth, then labiodental (labiodental).

The category of bilabial consonants includes nasal sonorant [m] and noisy voiced [b] and voiceless [n] (in Russian, both hard (velar) and soft (palatal)). Labial-dental consonants are represented by noisy [v] and [f].

Rounded vowels

When pronouncing vowels, the lips can either occupy a neutral, relaxed position or be tense. For example, the English closed vowel is characterized by a tense stretching of the lips in the horizontal plane.

However, rounded (labialized) vowels include those sounds of human languages, when pronounced, the lips are rounded and extended forward to varying degrees. In many languages, labialization serves as one of the important classifying features of vowel phonemes. Such vowels are [o] with moderate labialization and [у] ([u]) with strong labialization. In the Russian language, rounded vowel sounds correspond to both the letters O and U, and the vowel components of the pronunciation of the iotated vowels of the letters E and Yu. In a number of other languages, rounded vowels are opposed to each other in terms of the degree of openness-closedness (raising the tongue to the palate): for example, in French, German and Turkish languages ​​contrast the sounds [o] and [ö], [u] and [ü].

Labialization in the stream of speech

Since in the flow of speech the organs of articulation connect adjacent sounds with each other, even non-labial consonants acquire a labial overtone in the vicinity of labialized vowels, that is, they become labialized. The result of this is indicated in international phonetic transcription by a circle under the consonant symbol.

Issues of medicine and cosmetology

The lips can be the site of a number of diseases and serve as an indicator of the condition of other body systems. Among the infectious diseases on the lips, herpes appears. When nervous, your lips may tremble. Nervous twitching of the lips may be evidence of disorders in the central and peripheral nervous systems. Blue lips can occur both from cold and from heart failure.

Lip care

Lip care serves both cosmetic and hygienic purposes. For cosmetic purposes, lipstick containing pigments of varying brightness and shades is applied to the lips - usually a color close to the lips' natural pinkish-red color - to enhance their visibility on a woman's face, since lips form part of her attractiveness and are used for kissing.

To combat dry lips and painful chapping, both men and women can use hygienic balms and clear lipstick. Women's cosmetic lipstick also contains moisturizing ingredients and fats.

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Excerpt characterizing Lips

In the forest for the first mushrooms...

On the banks of the Nemunas River (Neman)

Dad was an excellent conversationalist, and I was ready to listen to him for hours if such an opportunity arose... Probably just his strict attitude towards life, the arrangement of life values, the never changing habit of not getting anything for nothing, all this created for me the impression that I must deserve it too...
I remember very well how, as a very small child, I hung on his neck when he returned home from business trips, endlessly repeating how much I loved him. And dad looked at me seriously and answered: “If you love me, you shouldn’t tell me this, but you should always show me...”
And it was these words of his that remained an unwritten law for me for the rest of my life... True, I probably wasn’t always very good at “showing”, but I always tried honestly.
And in general, for everything that I am now, I owe it to my father, who, step by step, sculpted my future “I”, never giving any concessions, despite how selflessly and sincerely he loved me. During the most difficult years of my life, my father was my “island of calm,” where I could return at any time, knowing that I was always welcome there.
Having lived a very difficult and turbulent life himself, he wanted to be sure that I could stand up for myself in any unfavorable circumstances for me and would not break down from any troubles in life.
Actually, I can say from the bottom of my heart that I was very, very lucky with my parents. If they had been a little different, who knows where I would be now, and whether I would be at all...
I also think that fate brought my parents together for a reason. Because it seemed absolutely impossible for them to meet...
My dad was born in Siberia, in the distant city of Kurgan. Siberia was not the original place of residence of my father's family. This was the decision of the then “fair” Soviet government and, as has always been accepted, was not subject to discussion...
So, my real grandparents, one fine morning, were rudely escorted from their beloved and very beautiful, huge family estate, cut off from their usual life, and put into a completely creepy, dirty and cold carriage, heading in a frightening direction - Siberia...
Everything that I will talk about further was collected by me bit by bit from the memories and letters of our relatives in France, England, as well as from the stories and memories of my relatives and friends in Russia and Lithuania.
To my great regret, I was able to do this only after my father’s death, many, many years later...
Grandfather’s sister Alexandra Obolensky (later Alexis Obolensky) and Vasily and Anna Seryogin, who voluntarily went, were also exiled with them, who followed their grandfather by their own choice, since Vasily Nikandrovich for many years was grandfather’s attorney in all his affairs and one of the most his close friends.

Alexandra (Alexis) Obolenskaya Vasily and Anna Seryogin

Probably, you had to be truly a FRIEND in order to find the strength to make such a choice and go of your own free will to where you were going, as you go only to your own death. And this “death”, unfortunately, was then called Siberia...
I have always been very sad and painful for our beautiful Siberia, so proud, but so mercilessly trampled by the Bolshevik boots! ... And no words can tell how much suffering, pain, lives and tears this proud, but tormented land has absorbed... Is it because it was once the heart of our ancestral home that the “far-sighted revolutionaries” decided to denigrate and destroy this land, choosing it for their own devilish purposes?... After all, for many people, even many years later, Siberia still remained a “cursed” land, where someone’s father, someone’s brother, someone’s died. then a son... or maybe even someone's entire family.
My grandmother, whom I, to my great chagrin, never knew, was pregnant with my father at that time and had a very difficult time with the journey. But, of course, there was no need to wait for help from anywhere... So the young Princess Elena, instead of the quiet rustling of books in the family library or the usual sounds of the piano when she played her favorite works, this time she listened only to the ominous sound of wheels, which seemed to menacingly They were counting down the remaining hours of her life, so fragile and which had become a real nightmare... She sat on some bags by the dirty carriage window and incessantly looked at the last pathetic traces of the “civilization” that was so familiar and familiar to her, going further and further away...
Grandfather's sister, Alexandra, with the help of friends, managed to escape at one of the stops. By general agreement, she was supposed to get (if she was lucky) to France, where her entire family was currently living. True, none of those present had any idea how she could do this, but since this was their only, albeit small, but certainly last hope, giving it up was too great a luxury for their completely hopeless situation. Alexandra’s husband, Dmitry, was also in France at that moment, with the help of whom they hoped, from there, to try to help her grandfather’s family get out of the nightmare into which life had so mercilessly thrown them, at the vile hands of brutal people...
Upon arrival in Kurgan, they were placed in a cold basement, without explaining anything and without answering any questions. Two days later, some people came for my grandfather and said that they allegedly came to “escort” him to another “destination”... They took him away like a criminal, without allowing him to take any things with him, and without deigning to explain, where and for how long he is being taken. No one ever saw grandfather again. After some time, an unknown military man brought his grandfather’s personal belongings to the grandmother in a dirty coal sack... without explaining anything and leaving no hope of seeing him alive. At this point, any information about my grandfather’s fate ceased, as if he had disappeared from the face of the earth without any traces or evidence...
The tormented, tormented heart of poor Princess Elena did not want to come to terms with such a terrible loss, and she literally bombarded the local staff officer with requests to clarify the circumstances of the death of her beloved Nicholas. But the “red” officers were blind and deaf to the requests of a lonely woman, as they called her, “of the nobles,” who was for them just one of thousands and thousands of nameless “license” units that meant nothing in their cold and cruel world ...It was a real inferno, from which there was no way out back into that familiar and kind world in which her home, her friends, and everything that she had been accustomed to from an early age remained, and that she loved so strongly and sincerely... And there was no one who could help or at least give the slightest hope of survival.
The Seryogins tried to maintain presence of mind for the three of them, and tried by any means to lift the mood of Princess Elena, but she went deeper and deeper into an almost complete stupor, and sometimes sat all day long in an indifferently frozen state, almost not reacting to her friends’ attempts to save her heart. and the mind from final depression. There were only two things that briefly brought her back to the real world - if someone started talking about her unborn child or if any, even the slightest, new details came about the supposed death of her beloved Nikolai. She desperately wanted to know (while she was still alive) what really happened, and where her husband was, or at least where his body was buried (or dumped).
Unfortunately, there is almost no information left about the life of these two courageous and bright people, Elena and Nicholas de Rohan-Hesse-Obolensky, but even those few lines from Elena’s two remaining letters to her daughter-in-law, Alexandra, which were somehow preserved in Alexandra's family archives in France show how deeply and tenderly the princess loved her missing husband. Only a few handwritten sheets have survived, some of the lines of which, unfortunately, cannot be deciphered at all. But even what was successful screams with deep pain about a great human misfortune, which, without experiencing, is not easy to understand and impossible to accept.

The lips are covered with thickened skin with a large number of sebaceous glands. The skin on the lips of men has hair,
women - fluff. On the lips themselves, the skin turns into a non-keratinizing epithelium, through which the venous network is visible, creating a red border. Behind the moderately pronounced subcutaneous tissue there are muscles (Fig. 33) surrounding the oral fissure and determining its position. The skin of the lips behind the red border passes into the mucous membrane of the vestibule of the mouth.

Rice. 33. Muscles of the mouth area:
1 - m. zygomaticus minor; 2 - m. levator labii superior; 3 - m. levator labii superior alaque nasi; 4 - m. orbicularis oris, pars marginalis; 5 - m. orbicularis oris, pars labialis; 6 - depressor labii inferior; 7 - m. mentalis; 8 - m. depressor anguli oris: 9 - m. zygomaticus major; 10 - ductus parotideus; 11 - m. buccinator; 12 - the coronoid process of the lower jaw is cut off. 13 - raphe pterygomandibularis; 14 - m. pterygoideus medialis; 15 - pterygoid process; 16 - m. pterygoideus lateralis; 17 - the zygomatic arch is cut off.

In the thickness of the lips there is a circular muscle of the mouth (m. orbicularis oris), which is divided into labial and marginal, or facial, parts (Charley). The first part is located within the red border, the second - in the area of ​​​​the lips lined with skin. The labial part is represented by circular muscle fibers - the sphincter, and the facial part is formed from an interweaving of circular fibers and muscle bundles that extend from the oral opening to the places of fixation on the bones of the skeleton.

When the group of circular mice contracts, it closes the mouth opening, presses the lips to the teeth, and reduces the visible part of the red border. With isolated contraction of the peripheral part of the orbicularis muscle, the lips protrude forward, the visible part of the red border increases, promoting the opening of the oral fissure. The orbicularis muscle is involved in the act of eating and producing sounds. Of the muscles that follow from the orbicularis oris muscle to the places of bone fixation, we will point out the main ones.

The muscle that lifts the upper lip (m. levator labii superior, s. caput infraorbitale m. quadratus labii superior) starts from the lower edge of the orbit and the beginning of the zygomatic process of the upper jaw, follows down and is attached to the skin of the upper lip. When contracting, raises the upper lip, except for the corner of the mouth. Gives an expression of sadness to the face, crying.

