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   METHODOGICAL
         GUIDELINE
          To practical classes on
«Operative surgery and Topographical Anatomy
           of The Head and Neck»
         For students of Dental Faculty




                    Donetsk 2012
                                                 2




                   MINISTRY OF HEALTH OF UKRAINE
                  Donetsk National Medical University Gorky

         The department of operative surgery and topographic anatomy


                           Guidelines for practical training for
     "Operative surgery and topographical anatomy of the head and neck"
                           for students of Faculty of Dentistry




                              UDC 611.91/.93 +617.51 / .53 (075.8)
                                       BBK 54.571/.572ya7
                                               M-54


        Methodological guidelines for practical work on "Operative surgery and
topographical anatomy of the head and neck" for students of Faculty of Dentistry. -
                                      Donetsk, 2012. - 78.
                 Antipov, N., Siroid DV, Zhilyaev RA, Zaritsky A., S. Voitenko


    Methodological guidelines are intended for students of second year dental faculty. For each
study subject, its relevance is indicated; general and specific learning goals are also included. To
determine the initial level of knowledge and skills of students, appropriate goals are set to check
the level and sources of information. The content of training for each topic contains a list of
theoretical questions, the graph of the logical structure of themes and sources of information. To
verify the achievement of specific learning goals, a set of tests with the standards answers are
provided. Each topic is accompanied by brief guidelines to work with during practical lessons.
Methodical instructions to help students with self-preparation for practical training in operative
                                                               3


surgery and topographic anatomy of the head and neck are also provided to help contribute to
students' ability to think clinically.




                 Approved at the meeting of the Academic Council, DNMU,
                                   Minutes № 2 of "24" February 2012

                                                       EDITORS:

A. Grona V.N, d. med.n., prof., Z.d.n.t. Ukraine, Professor Department of Pediatric Surgery,
Anesthesiology and Intensive Care DNMU.
B. Gulmammadov FI, d.med.n., Prof., Z.d.n.t. Ukraine, Professor Department of General
surgery, Anesthesiology and Resuscitation DNMU.
C. Buteva LV, k.med.n., Associate Professor of Department of Social Medicine, ooz, and the
History of Medicine, Methodist DNMU UMO.

                                              TABLE OF CONTENTS
                                                                                                                   Pages
List of literature................................................................................................    4
1. Surgical instruments and energy of the terminology .................................                               5
2. The separation of tissues ..........................................................................              17
3. Connection of tissues .............................................. .................................            21
4. Operative surgery and topographical anatomy of the brain part of the head …..                                     25
5. Operative surgery and topographical anatomy of the Skull cavity ……..............                                  29
6. Operative surgery and topographical anatomy of the lateral part of the face .                                     33
7. Innervation of the face, local anesthesia of the face ........................................                    38
8. Operative surgery and topographical anatomy of the anterior part of the face.                                     42
9. Operative surgery and topographical anatomy of the oral cavity ………........                                        46
10. Operative surgery and topographical anatomy of the neck area and triangles.
     Exposure and ligation of vessels of the neck ....................…………...………                                     50
11. Operative surgery and topographical anatomy of the spaces of the neck.
     Removal of lymph nodes of the neck ..............................................................               55
12. Topographic anatomy of the neck. Operations and manipulations on
    the respiratory tube ........................................................... ……………………                        59
13. Topographic anatomy of the neck; Operations on the thyroid gland.
     Vago-sympathetic blockage by Vishnevsky Method.......................................                           63
14. Practical skills in preparation to module exam................................................                   67
15. The final test control .......................................................................................  73-77
                                                 4



INTRODUCTION:

   The Knowledge of operative surgery and topographic anatomy of the head and neck is of
great practical value to physicians of any specialty, particularly - for dentists.
   The study of Topographic anatomy, features fiber structure and arrangement of organs, blood
vessels, nerves and other structures in the regions and cavities of the body, possible pathways of
pathological processes.
   This knowledge will help to anticipate potential complications and to avoid medical errors &
correctly describe the data of the objective examination of the patient, taking into account the
boundaries and external landmarks.
   Operative Surgery examines the technique of surgical interventions (operations and
manipulations). Doctors of all specialties must be able to provide emergency medical care (e.g.
to make a temporary arrest of arterial bleeding, assist in mechanical asphyxia, etc.). In addition,
doctors of all specialties in an emergency may be required to work as an assistant
surgeon. Therefore, dentists should be able to use the most common surgical instruments, own
technique of separation of tissues and joints, temporary and final stoppage of bleeding.
     To improve the quality of training, scientific-based organization of the educational process is
important. The main way of its implementation in the department of operative surgery and
topographic anatomy is to develop guidelines for each topic of classes that allows you to manage
the training of students in the classroom and extracurricular phases with a focus on professional
activities.
     Methodological guidelines were established in accordance with the curriculum and are
designed for students of second year of dental faculty. They help students to learn operative
surgery and topographic anatomy of the head and neck that will help reduce the risk of medical
errors in their practice.

MODULE "Operative Surgery and Topographic Anatomy of Head and Neck"
The overall goal: to be able to interpret the features of topographic anatomy of the head and
neck to make surgical intervention and acquire good medical skills.
The specific objectives (to be able to):
1. interpret the features of topographic anatomy of the head and neck;
2. denote the fluctuating terms, the boundaries of regions and the external orientation of the head
and neck, to hold the projection of structures and sections;
3. to decide the most common surgical procedures and manipulations performed on the head and
neck;
4. To simulate the disconnection & connection of tissues, stop bleeding, and manipulate
processes on the head and neck.
                                                  5



1. SURGICAL INSTRUMENTS AND TERMINOLOGY
Relevance of the topic:
    Dentists should be able to carry out primary debridement in cases of emergency as they may
be required to work as an assistant surgeon.
   Therefore, they should know the names and designation of the most common surgical
instruments. Failure to observe safety precautions when working with surgical instruments
(including the process of their proper handling and transfer) can cause damage to the hands of
members of the operating room staff and lead to infection, hence transmission of diseases via
blood. Therefore, dentists should be able to enjoy the society and safely utilize surgical
instruments to observe safety precautions when working with them. Knowledge of surgical
terminology is necessary for good communication between doctors, in reading medical literature
and for the correct interpretation of patient data.



                                                                           BACKGROUND
                  LEARNING OBJECTIVES
                                                                     KNOWLEDGE & SKILLS
                                         To be able to:
1. interpret the significance of surgical terms and perform         to determine the value of the
minor surgical procedures;                                          frequency segments - the
2. to determine the surgical instruments and suture material by names of body parts and
their names;                                                        actions performed in relation
3. Interpret the purpose of surgical instruments; particularly to   to them (Department of the
treat with surgical instruments and suture material                 Latin language)
4. Place the surgical instruments in the correct working
position and handing in
5. set public and surgical instruments on the operating table,
pass them to nurses,

6. mount the needle and pass it



Purpose: To solve the following tests:
                                             Test №1:
The surgeon removed the patient's spleen and draws up the protocol of the operation. What
prefix (name) corresponds to this part of the body?
A. splen-
                                                 6


B. Gastro-
S. duodeno-
D. Nephr-
E. Cysto-

                                              Test № 2
 During the imposition of a fistula in the stomach, the surgeon sutured the stomach wall to the
anterolateral wall of the abdomen. What is the term corresponding to the surgeon’s action?
A. tomy
B. stomy
C. ectomy
D. Raphia
E.-pexia

Standards of answers to tests to determine the initial level: № 1 - A; № 2 - E.

  Information necessary for obtaining basic knowledge and skills can be found via the following
sources:
1. Palasyuk GB, VV Cholach Latin language: Pіdruchnik. - Ternopil 'Ukrmedkniga ", 2000. -
344 s. - Pg. 215-219.
2. Cherniavsky, MN Latin language and the fundamentals of medical terminology textbook. -
Moscow: Meditsina, 1997. - 336. - Pg. 152-155.
CONTENTS OF TRAINING:
 After mastering the necessary basic knowledge and skills, you can proceed to study the
following materials:
LIST OF THEORETICAL ISSUES:
1. Determining the value of surgical terms and the implementation of dissections.
2. Classification of surgical instruments and suture material.
3. The purpose of surgical instruments in surgical procedures.
4. Operating position of surgical instruments, instrument transfer according to safety regulations.
5. Principles of setting general surgical instruments on folding operating table.
6. Principles of mounting and transfer of a needle holder.
7. The use of surgical instruments and suture material in surgical interventions.

 A graph of the logical structure to the topic can be found in the Appendix № 1.

 SOURCES OF INFORMATION:
 MAIN REFERENCES:
1. Operative Surgery and Topographic Anatomy / pid ed. Kulchitskogo K.І. - Dublin: Vishcha
wk., 1994. - Pg. 7-29.
2. Operative Surgery and Topographic Anatomy / ed. KI Kulchitsky, I.I.Bobrika. - K.: Vyshcha
School, 1989. - Pg. 15-30.
3. Lecture on "Surgical instruments".

FURTHER STUDY:
1. Operative Surgery and Topographic Anatomy: Pіdruchnik for dental students. Faculty tіv / MS
                                                  7


Skripnikov, AM Bіlich, V. I. Shepіtko іn., For Ed.MS Skripnikova. - K.: Vishcha wk., 2000. - S.
8-10, 14-15.
2. Siroid D. Technique of operational skills of Doctors.-Donetsk, 2009. - S. 9-31.
INDICATIVE FRAMEWORK FOR ACTION
  Students are expected to know the list of surgical instruments and suture materials and their
classification (see Appendix № 2).

SET OF TASKS TO ENSURE ACHIEVEMENT OF A PARTICULAR PURPOSE OF
STUDY
                                              Test № 1:
 A surgeon performed tracheostomy. What did the surgeon do with the patient's trachea in this
case?
A. Сut
B. Narrowed
C. Removed
D. Inserted a fistula
E. Recorded
                                              Test № 2
  An Inexperienced surgical nurse gave the surgeon a bellied scalpel instead giving him a sharp
pointed scalpel. How is this scalpel different from the required one?
A. The length of the handle
B. The thickness of the handle
C. The length of the working part
D. Severity of the blade
E. The angle of the tip
                                              Test № 3
 During surgery, the surgeon used a Billroth’s clamp, curved along the edge. What is this tool
used for?
A. Tissue disconnections
B. To arrest bleeding
C. Dissection of the wound edges
D. Performing operative reception
E. Connecting tissue
                                              Test №4
In the process of separation of tissue the surgeon used a pair of scissors. In this case the scissors
were fixed in the surgeon’s hand such that his thumb was fixed into one of the rings of the
scissors. What finger of the second hand should be fixed into the second ring of the scissors in
order to ensure proper fixation in the hand?
A. First
B. second
C. third
D. fourth
E. fifth

                                              Test № 5
                                                 8


On the operating table for general surgical instruments, the following were laid out in order:
scalpels, scissors, homeostatic clips, hooks, tweezers, forceps, hoe linen, drainage tube, Luer
cannula, Hegar’s needle holders, needles, sutures, and gauze. Which of the following should not
be on this table?
A. Hooks
B. forceps
C. Tsapko linen
D. Drainage tube
E. Luer cannula
                                               Test № 6.
 An operating nurse mounted a needle. To do this with one hand she held a needle holder with a
needle inserted into it and the fingers of the same hand fixed to one end of the ligature. The
second hand is fixed to the other end of the ligature; she took the needle and inserted the thread
through the needle’s eye. In the process of inserting the ligature, the surgical nurse scratched her
hand with the needle point. How should the direction of the movement of the hand be during
insertion of ligatures into needle’s eye (according to safety regulations)?
A. To the eye of the needle
B. To the needle tip
C. From the tip of the needle
D. By the needle holder rings
E. From the rings of needle holder
                                               Test № 7.
  When performing real-time access, surgeon cut aponeurosis. What hook is most appropriate for
fixing the tissues involved?
A. sharp single-toothed
B. blunt single-toothed
C. Sharp Multiple-teethed
D. Blunt Multiple-teethed
E. Farabeuf’s hook
Standards of response to targeted tests: № 1 - D; № 2 - E; № 3 - B; № 4 - D; № 5 - E; № 6 - C;
№ 7 - C.

