НАРУЖНЫЕ МЫШЦЫ ГЛАЗНОГО ЯБЛОКА [ extraocular (extrinsic) muscles of the eye ] Наружные мышцы глазного яблока, или глазодвигательные мышцы - это вспомогательные органы глаза, часть органа зрения, совокупность поперечно-полосатых мышц, непосредственно взаимодействующих с основной частью органа зрения - глазом и обеспечивающих его функции.
ОРГАН ЗРЕНИЯ: ОГЛАВЛЕНИЕ = organ of vision: content
- ВСПОМОГАТЕЛЬНЫЙ АППАРАТ ГЛАЗА – accessory visual apparatus
- ВЕКИ – eyelids, palpebrae
- КОНЪЮНКТИВА ВЕК И ГЛАЗНОГО ЯБЛОКА – conjunctiva of eyelids and eyeball
- ГЛАЗНИЦА – eye's orbit
- КОСТНАЯ ОСНОВА ГЛАЗНИЦЫ – bones of the eye's orbit
- МЯГКИЕ СОЕДИНИТЕЛЬНОТКАННЫЕ СТРУКТУРЫ ГЛАЗНИЦЫ – soft connective tissue within the eye orbit
- ВНЕШНИЕ МЫШЦЫ ГЛАЗНОГО ЯБЛОКА – extrinsic (extra-ocular) muscles
- СЛЁЗНЫЙ АППАРАТ – nasolacrimal apparatus
- КРОВЕНОСНЫЕ СОСУДЫ ГЛАЗНИЦЫ – blood vessels within the eye orbit
- ЛИМФАТИЧЕСКИЕ СТРУКТУРЫ ГЛАЗНИЦЫ – limphatic structures within the eye orbit
- НЕРВЫ ГЛАЗНИЦЫ – nervs within the eye orbit
- ГЛАЗ – eye
- ГЛАЗНОЕ ЯБЛОКО – eyeball
ОРГАН ЗРЕНИЯ: ОГЛАВЛЕНИЕ
ОРГАН ЗРЕНИЯ: ТАБЛИЦЫ
ОРГАН ЗРЕНИЯ: ИЛЛЮСТРАЦИИ
ОРГАН ЗРЕНИЯ: ЛИТЕРАТУРА
ГЛАЗНИЧНЫЕ МЫШЦЫ, ИЛИ ВНЕШНИЕ МЫШЦЫ ГЛАЗНОГО ЯБЛОКА
К глазному яблоку прикрепляется шесть поперечнополосатых глазничных мышц (внешних мышц глазного яблока, глазодвигательных мышц). Четыре прямые глазничные мышцы - верхняя прямая глазничная мышца, нижняя прямая глазничная мышца, латеральная прямая глазничная мышца и медиальная прямая глазничная мышца. Две косые глазничные мышцы: верхняя косая глазничная мышца и нижняя косая глазничная мышца. Эти шесть органов действуют как три пары глазодвигательных мышц-антагонистов: - верхняя прямая глазничная мышца и нижняя прямая глазничная мышца; - латеральная прямая глазничная мышца и медиальная прямая глазничная мышца; - верхняя косая глазничная мышца и нижняя косая глазничная мышца. При сокращении любой мышцы глазное яблоко совершает движения вокруг оси, перпендикулярной плоскости этой мышцы. Ось, перпендикулярная плоскости мышцы, проходит вдоль её мышечных волокон и пересекает точку вращения глаза.
Все прямые мышцы и верхняя косая начинаются в глубине глазницы на общем сухожильном кольце. Это сухожильное кольцо фиксировано на клиновидной кости и на надкостнице вокруг зрительного канала, а также частично на краях верхней глазничной щели. Через отверстие сухожильного кольца проходят зрительный нерв и глазная артерия. От общего сухожильного кольца начинается также мышца, поднимающая верхнее веко. Эта мышца расположена в глазнице над верхней прямой глазничной мышцей. Мышца, поднимающая верхнее веко, заканчивается в толще верхнего века.