The muscle that lifts the upper lip and wing of the nose (m. levator labii superior alaeque nasi, s. caput angulare m. quadrati labii superior) starts from the lower edge of the orbit and the frontal process of the upper jaw, goes down and is attached to the skin of the upper lip. By contracting, the muscle raises the upper lip and wings of the nose.

The levator anguli oris muscle (m. levator anguli oris, s. caninus) starts from fossa canina under the for. infraorbitale of the upper jaw, follows with the previously mentioned muscles to the corner of the mouth. Contracting, it pulls the corner of the mouth obliquely to the side and... up.

The zygomatic minor muscle (m. zygomaticus minor, s. caput zygomaticus m. quadrati labii superior) starts from the buccal surface of the zygomatic bone, follows down and inward and is attached to the corner of the mouth. When contracting, it raises the corner of the mouth, making the expression of sadness, crying, and tenderness more pronounced. Artists call this group of muscles “crying muscles.”

The zygomaticus major muscle (m. zygomaticus major) starts from the buccal surface of the zygomatic bone, follows down and inward and is attached to the skin of the corner of the mouth. By contracting, the muscle pulls the corner of the mouth and the nasolabial fold upward and backward, stretching the oral fissure. Participates in the expression of laughter (m. risorius - “laughing muscle”).

The buccal muscle (m. buccinator) starts from the pterygomaxillary suture and the alveolar processes of the jaws in the area of ​​the molars along with the buccal ridge of the lower jaw and is attached to the skin of the corner of the mouth and to the muscles of the upper and lower lips with partial decussation of muscle fibers at the corner of the mouth. Contraction of the muscle leads to a transverse expansion of the oral fissure and takes part in the act of spitting or blowing air from the oral cavity (“pipe muscle”).

The muscle that lowers the lower lip (m. depressor labii inferior, s. quadratus labii inferior) starts from the lower edge of the lower jaw, outward from the mental tubercle and is attached along the entire length of the lower lip. During contractions, it pulls the lower lip down and moves the corner of the mouth outward. The visible part of the red border of the lip increases, the lip turns out and the chin-labial fold stands out. Facial expressions reflect disgust and disgust.

The depressor anguli oris muscle, or triangular muscle of the mouth (m. depressor anguli oris, s. triangularis oris), starts from the lower edge of the lower jaw outward from the mental tubercle and is attached to the corner of the mouth and adjacent areas of the upper and lower lips. It partially overlaps the previous muscle. The muscle moves the corner of the mouth and the upper parts of the nasolabial fold down and back; simultaneous muscle contraction helps close the mouth gap, and a limited one reproduces an expression of sadness and a more pronounced expression of contempt.

The subcutaneous muscle of the neck (m. platysma) lines with a thin layer almost the entire anterior region of the neck and with its bundles, extending to the face, is woven into the muscles of the corner of the mouth. By contracting, it helps to shift the latter to the side and down.

The development of oral facial muscles varies, which, together with the individual qualities of the facial skeleton, creates different shapes of the mouth. With hyperplasia of the mucous glands and submucosal tissue, a protrusion of the area of ​​the mucous membrane adjacent to the red border is formed. A double lip is created, more typical of the upper lip (labium duplex).

The branches of the facial artery pass through the thickness of the lips: the upper and lower arteries of the lips (aa. labialis superior et inferior). They are located on the border of the posterior and middle quarters of the thickness of the lips, closer to the mucous membrane, at a distance of 6-7 mm from the free edge (A. A. Bobrov) and form a ring, ensuring good blood flow. Additionally, the lips receive blood from the small branches of a. infraorbitalis and a. mentalis. Veins are areas of the same name as arteries and accompany them.

The lymphatic vessels of the lips drain lymph to the submandibular and, in addition, to the buccal, parotid, superficial and deep cervical lymph nodes. Vessels from the middle part of the lower lip carry lymph to the mental nodes. The lymphatic vessels of both sides of the lips widely anastomose with each other. Therefore, the pathological process can cause reactions in the lymph nodes of the other side, which forces the submandibular lymph nodes on both sides to be removed for cancer of the lower lip.

The skin of the lips is innervated by the upper labial nerves (branches of the infraorbital), lower labial (branches of the mental) and in the area of ​​the corners of the mouth - branches of the buccal nerve.

The shape and size of both the mouth and lips varies. If embryonic development is abnormal, their pathological structure is observed.

The face of the embryo is formed from 5 processes or tubercles: a single frontal and paired maxillary and mandibular. These processes limit the naso-oral fossa. By the end of the second month of uterine life, the frontal process, descending, creates the nose and philtrum of the lip, fuses with the maxillary processes and forms the upper lip and upper jaw, and the lower processes, connecting, form the lower lip and lower jaw. In addition, the frontal process divides into nasal processes and forms the nostrils and the middle part of the upper jaw or premaxillary fossa. Between the mentioned processes there are clefts: median, transverse and oblique clefts of the face and lateral clefts of the upper lip. Schematic drawings give an idea of ​​what has been said (Fig. 34).

Rice. 34. Scheme of the formation of the human face, embryo (I) and hard palate according to Stones (II).
1.1 - frontal process; 2 - maxillary process; 3 - mandibular process; 4 - naso-oral fossa: 5 - median facial cleft; 6 - transverse cleft face; 7 - oblique facial cleft; 8 - peephole; 9 - external nasal process; 10 - internal nasal process; 11 - primary nasal opening. II 1 - nasal septum; 2 - palatal plates; 3 - language. A - palatal plates stand vertically on the sides of the tongue; B - palatal plates have taken a horizontal position; B - palatal plates are fused together.

In cases where the processes do not fully or partially fuse with each other, congenital deformity occurs - cleft lip, face and palate. When tissues are not fused only in certain layers, they speak of hidden clefts. The most common non-union of the external and internal nasal processes is the preservation of the lateral cleft lip (“cleft lip”). The defect corresponds to the position of the 2nd incisor; it can be bilateral or unilateral, most often on the left. The gap is distinguished between partial, which does not penetrate into the nasal cavity, and complete, which opens into this cavity. Among other rare malformations of the lip, we will also point out the following: 1) congenital underdevelopment (shortening) of the middle part of the upper lip - brachycheilia; 2) significant fusion of the lateral parts of the lips, reducing the oral gap - microstoma; 3) absence of lips - acheilia; 4) absence of an oral fissure - atresia.

Failure of fusion of the maxillary and mandibular tubercles leads to the formation of a pathological, large mouth - macrostomia. The transverse cleft can extend to the temporal region, often reaching the masticatory muscle, leading to drooling.

Failure of fusion of the maxillary and frontal processes leads to the persistence of an oblique facial cleft - coloboma. The gap passes through the upper lip, cheek and lower eyelid.

The median facial cleft corresponds to the midline of the body and can be on the upper and lower lip, it can extend to the upper jaw.

LIPS mouth (labia oris; Greek, chelos). The upper g. (labium sup.) and the lower g. (labium inf.) in the area of ​​the corners of the mouth (angulus oris), connecting by adhesions (commissura labiorum), form the oral fissure (rima oris). The upper g. is limited by the base of the nose, the oral fissure and the nasolabial grooves (sulcus nasolabialis), the lower g. is limited by the oral fissure and the labiomental groove (sulcus mentolabialis).

During ontogenesis, glands are formed from the jaw processes. The lower g. is formed at the end of the first month of uterine development as a result of the fusion of the mandibular processes, the upper - at the end of the second month with the fusion of the right and left maxillary processes with the median nasal process (see Face). Musculature in G. is found only in mammals. In humans, bundles of facial muscles are embedded in the thickness of the G., thanks to which the Crimea G. have great mobility and participate not only in the act of grasping and processing food, but also in the act of speech and facial expressions.

Anatomy

The shape and size of the mouth depend on the individual characteristics of the orbicularis oris muscle, the position or absence of the frontal teeth (see Bite), etc. In this regard, a distinction is made between protruded teeth (procheilia) and straight teeth (orthocheilia), sunken teeth (opistocheilia), which are usually observed in old and senile age with the loss of front teeth. Normally, the upper g. will stand somewhat in relation to the lower one. On the upper g., a groove (philtrum) runs in the vertical direction, dividing it into three parts: the middle and two lateral ones. In the area of ​​the red border, the groove ends with a labial tubercle (tuberculum labii sup.). The dimensions of the labial tubercle vary significantly. The line that defines the border of the skin and the red border of the upper thigh is called Cupid's arc.

G. consist of skin, subcutaneous tissue, muscle layer, and mucous membrane. G.'s skin is thin, contains hair follicles and a large number of sebaceous glands. Near the oral fissure, the skin passes into the red border, or intermediate part (pars intermedia), where the structure of the skin changes, approaching the structure of the oral mucosa. In the red border, outer and inner zones are distinguished, especially sharply demarcated in newborns, in whom the inner zone is covered with papillae; During the first weeks of life, the papillae of the red border smooth out and become less noticeable. The epithelium covering the red border has a thin stratum corneum. In this part of the gland there are no hair follicles and sweat glands, but there are sebaceous glands, which are mainly concentrated in the area of ​​the corners of the mouth, and there are more of them on the upper gland than on the lower one. The red border gradually passes into the mucous membrane of G.

The mucous membrane of G., covered with stratified squamous non-keratinizing epithelium, has a pronounced submucosal layer where small salivary glands (glandulae labiales) are located. The mucous membrane of the mouth passes into the mucous membrane of the cheeks and gums, forming folds along the midline of the vestibule of the oral cavity - the frenulum of the upper and lower tongue (Fig. 1). The muscle layer is formed by the circular muscle of the mouth (m. orbicularis oris), into which fibers of some other facial muscles are woven.

Blood supply G. occurs mainly from the facial artery, the edges at the level of the corners of the mouth are divided into the upper and lower labial arteries (a. labialis sup. et inf.). According to Yu. L. Zolotko, the blood supply to the upper G. from the facial artery occurs in 97.3% of cases, from the artery arising from the transverse artery of the face - in 1.8%, and from both at the same time - in 0.9%. The blood supply to the lower gland is carried out from the facial artery in 95.5% of cases, from the median artery of the chin - in 0.8%, and from both - in 3.6%. Typically, the arteries of the right and left sides merge along the midline and form a continuous ring. However, V. M. Kalinichenko (1970) found that in some cases the blood supply to the blood supply can be one-sided: to the lower blood supply in 19.6% of cases, to the upper blood supply in 16.1%; in this case, on one side the labial artery is absent or extends only to the corner of the mouth of the corresponding side.

The veins form a dense network and flow into the hl. arr. into the facial vein. M.A. Sreseli (1957) distinguishes two forms in the structure of the venous network of G.: with the first, a dense network of veins is observed with many anastomoses around the oral opening, spreading in depth; with the second, two veins of the upper and two veins of the lower vein are clearly visible, connected to each other by anastomoses.

Lymph vessels flow into the buccal, parotid, submandibular and cervical lymph nodes and into the deep cervical lymph nodes near the internal jugular vein (v. jugularis inf.). In addition, from the lower G. the outflow of lymph occurs into the submental lymph nodes.