           BRIEF NOTES TO THE STUDENTS OF PRACTICAL EXERCISES:
  Earlier, studies have been carried out to monitor and correct students’ basic level of
"knowledge and skills." Students then learn individually, set of surgical instruments and types
respectively, their standard classification; learn how to hold and transfer tools, lay them on the
table in the operating tables, mount the needle, choose the desired instrument and suture material
in a given situation. During independent work, skills of the students improve with respect to the
correct use of surgical instruments. After discussing the results of independent work, test control
is conducted and results summarized.




              Appendix № 1: GRAPH LOGIC STRUCTURES RELATED TO:
                  "SURGICAL INSTRUMENTS AND TERMINOLOGY"
                                                9



                             Surgical instruments and terminology


                      Surgical terminology and terminoobrazovanie


                        Classification of surgical instruments and suture
                                             material



     Name                                                                   Destination




                                         Technological Use


       Working                        Arrangement on the                           Mounting
      position and                      operating table                            the needle
                                                                                   holder and
        transfer
                                                                                 transferring it

                The use of surgical instruments for surgical intervention




Appendix № 2

A. Tools for quick access:

I. Tools for the separation of tissues:
1. Knife: sharp-ended scalpel
2. Knife: abdominal scalpel
3. Blunt scissors, straight on plan;
4. Blunt scissors, curved on the plane (Cooper’s)
5. Blunt scissors, curved on the edge
6. Sharp scissors, straight
7. Sharp scissors, curved on the plane
8. Pointed scissors, curved on the edge (Richter’s)
                                               10


9. Mixed scissors, straight
10. Mixed Scissors, curved on the plane
11. Mixed Scissors, curved on the edge
12. Amputating knife
13. Resection knife
14. Cutter
15. Chisel - straight, flat & broad
16. Chisel - straight, flat & narrow
17. Chisel - straight, fluted
18. Curved chisel
19. Chain-saw
20. Arc-saw
21. Wire Saw (Giglio)
22. Trephine with mills (spear, olive-shaped and spherical);
23. Straight rasp
24. Curved rasp

II. Tools for stopping bleeding (Hemostasis):
25. Kocher’s Hemostatic clamp, straight
26. Kocher’s Hemostatic clamp, curved on plane
27. Kocher’s Hemostatic clamp, curved along the edge
28. Billroth’s Hemostatic clamp, straight
29. Billroth’s Hemostatic clamp, curved in a plane
30. Billroth’s Hemostatic clamp, curved along the edge
31. "Mosquito" Hemostatic clip, straight
32. "Mosquito" Hemostatic clip; bent on a plane
33. "Mosquito" Hemostatic; curved along the edge
34. Deschamp’s ligature needle, blunt, right
35. Deschamp’s ligature needle, blunt, left
36. Deschamp’s ligature needle, sharp, right
37. Deschamp’s ligature needle, sharp, left

III. Tools for dilution of the wound edges and fixation of tissues (auxiliary):
38. Single-toothed sharp hook
39. Single-toothed blunt hook
40. Multiple-teethed Hook (2x, 3x, etc.), sharp
41. Multiple-teethed Hook (2x, 3x, etc.), blunt
42. Plate farabeuf’s hook
43. Abdominal mirror
44. Retractor screw
45. Salaskovy retractor
46. Dissecting forceps
47. Surgical forceps
48. Anatomical forceps
49. Tsapko linen
50. Forceps
                                              11


51. Drainage tube
52. Bellied probe


B. Tools for execution of operational techniques (intervention on organs):
IV. Special tools:
53. Luer’s Tracheostomy cannula
54. Gryunfelta’s hook
55 Tracheostomy Trusso
56. Gastrointestinal forceps, crushing (hard)
57. Gastrointestinal forceps, flexible (soft) &straight line
58. Gastrointestinal forceps, flexible (soft), curved on a plane
59. Gastrointestinal forceps, flexible (soft), curved along the edge
60. Amputating retractor and others

B. Tools for concluding (rounding up) operations:
V. Tools for connecting tissue:
61. Hager’s Needle holder
62. Troyanov’s Needle holder
63. Mathieu Needle Holder
64. Straight sharp needle
65. Straight blunt needle
66. Curved needle for stitching
67. Curved cutting needle

Suture material:
- Absorbable;
68. Catgut
- Non-absorbable;
69. Silk
70. Capron

                              Surgical Instruments (1-70)


   Applied when performing different           Used when performing typical/particular
   operations (general surgery) (1-52, 61-     operations (special) (53-60), see below
   70)


     For operative access (1-52)             For concluding a surgical operation (for
                                             suturing) (61-70) see below:



   For cutting or Peeling      Allow clamping of vessels     Neither for cutting nor sawing;
   surfaces (for the           or their ligature (to stop    surfaces not designed to stop
   separation of tissues)      bleeding) (25-37), see        bleeding (secondary) (38-52),
   (1-24) see below            below                         see below
                                                   12




                            2. DISCONNECTION OF TISSUE
 Relevance of the topic:
  On the list of skills that a physician of any specialization should normally possess is the ability
to perform the initial debridement and stoppage of external bleeding. Therefore, all physicians
must possess technique of separation of tissue and hemostasis. Understanding the fundamental
principles of separation of tissues would help make the right decision to perform several surgical
procedures. For the ligation of vessels, the physician must be able to tie knots.


                                                          BACKGROUND KNOWLEDGE AND
           SPECIFIC OBJECTIVES                                     SKILLS

                                          To be able to:
1 interpret the principles of separation of             use of general surgical instruments,
  tissues;                                              (Department of operative surgery and
2. to carry out the separation of tissues on the        topographic anatomy)
  cadaver and dummies
3. Knit using simple, sea, surgical, and finger
  method;
4. Perform timely and definitive hemostasis on
  the human cadaver and dummies




.
LEARNING OBJECTIVES:
  The overall goal: to be able to carry out the separation of tissues, to carry out timely and
definitive hemostasis in the human cadaver and dummies.

To determine the basic level of knowledge & skills and for self-assessment and self-correction
purpose, the following tests are provided to be solved:
                                              Test № 1
 A surgeon took a scalpel such that the finger was located on the back of the instrument. In what
position was the scalpel handled in this situation?
A. "The Fist"
B. "writing pen"
C. "Table Knife"
D. "Violin bow"
E.       –
                                              Test № 2
                                               13


 In order to temporarily arrest bleeding, the surgeon used a hemostatic "Mosquito" forceps. What
fingers of the surgeon should be placed in the rings of the tool to ensure optimum fixation in his
hand?
A First and second
B. First and third
C. First and fourth
D. Second and fifth
E. Second and forth
Standards answers to tests to determine the initial level: № 1 - C; № 2 - C.

 Information necessary for adequate knowledge and skills can be found in the following sources:
1. Operative surgery and Topographical anatomy / pid ed. Kulchitskogo K.І. - Dublin: Vishcha
wk., 1994. - Pg. 7-29.
2. Operative Surgery and Topographic Anatomy / ed. KI Kulchitsky, I.I.Bobrika. - K.: Vyshcha
School, 1989. - Pg. 15-30.

CONTENTS OF TRAINING
 After mastering the necessary basic knowledge and skills, you can proceed to study the
following materials:
LIST OF THEORETICAL ISSUES
1. The principles of separation of tissues.
2. Technique of separation of tissues.
3. Knitting machinery components (simple, sea and surgery), and finger apodaktly method.
4. Technique and time for stoppage of bleeding.
 A graph of the logical structure of the topic can be found in the Appendix.

                             SOURCES OF INFORMATION:
MAIN REFERENCES
1. Operative Surgery and Topographic Anatomy / pid ed. Kulchitskogo K.І. - Dublin: Vishcha
wk., 1994. - Pg. 29-30.
2. Operative Surgery and Topographic Anatomy / ed. KI Kulchitsky, I.I.Bobrika. - K.: Vyshcha
School, 1989. - Pg. 35-36, 37-38.
3. Lecture on the theme/topic.
FURTHER READING:
1. Operative Surgery and Topographic Anatomy: Pіdruchnik for dentistry students. Faculty tіv /
MS Skripnikov, AM Bіlich, V. I. Shepіtko that іn., For Ed.MS Skripnikova. - K.: Vishcha wk.,
2000. - Pg. 15-22.
2. Siroid D. Technique of operational skills a doctor. - Donetsk, 2009. - S. 31-45.


SET OF TASKS TO ENSURE ACHIEVEMENT OF SPECIFIC STUDY PORPOSE
                                              Test № 1
 A surgeon cuts the muscle between the superimposed hemostatic clips. What is the fundamental
principle of separation of tissue and disruption at the same time?
A. layered
B. Hemostatic
                                                14


C. Relative non-traumatic
D. Aseptic
E. Oblastnoy
                                               Test № 2
 During skin incision, the surgeon took a sharp scalpel in the "table knife" position and made an
incision. He made the cut in the desired length and direction, and then pierced through. At what
angle to the surface of the skin is it advisable to cut and pierce in this situation (for the proper
formation of the angles of the wound)?
A 10 °
B. 20 °
C. 45 °
D. 60 °
E. 90 °
                                               Test № 3
  The surgeon ties the knot in apodactyl way (with tools). What tools are best used to cover up
this site?
A tweezers or needle ligature
B. Scalpels and scissors
C. Sharp multiple-teethed hooks
D. Needle holders or clamps
E. Tsapko linen
                                               Test № 4
  In order to stop bleeding temporarily, the surgeon clamped the damaged vessel, together with
the surrounding muscle tissue with a hemostatic Kocher’s clamp. To finally stop the bleeding, he
tied this vessel, together with the surrounding tissue. At what point in time should the hemostatic
clip be removed from the tissue in order to stop bleeding?
A. Immediately after applying a ligature clip
B. After the formation of the initial stitch (before tightening)
C. In the preliminary round of tightening
D. After tightening the locking loops
E. After cutting the ends of the fibers
     Standard answers to tests: № 1 - C; № 2 - E; № 3 - D; № 4 - C.

        BRIEF NOTES TO THE STUDENTS OF PRACTICAL EXERCISES
 In early studies, monitoring and correcting the basic level of students’ "knowledge and skills"
are carried out. Students then independently learn the technique of separation of tissues, knitting
units, temporary and final stoppage of bleeding on the cadaver and dummies.
  During independent work/skills, students master the proper use of surgical instruments. After
discussing the results of students' independent work, test control should be organized and results
summarized.
                                 15


                           APPENDIX
GRAPH OF LOGIC STRUCTURES RELATED TO: "Separation of Tissues"


               Separation of tissue


                         Principles


   Disconn        Hemostas            Relative atraumat           aseptic
   ection         is                  ic



        Technique of Tissue separation


        Technique of Knotting with fingers & apodactyl method



     Simple                     Sea                    Surgical


          Technique of Timely and Total Stoppage of
                          Bleeding
                                                16


                               3. CONNECTING TISSUES
Relevance of the topic: The ability to perform primary debridement is a vital skill that a
physician of any specialty should possess. Therefore, all physicians must learn and understand
the techniques of tissue assembly/connection. Understanding the basic principles of making
tissue connections will ensure taking the right decisions in performing a variety of surgical
procedures. To create suture, you should be able to tie knots. Removal of sutures is also an
important skill that is required of all doctors.