От общего сухожильного кольца прямые глазничные мышцы проходят вперёд, вдоль соответствующих стенок глазницы, по сторонам от зрительного нерва. Эти мышцы прободают сухожильное влагалище (соединительнотканная оболочка, тенонова капсула) глазного яблока и короткими сухожилиями вплетаются в склеру. Место прикрепления сухожилий расположено впереди экватора склеры на расстоянии 5-8 мм от края роговицы. Прямые глазничные мышцы поворачивают глазное яблоко вокруг двух взаимно перпендикулярных осей: вертикальной оси и горизонтальной (поперечной) оси. Латеральная и медиальная прямые глазничные мышцы поворачивают глазное яблоко кнаружи и кнутри вокруг вертикальной оси, каждая в свою сторону. Соответственно повороту глазного яблока поворачивается и зрачок. Верхняя и нижняя прямые мышцы поворачивают глазное яблоко вверх и вниз вокруг поперечной оси. Зрачок при сокращении верхней прямой мышцы направляется кверху и несколько кнаружи, а при сокращении нижней прямой мышцы - вниз и кнутри.
Верхняя косая мышца расположена в верхнемедиальной части глазницы между верхней и медиальной прямыми мышцами. Вблизи блоковой ямки верхняя косая мышца переходит в тонкое круглое сухожилие. Это сухожилие, окутанное синовиальным влагалищем, перекидывается через блок, имеющий форму кольца, состоящего из волокнистого хряща. Пройдя через блок, сухожилие ложится под верхней прямой мышцей и прикрепляется к глазному яблоку в верхнелатеральной его части, позади экватора глазного яблока.
Нижняя косая мышца в отличие от остальных мышц глазного яблока начинается на глазничной поверхности верхней челюсти, возле отверстия носослёзного канала, на нижней стенке глазницы. Отсюда нижняя косая мышца направляется косо вверх и кзади между нижней стенкой глазницы и нижней прямой мышцей. Короткое сухожилие нижней косой мышцы прикрепляется к глазному яблоку с его латеральной стороны, позади экватора глазного яблока. Обе косые мышцы поворачивают глазное яблоко вокруг переднезадней оси. Верхняя косая мышца поворачивает глазное яблоко и зрачок вниз и латерально. Нижняя косая мышца поворачивает глазное яблоко и зрачок вверх и латерально. Движения правого и левого глазных яблок согласованы благодаря содружественному действию глазодвигательных мышц.
Внутренняя, верхняя и нижняя прямые мышцы, а также нижняя косая мышца иннервируются веточками глазодвигательного нерва, наружная прямая — веточками отводящего нерва и верхняя косая — веточками блокового нерва.
Схема. A. Движения глазного яблока. B. Оси глазного яблока и глазницы = A. Movements of the eyeball. B. Axes of of the eyeball and orbit. Модификация: Gray H., (1821–1865), Drake R., Vogl W., Mitchell A., Eds. Gray's Anatomy for Students. Churchill Livingstone, 2007, 1150 p. см.: Анатомия человека: Литература. Иллюстрации |
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Примечание:
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Of the seven muscles in the extrinsic group of muscles, one raises the eyelids, while the other six move the eyeball itself.
The movements of the eyeball, in three dimensions, are:
• elevation-moving the pupil superiorly;
• depression-moving the pupil inferiorly;
• abduction-moving the pupil laterally;
• adduction-moving the pupil medially;
• internal rotation-rotating the upper part of the pupil medially (or towards the nose);
• external rotation-rotating the upper part of the pupil laterally (or towards the temple).
Additionally, the axis of each orbit is directed slightly laterally from back to front, while each eyeball is directed anteriorly. Therefore, the pull of some muscles has multiple effects on the movement of the eyeball, while that of others has single effects. |
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Схема. Мышцы глазного яблока. A. Вид сверху. Вид сбоку = Muscles of the eyeball. A. Superior view. B. Lateral view. Модификация: Gray H., (1821–1865), Drake R., Vogl W., Mitchell A., Eds. Gray's Anatomy for Students. Churchill Livingstone, 2007, 1150 p. см.: Анатомия человека: Литература. Иллюстрации |
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Примечание:
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There are two groups of muscles within the orbit:
• extrinsic muscles of eyeball (extra-ocular muscles) involved in movements of the eyeball or raising upper eyelids;
• intrinsic muscles within the eyeball, which control the shape of the lens and size of the pupil.
The extrinsic muscles include the levator palpebrae superioris, superior rectus, inferior rectus, medial rectus, lateral rectus, superior oblique, and inferior oblique.