Sensitive innervation the upper G. is carried out by the second branch, and the lower G. by the third branch of the trigeminal nerve; sympathetic nerve fibers arise from the superior cervical ganglion; motor nerve branches to the G. muscles come from the facial nerve.

Pathology

Developmental defects

A significant place in the pathology of G.’s development is occupied by congenital clefts; according to most authors, they are found in one out of 1000 newborns. The occurrence of clefts is determined by Ch. arr. genetic factors, but may also be associated with impaired intrauterine development under the influence of endogenous and exogenous factors (complicated heredity, malnutrition, mental and physical trauma and illness of the mother at the beginning of pregnancy, etc.). Isolated cases of impaired fusion of the mandibular processes have been described, in which a median cleft occurs, as well as congenital fistulas of the lower gland in the form of blind canals of varying depths, lined with epithelium. Often there is a violation of the fusion of the maxillary and median nasal processes, which leads to the development of a congenital cleft of the upper nasal cavity (the so-called cleft lip). The shapes of the clefts are different - from a small notch at the red border to complete communication of the G. cleft with the opening of the nose. Sometimes the tissue cleft may be limited to only the muscle layer, which is called a hidden cleft; in this case, at the site of separation of the muscle layer, a sinking furrow of the skin or mucous membrane is visible. Clefts of the upper thigh can be one-sided or two-sided; in approximately 50% of cases they are combined with a cleft of the alveolar process and palate and are accompanied by deformation of the nose. A through bilateral cleft, as it were, separates the middle part of the upper nose along with the premaxillary bone, the edges stand forward, remaining connected to the vomer and the nasal septum. With a complete cleft of the upper gland, the child’s act of sucking becomes difficult, and in some cases impossible, breathing becomes shallow and frequent, and pneumonia often occurs as a complication.

Acheilia(absence of lips) is rare with congenital atresia of the oral opening. Sometimes syncheilia is observed - fusion of the lateral parts of the mouth, leading to a decrease in the oral gap, as well as brachycheilia - a short middle part of the upper tongue.

Hypertrophy of the mucous glands and submucosal tissue manifests itself in the form of the so-called. double lips (labium duplex) - folds of the mucous membrane of G., the edges are especially visible when smiling.

Thickening and shortening are common bridles upper G.

Damage

Damage occurs as a result of falls, blows, bites, and gunshot wounds to the face. Wounds can be cut, torn, bruised, with or without tissue defects; by length - superficial, deep, through. Damage is accompanied by the rapid development of G.'s edema or significant bleeding. A feature of the wounds is the strong gaping of the wound, which creates the impression of a larger size than in reality, especially on the upper chin. Damage to the lower chin with a tissue defect leads to the leakage of saliva, which irritates and macerates the skin of the chin, making it difficult to eat.

Gunshot wounds of G. are usually not isolated: according to materials from the Great Patriotic War, isolated wounds of the lips accounted for 4% of facial wounds.

Diseases

The skin of the lips is often affected by eczema, characterized by a rash of blisters, weeping and chronic, recurrent course (see Eczema). In men, chronic inflammation of the hair follicles is more often observed (see Sycosis). The skin and mucous membrane of G. can be affected by herpes (see), lichen planus (see Lichen planus), lupus erythematosus (see), etc. Lesions of the mucous membrane of G. (without skin lesions) are observed with stomatitis (see .), sometimes with candidiasis (see); some forms of inflammation of the red border of G. are identified under the name cheilitis (see).

Boils and carbuncles are difficult, especially when localized on the upper lip. M. A. Sreseli established that venous thrombosis, observed with purulent inflammation in the area of ​​the upper G., sometimes spreads first along the facial vein, and then along the angular and superior ophthalmic veins, followed by a transition to the cavernous sinus; More often, thrombosis can spread through the venous anastomosis to the pterygoid plexus, then through the vein of the foramen ovale to the cavernous sinus. When purulent inflammation is localized on the lower lip, venous thrombosis can spread through the venous anastomoses of the face, the pterygoid plexus and the vein of the foramen ovale, less often - along the external jugular vein with subsequent transition to the sinuses of the dura mater.

For cutaneous form anthrax G.'s lesion resembles a banal boil or carbuncle, but the lesion is painless against the background of a sharp deterioration in the general condition and a rapid increase in intoxication of the body; When examining the discharge from the lesion, anthrax bacteria are detected (treatment - see Anthrax).

Tuberculous lesions of G. most often manifest themselves in the form of lupus (see Tuberculosis of the skin).

G.'s defeat during syphilis can occur in the primary period - the appearance of hard chancre on the lip, in the secondary - the appearance of papules, in the tertiary period - gumma may appear in the tissues of G.; characterized by painlessness (see Syphilis).

Tumors

Benign tumors include papilloma, keratoacanthoma, mixed tumors from the minor salivary glands, tumor-like vascular neoplasms - hemangioma and lymphangioma (usually found in early childhood), retention cyst. The most common malignant tumor of G. is cancer; angiosarcoma, neurogenic sarcoma, melanoma, etc. are observed extremely rarely. Cancer of the lower gland often develops against the background of long-existing pretumor changes - dyskeratosis, less often papillomas, keratoacanthoma. Dyskeratosis can be diffuse and focal: with diffuse, loss of shine, dryness, roughness, and peeling of the red border are observed; focal dyskeratosis is manifested by areas of leukoplakia (see) or hyperkeratosis (see) in the form of a flat or spiky horny protrusion. Erosion, ulcers, and slit-like fissures, characteristic of the malignant form of dyskeratosis, may be observed (see). The transition of dyskeratosis into cancer cannot always be detected clinically; if suspected, a histol examination should be performed (see Biopsy).

Papilloma- a clearly demarcated papillary formation on the red border or on the mucous membrane of the lip. The tumor is often single, less often in the form of several formations, usually small in size (up to 0.5-1 cm in diameter), pedunculated or broad based; acts as an exophyte above the surface of the red border or mucous membrane (color. Fig. 2). Its color is pink, its consistency is soft, covered with normal, sometimes slightly thinned epithelium (see Papilloma, papillomatosis). The appearance of ulceration, bleeding or infiltration of the base of the papilloma are signs that raise suspicion of the onset of cancer.

Keratoacanthoma occurs more often on the red border of the lower G. in the form of a towering spherical tumor measuring 1-2 units in diameter (tsvetn. Fig. 3 and 4). The center of the tumor is crater-shaped, filled with horny masses, its edge is raised in the form of a clearly defined ridge. The tumor grows quite quickly in the first 3-4 weeks, then its growth stabilizes, and in some cases after 6-8 months. the tumor may disappear spontaneously, with the horny crust in the center falling off, the tumor flattening and a scar forming. Relapses are observed in 4-5% of cases (see Keratoacanthoma). The development of cancer from keratoacanthomas occurs in 20% of cases. Differential diagnosis with squamous cell carcinoma (clinically and even morphologically) is often difficult.

Mixed tumors from minor salivary glands on G. are observed extremely rarely. They are usually localized on the inner surface of the gland, covered with unchanged mucous membrane, clearly demarcated (tsvetn. Fig. 5). Their consistency is dense, the surface is smooth. These tumors rarely reach large sizes and grow slowly; according to gistol, the structure does not differ from similar tumors of the major salivary glands (see Mixed tumors).

Hemangioma, simple or cavernous, has the appearance of a node or a diffuse bluish-reddish tumor-like formation, causing G.’s deformation (tsvetn. Fig. 7). Its consistency is usually soft, and when squeezed it decreases in size. The mucous membrane over the hemangioma is thinned, and sometimes there may be bleeding. Hemangioma grows slowly, but often spreads to adjacent areas of the face or oral cavity (see Hemangioma).

Lymphangioma manifests itself similarly (tsvetn. Fig. 6), but the red border or mucous membrane has a normal color, giving the impression of swelling of the lip (see Lymphangioma).

Retention cyst of the mucous gland quite often occurs on the inner surface of the lips, closer to the corner of the mouth (print. Fig. 8); has the appearance of a spherical bulge up to 0.5-1 cm in diameter. The mucous membrane over the cyst is thinned, translucent, less often whitish in the center. Upon palpation in the thickness of the G., a clearly demarcated node of soft-elastic consistency is determined. A retention cyst occurs due to retention of secretions or obstruction of the duct of the mucous gland and contains a light mucous fluid (see Cyst).

Cancer in 90-95% of observations it is localized on the red border of the lower G. In the upper G., cancer most often comes from the skin, spreading to the red border secondarily. Most patients with lower leg cancer are men aged 40-60 years. Predisposing factors - chronic, mechanical, thermal and chemical. irritations, particularly smoking.

G.'s cancer is more often squamous cell keratinizing (80-95% of all cases), less often squamous cell non-keratinizing and extremely rarely - undifferentiated.

According to the wedge, the picture distinguishes papillary and ulcerative forms of cancer. The initial period of the papillary form is characterized by the appearance of a painless round-shaped compaction with fuzzy contours, covered with a crust; upon removal, a pink, easily bleeding area is revealed. As the process develops, a roller-like edge of the tumor becomes noticeable, and then an ulcer with uneven roller-like edges, with a necrotic bottom in the center, forms. In the ulcerative form, a fissure that does not heal for a long time is first discovered, turning into an ulcer with roller-like edges and infiltration in the underlying tissues; infiltration and destruction proceed faster than in the papillary form; the process involves not only the submucosal but also the muscular layer of the gland. In a later period, the differences in the manifestation of the papillary and ulcerative forms are erased, the ulcerative-infiltrative process predominates with the formation of an increasingly extensive defect of the gland (color fig. 9). Cancer of the lower gland is characterized by lymphogenous metastasis with damage to the submandibular and submental lymph nodes, and subsequently to the deep cervical lymph nodes. Distant metastases are rare.

It is customary to distinguish four stages of G cancer. Stage I is a limited tumor or ulcer with a diameter of 1-1.5 cm in the thickness of the mucous membrane and red border, without metastases. Stage II: a) tumor or ulcer with a diameter of more than 1.5 cm, limited to the mucous membrane and under the mucous layer, occupying no more than half of the lower g., without metastases; b) a tumor or ulcer of the same or smaller size, but in the presence of one or two mobile metastases in the regional lymph. nodes. Stage III: a) a tumor or ulcer that occupies most of the gastrointestinal tract with germination of its thickness or spread to the corner of the mouth, cheek and soft tissue of the chin; b) a tumor or ulcer of the same size or less widespread, but with the presence of limitedly mobile regional metastases. Stage IV - a disintegrating tumor that occupies most of the tumor with germination of its entire thickness and spread to the jaw bone, or a tumor with fixed metastases in the regional lymph. nodes, or a tumor of any size with distant metastases.