LEARNING OBJECTIVES:
 The overall goal: to be able to perform tissue connection procedures and removal of stitches on
the cadaver and dummies.
                                                     Background Level of Knowledge and Skills
              Specific Objectives
                                            To be able to:
1. Interpret the principles of connection of        1. Use general surgical instruments (Dept. of
  tissues.                                            Operative Surgery and Top-Anatomy)
 2. To device Techniques to make the                2. Knit (simple, sea, surgical, finger–type) and
connection by imposing nodal tissue, and              apodactyl method (Dept. of Operative
continuous sutures on Cadavers and dummies.           Surgery and Top-Anatomy)
3. To remove interrupted sutures.


  To determine the basic level of knowledge & skills for self-assessment and self-correction
purposes, the following tests are provided to be solved:
                                              Test № 1
  In the process of connecting tissues, the surgeon used a Hegar’s needle holder for suturing a
deep wound. What fingers of the surgeon should be placed in the rings of the tool to ensure
optimum fixation in his hand?
A. First and second
B. First and third
C. First and fourth
D. Second and fifth
E. Second and fourth
                                              Test № 2
 Upon application of a simple hub on the skin suture, the surgeon decided to use a simple
("female") node. For this purpose, he made a single preliminary round and placed it to the
neighboring end of the wound. How should the fixing turn be made correctly in this situation?
A. Single, in the same direction
B. Single, in the opposite direction
C. Double, in the same direction
D. Double in the opposite direction
E. Triple in the same direction
Standards of answers to tests to determine the initial level: № 1 - C; № 2 - A.
  Information necessary for the formation of initial knowledge and skills can be found in the
following sources:
                                               17


1. Operative Surgery and Topographic Anatomy / pid ed. Kulchitskogo K.І. - Dublin: Vishcha
wk., 1994. - Pg. 18-29, 31.
2. Operative Surgery and Topographic Anatomy / ed. KI Kulchitsky, I.I.Bobrika. - K.: Vyshcha
School, 1989. - Pg. 15-30.

                              CONTENTS OF TRAINING
After mastering the necessary basic knowledge & skills, you can proceed to study the following
materials:
 LIST OF THEORETICAL PROBLEMS:
1. Principles of connection of tissues.
2. Knitting machinery components (simple, sea and surgery), and finger apodaktly method.
3. Suturing technique: nodes (single node, U-shaped, Donati’s) and continuous (simple
continuous by Multanovsky, mattress, cosmetic) and their comparative characteristics.
4. Technique of simple removal of nodal sutures.
 A graph of the logical structure to the topic can be found in the Appendix.

 SOURCES OF INFORMATION:
MAIN REFERENCES
1. Operative Surgery and Topographic Anatomy / pid ed. Kulchitskogo K.І. - Dublin: Vishcha
wk., 1994. - Pg. 29-31.
2. Operative Surgery and Topographic Anatomy / ed. KI Kulchitsky, I.I.Bobrika. - K.: Vyshcha
School, 1989. - Pg. 36-37.
3. Lecture materials on the theme/topic.
FOR FURTHER STUDY:
1. Operative Surgery and Topographic Anatomy: Pіdruchnik for Dentistry students. Faculty tіv /
MS Skripnikov, AM Bіlich, V. I. Shepіtko that іn., For Ed.MS Skripnikova. - K.: Vishcha wk.,
2000. - Pg. 15-22.
2. Siroid D. Technique of operational skills of physician: - Donetsk, 2009 - Pg.31-55.

   SET OF TASKS TO ENSURE ACHIEVEMENT OF A PARTICULAR PURPOSE OF
                                             STUDY:
                                             Test № 1
 Upon completion of a "Caesarean section" operation, the surgeon sutured the skin with
subcutaneous fat and superficial fascia of the anterior leaflet of rectum. Cosmetic properties of
postoperative scar were poor – the scar was "locked-in" and sedentary. The violation of which of
the following principles of tissue connection led to the formation of a postoperative scar?
A. layer
B. Hemostatic
C. Non-traumatic
D. Aseptic
E. Oblastnoiy
                                             Test № 2
 A surgeon makes a simple interrupted stitch on the skin. What kind of needle should be used in
such a situation?
A. Straight, blunt
                                                18


B. Straight, sharp
C. Curved, sharp
D. Curved, cutting
E. Atraumatic, sharp
                                              Test № 3
 Surgeon puts stitches of the Multanovsky seam in muscle. Which group of stitches was applied
by the surgeon in this situation?
A. Simple
B. Sea
C. Surgical
D. Intermittent
E. Continuous
                                              Test № 4
 Upon completion of a surgical procedure, the surgeon places a seam on the skin. For this
purpose, he punctures the wound with a needle on one side, and removes the needle from the
opposite edge of the wound and then connects the ends of the strands together. What kind of
seam did the surgeon put in this situation?
A. Simple node
B. U-shaped
C. Donati’s
D. Multanovsky
E. Mattress
                                              Test № 5
 A surgeon removes the stitches of simple knots via straight scissors having one sharp end. At
what point should he cut the ligature after fixation?
A. In the middle
B. Under the knot
C. Above the knot
D. Through the knot
E. In the opposite side of the knot
Standards of response to targeted tests: № 1 - A; № 2 - D; № 3 - E; № 4 - A; № 5 - B.

            BRIEF NOTES OF PRACTICAL EXERCISES TO THE STUDENTS
 Earlier, studies are carried out to monitor and correct the basic level of "knowledge and skills"
of the students. Students then independently learn the techniques of knitting; producing various
stitches and their removal on the cadaver and dummies. During independent work, skills of the
students in proper use of surgical instruments are mastered. After discussing the results of
students' independent work, tests control are carried out and results are summarized.
                                   19


                              APPENDIX
          GRAPH OF LOGICAL STRUCTURES RELATED TO:
                    "TISSUES CONNECTION”

                       Connecting Tissues

                           Principles


    Disconn         Hemostas            Relative                   Antisepsi
    ection          is                  atraumatic                 s


          Knotting Techniques with Fingers & apodactly method



        Simple                Marine                 Surgical

                   Technique of Tissue connection



    Bloodless Method                          Method Involving
                                              Blood

                          Suturing Technique



          Nodal                                       Continuous


Simpl     U-            Don       Simpl       Multano       Mattre     Cosmeti
e         Shaped        ati       e           vsky          ss         c

                              Techniques of Suture
                              removal
                                                 20


 4. Operative surgery and topographic anatomy of the Brain part of the Head
Relevance of the topic:
 Dentists should be able to interpret the features of topographic anatomy of
the cerebral department of head for correct diagnosis, to anticipate possible complications,
including - the possible pathway of the pathological process. All doctors should be able to use
external landmarks of the brain on the head to describe the data of physical examination, for the
determination of fluctuating points and perform other manipulations.

LEARNING OBJECTIVES
 The overall goal: to be able to interpret the features of topographic anatomy of the brain part of
the head, to perform surgical manipulations and improve medical skills.

                                                                       Background Level of
                    Specific Objectives
                                                                       Knowledge and skills
                                          To be able to:
1. Interpret the features of Topographic anatomy of the           Recognize the brain part of the
  cranial vault and Skull base;                                   head (Department of general
2. Identify possible pathways of pathological processes and       anatomy).
  their location;
3. Locate the pulsating point on the surface of the temporal
  and occipital artery;
4. Denote the projection of the cuts at the opening of
  abscesses of the cranial vault
5. Perform anthrotomy



  To determine the basic level of knowledge & skills for self-assessment and self-correction
purpose, the following tests are provided to be solved:
                                             Test № 1
 A head injury led to the damage of one of its muscles (Muscles of the head) and formed a scalp
injury. The wounded structure was part of the helmet tendon (bell of the aponeurosis). What part
of muscle was described above?
A. Temporal
B. Tempero-occipital
C. Masticatory
D. Buccal
E. Lateral pterygoid
                                             Test № 2
The doctor performed the central anesthesia of the mandible. To do this, he led an anesthetic to
the hole through which the mandibular nerve leaves the cranial cavity. What is this hole?
A. Round
B. Oval
C. Neural
D. Stylo-mastoid
                                                21


E. jugular
Standards of answers to tests to determine the initial level: № 1 - B; № 2 - B.

Information necessary for obtaining initial knowledge and skills can be found in the following
sources:
1. Prywes M., N. Lysenkov Human Anatomy. - Moscow: Meditsina, 1985. - Pg. 45-51.
2. Sinelnikov RD Atlas of Human Anatomy. - Moscow: Gos. ed. honey.literature, 1963. -
Volume 1. - Pg. 108-124.
3. Sapin MR Human Anatomy. - Moscow, 1993. - Pg. 89-106.
4. Tests on human anatomy. - Donetsk, 1999. - Pg. 52-61.

CONTENTS OF TRAINING
After mastering the necessary basic knowledge and skills, you can proceed to study the
following materials:
LIST OF THEORETICAL ISSUES
1. Topographic anatomy of the skull base and cranial vault (frontal-parietal-occipital), temporal
and mastoid regions; possible location and pathways of pathological processes.
2. Determination of the pulse at the superficial temporal and occipital arteries.
3. Opening the abscess of the cranial vault.
4. Technique of trepanation of the mastoid process (anthrotomy); the concept of Shippo’s
triangle; Likely complications.
  On a graph of the logical structure of the topic, we can find the appendix.

SOURCES OF INFORMATION:
MAIN REFERENCES
1. Operative Surgery and Topographic Anatomy / pid ed. Kulchitskogo K.І. - Dublin: Vishcha
wk., 1994. - Pg. 33-45, 71-79.
2. Operative Surgery and Topographic Anatomy / ed. KI Kulchitsky, I.I.Bobrika. - K.: Vyshcha
School, 1989. - Pg. 44-51, 89.
3. Lecture on the theme sessions.
FURTHER READING:
1. Operative Surgery and Topographic Anatomy: handbook for students of Dentistry
students. Faculty tіv / MS Skripnikov, AM Bіlich, V. I. Shepіtko that іn., For Ed.MS
Skripnikova. - K.: Vishcha wk., 2000. - Pg. 37-43, 44-46, 51-53, 153-154.
2. Siroid D. Technique of operational skills of a doctor. - Donetsk, 2009. - Pg. 65, 71, 72-73, 76-
78.

  SET OF TASKS TO ENSURE ACHIEVEMENT OF A PARTICULAR PURPOSE OF
                                              STUDY
                                              Test № 1
Incision of a patient’s wound at the anterior fronto-parieto-occipital region was made. Which of
the following corresponds to the anterior border of this area?
A. Upper nuchal line
B. Nose and supraorbital arches
C. The upper temporal line
                                                22


D. Lower temporal line
E. suture between the parietal and frontal bone
                                                Test № 2
  A patient has an abscess of size 2x2 cm at the temporo-parietal-occipital region. In what layer is
the inflammatory process localized in this situation?
A. The thicker skin
B. In the subcutaneous tissue
C. In the aponeurosis tissue
D. In the subgaleal tissue
E. In the subperiosteal tissue
                                                Test № 3
  The doctor determined the pulse of the patient on the superficial temporal artery. Where is the
point of this artery pulsation?
A. The width of a finger anterior to the tragus of the ear
B. A finger width posterior to the ear
C. 2 cm posterior to the mastoid
D. On the front of the masseter muscle
E. On the ear
                                                Test № 4
  Patient has an abscess in the left parietal region. The surgeon conducts an autopsy on the
abscess. What incision or cut would be the most correct and least traumatic in this case?
A. Cross-sectional
B. Longitudinal
C. Radial relative to the crown
D. The radial relative to the ear tragus
E. Arc
Test № 5
  There was damage to the facial nerve during trepanation, what boundary of the Shipo’s triangle
trepanation was violated in this situation?
A. Superior
B. Front
C. Back
D. Lateral
E. Medial
Standards of response to targeted tests: № 1 - B; № 2 -; № 3 - A; № 4 - C; № 5 - B.