The intrinsic muscles include the ciliary muscle, the sphincter pupillae, and the dilator pupillae.
Of the seven muscles in the extrinsic group of muscles, one raises the eyelids, while the other six move the eyeball itself.
The movements of the eyeball, in three dimensions, are:
• elevation-moving the pupil superiorly;
• depression-moving the pupil inferiorly;
• abduction-moving the pupil laterally;
• adduction-moving the pupil medially;
• internal rotation-rotating the upper part of the pupil medially (or towards the nose);
• external rotation-rotating the upper part of the pupil laterally (or towards the temple).
Additionally, the axis of each orbit is directed slightly laterally from back to front, while each eyeball is directed anteriorly. Therefore, the pull of some muscles has multiple effects on the movement of the eyeball, while that of others has single effects. |
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Таблица. Внешние мышцы глазного яблока = Extrinsic (extra-ocular) muscles. c. 613. Модификация: Gray H., (1821–1865), Drake R., Vogl W., Mitchell A., Eds. Gray's Anatomy for Students. Churchill Livingstone, 2007, 1150 p. см.: Анатомия человека: Литература. Иллюстрации. |
№ |
Muscle |
Origin |
Insertion |
Innervation |
Function |
1 |
Мышца, поднимающая верхнее веко = Levator palpebrae superioris |
Lesser wing of sphenoid anterior to optic canal |
Anterior surface of tarsal plate; a few fibers to skin and superior conjunctival fornix |
Oculomotor nerve [III]- superior branch |
Elevation of upper eyelid |
2 |
Верхняя прямая мышцаSuperior rectus |
Superior part of common tendinous ringAnterior half of eyeball superiorly |
Anterior half of eyeball superiorly |
Oculomotor nerve [III]- superior branch |
Elevation, adduction, medial rotation of eyeball |
3 |
Нижняя прямая мышца = Inferior rectus |
Inferior part of common tendinous ring |
Anterior half of eyeball inferiorly |
Oculomotor nerve [III]- inferior branch |
Depression, adduction, lateral rotation of eyeball |
4 |
Медиальная прямая мышца = Medial rectus |
Медиальная часть общего сухожильного кольца = Medial part of common tendinous ring |
Передняя медиальная половина глазного яблока = Anterior half of eyeball medially |
Нижняя ветвь глазодвигательного нерва = Oculomotor nerve [III]- inferior branch |
Приведение глазного яблока = Adduction of eyeball |
5 |
Латеральная прямая мышца = Lateral rectus |
Lateral part of common tendinous ring |
Anterior half of eyeball laterally |
Abducent nerve [VI] |
Abduction of eyeball |
6 |
Верхняя косая мышца = Superior oblique |
Body of sphenoid, superior and medial to optic canal |
Outer posterior quadrant of eyeball |
Trochlear nerve [IV] |
Depression, abduction, medial rotation of eyeball |
7 |
Нижняя косая мышца = Inferior oblique |
Medial floor of orbit posterior to rim; maxilla lateral to nasolacrimal groove |
Outer posterior quadrant of eyeball |
Oculomotor nerve [III]- inferior branch |
Elevation, abduction, lateral rotation of eyeball |
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Примечание:
Four rectus muscles occupy medial, lateral, inferior, and superior positions as they pass from their origins posteriorly to their points of attachment on the anterior half of the eyeball. They originate as a group from a common tendinous ring at the apex of the orbit and form a cone of muscles as they pass forward to their attachment on the eyeball. |
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Superior and inferior rectus muscles
The superior and inferior rectus muscles have complicated actions because the apex of the orbit, where the muscles originate, is medial to the central axis of the eyeball when looking directly forward:
• the superior rectus originates from the superior part of the common tendinous ring above the optic canal;
• the inferior rectus originates from the inferior part of the common tendinous ring below the optic canal. As these muscles pass forward in the orbit to attach to the anterior half of the eyeball they are also directed laterally. Because of these orientations:
• contraction of the superior rectus elevates, adducts, and internally rotates the eyeball;
• contraction of the inferior rectus depresses, adducts, and externally rotates the eyeball.