Treatment

For purulent processes on the gland (furuncle, carbuncle), treatment is mainly conservative; you should not squeeze out the so-called. rods. Good results are obtained by using local novocaine blockade with antibiotics with simultaneous intramuscular administration of broad-spectrum antibiotics. In the first stage of inflammation, during the period of infiltration, radiotherapy at 120 kV, a 1-3 mm Al filter, a field that covers normal tissues surrounding the infiltrate by 1-1.5 cm, with a single dose of 15-25 r daily or every other day up to a total dose of 75-125 r. Under the influence of radiation, the infiltrate disappears, surgical intervention is not required. Surgical treatment is indicated for a formed abscess (see Carbuncle, Furuncle).

Treatment of malignant tumors can be divided into treatment of the primary tumor and regional metastases.

To treat the primary tumor, radiation therapy or a combined method is used (in the first stage - radiation therapy, in the second - wide excision with primary plastic surgery). Treatment of regional metastases is carried out mainly by surgery.

Radiation therapy for cancer of G. is carried out using the methods of interstitial gamma therapy (see), close-focus radiotherapy (see), electronic therapy (see), less often - application gamma therapy.

For the treatment of patients with stage I - II cancer, close-focus radiotherapy and interstitial gamma therapy are indicated. At stage III, interstitial gamma therapy and electron therapy have an advantage. For stage IV G. cancer, combined radiation therapy is indicated: remote gamma therapy or electron therapy, followed by the use of close-focus radiotherapy or interstitial gamma therapy. When the mucous membrane and skin of the mouth are affected, when the tumor is localized in the corners of the mouth, as well as when cancer recurs, the interstitial method has an advantage.

A contraindication for radiation therapy is the presence of a concomitant inflammatory process, upon elimination of which radiation therapy can be carried out. A contraindication for interstitial gamma therapy and close-focus radiotherapy is also the spread of the tumor to bone tissue and the inability to determine its boundaries, and in case of relapses, significant radiation changes in the surrounding normal tissues.

For close-focus radiotherapy, a single dose is 400-500 rad, the total dose to the lesion is 6000-6500 rad; irradiation field no more than 25 cm 2 .

In the interstitial method, needles with 226 Ra, 60 Co are used; The most convenient are nylon threads with 60 Co granules. Radioactive drugs are administered after local anesthesia with 0.25% novocaine solution. Irradiation is continuous for 6-7 days. The total focal dose is 5000-7000 rad at a dose rate of 30-40 rad/hour.

For electronic therapy, Betatron type devices with radiation energy of 8-15 MeV are used. Single dose 400 rad, total dose 5000-7000 rad, if; used as the only method. When combined with the interstitial method, the dose from electronic therapy is reduced.

The application method using 60Co preparations allows for fractional treatment with a daily dose of 500-600 rads and a total dose of 5000-6500 rads.

During radiation therapy, protection of the alveolar part of the lower jaw is required; the edges are provided with plexiglass or methyl methacrylate gaskets between the jaw and the jaw bone.

In stage I cancer of the lower cervix, a permanent cure is achieved in 95-96% of cases; Regional lymph nodes are not removed. Radiation therapy provides a high percentage of radical cure, better cosmetic and functional results compared to the surgical method, and fewer cases of relapses and metastases.

In stages II-IV of cancer, when the primary tumor is cured, even in the absence of enlarged lymph nodes, an upper cervical excision operation should be performed, in which not only the submandibular and submental lymph nodes, but also deep cervical lymph nodes located in the bifurcation area are removed carotid artery. In the presence of clinically significant regional metastases, preoperative external gamma or electron therapy with conventional dose fractionation and a total dose of 4000-4500 rad is indicated. The operation is performed after 2-3 weeks. after completion of radiation therapy.

Operations on G. taken to treat wounds, for purulent processes, for the treatment of tumors, etc.; A special place is occupied by operations on children and plastic surgeries.

Primary surgical treatment of wounds of G. should be performed taking into account functional and cosmetic requirements. Excision of tissue should be minimal and only tissue that is obviously non-viable and crushed. When applying layer-by-layer sutures, it is imperative to restore the continuity of the orbicularis oris muscle. The suture should be applied especially carefully to the skin and red border of the lips. In case of injury with a large defect in the tissue of the lips, when the edges of the wound cannot be sutured without tension, primary plastic surgery should be performed using tissue from areas of the face adjacent to the defect.

If the frenulum is thick and short, limiting G.’s mobility, it is excised ( frenectomy) . To avoid scar formation, it is better to make a middle incision along the frenulum and use opposing triangular flaps.

With the so-called the double lip is surgically removed; excess submucosal tissue and mucous glands and fix the mucous membrane to the G muscle.

The retention cyst is removed with suturing of the mucous membrane. A mixed tumor should be removed along with the capsule and the mucous membrane covering it. The papilloma is excised with a small area of ​​adjacent tissue. For small-sized hemangioma and lymphangioma, they are excised. With diffuse hemangioma, it can be reduced by introducing 70% alcohol into it to produce tissue sclerosis. For keratoacanthoma, they resort to either excision or close-focus radiotherapy.

Treatment of children with congenital cleft lip. Cheiloplasty

Treatment of children with congenital cleft lip is only surgical.

Cheiloplasty(surgical closure of the defect) is used to restore the anatomical integrity of the nose, create a vestibule of the oral cavity, as well as to correct deformities of the wing of the nose and the bottom of the nasal passage, and the nasal septum. The operation is performed on the first - third days after birth in specialized treatment. institutions. If the first days are missed, the operation is performed in the third month of life (the second month is unfavorable, since immunobiological restructuring of the body occurs and surgical intervention is complicated by suture dehiscence). When performing cheiloplasty, one should take into account not only the shape of the cleft, but also prevent the occurrence of nasal deformity. During early primary rhinocheiloplasty, one should avoid interventions on cartilages in the places of their growth zones; it is not recommended to peel off and isolate the nasal cartilage along the inner surface, incise, dissect or excise the internal and external legs of the alar cartilage, especially along the posterior edge, and apply a lamellar suture.

Various operations have been proposed for the treatment of children with cleft of the upper thigh; a number of them are of predominantly historical interest (operations according to Orlrvsky - Maslov, Miro, etc.). The main stages of cheiloplasty are layer-by-layer suturing of the refreshed edges of the defect, restoration of the contour of the edge of the red border, lengthening of the middle part of the lip, in case of complete clefts, in addition, restoration of the bottom of the nasal opening and correction of the shape and position of the wing of the nose.

Rice. 2. Some stages of plastic surgery according to Obukhova - Limberg for unilateral cleft of the upper lip (1-3) and bilateral cleft (4-6): 1 and 4 - forms of incisions; 2 and 5 - position of the resulting flaps after movement; 3 and 6 - sutures were applied to the displaced flaps.

The most rational methods are Obukhova-Limberg, Frolova and the modified Le Mesurier method. Using the Obukhova-Limberg method, the base of the nasal wing is created using a flip-over triangular flap, as described above, the middle part of the nose is lengthened, for which the skin is cut in the area of ​​the edge of the defect of the nose in the horizontal direction, the edges of the wound are spread to the required length of the lip and into the resulting defect a triangular flap cut in the lower part of the other side of the defect is sewn in (Fig. 2).

Le Mesurier (A.V. Le Mesurier) in 1949 proposed to cut out a quadrangular flap on the outer area of ​​​​the G. instead of a triangular flap. When planning the operation and choosing the length of the incisions, the author suggests being guided by the height of the G. of a healthy child of the same age and weight.

L. E. Frolova (1956) is limited to cutting out a triangular flap only in the lower part of the upper nose. The narrowing of the nasal opening and the formation of an oval wing of the nose is achieved by forming an apron-shaped flap from the mucous membrane with its base in the region of the edge of the pyriform opening. The possibility of significant mobilization of the mucous membrane makes it possible to create a voluminous vestibule of the oral cavity.

Plastic surgeries for tissue defects of various origins can be performed using local tissues, free skin grafts, and Filatov stem; sometimes these methods are combined. The most favorable functional and cosmetic results are obtained by operations with the movement of tissue sections taken adjacent to the defect. When performing plastic surgery on the oral cavity, you should be especially careful with the remaining muscles of the perioral area. The basic principles of gastric restoration operations using musculocutaneous flaps from the perioral area, developed in the 19th century, have not lost their practical significance. The most common operations are as follows.

Lip plastic according to Bruns - restoration of the upper lip with two quadrangular flaps cut in the area of ​​the nasolabial folds on both sides of the defect (Fig. 3, 4 and 5). The flaps are brought together over the defect area and connected with sutures placed on the skin, muscles and mucous membrane. A semblance of a red border is created by suturing the mucous membrane and skin of the flaps.

Lip plasty according to Sediyo - replacement of a total defect of the upper G. On the sides of the defect in the entire thickness of the right and left cheeks, two rectangular flaps are formed in the vertical direction with their base on the sides of the wings of the nose (Fig. 3, 1-3). The flaps are rotated upward by 90° and sutured in layers along the midline. Mucocutaneous sutures are placed along the lower edge of the flaps, thereby creating a semblance of a red border. If it is necessary to replace extensive defects of the face, combined with a defect of the adjacent part of the face, a Filatov stem is used (see Plastic surgery).

Lip plasty according to Abbey - replacement of a defect in one lip with a pedunculated flap from another lip. The operation is indicated for sunken and flattened upper lip. The upper lip is dissected through and through in the vertical direction. After spreading the edges of the wound, a through triangular defect is formed, which is replaced by a triangular flap on a pedicle, excised throughout the entire thickness of the lower G. After 10-12 days, its feeding pedicle is crossed and the upper G. is finally formed (Fig. 3, 6-9). The described methods can also be used to restore the lower hip. A number of variants of these operations have been proposed, used for both symmetrical and unilateral defects of various origins.

The immediate results of cheiloplasty in children are favorable. Partial divergence of sutures, according to G. A. Vasiliev (1964), is observed in 3-6.2% of cases; the total discrepancy does not exceed 1%. The occurrence of secondary deformations of the nose and upper nose after cheiloplasty largely depends on the underdevelopment of the edge of the pyriform opening on the side of the cleft. In order to prevent this deformation, the inferior turbinate is grafted under the base of the nasal wing or bone autoplasty is performed on the lower edge of the pyriform opening. Corrective surgeries for secondary deformities of the nose and upper nose should be performed at the age of 12-14 years. This period is justified by the ontogenetic development of the face and age-related anthropometry of the external nose.

Bibliography:

Anatomy- Burian F. Atlas of Plastic Surgery, trans. from Czech., vol. 2, p. 86, Prague - M., 1967; Zolotareva T.N. and Toporov G.N. Surgical anatomy of the head, p. 161, M., 1968; 3 o l o t k o Yu. L. Atlas of topographic human anatomy, part 1, p. 105, M., 1964; Kudrin I. S. Anatomy of the oral cavity, p. 62, M., 1968; Falin L.I. Histology and embryology of the oral cavity and teeth, M., 1963, bibliogr.