       BRIEF NOTES TO THE STUDENTS OF PRACTICAL EXERCISES
 At the beginning of this study; monitoring and correction of the initial level of "knowledge &
skills" were carried out. Then, students individually learn features of topographic anatomy of the
cerebral department of the head on the cadaver, models and posters; work out methods to
determine the pulse of superficial temporal and occipital arteries and the direction of the cuts to
carry out the opening of abscesses of the cranial vault and mark the boundaries of the trepanation
of Shippo’s triangle. During independent work, skills of the students’ proper use of surgical
instruments are reinforced. After discussing the results of students' independent work, test
control is carried out and its results are summarized.
                                             23


                                       APPENDIX:
                 GRAPH OF LOGICAL STRUCTURES RELATED TO:
            “Operative surgery and topographic anatomy of the BRAIN part of the head"


                                  The Brain Part Of the Head




                            Calvaria                          Base of the Skull



           Fronto-parietal-occipital      Temporal               Mastoid Area
           region                         Region


                        Topographical Anatomy



                                          Features of Blood
       Boundaries       Structure of                                   Possible location
                                          supply, innervation,
       and              Layers                                         and pathways of
                                          venous and lymphatic
       external                                                        pathological processes
                                          drainage
       Landmarks



                    Operative intervention and manipulation




The                       Trepanation of the mastoid                 Determination of the
incisions for abscess     process (the boundary of the Shipo’s       pulse at the superficial
es of the cranial         triangle trepanation)                      temporal and
vault                                                                occipital arteries
                                                24


5. Operative surgery and topographic anatomy of the cranial cavity

 Relevance of the topic: Doctors of all specialties, including dentists, should be able to
exercise primary surgical treatment of wounds of the cranial vault, have an understanding of
the scheme of brain topography and how to run craniotomy.

 LEARNING OBJECTIVES:
  The overall goal: to be able to interpret the features of topographic anatomy of the cranial
cavity in order to perform surgical intervention and acquire improved medical skills.

              Specific Objectives                    Background level of knowledge and skills
                                           To be able to:
1. interpret the features                          Recognize the formation of the skull cavity
  of topographic anatomy of the cranial cavity; (Department of general anatomy).
2. identify possible pathways of pathological
  processes in the cranial cavity;
3. use external landmarks of the head to
  indicate the brain circulatory topography
  and determine the projection of the
  various formations of the cranial cavity;
4. Implementation of the technique of
  craniotomy and primary surgical treatment of
  traumatic brain injuries.




 To determine the initial level of knowledge and skills, for independent work and for self-
correction purposes, the following tests are recommended:

                                             Test № 1:
  During osteoplastic craniotomy, the surgeon makes a cut in and restricted to the cranial
cavity. What kind of method of cutting does the surgeon make in this situation?
A. Belly of the aponeurosis
B. The periosteum
C. The dura mater
D. Arachnoid mater
E. Pia mater
                                             Test № 2
 Patient with cranial vault injury had subarachnoid hemorrhage. Bleeding occurs in this situation
directly under which mater?
A. Dura
B. Arachnoid
C. Pia
D. -
                                                  25


E. -
Standards of answers to tests to determine the initial level: № 1 - C; № 2 - B.

Information necessary for creating basic knowledge and skills, can be found in the following
sources:
1. Prywes M N. Lysenkov- Human Anatomy. - Moscow: Meditsina, 1985. - Pg. 45-51.
2. Sinelnikov RD Atlas of Human Anatomy. - Moscow: Gos. ed. honey.literature, 1963. -
Volume 1. - pg. 108-124.
3. Sapin MR Human Anatomy. - Moscow, 1993. - Pg. 89-106.
4. Tests on human anatomy. - Donetsk, 1999. - Pg. 52-61.
CONTENTS OF TRAINING
 After mastering the necessary basic knowledge & skills, you can proceed to studying the
following materials:
LIST OF THEORETICAL ISSUES
A. Topographic anatomy of the cranial cavity; meninges and the spaces between them.
B. Possible pathways of pathological processes in the cranial cavity.
C. The scheme of brain topography by Krenleyna Bryusov; Designation of the approximate
projection of the main arterial trunk of the skull, its anterior and posterior branches of the central
and lateral brain sulci and the anterior cerebral artery.
D. Classification of traumatic brain injury and intracranial hematomas; the principles of primary
surgical treatment of wounds of the cranial vault; Technique of craniotomy (bone and plastic - to
Olecranon resection at Cushing) and the possible complications.
 A graph of the logical structure to the topic can be found in the Appendix.

SOURCES OF INFORMATION:
MAIN REFERENCES:
1. Operative Surgery and Topographic Anatomy / pid ed. Kulchitskogo K.І. - Dublin: Vishcha
wk., 1994. - Pg. 33-45, 71-79.
2. Operative Surgery and Topographic Anatomy / ed. KI Kulchitsky, I.I.Bobrika. - K.: Vyshcha
School, 1989. - Pg. 51-57, 84, 85-89.
3. Lecture on the theme sessions.
FURTHER READING:
1. Operative Surgery and Topographic Anatomy: Pіdruchnik for dental students. Faculty tіv / MS
Skripnikov, AM Bіlich, V. I. Shepіtko that іn., For Ed.MS Skripnikova. - K.: Vishcha wk.,
2000. - Pg. 47-64, 146-153.
2. Siroid D. Technique of operational skills of a doctor. - Donetsk, 2009. - Pg. 65, 71, 72-73, 76-
78.

SET OF TASKS TO ENSURE ACHIEVEMENT OF SPECIFIC GOALS OF STUDY:
                                            Test № 1
 The victim from the trauma of the cranial vault has a hemorrhage, which is located between the
dura and arachnoid meninges. What kind of bleeding occurs in the victim in this situation?
A. Epidural
B. Subdural
S. Subarachnoid
                                                 26


D. Subperiosteal
E. subgleal
                                             Test № 2
 Pathological process spreads to the cranial cavity through a blind hole. In which cranial fossa
did the pathology process spread in this situation?
A. The front
B. Middle
C. The rear
D. –
E. –
                                             Test № 3
The doctor held the front vertical schemes of the brain topography by Krenleyna-Bryusov.
Through which of the following structures is a reference line drawn by the doctor in this
situation?
A. Glabella
B. Chin projection
C. The outer corner of the eye
D. The front edge of the masticatory muscles
E. The middle of the zygomatic arch
                                             Test № 4
 During a decompression craniotomy for Cushing, the surgeon cut the temporal
aponeurosis. What proper section should be used by the surgeon to cut the aponeurosis in this
situation?
A. Cross
B. Longitudinal
C. Corner
D. T-
E. U-shaped
Standards of response to targeted tests: № 1 - B; № 2 - A; № 3 - E; № 4 - B.

               BRIEF NOTES TO STUDENTS OF PRACTICAL EXERCISES
   The monitoring and correction of the initial level of students’ "knowledge & skills" were
carried out in the previous (earlier) study. Then, students start individual study of features of the
topographic anatomy of the cranial cavity on the cadaver, models and posters; with the help of
external landmarks, lines, diagrams, observing brain topography, by memorizing the projection
of intracranial structures, by simulating the primary surgical treatment of wounds of the cranial
vault, implementing the proper techniques of craniotomy and the cutting of skin and aponeurotic
flap to make incisions and drill holes. During independent work, skills of the students with
regards to the proper use of surgical instruments are reinforced. After discussing the students’
results, independent work is carried out via a test control and total results are summarized.
                                            27


                                      APPENDIX:
                 GRAPH LOGICAL STRUCTURES RELATED TO:
           "Operative surgery and topographic anatomy of the cranial cavity"

                                 CRANIAL CAVITY

                                        Cranial cavity



       Anterior                         Middle                        The posterior
       cranial fossa                    Cranial fossa                 cranial fossa

                       Topographical Anatomy


   The                 The location of       Features of the       Possible location
   boundaries          the                   blood                 and pathways of
   and guideline       meninges and          supply, innervation   pathological processes
   s, the scheme       other entities of     , venous and
   of                  the cranial cavity    lymphatic drainage
   Krenleyna-
   Bryusov

                   Operative intervention and manipulation


Primary surgical treatment of traumatic              Skull
brain injuries and their classification
                                                     Trepanation


       Osteoplastic (by Olive                    Resection (decompression by
       kronu)                                    Cushing)
                                                 28



6. Operative surgery and topographic anatomy of ‘’SIDE OF FACE’’
Relevance of the topic:
 All doctors should be aware of the side of the border areas of a person in order to be competent
enough to describe the data of the objective examination of patients. In order to carry out
surgical intervention and manipulations performed on the face, the doctors should be able to
interpret the features of the topographic anatomy of the body. These skills help avoid medical
errors. In addition, they play an important role in the prediction of possible complications,
including - pathways of pathological processes. Doctors of all specialties should be able to help
determine the projection of the external landmarks entities of a person, find the point of the facial
artery pulsation and also be capable of performing temporary stoppage of blood flow.

LEARNING OBJECTIVES:
 The overall goal: to be able to interpret the features of topographic anatomy of the lateral part of
the face, to support operational procedures and obtain improved medical skills.

SPECIFIC OBJECTIVES FOR OBTAINIG BASIC KNOWLEDGE & SKILLS
To Be able to:
A. interpret the features of topographic anatomy of the lateral part of the face;
B. identify possible pathways of pathological processes of the lateral part of the face;
C. denote the fluctuating point of the facial artery;
D. substantiate the operational procedures and manipulation on the sides of the face.
  Department of Education that recognizes the side of the face: - The Department of the general
anatomy.

 To determine the initial level of knowledge & skills to make individual progress and for
self-correction proposes, the following test questions should be solved independently:
Test № 1
 A patient had an incised wound in the parotid-masticatory area with damage to parotid salivary
gland and the nerve that passes through its thickness along the superficial temporal artery. What
nerve has been damaged in this situation?
A. Aurico-temporal
B. Orbital
C. Sublingual
D. Glossopharyngeal
E. Lingual
                                             Test № 2
 A cutting wound on the side of the face resulted in bleeding from the thickness of the parotid
gland. Bleeding occurred from an artery which is continuation of the external carotid
artery. Which artery was damaged in this case?
A. The lower alveolar
B. The occipital
C. The posterior auricular
D. The anterior auricular
E. Superficial temporal
                                                29


                                          Test number 3
A patient had an incised wound anterior to the anterior edge of the masticatory (chewing)
muscles. What muscle could be damaged as a result of this injury?
A. The lateral pterygoid
B. The medial pterygoid
C. Temporal
D. Buccal
E. Tempero-occipital
Standards of answers to tests to determine the initial level: № 1 - A; № 2 - E; № 3 - D.