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Схема. Действия наружных мышц глазного яблока на его положение. A. Действие отдельных мышц (на анатомическое положение). B. Движения глаза при клиническом тестировании функций отдельных мышц = Actions of muscles of the eyeball. A. Action of individual muscles (anatomical action). B. Movement of eye when testing specific muscle (clinical testing). Модификация: Gray H., (1821–1865), Drake R., Vogl W., Mitchell A., Eds. Gray's Anatomy for Students. Churchill Livingstone, 2007, 1150 p. см.: Анатомия человека: Литература. Иллюстрации |
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Примечание:
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The superior branch of the oculomotor nerve [III] innervates the superior rectus, and the inferior branch of the oculomotor nerve [III] innervates the inferior rectus.
To isolate the function of and to test the superior and inferior rectus muscles, a patient is asked to track a physician's finger laterally and then either upwards or downwards. The first movement brings the axis of the eyeball into alignment with the long axis of the superior and inferior rectus muscles. Moving the finger upwards tests the superior rectus muscle and moving it downwards tests the inferior rectus muscle.
Medial and lateral rectus muscles
The orientation and actions of the medial and lateral rectus muscles are more straightforward than those of the superior and inferior rectus muscles.
The medial rectus originates from the medial part of the common tendinous ring medial to and below the optic canal, whereas the lateral rectus originates from the lateral part of the common tendinous ring as the common tendinous ring bridges the superior orbital fissure.
The medial and lateral rectus muscles pass forward and attach to the anterior half of the eyeball. Contraction of each medial rectus adducts the eyeball, whereas contraction of each lateral rectus abducts the eyeball.
The inferior branch of the oculomotor nerve [III] innervates the medial rectus, and the abducent nerve [VI] innervates the lateral rectus.
To isolate the function of and test the medial and lateral rectus muscles, a patient is asked to track a physician's finger medially and laterally, respectively, in the horizontal plane.
Oblique muscles
The oblique muscles are in the superior and inferior parts of the orbit, do not originate from the common tendinous ring, are angular in their approaches to the eyeball, and, unlike the rectus muscles, attach to the posterior half of the eyeball.
Superior oblique
The superior oblique arises from the body of the sphenoid, superior and medial to the optic canal and medial to the origin of the levator palpebrae superioris. It passes forward, along the medial border of the roof of the orbit, until it reaches a fibrocartilaginous pulley (the trochlea), which is attached to the trochlear fovea of the frontal bone.
The tendon of superior oblique passes through the trochlea and turns laterally to cross the eyeball in a posterolateral direction. It continues deep to the superior rectus muscle and inserts into the outer posterior quadrant of the eyeball.
Contraction of the superior oblique therefore directs the pupil down and out.
The trochlear nerve [IV] innervates the superior oblique along its superior surface.
To isolate the function of and to test the superior oblique muscle, a patient is asked to track a physician's finger medially to bring the axis of the tendon of the muscle into alignment with the axis of the eyeball, and then to look down, which tests the muscle.
Inferior oblique
The inferior oblique is the only extrinsic muscle that does not take origin from the posterior part of the orbit. It arises from the medial side of the floor of the orbit, just posterior to the orbital rim, and is attached to the orbital surface of the maxilla just lateral to the nasolacrimal groove.
The inferior oblique crosses the floor of the orbit in a posterolateral direction between the inferior rectus and the floor of the orbit, before inserting into the outer posterior quadrant just under the lateral rectus.
Contraction of the inferior oblique directs the pupil up and out.
The inferior branch of the oculomotor nerve innervates the inferior oblique.
To isolate the function of and to test the inferior oblique muscle, a patient is asked to track a physician's finger medially to bring the axis of the eyeball into alignment with the axis of the muscle and then to look up, which tests the muscle).
Extrinsic muscles and eyeball movements
Six of the seven extrinsic muscles of the orbit are directly involved in movements of the eyeball.
For each of the rectus muscles, the medial, lateral, inferior, and superior, and the superior and inferior obliques, a specific action or group of actions can be described (Table 8.8). However, these muscles do not act in isolation. They work as teams of muscles in the coordinated movement of the eyeball to position the pupil as needed.