Pathology- Congenital clefts of the upper lip and palate, ed. A. I. Evdokimova et al., M., 1964; Glazunov M. F. Selected works, p. 234, L., 1971, bibliogr.; DoletskyS. Ya. and Isakov Yu. F. Pediatric surgery, p. 289, M., 1970; Kozlova A. V. Radiation therapy of malignant tumors, M., 1971; Korelenshtein R. Ya. Keratoacanthoma of the red border of the lips, Vopr, onkol., t. 17, No. 1, p. 67, 1971, bibliogr.; Mashkilleyson A. L. Precancer of the red border and oral mucosa, M., 1970, bibliogr.; Messina V. M. Primary skin grafting for trauma to the soft tissues of the face, M., 1970, bibliogr.; M i h e l s o n H. M. et al. Cosmetic operations of the face, M., 1965, bibliogr.; Naumov P.V. Primary reconstructive operations in the treatment of tumors of soft tissues of the face, M., 1973, bibliogr.; Novik I. O. Diseases of the teeth and oral mucosa in children, M., 1971, bibliogr.; Pashkov B. M. Lesions of the oral mucosa in skin and venereal diseases, M., 1963, bibliogr.; Perez le-guinI. A. and SargsyanYu. X. Clinical radiology, M., 1973; Guide to surgical dentistry, ed. A. I. Evdokimova, p. 436, 474, M., 1972; Semiotics and diagnosis of malignant tumors, ed. A. I. Serebrov and S. A. Holdina, p. 189, L., 1970; T i-t a p e in V. I. Reconstructive surgeon of congenital cleft lip and palate, Chisinau, 1965, bibliogr.; U r b a n island and h L. I. Inflammatory diseases of the red border of the lips, Kyiv, 1974; Frolova L. E. Treatment of congenital clefts of the upper lip, Tashkent, 1967.

P. V. Naumov; R. V. Mikhailova (rad.), G. V. Falileev (onc.).

Among the sounds of speech, primarily labiolabial and labiodental consonants, as well as rounded vowels).

By analogy with the lips of the mouth, anatomists call some other paired structures of the body lips, and the full names of these structures include corresponding clarifications. Thus, among the external organs of the female reproductive system, a pair of labia majora and a pair of labia minora are distinguished.

In technology, lips or sponges are longitudinal projections on the edges of some tools and devices that serve to capture and hold workpieces, just as the lips of the mouth serve to capture food. Vices, pliers, and round nose pliers are supplied with jaws.

Structure

The outer, visible surface of the lips is covered with skin, which passes into the mucous membrane of their back surface, facing the teeth - it is covered with a mucous membrane, smooth, moist and passes into the mucous membrane of the alveolar processes - into the surface of the gums.

The structure of each lip is divided into three parts: cutaneous, intermediate and mucous.

• skin part, pars cutanea, has the structure of the skin. Covered with stratified squamous keratinizing epithelium, contains sebaceous and sweat glands, as well as hair;
• intermediate part, pars intermedia, a pink area, also has skin, but the stratum corneum is preserved only in the outer zone, where it becomes thin and transparent. The junction of the skin and the mucous membrane - the red border - is replete with translucent blood vessels, which determine the red color of the edge of the lip, and contains a large number of nerve endings, making the red edge of the lip very sensitive.
• mucous part, pars mucosa, occupying the posterior surface of the lips, is covered with stratified squamous non-keratinizing epithelium. The ducts of the salivary glands open here

The thickness of the lips is formed by: predominantly the orbicularis oris muscle, loose connective tissue, skin and mucous membrane.

When the mucous membrane of the lips passes into the gums, two median vertical folds are formed, called frenulum of the upper lip And frenulum of the lower lip.

The superior and inferior labial arteries, the mental artery (aa. labiales, superior et inferior, mentalis).

Anthropological aspect

In anthropology, lips are distinguished by thickness, direction and contour of the upper lip, and the width of the oral opening. By thickness, lips are divided into thin, medium, thick, and swollen. The upper lip can protrude forward (procheilia), have a vertical profile (orthocheilia), or, less commonly, recede back (opistocheilia). The thickest (swollen) lips and procheilia are characteristic of the equatorial (Negro-Australoid) race. Caucasians are characterized by orthocheilia. The thinnest lips are found among some peoples in Northern Europe and Asia. The upper lip can have a different contour - concave, straight, convex. The latter is especially characteristic of the pygmies of Central Africa and the Semang (Malacca Peninsula). The height and profile of the upper lip, the thickness of the lips and the width of the mouth also vary depending on age and gender. With age, the thickness of the lips (after 25 years) and procheilia decrease, the height of the upper lip and the width of the mouth increase.

Physiology

Participation in meals

Participation in facial expressions

Participation in sound production

Being the last barrier on the path of air exhaled through the oral cavity, the lips participate in the formation of speech sounds and are an important part of the articulatory apparatus - the human speech organs.

Due to the great mobility of the lower jaw relative to the upper, the lower lip is one of the active organs of speech along with the tongue and soft palate. The upper lip is a passive organ of speech due to its less mobility.

Air flows through the lips when pronouncing all speech sounds, but they play the most important role when pronouncing labial consonants and rounded vowels.

Consonant sounds are formed when the flow of exhaled air overcomes an obstacle in the oral cavity. Consonants are called labial (labial) if the lips serve as a barrier.

Labial consonants

Labial consonants are divided into two categories according to which organ serves as a passive organ paired with the active lower lip. If the barrier to air is formed by the contact of the lower lip with the upper lip, then the resulting consonant sounds will be labiolabial (bilabial, bilabial), and if the lower lip touches the upper teeth, then labiodental (labiodental).

The category of bilabial consonants includes nasal sonorant [m] and noisy voiced [b] and voiceless [n] (in Russian, both hard (velar) and soft (palatal)). Labial-dental consonants are represented by noisy [v] and [f].

Rounded vowels

When pronouncing vowels, the lips can either occupy a neutral, relaxed position or be tense. For example, the English closed vowel is characterized by a tense stretching of the lips in the horizontal plane.

However, rounded (labialized) vowels include those sounds of human languages, when pronounced, the lips are rounded and extended forward to varying degrees. In many languages, labialization serves as one of the important classifying features of vowel phonemes. Such vowels are [o] with moderate labialization and [у] ([u]) with strong labialization. In the Russian language, rounded vowel sounds correspond to both the letters O and U, and the vowel components of the pronunciation of the iotated vowels of the letters E and Yu. In a number of other languages, rounded vowels are opposed to each other in terms of the degree of openness-closedness (raising the tongue to the palate): for example, in French, German and Turkish languages ​​contrast the sounds [o] and [ö], [u] and [ü].

Labialization in the stream of speech

Since in the flow of speech the organs of articulation connect adjacent sounds with each other, even non-labial consonants acquire a labial overtone in the vicinity of labialized vowels, that is, they become labialized. The result of this is indicated in international phonetic transcription by a circle under the consonant symbol.

Issues of medicine and cosmetology

The lips can be the site of a number of diseases and serve as an indicator of the condition of other body systems. Among the infectious diseases on the lips, herpes appears. When nervous, your lips may tremble. Nervous twitching of the lips may be evidence of disorders in the central and peripheral nervous systems. Blue lips can occur both from cold and from heart failure.

Lip care

Lip care serves both cosmetic and hygienic purposes. For cosmetic purposes, lipstick containing pigments of varying brightness and shades is applied to the lips - usually a color close to the lips' natural pinkish-red color - to enhance their visibility on a woman's face, since lips form part of her attractiveness and are used for kissing.

To combat dry lips and painful chapping, both men and women can use hygienic balms and clear lipstick. Women's cosmetic lipstick also contains moisturizing ingredients and fats.

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Excerpt characterizing Lips

Since the morning of that day, Natasha had not had a minute of freedom, and not once had time to think about what lay ahead of her.
In the damp, cold air, in the cramped and incomplete darkness of the swaying carriage, for the first time she vividly imagined what awaited her there, at the ball, in the illuminated halls - music, flowers, dancing, the sovereign, all the brilliant youth of St. Petersburg. What awaited her was so beautiful that she did not even believe that it would happen: it was so incongruous with the impression of cold, cramped space and darkness of the carriage. She understood everything that awaited her only when, having walked along the red cloth of the entrance, she entered the entryway, took off her fur coat and walked next to Sonya in front of her mother between the flowers along the illuminated stairs. Only then did she remember how she had to behave at the ball and tried to adopt the majestic manner that she considered necessary for a girl at the ball. But fortunately for her, she felt that her eyes were running wild: she could not see anything clearly, her pulse beat a hundred times a minute, and the blood began to pound at her heart. She could not accept the manner that would make her funny, and she walked, frozen with excitement and trying with all her might to hide it. And this was the very manner that suited her most of all. In front and behind them, talking just as quietly and also in ball gowns, guests entered. The mirrors along the stairs reflected ladies in white, blue, pink dresses, with diamonds and pearls on their open arms and necks.
Natasha looked in the mirrors and in the reflection could not distinguish herself from others. Everything was mixed into one brilliant procession. Upon entering the first hall, the uniform roar of voices, footsteps, and greetings deafened Natasha; the light and shine blinded her even more. The owner and hostess, who had already been standing at the front door for half an hour and said the same words to those entering: “charme de vous voir,” [in admiration that I see you], also greeted the Rostovs and Peronskaya.
Two girls in white dresses, with identical roses in their black hair, sat down in the same way, but the hostess involuntarily fixed her gaze longer on thin Natasha. She looked at her and smiled especially at her, in addition to her masterful smile. Looking at her, the hostess remembered, perhaps, her golden, irrevocable girlhood time, and her first ball. The owner also followed Natasha with his eyes and asked the count who was his daughter?
- Charmante! [Charming!] - he said, kissing the tips of his fingers.
Guests stood in the hall, crowding at the front door, waiting for the sovereign. The Countess placed herself in the front row of this crowd. Natasha heard and felt that several voices asked about her and looked at her. She realized that those who paid attention to her liked her, and this observation calmed her somewhat.
“There are people just like us, and there are people worse than us,” she thought.
Peronskaya named the countess the most significant people who were at the ball.
“This is the Dutch envoy, you see, gray-haired,” said Peronskaya, pointing to an old man with silver gray curly, abundant hair, surrounded by ladies, whom he made laugh for some reason.
“And here she is, the queen of St. Petersburg, Countess Bezukhaya,” she said, pointing to Helen as she entered.
- How good! Will not yield to Marya Antonovna; Look how both young and old flock to her. She is both good and smart... They say the prince... is crazy about her. But these two, although not good, are even more surrounded.
She pointed to a lady passing through the hall with a very ugly daughter.
“This is a millionaire bride,” said Peronskaya. - And here are the grooms.
“This is Bezukhova’s brother, Anatol Kuragin,” she said, pointing to the handsome cavalry guard who walked past them, looking somewhere from the height of his raised head across the ladies. - How good! is not it? They say they will marry him to this rich woman. And your sauce, Drubetskoy, is also very confusing. They say millions. “Why, it’s the French envoy himself,” she answered about Caulaincourt when the countess asked who it was. - Look like some kind of king. But still, the French are nice, very nice. No miles for society. And here she is! No, our Marya Antonovna is the best! And how simply dressed. Lovely! “And this fat one, with glasses, is a world-class pharmacist,” said Peronskaya, pointing to Bezukhov. “Put him next to your wife: he’s a fool!”
Pierre walked, waddling his fat body, parting the crowd, nodding right and left as casually and good-naturedly as if he were walking through the crowd of a bazaar. He moved through the crowd, obviously looking for someone.
Natasha looked with joy at the familiar face of Pierre, this pea jester, as Peronskaya called him, and knew that Pierre was looking for them, and especially her, in the crowd. Pierre promised her to be at the ball and introduce her to the gentlemen.
But, before reaching them, Bezukhoy stopped next to a short, very handsome brunette in a white uniform, who, standing at the window, was talking with some tall man in stars and a ribbon. Natasha immediately recognized the short young man in a white uniform: it was Bolkonsky, who seemed to her very rejuvenated, cheerful and prettier.
– Here’s another friend, Bolkonsky, do you see, mom? - Natasha said, pointing to Prince Andrei. – Remember, he spent the night with us in Otradnoye.
- Oh, do you know him? - said Peronskaya. - Hate. Il fait a present la pluie et le beau temps. [It now determines whether the weather is rainy or good. (French proverb meaning that he is successful.)] And such pride that there are no boundaries! I followed my daddy's lead. And I contacted Speransky, they are writing some projects. Look how the ladies are treated! “She’s talking to him, but he’s turned away,” she said, pointing at him. “I would have beaten him if he had treated me the way he treated these ladies.”