 Information necessary for attaining basic knowledge and skills can be found in the following
sources:
A. Prywes M., N. Lysenkov Human Anatomy. - Moscow: Meditsina, 1985. - Pg. 138-148, 252-
258, 379-381, 497-499, 672-682.
B. Sinelnikov RD Atlas of Human Anatomy. - Moscow: Gos. ed. honey. literature, 1963. -
Volume 1. - Pg. 122-135.
C. Sapin MR Human Anatomy. - Moscow, 1993. - Pg. 89-106.
D. Tests on human anatomy. - Donetsk, 1999. - Pg. 52-61.

CONTENTS OF TRAINING
 After mastering the necessary basic knowledge and skills, you can proceed to study the
following materials:
LIST OF THEORETICAL ISSUES
1. Topographic anatomy of the lateral part of the face (cheek, parotid-masticatory area and the
deep space of the face) and external boundary landmarks, especially layered structures, blood
supply, innervation, venous and lymphatic drainage. The concept of submandibular fovea,
topographic anatomy of the parotid gland, "weak" points of its capsule.
2. Determination of the projections of the facial structures: ductless parotid gland, the facial
artery pulsation point.
3. Possible pathways of pathological processes (processes in the course of the fat in cheeks, deep
spaces of the inter-muscular space, a person with phlegmon parotid salivary gland, etc.).
4. Surgical interventions and manipulations performed in the lateral part of the face: a temporary
cessation of bleeding, cuts in purulent processes, operations on the parotid gland.
On a graph of the logical structure to the topic, the Appendix can be found.

SOURCES OF INFORMATION:
MAIN REFERENCES:
A. Operative Surgery and Topographic Anatomy / pid ed. Kulchitskogo K.І. - Dublin: Vishcha
wk., 1994. - S. 45-70, 82-83.
B. Operative Surgery and Topographic Anatomy / ed. KI Kulchitsky, I.I.Bobrika. - K.: Vyshcha
School, 1989. - S. 78-82, 92-94.
C. Lecture on the theme sessions.
FURTHER READING:
A. Operative Surgery and Topographic Anatomy: Pіdruchnik for dental students. Faculty tіv /
MS Skripnikov, AM Bіlich, V. I. Shepіtko that іn., For Ed.MS Skripnikova. - K.: Vishcha wk.,
                                                30


2000. - Pg. 113-114, 135-144, 169-173.
B. Siroid D. Technique of operational skills a doctor. - Donetsk, 2009. - Pg. 65-70, 73-77.

   SET OF TASKS TO ENSURE ACHIEVEMENT OF A PARTICULAR PURPOSE OF
                                               STUDY
                                               Test № 1
 The patient had an incised wound in the parotid and cheek (masticatory) region, on the left
side. To describe the localization of the wound the doctor with the help of external landmarks
defined border between these areas. How did the doctor have to draw the line in this situation?
A. According to the line connecting the wing of the nose and corner of the mouth
B. At the nasolabial fold and nasal-cheek fold
C. At the lower edge of the orbit
D. On the front of the masseter muscle
E. At the bottom edge of the body of the mandible
                                               Test № 2
 A surgeon does a primary surgical treatment of wounds in the cheek area. As a result of
complications, he damaged the buccinator. What fascia covering the outer surface of the muscle
was also damaged in this situation?
A. Supracranial
B. Temporal
C. Peripharyngeal
D. Bucco-pharyngeal
E. Inter-pterigoid
                                               Test № 3
  A patient with cellulitis of the parotid gland had inflammatory process spread through
appendage and pharyngeal cancer. In what cellular spaces did the disease process spread in this
situation?
A. Front peripharyngeal
B. Rear peripharyngeal
C. Retropharyngeal
D. Temporo-pterygoid
E. Inter-pterigoid
                                              Test № 4
 The patient has an inflammatory process localized in an interval of deep pterigoid space which
spread through the foramen ovale. Which cavity did the disease process spread in this situation?
A. Skull
B. Hollow
C. Nose
D. Mouth
E. Ear
                                               Test № 5
 Dentist temporarily stopped the bleeding from the buccal area by pressing the facial artery to
the lower jaw. For achieving this goal, he divided the mandible on the side into three half. Where
on the lower jaw is the pulsating point of the artery in order to allow proper clamping by the
physician in this situation?
A. In the middle
                                                31


B. Between the anterior and middle third
C. Between the posterior and middle third
D. In the middle of the anterior third
E. In the middle of the posterior third
                                             Test № 6
 The surgeon performed incision in a parotid phlegmon. Which section should be used in this
situation?
A Longitudinal
B. Cross
C. Oblique
D. Radial
E. T-shaped
Standards of response to targeted tests: № 1 - D; № 2 - D; № 3 - A; № 4 - A; № 5 - C; № 6 - D.

  BRIEF NOTES TO THE STUDENTS OF PRACTICAL EXERCISES:
In early studies monitoring and correction of the initial level of ’’knowledge and skills’’ were
carried out. Students then do individual study on features of the topographic anatomy of the
lateral part of the face on the cadaver, models and posters. Using external landmarks, they define
the boundaries of the face, conducting the projection of structures and sections. During
independent work of the students, skills in the proper use of surgical instruments, tissue
separation and connection are reinforced. After discussing the results of students' independent
work, test control and summarizing of results are finally carried out.
                                               32


                                      APPENDIX
                GRAPH LOGIC STRUCTURES RELATED TO:
          "Operative surgery and topographic anatomy SIDE OF FACE'’


                                          Side of Face




 Neck             Parotid-masticatory area          Deep space of
 region
                                                    the face
                           Topographical Anatomy


                                                       Syntopy, skel
                                                       piya agencies




                                                                                   Possible path
                                                       etopy, goloto
                                innervation,




                                                                                   pathological
 boundaries,




                                                        and entities
                                venous and
 landmarks


               structure




                                lymphatic




                                                                                   processes
                                drainage
 external


               Layer-




                                                                                   ways of
                                supply,
                                Blood
 The




                  Operative intervention and manipulation


Incisions in                     Operations on                         Determination of the
purulent proce                   the parotid gla                       pulse at the radial artery and
sses                             nd                                    the temporary cessation of
                                                                       bleeding
                                                33




7. FACE INNERVATION. CONDUCTION ANESTHESIA ON UPPER AND
LOWER JAW
   Relevance of the topic: Knowledge of topographic anatomy of the facial features of the head
(in particular - where the terminal branches of trigeminal nerve exit the skull) and how to
maneuver the different ways of conduction anesthesia in the maxilla and mandible. Clumsily-
made incisions in the sides of the face can lead to a violation of the motor innervations of the
facial muscles, so doctors need to know the projection of the branches of the facial nerve.
LEARNING OBJECTIVES:
  The overall goal: to be able to make regional anesthesia in the maxilla and mandible, incisions
in the sides of the face with respect to the innervations of the facial structures of the head.
  SPECIFIC OBJECTIVES TO BACKGROUND KNOWLEDGE & SKILLS
To Be able to:
A. interpret the features of the innervations of the face;
B. base and model for regional anesthesia of the upper jaw;
C. base and simulation of regional anesthesia in the mandible. to determine the origins of the
trigeminal nerve, the projection of the branches of the facial nerve (Department of general
anatomy; department of operative surgery and top. anatomy).
  To determine the initial level of knowledge and skills to self-control and self-correction propose
to solve the following tests:
                                               Test № 1
 During administration of anesthesia with an anesthetic tagged- "for foramen ovale," the doctor
summed anesthetic agent to the foramen ovale of the skull base. What nerve leaves the cranial
cavity through this hole?
A. Face
B. Vagus
C. First branch of the trigeminal
D. Second branch of the trigeminal
E. Third branch of the trigeminal
                                               Test № 2
When opening a parotid gland phlegmon, a nerve branch was damaged, resulting in a damage of
motor innervations to some muscles of the face. What branches of the nerve had been damaged
in this situation?
A. Orbital
B. maxillary
C -
D. The facial
E. Chin
Standards of answers to tests to determine the initial level: № 1 - E; № 2 - D.

Information necessary for the formation of basic knowledge and skills, can be found in the
following sources:
A. Prywes M., N. Lysenkov Human Anatomy. - Moscow: Meditsina, 1985. - Pg. 138-148, 252-
258, 379-381, 497-499, 672-682.
                                               34


B. Sinelnikov RD Atlas of Human Anatomy. - Moscow: Gos. ed. honey.literature, 1963. -
Volume 1. - Pg. 122-135.
C. Sapin MR Human Anatomy. - Moscow, 1993. - pg. 89-106.
D. Tests on human anatomy. - Donetsk, 1999. - Pg. 52-61.
CONTENTS OF TRAINING:
 After mastering the necessary basic knowledge and skills required, you can proceed to studying
the following materials:
LIST OF THEORETICAL ISSUES:
A. Features of motor and sensory innervations of the face.
B. Technique of central and peripheral conduction anesthesia in the maxilla and mandible.
 On a graph of the logical structure to the topic can be found in the Appendix.

                              SOURCES OF INFORMATION:
                                   MAIN REFERENCES:
A. Operative surgery and topographical anatomy / pid ed. Kulchitskogo K.І. - Dublin: Vishcha
wk., 1994. - pg. 79-84.
B. Operative Surgery and Topographic Anatomy / ed. KI Kulchitsky, I.I.Bobrika. - K.: Vyshcha
School, 1989. – pg. 64-67, 89-92.
C. Lecture on the theme sessions.
FURTHER READING:
A. Operative Surgery and Topographic Anatomy: Pіdruchnik for dental students. Faculty tіv /
MS Skripnikov, AM Bіlich, V. I. Shepіtko that іn., For Ed.MS Skripnikova. - K.: Vishcha wk.,
2000. - pg. 70-77, 155-164.
B. Siroid D. Technique of operational skills a doctor. - Donetsk, 2009. - Pg. 67-70, 73-76.

SET OF TASKS TO ENSURE ACHIEVEMENT OF A PARTICULAR PURPOSE OF
STUDY
                                              Test № 1
 When opening a phlegmon of the parotid gland the surgeon damaged a branch of the facial
nerve, resulting in damaged motor innervations of the facial muscles of the face. How was the
cut made in this case?
A. Arched behind the boil
B. Longitudinal
C. Cross-
D. Radially relative to the base of the ear lobe
E. Radially relative to the angle of the eye
                                              Test № 2
 The surgeon performs the extra-infraorbital anesthesia. In what direction should the needle be
moved in this situation?
A. Up and outwards
B. Up and medially
C. Down and medially
D. Down and outwards
E. Perpendicular to the surface of the skin
Test № 3
                                                35


 A doctor, performing the central mandibular nerve anesthetics, inserted the needle into the
middle tragoorbital line, made a puncture all the way to the pterygoid process of sphenoid bone,
partially withdrew the needle and carried out a second puncture at the same depth. In what
direction should the needle puncture be oriented in this situation?
A. Perpendicular to the skin
B. Posterior
C. The anterior
D. Up
E. Down
Standards of response to targeted tests: № 1 - D; № 2 - A; № 3 - B.