For example, although the lateral rectus is the muscle primarily responsible for moving the eyeball laterally, it is assisted in this action by the superior and inferior oblique muscles. |
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Примечание:
The oculomotor nerve [III] leaves the anterior surface of the brainstem between the midbrain and the pons. It passes forward in the lateral wall of the cavernous sinus. |
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Just before entering the orbit the oculomotor nerve [III] divides into superior and inferior branches. These branches enter the orbit through the superior orbital fissure, lying within the common tendinous ring. Inside the orbit the small superior branch passes upward on the lateral side of the optic nerve to innervate the superior rectus and levator palpebrae superioris muscles.
The large inferior branch divides into three branches:
• one passing below the optic nerve as it passes to the medial side of the orbit to innervate the medial rectus muscle;
• a second descending to innervate the inferior rectus muscle;
• the third descends as it runs forward along the floor of the orbit to innervate the inferior oblique muscle.
As the third branch descends, it gives off the branch to the ciliary ganglion. This is the parasympathetic root to the ciliary ganglion and carries preganglionic parasympathetic fibers that will synapse in the ciliary ganglion with postganglionic parasympathetic fibers. The postganglionic fibers are distributed to the eyeball through short ciliary nerves and innervate the sphincter pupillae and ciliary muscles.
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Примечание:
The trochlear nerve [IV] arises from the posterior surface of the midbrain, and passes around the midbrain to enter the edge of the tentorium cerebelli. It continues on an intradural path arriving in and passing through the lateral wall of the cavernous sinus just below the oculomotor nerve [III]. |
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Just before entering the orbit, the trochlear nerve ascends, passing across the oculomotor nerve [III] and enters the orbit through the superior orbital fissure above the common tendinous ring (Fig. 8.94). In the orbit the trochlear nerve [IV] ascends and turns medially, crossing above the levator palpebrae superioris muscle to enter the upper border of the superior oblique muscle.
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Примечание:
The ophthalmic nerve [V1] is the smallest and most superior of the three divisions of the trigeminal nerve. This purely sensory nerve receives input from structures in the orbit and from additional branches on the face and scalp.
Leaving the trigeminal ganglion, the ophthalmic nerve [V1] passes forward in the lateral wall of the cavernous sinus inferior to the trochlear [IV] and oculomotor [III] nerves. |
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Just before entering the orbit, the trochlear nerve ascends, passing across the oculomotor nerve [III] and enters the orbit through the superior orbital fissure above the common tendinous ring. In the orbit the trochlear nerve [IV] ascends and turns medially, crossing above the levator palpebrae superioris muscle to enter the upper border of the superior oblique muscle.
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Примечание:
The ophthalmic nerve [V1] is the smallest and most superior of the three divisions of the trigeminal nerve. This purely sensory nerve receives input from structures in the orbit and from additional branches on the face and scalp.
Leaving the trigeminal ganglion, the ophthalmic nerve [V1] passes forward in the lateral wall of the cavernous sinus inferior to the trochlear [IV] and oculomotor [III] nerves. Just before it enters the orbit it divides into three branches-the nasociliary, lacrimal, and frontal nerves. These branches enter the orbit through the superior orbital fissure with the frontal and lacrimal nerves outside the common tendinous ring, and the nasociliary nerve within the common tendinous ring. |
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Just before entering the orbit, the trochlear nerve ascends, passing across the oculomotor nerve [III] and enters the orbit through the superior orbital fissure above the common tendinous ring. In the orbit the trochlear nerve [IV] ascends and turns medially, crossing above the levator palpebrae superioris muscle to enter the upper border of the superior oblique muscle.
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Примечание:
The nasociliary nerve is intermediate in size between the frontal and lacrimal nerves and is usually the first branch from the ophthalmic nerve. It is most deeply placed in the orbit, entering the area within the common tendinous ring between the superior and inferior branches of the oculomotor nerve [III].
Once in the orbit, the nasociliary nerve crosses the superior surface of the optic nerve as it passes in a medial direction below the superior rectus muscle. Its first branch, the communicating branch with the ciliary ganglion (sensory root to the ciliary ganglion), is given off early in its path through the orbit. |
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The nasociliary nerve continues forward along the medial wall of the orbit, between the superior oblique and the medial rectus muscles, giving off several branches. These include:
• the long ciliary nerves, which are sensory to the eyeball but may also contain sympathetic fibers for pupillary dilation;
• the posterior ethmoidal nerve, which exits the orbit through the posterior ethmoidal foramen to supply posterior ethmoidal air cells and the sphenoidal sinus;
• the infratrochlear nerve, which distributes to the medial part of the upper and lower eyelids, the lacrimal sac, and skin of the upper half of the nose;
• the anterior ethmoidal nerve, which exits the orbit through the anterior ethmoidal foramen to supply the anterior cranial fossa, nasal cavity, and skin of the lower half of the nose.