1. Thyroid gland

2. Parathyroid glands

Thyroid– contains 2 types of endocrine cells: follicular endocrinocytes, thyrocytes (produce thyroxine), and parafollicular endocrinocytes (produce calcitonin).

The gland is surrounded by a connecting capsule, the layers of which divide the organ into lobules. The main structural components of the parenchyma are follicles. They are separated by layers of RVST with blood and lymphatic capillaries, mast cells and lymphocytes.

Follicular endocrinocytes (thyrocytes)- glandular cells make up most of the wall of the follicles. Protein products synthesized by thyrocytes are secreted into the follicle cavity, where the formation of iodinated tyrosines and thyronines (amino acids) is completed.

Parafollicular endocrinocytes (calcitoninocytes)– in the wall of the follicles, in the interfollicular layers of connective tissue. Cells do not absorb iodine, but combine the formation of neuroamines (norepinephrine and serotonin) with the synthesis of protein hormones (calcitonin and somatostatin).

Parathyroid glands:

The functional significance of the parathyroid glands is the regulation of calcium metabolism. They produce the protein hormone parathyrin, which stimulates bone resorption by osteoclasts, increasing the level of calcium in the blood, and reduces the level of phosphorus in the blood, inhibiting its resorption in the kidneys, and reduces the excretion of calcium by the kidneys.

The gland is surrounded by a connective tissue capsule. The parenchyma is represented by trabeculae - accumulations of epithelial cells - parathyrocytes. There are main parathyrocytes and oxyphilic parathyrocytes. Chief cells secrete parathyrin.

The secretory activity of the parathyroid glands is not influenced by pituitary hormones. The parathyroid gland, using a feedback principle, quickly responds to the slightest fluctuations in the level of calcium in the blood. Its activity is enhanced by hypocalcemia and weakened by hypercalcemia. Parathyrocytes have receptors that can directly perceive the direct effects of calcium ions on them.

Adrenal glands:

The outside of the adrenal glands is covered with a connective tissue capsule. In the adrenal cortex, a complex of steroid hormones is formed that regulate the metabolism of carbohydrates, the composition of ions in the internal environment of the body and sexual functions - glucocorticoids, mineralocorticoids, sex hormones. The function of the cortex, except for the zona glomerulosa, is controlled by adrenocorticotropic hormone of the pituitary gland (ACTH) and kidney hormones - the renin-angiotensin system. The medulla produces catecholamines, which affect heart rate, smooth muscle contraction, and the metabolism of carbohydrates and lipids.

TO adenohypophysis-dependent endocrine glands and structures include the thyroid gland (follicular endocrinocytes - thyrocytes), adrenal glands (fascicular and reticular zones of the cortex) and gonads, the activity of which is regulated by hormones of the adenohypophysis.

TO adenohypophysis-independent endocrine glands and structures include the parathyroid glands, calcitoninocytes of the thyroid gland, zona glomerulosa cortex and adrenal medulla, endocrinocytes of the pancreatic islets, single hormone-producing cells.

№ 24 Morpho-functional characteristics of the endocrine glands. Central and peripheral parts of the endocrine system. Neuroendocrine sections of the hypothalamus: structure of neurosecretory cells, functional significance. Connection of the pituitary gland with the adeno- and neurohypophysis.

The endocrine system is a collection of structures: organs, parts of organs, individual cells that secrete hormones into the blood and lymph. The endocrine system includes specialized endocrine glands, or endocrine glands, devoid of excretory ducts, but abundantly supplied with microvasculature, into which the secretion products of these glands are released.

Distinguish central and peripheral sections:

I. Central regulatory formations of the endocrine system

1. Hypothalamus (neurosecretory nuclei)

2. Pituitary gland (adenohypophysis and neurohypophysis)

3. Epiphysis

II. Peripheral endocrine glands

1. Thyroid gland

2. Parathyroid glands

3. Adrenal glands (cortex and medulla)

The hypothalamus is the highest nerve center for the regulation of endocrine functions. It controls the visceral functions of the body and combines endocrine regulatory mechanisms with nervous ones, being the brain center of the sympathetic and parasympathetic divisions of the autonomic nervous system. The substrate for the unification of the nervous and endocrine systems is neurosecretory cells, which are located in the neurosecretory nuclei of the hypothalamus.

In the hypothalamic-adenopituitary system, adenohypophysiotropic neurohormones - liberins and statins - accumulate, which then enter the portal system of the pituitary gland. In the hypothalamic-neurohypophyseal system, the neurohemal organ is the neurohypophysis (posterior pituitary gland), where vasopressin and oxytocin accumulate, released into the blood.

Secretory neurons are located in the nuclei of the gray matter of the hypothalamus.

In the anterior hypothalamus there are paired supraoptic and paraventricular nuclei, which are formed by large cholinergic neurosecretory cells. In the nuclei of the middle hypothalamus, adrenergic neurosecretory cells produce adenohypophysiotropic neurohormones, with the help of which the hypothalamus controls the hormone-forming activity of the adenohypophysis. These neurohormones are divided into liberins, which stimulate the release and production of hormones from the anterior and middle lobes of the pituitary gland, and statins, which inhibit the functions of the adenohypophysis.

The pituitary gland consists of adenohypophysis(anterior lobe) and neurohypophysis(posterior lobe).

Neurohypophysis: hormones are not synthesized: here only neurohormones formed in the hypothalamus, ADH and oxytocin enter the blood.

Three components. There are no secretory cells in the posterior lobe of the pituitary gland.

There are three components.

Pituycytes are small glial cells that have numerous processes that form a stroma.

Blood vessels are numerous, capillaries predominate among them.

The axons of the nerve cells of the hypothalamus form numerous bundles and end in storage bodies.

Adenohypophysis:

Hormones:Gonadotropic hormones(stimulate the gonads): follicle-stimulating hormone (FSH), luteinizing hormone (LH), or lutropin, lactotropic hormone (LTH), prolactin, or luteotropic hormone.

Action: FSH stimulates the growth of follicles in the ovaries, and the growth of seminiferous tubules and spermatogenesis in the testes.

LH stimulates the final maturation of the follicle and the secretion of estrogen in the ovaries, and the secretion of testosterone in the testes.

LTG stimulates the production of progesterone by the corpus luteum of the ovary and the secretory activity of the mammary glands.

Hormones: Hormones that stimulate other (non-reproductive) glands: thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH).

Action: TSH stimulates the formation and secretion of thyroid hormones (thyroxine, etc.).

ACTH stimulates the formation of hormones in the adrenal cortex.

№ 25 Stomach. Sources of development. Features of the structure of various departments. Endocrine functions of the stomach (cells of the diffuse endocrine system).

The stomach performs a number of important functions in the body. The main one is secretory. It involves the production of gastric juice by the glands. It contains the enzymes pepsin, renin, lipase, as well as hydrochloric acid and mucus. Pepsin is the main enzyme of gastric juice, with the help of which the process of protein digestion begins in the stomach. Mucus, covering the surface of the gastric mucosa, protects it from the action of hydrochloric acid and from damage by rough lumps of food. Carrying out chemical processing of food, the stomach at the same time performs some other important functions for the body. The mechanical function of the stomach is to mix food with gastric juice and push processed food into the duodenum.

Absorption of substances such as water, alcohol, salts, and sugar occurs through the wall of the stomach.

The endocrine function of the stomach is to produce a number of biologically active substances - gastrin, histamine, serotonin. These substances have a stimulating or inhibitory effect on the motility and secretory activity of glandular cells of the stomach and other parts of the digestive tract.

Development. The stomach appears in the 4th week of intrauterine development. The single-layer prismatic epithelium of the stomach develops from the endoderm of the intestinal tube. The glands are located at the bottom of the gastric pits. Parietal cells appear in them, then chief and mucous cells. 6-7th week - first the annular layer of the muscular layer is formed from the mesenchyme, then the muscular plate of the mucous membrane.

Structure. The wall of the stomach consists of the mucous membrane, submucosa, muscular and serous membranes.

The relief of the inner surface of the stomach is characterized by the presence of three types of formations - longitudinal gastric folds, gastric fields and gastric dimples. Gastric folds are formed by the mucous membrane and submucosa. The gastric fields are areas of the mucous membrane delimited from each other by grooves. Gastric dimples are depressions of the epithelium in the lamina propria of the mucous membrane.

Mucous membrane The stomach consists of three layers - the epithelium, the lamina propria and the muscular lamina. The epithelium is single-layer prismatic glandular. All surface epithelial cells of the stomach constantly secrete mucoid secretion.

The lamina propria of the mucous membrane contains the gastric glands, between which there are thin layers of RVSt. It contains accumulations of lymphoid elements.

The muscular plate of the mucous membrane consists of three layers formed by smooth muscle tissue: internal and external circular and middle - longitudinal.

Stomach glands: There are three types of gastric glands: the gastric glands are simple, unbranched tubular, the pyloric and cardiac glands are simple tubular.

Submucosa: consists of loose fibrous unformed connective tissue containing a large number of elastic fibers. It contains the arterial and venous plexuses, a network of lymphatic vessels and the submucosal nerve plexus.