BRIEF NOTES TO THE STUDENTS OF PRACTICAL EXERCISES
 In early studies, monitoring and correction of the initial level of ’’knowledge and skills’’ were
carried out. Students then carried individual studies of the innervations of the structures in the
facial department of the head on the cadaver, models and posters. Using external landmarks,
students determine the projection of the branches of the facial nerve, the origins and end
branches of the trigeminal nerve, maneuver and simulate various types of administration of
anesthesia in the maxilla and mandible. During independent work, students reinforce their skills
in the proper use of surgical instruments, tissue separation and connection. After discussing the
results of independent work, test control and summarizing of results are conducted.
                                                                                   36


                                                                     APPENDIX
                           GRAPH OF LOGIC STRUCTURES RELATED TO:
                 "FACE INNERVATION. CONDUCTION OF ANASTHESIA ON UPPER AND
                                        LOWER JAW”


                                                                     innervation of the face

                             Motor (including the                                                      Sensory (including the origins
                              projection of the                                                         and the end branches of the
                         branches of the facial nerve)                                                       trigeminal nerve)


                                          Conduction anesthesia technique



                              On the upper jaw                                          On the lower jaw

         Central (the round-                              Periphera                             Central (the foramen                     Peripheral
         hole logo)                                       l                                     ovale
                                                                                                            Sub-zygomatic
Subpterigoidal




                                                                                        Premaxillary




                                                                                                                            Mandibular




                                                                                                                                                  Mandibular
                                          Infraorbital
                               Tuberous




                                                                        Tuberous
                   Palatine




                                                          Palatine




                                                                                                                                         Mental




                               Extra-                    Intra-oral                                         Extra-                       Intra-oral
                               Oral                                                                         Oral
                                                37




8. Operative surgery and topographic anatomy of the “Front of the Face”

  Relevance of the topic: All doctors should be aware of normal boundaries on a person in
order to describe the data of the objective examination of the patient. In order to perform surgical
procedures and manipulations on the anterior face, the doctors should be able to interpret the
features of the topographic anatomy of the body. These skills help avoid medical errors. In
addition, they play an important role in the prediction of possible complications, including -
pathways of pathological processes. Doctors of all specialties should be able to exercise primary
surgical treatment of wounds of the face.
LEARNING OBJECTIVES:
The overall goal: to be able to interpret the features of topographic anatomy of the anterior face
to make surgical intervention and acquire good medical skills.

SPECIFIC OBJECTIVES BACKGROUND KNOWLEDGE & SKILLS
Be able to:
A. Interpret the features of topographic anatomy of the anterior face;
B. identify possible pathways of pathological processes of the anterior face;
C. substantiate the operational intervention and manipulations on the face; Education to
recognize the anterior face (Department of the general anatomy).
 To determine the initial level of knowledge and skills for self-assessment and to make self-
corrections, the following tests should be taken:
                                              Test № 1
 The victim had a fracture due to injury of the bone base of the nose. What processes of the
bones could be damaged in this situation?
A. Cheek (frontal)
B. Frontal (cheek)
C. Frontal (maxillary)
D. Mastoid (temporal)
E. Pterygoid (wedge)
                                              Test № 2
 Infected venous blood through the orbital veins flowed into the dural (venous) sinus. In what
sinus has the infected venous blood gotten in this situation?
A. Superior sagittal
B. Cavernous
C. The sigmoid
D. Occipital
E. Cross
Standards of answers to test questions: № 1 - C; № 2 - B.
 Information necessary for the formation of basic knowledge & skills, can be found in the
following sources:
A. Prywes M., N. Lysenkov Human Anatomy. - Moscow: Meditsina, 1985. - Pg. 138-148, 252-
258, 379-381, 497-499, 672-682.
B. Sinelnikov RD Atlas of Human Anatomy. - Moscow: Gos. ed. honey.literature, 1963. -
Volume 1. - Pg. 122-135.
                                                38


C. Sapin MR Human Anatomy. - Moscow, 1993. - Pg. 89-106.
4. Tests on human anatomy. - Donetsk, 1999. - Pg. 52-61.
CONTENTS OF TRAINING:
After mastering the necessary basic knowledge and skills, you can proceed to study the
following materials:
LIST OF THEORETICAL ISSUES:
A. Topographic anatomy of the anterior face (chin, nose, mouth, and orbital regions): the
boundaries and external orientations, especially of layered structures, blood supply, innervation,
venous and lymphatic drainage; eye sockets and nasal cavity, paranasal sinuses.
B. Possible pathways of pathological processes, the concept of the "triangle of death".
C. Surgical interventions and manipulations performed in the anterior face: primary surgical
treatment of wounds, surgical interventions in the paranasal sinuses, the principles of
rhinoplasty, the notion of migrating stem by Filatov.
 The Appendix can be found on a graph of the logical structure to the topic.

SOURCES OF INFORMATION:
MAIN REFERENCES
A. Operative Surgery and Topographic Anatomy / pid ed. Kulchitskogo K.І. - Dublin: Vishcha
wk., 1994. - Pg. 45-70, 82-83.
B. Operative Surgery and Topographic Anatomy / ed. KI Kulchitsky, I.I.Bobrika. - K.: Vyshcha
School, 1989. - Pg. 67-73, 92-95.
C. Lecture on the theme sessions.
FURTHER READING:
A. Operative Surgery and Topographic Anatomy: Pіdruchnik for dentistry students. Faculty tіv /
MS Skripnikov, AM Bіlich, V. I. Shepіtko that іn., For Ed.MS Skripnikova. - K.: Vishcha wk.,
2000. - Pg. 28-29, 114-135, 173-179.
B. Semenova TV Clinical anatomy and operative surgery: a course / T. Semenova. - Donetsk,
2006. - Pg. 49-80.
C. Siroid D. Technique of operational skills a doctor. - Donetsk, 2009. - Pg. 65-70, 73-77.

SET OF TASKS TO ENSURE ACHIEVEMENT OF A PARTICULAR PURPOSE OF
STUDY:
                                            Test № 1
 A patient was diagnosed with maxillary odontogenic disease origination. What wall of the
maxillary sinus became a "weak" point after the spread of the disease process in this situation?
A. The upper
B. Lower
C. Back
D. Lateral
E. Medial
                                            Test № 2
 A patient had an inflammatory process spread through the temporo-pterygoid gap into the
orbital cavity. Through what formation did the inflammatory process spread in this case?
A. The lower orbital space
B. The upper orbital space
                                                39


C. A round hole
D. Foramen ovale
E. Connecting hole.
                                            Test № 3
 Surgery is performed on the maxillary named sinusotomy by Konduellu-Luc. On the part of
what wall of the maxillary sinus was access into the sinus made in this situation?
A. Upper
B. Lower
C. Rear
D. Frontal
E. Medial
Standards of answers to tests: № 1 - B; № 2 - A; № 3 - D.

             BRIEF NOTES TO THE STUDENTS OF PRACTICAL EXERCISES
 In early studies, monitoring and correction of the initial level of "knowledge and skills" were
performed. Then students individually learn features of the topographic anatomy of the anterior
face on the cadaver, models and posters. Using external landmarks and points, they define the
boundaries by conducting the projection of structures and sections. During independent work,
skills of the students in the proper use of surgical instruments, tissue separation and connection
are reinforced. After discussing the results of students’ independent work, test control and
summarizing of its results are then conducted.
                                           40


                                      APPENDIX
                 GRAPH LOGIC STRUCTURES RELATED TO:
"Operative surgery and topographic anatomy of the Frontal Department of the Face”



                                        Anterior face


            Areas of             Area and the nasal         Area and       Chin Area
            the eye              cavity, paranasal          mouth
            sockets and          area                       cavity
            mouth




                           Topographical Anatomy
                                innervation




                                                                       pathologica
 Landmarks
 boundaries




                                                                       l processes
                                                      formations
                                lymphatic



                                                      Synotopy,
                                                      skeletopy,




                                                                       pathways
               structure




                                drainage




                                                      golotopy
                                , venous
 external




                                                                       Possible
                                supply,
                                Blood
               Layer
 The




                                and
 and




                                                                       of
                  Operative intervention and manipulation


Primary           Surgeries on the                    Principles        The
surgical          paranasal sinuses                   of                concept of
treatment         (opening of frontal and             Rhinoplas         migrating
of wounds         maxillary sinuses,                  ty                stem
                  gaymorotsentez)                                       Filatova
                                                41




   9. Operative surgery and topographic anatomy of the “ORAL CAVITY”
Relevance of the topic: Dentists must possess knowledge of the characteristics of topographic
anatomy of oral cavity, to avoid errors and complications in the course of their practice, and
allow prediction of the possible pathways of pathological processes. Dentists should be aware of
the surgical interventions and maneuvers performed in the oral cavity.
LEARNING OBJECTIVES
The overall goal: to be able to interpret the features of topographic anatomy of the mouth to
make necessary surgical intervention and acquire reputable medical skills.

SPECIFIC OBJECTIVES TO BACKGROUND KNOWLEDGE & SKILLS
Be able to:
A. interpret the features of topographic anatomy of the oral cavity;
B. identify possible pathways of pathological processes of the oral cavity;
C. to perform surgical interventions in the oral cavity; Education to recognize the oral cavity
(Department of the general anatomy).

 To determine the basic level of knowledge and skills in order to perform self-assessment and
self-correction, solving the following tests is highly recommended:
                                               Test № 1
On examination of the oral cavity, dentist discovered an enlarged tonsil, located between the
palatine arches. What type of tonsil was inflamed in this situation?
A. Palatine
B. Pipe
C. Lingual
D. Pharyngeal
E. –
                                               Test № 2
 Dentist sealed the upper-left "fourth" tooth in an adult patient. On what tooth was the seal placed
in this situation?
A. Incisor
B. Canine
C. The first premolar
D. Second premolar
E. first molar
Standards of answers to test: № 1 - A; № 2 - C.

 Information necessary for the acquiring basic knowledge and skills can be found in the
following sources:
1. Prywes M., N. Lysenkov Human Anatomy. - Moscow: Meditsina, 1985. - Pg. 138-148, 252-
258, 379-381, 497-499, 672-682.
2. Sinelnikov RD Atlas of Human Anatomy. - Moscow: Gos. ed. honey.literature, 1963. -
Volume 1. - Pg. 122-135.
                                                42


3. Sapin MR Human Anatomy. - Moscow, 1993. - pg. 89-106.
4. Tests on human anatomy. - Donetsk, 1999. - Pg. 52-61.

CONTENTS OF TRAINING:
After mastering the necessary basic knowledge and skills, you can proceed to study the
following materials:
LIST OF THEORETICAL ISSUES:
1. Features of topographic anatomy of the oral cavity (vestibule, floor, palate, pharynx, tongue,
teeth).
2. Possible pathways of pathological processes in the mouth cavity.
3. Surgical interventions and manipulations performed in the oral cavity: tooth extraction,
palatoplasty, cheiloplasty, resection of the upper and lower jaw, surgery on the tongue, with
ankylosis of the temporo-mandibular joint.
  A graph of the logical structure to the topic can be found in the Appendix.

                               SOURCES OF INFORMATION:
                                   MAIN REFERENCES:
1. Operative Surgery and Topographic Anatomy / pid ed. Kulchitskogo K.І. - Dublin: Vishcha
wk., 1994. - Pg. 45-70, 82-83.
2. Operative Surgery and Topographic Anatomy / ed. KI Kulchitsky, I.I.Bobrika. - K.: Vyshcha
School, 1989. - Pg. 73-78, 95-101.
3. Lecture on the theme sessions.
FURTHER READING:
A. Operative Surgery and Topographic Anatomy: Pіdruchnik for dental students. Faculty tіv /
MS Skripnikov, AM Bіlich, V. I. Shepіtko that іn., For Ed.MS Skripnikova. - K.: Vishcha wk.,
2000. - Pg. 94-113, 164-167, 184-203.
B. Siroid D. Technique of operational skills a doctor. - Donetsk, 2009. - S. 65-70, 73-77.