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Примечание:
The ciliary ganglion is a parasympathetic ganglion of the occulomotor nerve [III]. It is associated with the nasociliary branch of the ophthalmic nerve [V1]. |
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It is the site where preganglionic and postganglionic parasympathetic neurons synapse as fibers from this part of the autonomic division of the PNS make their way to the eyeball. The ciliary ganglion is also traversed by postganglionic sympathetic fibers and sensory fibers as they travel to the eyeball.
The ciliary ganglion is a very small ganglion, in the posterior part of the orbit immediately lateral to the optic nerve and between the optic nerve and the lateral rectus muscle. It is usually described as receiving at least two, and possibly three, branches or roots from other nerves in the orbit.
Parasympathetic root
As the inferior branch of the oculomotor nerve [III] passes the area of the ciliary ganglion, it sends a branch to the ganglion (the parasympathetic root). The parasympathetic branch carries preganglionic parasympathetic fibers, which enter the ganglion and synapse with postganglionic parasympathetic fibers within the ganglion.
The postganglionic parasympathetic fibers leave the ganglion through short ciliary nerves, which enter the posterior aspect of the eyeball around the optic nerve.
In the eyeball the parasympathetic fibers innervate:
• the sphincter pupillae muscle, responsible for pupillary constriction;
• the ciliary muscle, responsible for accommodation of the lens of the eye for near vision.
Sensory root
A second branch (the sensory root), passes from the nasociliary nerve to the ganglion. This branch enters the posterosuperior aspect of the ganglion, and carries sensory fibers, which pass through the ganglion and continue along the short ciliary nerves to the eyeball. These fibers are responsible for sensory innervation to all parts of the eyeball.
Sympathetic root
The third branch to the ciliary ganglion is the most variable. This branch, when present, is the sympathetic root and contains postganglionic sympathetic fibers from the superior cervical ganglion. These fibers travel up the internal carotid artery, leave the plexus surrounding the artery in the cavernous sinus, and enter the orbit through the common tendinous ring. In the orbit they enter the posterior aspect of the ciliary ganglion, cross the ganglion, and continue along the short ciliary nerves to the eyeball.
Sympathetic fibers to the eyeball may not enter the ganglion as a separate branch. The postganglionic sympathetic fibers may leave the plexus associated with the internal carotid artery in the cavernous sinus, join the ophthalmic nerve [V1] and distribute to the ciliary ganglion through the sensory root from the nasociliary nerve.
Whatever their path, postganglionic sympathetic fibers reach the eyeball and innervate the dilator pupillae muscle.
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«Я У Ч Е Н Ы Й И Л И . . . Н Е Д О У Ч К А ?» Т Е С Т В А Ш Е Г О И Н Т Е Л Л Е К Т А
Предпосылка: Эффективность развития любой отрасли знаний определяется степенью соответствия методологии познания - познаваемой сущности. Реальность: Живые структуры от биохимического и субклеточного уровня, до целого организма являются вероятностными структурами. Функции вероятностных структур являются вероятностными функциями. Необходимое условие: Эффективное исследование вероятностных структур и функций должно основываться на вероятностной методологии (Трифонов Е.В., 1978,..., ..., 2015, …).
Критерий: Степень развития морфологии, физиологии, психологии человека и медицины, объём индивидуальных и социальных знаний в этих областях определяется степенью использования вероятностной методологии.
Актуальные знания: В соответствии с предпосылкой, реальностью, необходимым условием и критерием...
... о ц е н и т е с а м о с т о я т е л ь н о: — с т е п е н ь р а з в и т и я с о в р е м е н н о й н а у к и, — о б ъ е м В а ш и х з н а н и й и — В а ш и н т е л л е к т !
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♥ Ошибка? Щелкни здесь и исправь ее! Поиск на сайте E-mail автора (author): tryphonov@yandex.ru
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