Muscular membrane: There are three layers formed by smooth muscle cells. External - longitudinal. The middle one is circular. Internal - bundles of smooth muscle cells,

Serosa forms the outer part of its wall.

Vascularization. Arteries, feeding the wall of the stomach, pass through the serous and muscular membranes, giving off branches, then pass into the plexus in the submucosa. Branches from this plexus penetrate through the muscular plate of the mucous membrane into its own plate and form a second plexus there. Small arteries extend from this plexus and continue into blood capillaries. , entwining glands and providing nutrition to the epithelium of the stomach. From the blood capillaries lying in the mucous membrane, blood collects in small veins . Large postcapillary veins pass under the epithelium. The veins of the mucous membrane form a plexus located in the lamina propria near the arterial plexus. The second venous plexus is located in the submucosa.

The lymphatic network of the stomach originates from lymphatic capillaries, the ends of which are located under the epithelium of the gastric pits and glands in the lamina propria of the mucous membrane. This network communicates with the network of lymphatic vessels located in the submucosa. Separate vessels depart from the lymphatic network and penetrate the muscular layer. Lymphatic vessels flow into them from the plexuses lying between the muscular layers.

Innervation. The stomach has two sources of efferent innervation: parasympathetic (from the vagus nerve) and sympathetic (from the sympathetic trunk). There are three nerve plexuses in the wall of the stomach: intermuscular, submucosal and subserous. Stimulation of the vagus nerve leads to accelerated contractions of the stomach and increased secretion of gastric juice by the glands. Excitation of the sympathetic nerves, on the contrary, causes a slowdown in the contractile activity of the stomach and a weakening of gastric secretion.

№ 26 Hematopoiesis. The concept of stem and semi-stem cells, differons, features of embryonic and post-embryonic hematopoiesis. The structure of red bone marrow. Characteristics of postembryonic hematopoiesis in the red bone marrow. Interaction of stromal and hematopoietic elements.

Hematopoiesis (hematopoiesis

Red bone marrow is the hematopoietic part of the bone marrow. It contains hematopoietic stem cells (HSCs) and differons of hematopoietic cells of the erythroid, granulocyte and megakaryocytic series, as well as the precursors of B and T lymphocytes. The bone marrow stroma is reticular tissue that forms a microenvironment for hematopoietic cells. Currently, elements of the microenvironment also include osteogenic, adipose, adventitial, endothelial cells and macrophages.

Postembryonic hematopoiesis. In the postembryonic period, the formation of various blood elements is concentrated mainly in the red bone marrow, spleen and lymph nodes. For the formation of blood cells, folic acid and vitamin B 12 are necessary. The differentiation of hematopoietic cells, as well as their balance, is controlled by so-called transcription factors, or hematopoietins.

Red blood cells, granulocytes and platelets develop in the red bone marrow in adults. From birth to puberty, the number of hematopoietic foci in the bone marrow decreases, although the bone marrow fully retains its hematopoietic potential. Almost half of the bone marrow turns into yellow bone marrow, which is made up of fat cells. Yellow bone marrow can restore its activity if it is necessary to enhance hematopoiesis (for example, in case of severe bleeding). The active areas of the bone marrow (called red bone marrow) produce mainly red blood cells.

Stem cells. The red bone marrow contains so-called stem cells - the precursors of all the formed elements of blood, which (normally) enter the bloodstream from the bone marrow already fully mature.

Stromal reticular and hematopoietic elements. Myeloid and all types of lymphoid tissue are characterized by the presence stromal reticular and hematopoietic elements, forming a single functional whole.

The thymus has a complex stroma, represented by both connective tissue and reticuloepithelial cells. Epithelial cells secrete special substances - thymosins, which influence the differentiation of T-lymphocytes from HSCs. In the lymph nodes and spleen, specialized reticular cells create the microenvironment necessary for the proliferation and differentiation of T and B lymphocytes and plasma cells in special T- and B-zones. HSCs are pluripotent precursors of all blood cells

№ 27 Hematopoietic organs. Spleen. Structure and functional significance. Features of blood supply, embryonic and postembryonic hematopoiesis in the spleen. T- and B-zones.

To the central authorities

Spleen- an important hematopoietic (lymphopoietic) and protective organ, taking part both in the elimination of aging or damaged red blood cells and platelets, and in organizing protective reactions against antigens that have entered the bloodstream, as well as in the deposition of blood.

In the spleen, antigen-dependent proliferation and differentiation of T and B lymphocytes and the formation of antibodies occur, as well as the production of substances that inhibit erythropoiesis in the red bone marrow.

Structure. The human spleen is covered with connective tissue capsule And peritoneum. The thickest capsule in gate the spleen, through which blood and lymphatic vessels pass. The capsule consists of dense fibrous connective tissue containing fibroblasts and numerous collagen and elastic fibers. Between the fibers lies a small number of smooth muscle cells.

They extend inside the capsule trabeculae of the spleen, which in the deep parts of the organ anastomose with each other. In the trabeculae of the human spleen there is little smooth muscle cells. Elastic fibers in the trabeculae are more numerous than in the capsule.

In the spleen there are white pulp And red pulp. The splenic pulp is based on reticular tissue, which forms its stroma.

The stroma of the organ is represented by reticular cells and reticular fibers containing collagen types III and IV.

Vascularization. Enters the gate of the spleen splenic artery, which branches into trabecular arteries. Pulp arteries arise from the trabecular arteries. Not far from the trabeculae, periarterial arteries appear in the adventitia of the pulp arteries. lymphatic vaginas And lymph nodes.

The central artery passing through the nodule gives off several hemocapillaries and branches into several brush arterioles. The distal end of this arteriole continues into ellipsoidal (sleeve) arteriole. Short ones follow. arterial hemocapillaries. Most of the capillaries of the red pulp flow into venous sinuses(closed circulation), but some can open directly into the reticular tissue (open circulation). Closed circulation is a way of rapid circulation and oxygenation of tissues. Open blood circulation is slower, ensuring contact of blood cells with macrophages.

The outflow of venous blood from the pulp of the spleen occurs through the venous system.

Hematopoiesis (hematopoiesis) - the process of formation, development and maturation of blood cells - leukocytes, erythrocytes, platelets. Hematopoiesis is carried out by hematopoietic organs. There are embryonic (intrauterine) hematopoiesis, which begins at very early stages of embryonic development and leads to the formation of blood as tissue, and postembryonic hematopoiesis, which can be considered as a process of physiological renewal of blood. In the adult body, massive death of blood cells continuously occurs, but dead cells are replaced by new ones, so that the total number of blood cells is maintained with great constancy.

Features of hematopoiesis. The universal hematopoietic organ in the first half of embryonic life is spleen. All blood cells develop in it. As the fetus grows, the formation of red blood cells in the spleen and liver fades, and this process moves to Bone marrow, which is first formed at the end of the 2nd month of embryonic life in the clavicles, and later in all other bones.

T- AndB-zones. In the lymph node one can distinguish peripheral, denser cortex, consisting of lymphatic nodules, paracorticalmedulla, educated brain cords And sinuses.

№ 28 Hematopoietic organs. The structure and functional significance of lymph nodes and lymphoid nodules of the mucous membranes of various organs. Participation of lymphoid organs in the proliferation, differentiation and maturation of T- and B-lymphocytes.

To the central authorities hematopoiesis in humans includes red bone marrow and thymus. Red bone marrow produces red blood cells, platelets (platelets), granulocytes and lymphocyte precursors. The thymus is the central organ of lymphopoiesis.

In peripheral hematopoietic organs(spleen, lymph nodes, hemolymphatic nodes) T- and B-lymphocytes brought here from the central organs multiply and specialize under the influence of antigens into effector cells that carry out immune defense and memory cells (MC). In addition, blood cells that have completed their life cycle die here.

The lymph nodes located along the lymphatic vessels, they are organs of lymphocytopoiesis, immune defense and deposition of flowing lymph.

In the lymph nodes, antigen-dependent proliferation (cloning) and differentiation of T and B lymphocytes into effector cells and the formation of memory cells occur. Usually the lymph nodes have a depression on one side. In this place called gates, arteries and nerves enter the node, and veins and efferent lymphatic vessels exit. The vessels bringing lymph enter from the opposite, convex side of the node. Due to this location of the node along the lymphatic vessels, it is not only a hematopoietic organ, but also a kind of filter for fluid (lymph) flowing from the tissues on its way to the bloodstream.

Structure. The outside of the node is covered with connective tissue capsule, somewhat thickened in the area of ​​the gate. The capsule contains a lot of collagen and few elastic fibers. In addition to connective tissue elements, it contains, mainly in the hilum area, individual bundles of smooth muscle cells, especially in the nodes of the lower half of the body. Thin connective tissue septa, or trabeculae, anastomosing with each other in the deep parts of the node.

You can distinguish peripheral, denser cortex, consisting of lymphatic nodules, paracortical(diffuse) zone, as well as the central light medulla, educated brain cords And sinuses. Most of the cortical layer and medullary cords constitute the area of ​​B-lymphocyte population (B-zone), and the paracortical, thymus-dependent zone contains predominantly T-lymphocytes (T-zone).

Cortical substance. A characteristic structural component of the cortex are lymph nodes.

In the reticular skeleton of the nodules there are thick, sinuous reticular fibers, mostly circularly directed. In the loops of reticular tissue lie lymphocytes, lymphoblasts, macrophages and other cells. In the peripheral part of the nodules there are small lymphocytes in the form of a crown.

Lymph nodules are covered with reticuloendothelial cells lying on reticular fibers. Among the reticuloendothelial cells there are many fixed macrophages. The central part of the nodules consists of lymphoblasts, typical macrophages, dendritic cells, lymphocytes. Lymphoblasts are usually in various stages of division, as a result of which this part of the nodule is called germinal center, or breeding center.

Paracortical zone. Located at the border between the cortex and medulla paracortical thymus-dependent zone. It contains mainly T lymphocytes. The microenvironment for lymphocytes of the paracortical zone is a type of macrophages that have lost the ability to phagocytose - "interdigitating cells".

Brain matter. From the nodules and paracortical zone into the node, into its medulla, extend brain cords, anastomosing with each other. They are based on reticular tissue, in the loops of which there are B lymphocytes, plasma cells and macrophages. This is where plasma cells mature.

№ 29 Respiratory system. Morpho-functional characteristics. Sources of development. The structure of the airways (nasal cavity, larynx, trachea, bronchi of various sizes).

Respiratory system- a set of organs that provide V the body external respiration, as well as a number of important non-respiratory

The respiratory system consists of various organs that perform

air-conducting and respiratory (gas exchange) functions: cavitynose, nasopharynx, larynx, trachea, extrapulmonary bronchi and lungs.

Functions. External respiration, i.e., the absorption of oxygen from the inhaled air and its supply to the blood, as well as the removal of carbon dioxide from the body, is the main function of the respiratory system.