SET OF TASKS TO ENSURE ACHIEVEMENT OF A PARTICULAR PURPOSE OF
STUDY
                                              Test № 1
 An examination of the patient's mouth was carried out. In order to reduce the accumulation of
saliva in the mouth the dentist used four turundy gauzes. He placed 2 of them between the
patient’s cheeks and his upper alveolar ridge. Prevention of saliva from which glands was made
with these turundies?
A. submandibular
B. sublingual
C. speaking
D. Buccal
E. Parotid
                                              Test № 2
 The patient has an inflammatory process which spread from the floor of the mouth along the
glossopharyngeal nerve. In what cellular spaces did the inflammatory process spread in this
situation?
A. Retropharyngeal
B. Front peripharyngeal
                                                43


C. Rear peripharyngeal
D. Inter-pterigoidal
E. Temporo-mandibular wing
                                              Test № 3
 A surgeon performed a mandibular osteotomy of diagonal branch by Rauer. What type of skin
incision did the surgeon have to use in this situation?
A. linear
B. Corner
C. T-shaped
D. Horseshoe
E. Multiple
Standards of response to targeted tests: № 1 - E; № 2 - C; № 3 - B.

        BRIEF NOTES TO THE STUDENTS OF PRACTICAL EXERCISES
 In earlier studies, monitoring and correction of the basic level of "knowledge & skills" of
students was performed. Then students carry out individual study on the features of topographic
anatomy of the mouth on the cadaver, models and posters; study parse errors and possible
complications when performing surgery in this part of the human body. During independent
work and skills, students reinforce their skills in the proper use of surgical instruments, tissue
separation and connection. After discussing the results of students' independent work, test
control and summarizing of its results are carried out.
                                                              Boundaries
                                                              and
exodontia                                                     Landmarks




                                                                                                      of mouth
                                                                                                      Threshold
Palatoplasty                                                  Layer
                                                              structure
                                                                                                    cavity
                                                                                                    mouth
cheiloplasty
                                                                                                    Floor of


                                                              Layer-
                                                              Perfusion,
                                                              innervation
Resection of                                                  , venous
maxilla                                                       and
                                                              lymphatic
                                                              outflow
                                                                                                                                                                                                        44




                                                                                                          Tongue




                                                                            Topographical anatomy

Resection of the
                                                                                                                                                                                             APPENDIX




mandible
                                                                                                       h
                                                                                                                   Mouth cavity




                                                              Syntopy,
                                                                                                      Teet




                                                              skeletopy,
                                                              holotopy of
Operation on the                                              organds

                    Operative intervention and manipulation
Tongue (joint,                                                and their
                                                                                                       e




resection and                                                 entities
                                                                                                      Palat




removal)
                                                                                                                                       GRAPH LOGIC STRUCTURES RELATED TO:




                                                              Possible
                                                                                                                                  "Operative surgery and topographic anatomy of the MOUTH"




Transactions with                                             pathways
                                                                                                      ynx
                                                                                                      Phar




ankylosis of the                                              of
temporomandibular                                             pathologica
joint                                                         l processes
                                                45



   10. Operative surgery and topographic anatomy of the “NECK AND ITS
          TRIANGLES”. Exposure and ligation of the neck vessels
Relevance of the topic: The neck is a relatively small area of the human body which contains
very vital organs and neuro-vascular formation. Therefore, the neck is often the object of surgical
manipulations. The knowledge of topographic anatomy of the neck and its structures helps solve
complex problems of diagnosis, predict the possible pathways of pathological processes and
helps avoid medical errors. For an accurate description of the data of the objective examination
of the patient, there is need to know the boundaries of areas of triangles of the neck and the neck
itself.
LEARNING OBJECTIVES:
The overall goal: to be able to interpret the features of topographic anatomy of areas, triangles,
and the main neurovascular trunk of the neck, to carryout surgical intervention and acquire
necessary medical skills.
SPECIFIC OBJECTIVES TO BACKGROUND KNOWLEDGE & SKILLS
Be able to:
A. interpret the features of topographic anatomy of the neck area and triangles;
B. interpret the main features of topographic anatomy of neurovascular trunk of the neck;
C. identify pulsation point of the common carotid
D. Justify ligation of the common carotid, external carotid and lingual arteries.
  Identifying parts and formations of the neck (Department of the general anatomy).

 To determine the basic level of knowledge and skills for self-assessment and self-correction
purpose, the following tests should be solved:
                                             Test № 1
In the implementation of primary surgical treatment of wounds on the neck, the surgeon
mistakenly damaged the muscles that are attached to the transitional tendon of the hyoid
bone. Which muscles could have been damaged by the surgeon in this situation?
A. infrahyoid
B. Oral and sublingual
C. digastric
D. Hyo-lingual
E. sternohyoid
                                             Test № 2
 When the ligation of lingual artery was made in the Pirogov triangle, the surgeon damaged a
nerve, resulting in impaired motor innervation of the tongue. What nerve was damaged?
A. lingual
B. recurrent laryngeal
C. Glossopharyngeal
D. Hypoglossal
E. Vagus
Standards of answers to tests to determine the initial level: № 1 - C; № 2 - D.
 Information necessary for acquiring basic knowledge and skills, can be found in the following
sources:
A. Prywes M., N. Lysenkov Human Anatomy. - Moscow: Meditsina, 1985. - Pg. 138-258.
                                                 46


B. Sinelnikov RD Atlas of Human Anatomy. - Moscow: Gos. ed. honey.literature, 1963. -
Volume 2. - Pg. 278-305.
C. Sapin MR Human Anatomy. - Moscow, 1993. - Pg. 270-295.
D. Tests on human anatomy. - Donetsk, 1999. - Pg. 82-87.
CONTENTS OF TRAINING:
After mastering the necessary basic knowledge and skills, you can proceed to study the
following materials:
LIST OF THEORETICAL ISSUES
A. Topographic anatomy of the areas of the neck and its triangles: border and external
landmarks, especially of layered structures; Modified classification of neck fascia by
Shevkunenko.
B. Topographic anatomy of the main neurovascular trunk of the neck: Syntopy components
skeletopy & holotopy; Criteria for differentiating between external and internal carotid arteries.
C. Determination of the pulse at the carotid artery, temporary stoppage of arterial bleeding.
D. Rationale for access to the main neurovascular bundle of neck, ligation of the common
carotid, external carotid and lingual arteries.
  A graph of the logical structure to the topic can be found in the Appendix.

SOURCES OF INFORMATION:
MAIN REFERENCES:
1. Operative Surgery and Topographic Anatomy / pid ed. Kulchitskogo K.І. - Dublin: Vishcha
wk., 1994. - Pg. 91-100, 105-112.
2. Operative Surgery and Topographic Anatomy / ed. KI Kulchitsky, I.I.Bobrika. - K.: Vyshcha
School, 1989. - Pg. 102-105, 106-111, 116-118, 122-123.
3. Lecture on the theme sessions.
FURTHER READING:
1. Operational hіrurgіya i topografіchna anatomіya: Pіdruchnik for studentіv stomatitis. Faculty
tіv / MS Skripnikov, AM Bіlich, V. I. Shepіtko that іn., For Ed.MS Skripnikova. - K.: Vishcha
wk., 2000. - S. 209-223, 229-233, 238-241.
2. Siroid D. Technique of operational skills a doctor. - Donetsk, 2009. - Pg. 79-82, 85-89.

SET OF TASKS TO ENSURE ACHIEVEMENT OF A PARTICULAR PURPOSE OF
STUDY
                                               Test № 1
The doctor performs palpation of the left lateral (outer side) triangle of the neck. What limits the
formation of the triangle below (lower border)?
A. The lower belly of the scapular-hyoid muscles
B. The rear belly of digastric
C. The hyoid bone
D. Jugular notch of sternum
E. Clavicle
                                               Test № 2
 A patient was injured and the external carotid artery was severed (affected). The doctor
performs a temporary hemostatic procedure by pressing the common carotid artery to the bone
through its pulsation point. In order to stop the bleeding, the artery should be pressed against the
transverse process tubercle of which cervical vertebra?
                                                47


A. 2nd
B. 3rd
C. 4th
D. 5th
E. 6th
                                               Test № 3
 The surgeon accesses the common carotid artery. In what direction should he shift the
sternocleidomastoid muscle in this process of access?
A. inward and anteriorly
B. outwards and backwards
C. Inward and backward
D. Laterally and anteriorly
E. Up
                                               Test № 4
 A surgeon made access into the carotid triangle, to the external carotid artery but mistakenly tied
the internal carotid artery instead of the external. What is the difference between the tied artery
and the external carotid artery (in the surgical wound)?
A. Does not give branches
B. Gives branches
C. It is located medially
D. Located superficial
E. It occupies the front position
                                               Test № 5
 For ligation of the lingual artery in a wound, the surgeon identified the edge of a muscle, which
was the front side of the Pirogov’s triangle. The edge of what muscle did the surgeon identify in
this situation?
A. Sternocleidomastoid
B. Shoulder-hyoid
C. hyo-lingual
D. Digastric
E. Oral and sublingual
Standards of response to targeted tests: № 1 - E; № 2 - E; № 3 - In; № 4 - A; № 5 - E.

            BRIEF NOTES TO THE STUDENTS ON PRACTICAL EXERCISES:
In early studies, monitoring and correction of the basic level of "knowledge and skills" was
carried out. Students then learn on their own: - particular areas of topographic anatomy, triangles
and the main neurovascular bundle of the neck on cadavers, models and posters. Using external
landmarks, students define the boundaries of the triangles and areas of the neck, especially
studying the layered structure in them, and learn the appropriate access to the main
neurovascular trunk of the neck, ligation of the common carotid, external carotid and lingual
arteries. During their independent work, students reinforce their skills in the proper use of
surgical instruments, tissue separation and connection. After discussing the results of
independent work, test control and summarizing of its results are carried out.
                                                                        The boundaries
etermination                                                            and external
of the pulse at                                                         landmarks




                                                                                                                                                                Lateral
the carotid                                                                                                       Scapuloclavic




                                                                                                                                                                Triangles
artery, and the                                                                                                   ular triangles
temporary                                                               Layer-structure
cessation of                                                            5 fascias of
bleeding                                                                neck
                                                                                                                  Scapulo-
                                                                                                                  trapezius
                                                                        Features of the                           triangles
                                                                                                                                                                                     Anterior Region


                                                                        blood supply,

                                                                                                                                                          muscle
                                                                        innervation,
                                                                                                                                                          Areas of
                                                                        venous and
Access to a                                                             lymphatic
common,                                                                 drainage                                  submandibula
                                                                                                                                                                                                                                                                                                     48




                                                                                                                  r triangle
                                                                                                                                                                                                       Neck




external




                                                                                          Topographical Anatomy
carotid and
                                                                                                                                                          sternocleidomastoid
                                                                                                                                                                                                                                                                                          APPENDIX




lingual                                                                 Syntopy,
                                                                                                                                   region
arteries                                                                skeletopy,                                submental
                                                                                                                                   suprahyoid


                                                                        holotopy of the                           triangle
                                                                        main
                                                                        neurovascular
                                                                                                                                                                                                                                  Exposure and ligation of the neck vessels"




                                                                        bundle in the
                                                                        neck
                                                                                                                                                          triangle
                                                                                                                                                          (medial)
                                                                                                                                                                                region




                                                                                                                  carotid
                                                                                                                                                          The median
                                                                                                                                                                                                                           GRAPH OF LOGICAL STRUCTURES RELATED TO:




                                                                                                                                                                                Posterior




                                                                                                                  triangle




                  Operative intervention and manipulation of the neck
Ligation of
the arteries: a                                                                                                   Shoulder
common,                                                                                                           tracheal
external
                                                                                                                                        Infrahyoid area




                                                                                                                  triangles
                                                                                                                                                                                                              "Operative surgery and topographic anatomy of the NECK AND ITS TRIANGLES.




carotid and
lingual
                                                49



11. Operative surgery and topographic anatomy of cellular spaces of the neck.
                    Removal of lymph nodes in the neck
Relevance of the topic: Lymph nodes on the neck may be affected by metastasis while
inflammatory processes can be localized into cellular spaces of the neck. Knowledge of
topographic anatomy of the neck structures and organs helps solve complex problems of
diagnosis, to predict the possible pathways of pathological processes and to avoid unnecessary
medical errors.
 LEARNING OBJECTIVES:
The overall goal: to be able to interpret the features of topographic anatomy of the spaces in the
neck to perform surgical intervention and assure acquiring good medical skills.