Among the non-respiratory functions of the respiratory system, thermoregulation and humidification of inhaled air, the deposition of blood in a richly developed vascular system, participation in the regulation of blood coagulation, participation in the synthesis of certain hormones, in water-salt and lipid metabolism, as well as in voice formation and smell and immune function are very important. protection.

Development. The larynx, trachea and lungs develop from one common rudiment, which appears at the 3-4th week by protrusion of the ventral wall of the foregut. The larynx and trachea are formed in the 3rd week from the upper part of the unpaired sac-like protrusion of the ventral wall of the foregut. In the lower part, this unpaired rudiment is divided along the midline into two sacs, giving rise to the rudiments of the right and left lungs. At week 8 the rudiments of the bronchi appear in the form of short, even tubes, and on 10-12 weeks their walls become folded, lined with cylindrical epithelial cells (a tree-like branched system of bronchi is formed - the bronchial tree). At this stage of development, the lungs resemble a gland (glandular stage). At 5-6 months embryogenesis, the development of final (terminal) and respiratory bronchioles, as well as alveolar ducts, surrounded by a network of blood capillaries and growing nerve fibers (tubular stage) occurs.

From the mesenchyme surrounding the growing bronchial tree, smooth muscle tissue, cartilaginous tissue, fibrous connective tissue of the bronchi, elastic, collagen elements of the alveoli, as well as layers of connective tissue growing between the lobules of the lung are differentiated. From the end of the 6th - beginning of the 7th month and before birth, part of the alveoli and the alveolocytes of the 1st and 2nd types lining them are differentiated (alveolar stage).

Nasal cavity. In the nasal cavity, a distinction is made between the vestibule and the nasal cavity itself, which includes the respiratory and olfactory regions.

Structure. The vestibule is formed by a cavity located under the cartilaginous part of the nose. It is lined with stratified squamous keratinizing epithelium. Under the epithelium in the connective tissue layer are sebaceous glands and roots of bristle hair. In the deeper parts of the vestibule, the epithelium becomes non-keratinized, turning into multirow, ciliated.

The inner surface of the nasal cavity proper, the inspiratory part, is covered mucous membrane, consisting of multirow prismatic ciliated epithelium and connective tissue lamina propria, connected to the perichondrium or periosteum. In the epithelium, located on the basement membrane, there are 4 types of cells: ciliated, microvillous, basal And goblet-shaped.

Ciliated cells equipped with flickering eyelashes. Between the ciliated cells are located microvilli, with short villi on the apical surface and basal unspecialized cells.

Goblet cells are single-celled mucous glands that normally moderately moisturize the free surface of the epithelium.

Own record The mucous membrane consists of loose fibrous unformed connective tissue containing a large number of elastic fibers. It contains the terminal sections of the mucous glands, the excretory ducts of which open on the surface of the epithelium.

Larynx- an organ of the pneumatic section of the respiratory system, which takes part not only in the conduction of air, but also in sound production. The larynx has three membranes: mucous, fibrocartilaginous and adventitial.

Mucous membrane lined with multirow ciliated epithelium. The lamina propria, represented by loose fibrous connective tissue, contains numerous elastic fibers.

On the anterior surface, in the lamina propria of the laryngeal mucosa, there are mixed protein-mucosal glands. There are also significant accumulations of lymph nodes, called laryngeal tonsils.

In the middle part of the larynx there are folds of the mucous membrane, forming the so-called true And false vocal cords. In the mucous membrane above and below the true vocal cords there are mixed protein-mucosal glands.

Fibrocartilaginous sheath consists of hyaline and elastic cartilage surrounded by dense fibrous connective tissue. It acts as a protective and supporting frame for the larynx.

Adventitia consists of collagenous connective tissue.

Trachea- a hollow tubular organ consisting of mucous membrane, submucosa, fibrocartilaginous And adventitia.

Mucous membrane with the help of a thin submucosa it is connected to the fibrocartilaginous membrane of the trachea and, as a result, does not form folds. It's lined multirow prismatic ciliated epithelium, in which they distinguish ciliated, goblet, endocrine And basal cells.

Under the basement membrane of the epithelium is located lamina propria, consisting of loose fibrous unformed connective tissue, rich in elastic fibers. In the lamina propria of the mucous membrane there are lymph nodes and individual circularly arranged bundles of smooth muscle cells.

Submucosa The trachea consists of loose fibrous connective tissue, which turns into dense fibrous connective tissue of the perichondrium of open cartilaginous rings. Located in the submucosa mixed protein-mucous glands.

Fibrocartilage sheath The trachea consists of hyaline cartilaginous rings that are not closed on the posterior wall of the trachea.

Adventitia The trachea consists of loose, fibrous, unformed connective tissue that connects this organ to the adjacent parts of the mediastinum.

Large caliber bronchi characterized by a folded mucous membrane, due to the contraction of smooth muscle tissue, multirow ciliated epithelium, the presence of glands, large cartilaginous plates in the fibrocartilaginous membrane.

Medium caliber bronchi are distinguished by a smaller height of cells of the epithelial layer and a decrease in the thickness of the mucous membrane, the presence of glands, and a decrease in the size of cartilaginous islands.

In small caliber bronchi the ciliated epithelium is double-rowed, and then single-rowed, there is no cartilage or glands, the muscular plate of the mucous membrane becomes more powerful in relation to the thickness of the entire wall.

№ 31 General cover. Sources of development. The structure of the skin and its derivatives: skin glands, hair, nails. Processes of keratinization and physiological regeneration of the skin epidermis.

Leather forms the outer cover of the body, the area of ​​which in an adult reaches 1.5-2 m2. The skin consists of the epidermis (epithelial tissue) and the dermis (connective tissue base). The skin is connected to the underlying parts of the body by a layer of adipose tissue - subcutaneous tissue, or hypodermis.

Development. Skin develops from two embryonic primordia. Its epithelial cover (epidermis) is formed from the skin ectoderm, and the underlying connective tissue layers are formed from dermatomes (derivatives of somites). In the first weeks of embryonic development, the skin epithelium consists of only one layer of flat cells. Gradually these cells become taller. At the end of the 2nd month, a second layer of cells appears above them, and by the 3rd month the epithelium becomes multilayered. At the same time, keratinization processes begin in its outer layers (primarily on the palms and soles). In the 3rd month of the prenatal period, epithelial rudiments of hair, glands and nails are formed in the skin. During this period, fibers and a dense network of blood vessels begin to form in the connective tissue base of the skin. In the deep layers of this network, foci of hematopoiesis appear in places. Only in the 5th month of intrauterine development does the formation of blood elements in them stop and adipose tissue forms in their place.

Epidermis. The epidermis is represented by multilayered squamous keratinizing epithelium, in which cell renewal and specific differentiation (keratinization) constantly occur.

On the palms and soles, the epidermis consists of many dozens of layers of cells, which are combined into 5 main layers: basal, spinous, granular, shiny And horny. In other areas of the skin there are 4 layers (there is no shiny layer). There are 5 types of cells: keratinocytes (epithelial cells), Langerhans cells (intraepidermal macrophages), lymphocytes, melanocytes, Merkel cells. Of these cells in the epidermis and each of its layers, the basis is made up keratinocytes. They are directly involved in keratinization (keratinization) of the epidermis.

Keratinization process. At the same time, special proteins, filaggrin, involucrin, keratolinin, etc., resistant to mechanical and chemical influences, are synthesized in keratinocytes, and keratin tonofilaments and keratinosomes are formed. Then the organelles and nuclei in them are destroyed, and between them an intercellular cementing substance is formed, rich in lipids - ceramides (ceramides), etc. and therefore impermeable to water. At the same time, keratinocytes gradually move from the lower layer to the surface layer, where their differentiation is completed and they are called horny scales (corneocytes). The entire keratinization process lasts 3-4 weeks (faster on the soles of the feet).

Actually skin, or dermis, is divided into two layers - papillary And reticulate, which do not have a clear boundary between each other.

Skin glands . There are three types of glands in human skin: milk, sweat And greasy.Sweat glands are divided into eccrine(merocrine) and Apocrine.

Sweat glands are simple tubular in structure. They consist of excretory duct And end section. End sections are located in the deep parts of the reticular layer at its border with the subcutaneous tissue, and excretory ducts Eccrine glands open on the surface of the skin to produce sweat. The excretory ducts of many apocrine glands do not enter the epidermis and do not form sweat pores, but flow together with the excretory ducts of the sebaceous glands into the hair funnels.

Terminal sections of eccrine sweat glands lined with glandular epithelium, the cells of which are cubic or cylindrical in shape. Among them there are light And dark secretory cells.

Terminal sections of apocrine glands consist of secretory And myoepithelial cells. Transition of the end section to excretory duct is done abruptly. The wall of the excretory duct consists of bilayer cuboidal epithelium.

Sebaceous glands are simple alveolar with branched terminal sections. They secrete according to the holocrine type.

End sections consist of sebocyte cells, among which there are undifferentiated, differentiated and necrotic (dying) forms.

The excretory duct is short. Its wall consists of multilayered squamous epithelium. Closer to the terminal section, the number of layers in the duct wall decreases, the epithelium becomes cubic and passes into the outer germinal layer of the terminal section.

Hair. There are three types of hair: long, bristly And cannon

Structure. Hair is an epithelial appendage of the skin. Hair has two parts: the shaft and the root. The hair shaft is located above the surface of the skin. The hair root is hidden in the thickness of the skin and reaches the subcutaneous tissue.

Kernel long and bristly hair consists of a cortex, medulla and cuticle; vellus hair contains only the cortex and cuticle. Root The hair consists of epitheliocytes that are at different stages of formation of the cortex, medulla and cuticle of the hair.

The hair root is located in the hair sac, the wall of which consists of internal And external epithelial (root) sheaths. Together they make up the hair follicle. The follicle is surrounded by a connective tissue dermal sheath (hair bag).

Nails. The nail is a horny plate lying on the nail bed. The nail bed consists of epithelium and connective tissue. The epithelium of the nail bed - the subungual plate, is represented by the germinal layer of the epidermis. The nail plate lying on it is its stratum corneum. The nail bed is limited at the sides and at the base by skin folds - nail folds(back and sides). The growth layer of their epidermis passes into the epithelium of the nail bed, and the stratum corneum moves onto the nail from above (especially at its base), forming supracungual plate or skin. Between the nail bed and the nail folds there are nail slits (posterior and lateral). Nail(horny) plate its edges protrude into these cracks. It is formed by horny scales tightly adjacent to each other, which contain hard keratin.

Nail (horny) plate divided into root, body And edge.

№ 32 Urinary system. Its morpho-functional characteristics. Ureters, bladder, urethra. Sources of their development, structure, innervation.

To urinaryauthorities relate kidneys, ureters, bladder And urethra. Among them, the kidneys are the urinary organs, and the rest constitute the urinary tract.