 SPECIFIC OBJECTIVES TO BACKGROUND KNOWLEDGE & SKILLS:
To Be able to:
A. interpret the features of topographic anatomy of the spaces of neck;
B. identify possible pathways of pathological processes in the neck;
C. perform surgery on the neck: make incisions in inflammatory processes, remove lymph
nodes.
   Education provided to recognize the neck properly (Department of the normal anatomy).
To determine the basic level of knowledge and skills, to make self-assessment and self-
correction, the following tests are recommended to be solved:
                                             Test № 1
For opening a neck phlegmon, a surgeon made an oblique incision along the anterior edge of a
muscle which is attached to the mastoid, clavicle and sternum. On the edge of which muscle was
the incision made in this situation?
A. Omohyoid
B. Oral and sublingual
C. Digastric
D. Sternocleidomastoid
E. Sternohyoid
                                             Test № 2
 In a case of cancer of the tongue metastasis occurred in lymph nodes of the neck, located
between the anterior and posterior belly of digastric muscle. In what lymph nodes did metastases
occur here?
A. Chin
B. Submandibular
C. The occipital
D. Supraclavicular
E. Subclavian
Standards answers to tests to determine the initial level: № 1 - D; № 2 - B.

 Information necessary for the formation of initial knowledge & skills, can be found in the
following sources:
A. Prywes M., N. Lysenkov Human Anatomy. - Moscow: Medical, 1985. - Pg. 138-258.
                                               50


B. Sinelnikov RD Atlas of Human Anatomy. - Moscow: Gos. ed. honey.literature, 1963. -
Volume 2. - Pg. 278-305.
C. Sapin MR Human Anatomy. - Moscow, 1993. - Pg. 270-295.
D. Tests on human anatomy. - Donetsk, 1999. - Pg. 82-87.
CONTENTS OF TRAINING:
 After mastering the necessary basic knowledge and skills, you can proceed to study the
following materials:
LIST OF THEORETICAL ISSUES:
1. Topographic anatomy of the cellular spaces of the neck; the potential localization of
inflammatory processes in the neck & the possible pathways of pathological processes.
2. Surgeries on the neck: the cuts in inflammatory processes, removal of lymph nodes.
 A graph of the logical structure to the topic can be found in the Appendix.

                              SOURCES OF INFORMATION:
                                    MAIN REFERENCES
1. Operative Surgery and Topographic Anatomy / pid ed. Kulchitskogo K.І. - Dublin: Vishcha
wk., 1994. - Pg. 91-100, 105-112.
2. Operative Surgery and Topographic Anatomy / ed. KI Kulchitsky, I.I.Bobrika. - K.: Vyshcha
wk., 1989. - Pg. 105-106, 120-122, 131-133.
3. Lecture on the theme sessions.
FURTHER READING:
A. Operative Surgery and Topographic Anatomy: Pіdruchnik for dental students. Faculty tіv /
MS Skripnikov, AM Bіlich, V. I. Shepіtko іn., For Ed.MS Skripnikova. - K.: Vishcha wk.,
2000. - Pg. 217-218, 234-236.
B. Operative Surgery and Topographic Anatomy: Pіdruchnik / YTAhtemіychuk, JM Vovk,
S. Doroshenko, for Ed. Professor. MP Kovalskogo. - K.: NE "Medicine", 2010. - Pg. 108-110,
124-126.
C. Siroid D. Technique of operational skills of a doctor. - Donetsk, 2009. - Pg. 79-82, 85-89.

SET OF TASKS TO ENSURE ACHIEVEMENT OF A PARTICULAR PURPOSE OF
STUDY
                                            Test № 1
 In order to open up a phlegmon of submandibular salivary gland, the surgeon cuts the fascia,
which forms the sheath of the gland. What is the name of the fascia (according to the modified
classification by Shevkunenko) that the surgeon cut in this situation?
A. First
B. Second
C. Third
D. Fourth
E. Fifth
                                            Test № 2
 The patient has an inflammatory process that has spread from the neck down to the pre visceral
space. In what region did the disease process spread in this situation?
A. In the peri-pharyngeal space
B. In the retropharyngeal space
C. In the anterior mediastinum
                                                51


D. In the posterior mediastinum
E. In the preperitoneal tissue
                                             Test № 3
 A surgeon opened the phlegmon of the episternal intra-aponeurotic space. For opening the
phlegmon, the surgeon chose an incision with light lines & low tension to ensure high cosmetic
properties. Which incision was made in this situation?
A Longitudinal
B. Cross
C. Oblique
D. Radial
E. H-shaped
Standards of response to targeted tests: № 1 - B; № 2 - C; № 3 - B.

                BRIEF NOTES TO THE STUDENTS OF PRACTICAL EXERCISES
 In early studies, monitoring and correction of the basic level of "knowledge and skills" was
carried out. Then students proceed onto individual learning of features of topographic anatomy
of the neck in the cellular spaces on cadavers, models and posters; and to identify possible
pathways of pathological processes. Using external landmarks, students determine the projection
of the cuts used for the opening of the neck phlegmon and abscesses, removing lymph nodes in
the neck and implement the technique of surgical operations. During independent work of
students, skills in the proper use of surgical instruments, tissue separation and connection are
appropriately reinforced. After discussing the results of independent work, test control is carried
out and summarizing its results follows finally.
                                                                                                                           52


                                                                                                     APPENDIX
              LOGIC GRAPH OF STRUCTURES RELATED TO:
"Operative surgery and topographic anatomy of cellular spaces NECK. Removal of
                           lymph nodes in the neck"

                                                                              Cellular spaces of the neck
                                                                   (possible localization of inflammatory process)




                                                                                                                                neurovascular trunk of the neck




                                                                                                                                                                                             Space of the lateral triangle of
                                  sternocleidomastoidus muscle


                                                                    the sternocleidomastoid muscle
  Submandibular gland sac




                                                                                                                                The Vagina of the main



                                                                                                                                                                      Retro Visceral space
                                                                                                     With visceral space




                                                                                                                                                                                                                                Prevertebral space
                                                                    Blind sacs behind
                                  Fascia of the




                                                                                                                                                                                             the neck
                                                                    (Gruber)




                                                                 Topographical anatomy


                   Location (between                                                             Contents                                             Possible pathways of
                   what fascia)                                                                                                                       pathological processes



                                                                   Surgical interventions on the neck


                            Incisions in                                                                                                                          Removal
                            inflammatory                                                                                                                          of lymph nodes in
                            processes neck                                                                                                                        the neck



                                                                   Vanaha’s                                                                Kraila’s
                                                                   Operation                                                               operation
                                                53


   12. TOPOGRAPHIC ANATOMY OF THE NECK. OPERATIONS AND
                 MANIPULATION BY SNORKEL
Relevance of the topic: Organs of the neck are often the object of surgical procedures. All
doctors should be able to provide emergency assistance in case of mechanical asphyxia. A good
knowledge of the characteristics of topographic anatomy of the neck helps to avert avoidable
medical errors not only during surgery, but also in solving the complex problems of diagnosis.
LEARNING OBJECTIVES:
The overall goal: to be able to interpret the features of topographic anatomy of the neck to
support surgical operations and other manipulations performed on the respiratory tube (e.g.
Trachea, Bronchi).
SPECIFIC OBJECTIVES TO OBTAINING BACKGROUND KNOWLEDGE & SKILLS
To be able to:
A. interpret the features of topographic anatomy of the neck;
B. substantiate the operational intervention and manipulation performed on the respiratory tube.
   Recognize the organs of the neck, its parts and other vital entities of the neck (Department of
the general anatomy).

 To determine the basic level of knowledge & skills for making self-assessment and self-
correction; the following tests should be solved:
                                              Test № 1
 A case of mechanical asphyxia was brought to the emergency room, and the doctor decided to
cut/puncture the thyro-cricoid membrane (lig. conicum). To determine the puncture site, the
physician palpated two cartilages of larynx. Which of the following cartilages should be
punctured in this situation?
A. Thyroid
B. Cricoid
C. Arytenoid
D. Wedge
E. Rozhkovidniy
                                              Test № 2
 The surgeon cut through the first ring of the trachea and introduced a tracheostomy cannula. At
what laryngeal cartilage will he put pressure into the cannula in this situation?
A. Thyroid
B. Annular
С. Arytenoid
D. Wedge-shaped
E. Rozhkovidny
Standards of answers to tests to determine the initial level: № 1 - A; № 2 - B.

Information necessary for acquiring of basic knowledge & skills can be found in the
following sources:
1. Prywes M., N. Lysenkov Human Anatomy. - Moscow: Meditsina, 1985. - Pg. 138-258.
2. Sinelnikov RD Atlas of Human Anatomy. - Moscow: Gos. ed. honey.literature, 1963. -
Volume 2. - Pg. 278-305.
C. Sapin MR Human Anatomy. - Moscow, 1993. - Pg. 270-295.
D. Tests on human anatomy. - Donetsk, 1999. - Pg. 82-87.
                                               54



CONTENTS OF TRAINING:
After mastering the necessary basic knowledge & skills, you can proceed to studying the
following materials:
LIST OF THEORETICAL ISSUES:
1. Topographic anatomy of the neck (larynx, trachea, pharynx, esophagus, thyroid, parathyroid,
and submandibular glands): features of location, blood supply, innervation, venous and
lymphatic drainage.
2. Operations and manipulations on the respiratory tract, upper and lower tracheotomy (-stomy)
conichotomy (-tsentez), endotracheal intubation; Technique, errors and complications.
A graph of the logical structure to the topic can be found in the Appendix.
SOURCES OF INFORMATION:
MAIN REFERENCES
A. Operative Surgery and Topographic Anatomy / pid ed. Kulchitskogo K.І. - Dublin: Vishcha
wk., 1994. - Pg. 100-105, 112-116.
B. Operative Surgery and Topographic Anatomy / ed. KI Kulchitsky, I.I.Bobrika. - K.: Vyshcha
School, 1989. - Pg. 111-116, 124-126.
C. Lecture on the theme sessions.
FURTHER READING:
A. Operative Surgery and Topographic Anatomy: Pіdruchnik for dentistry students. Faculty tіv /
MS Skripnikov, AM Bіlich, V. I. Shepіtko that іn., For Ed.MS Skripnikova. - K.: Vishcha wk.,
2000. - Pg. 223-228, 242-245.
B. Siroid D. Technique of operational skills of a doctor. - Donetsk, 2009. - Pg. 82-87, 90-92.

SET OF TASKS TO ENSURE ACHIEVEMENT OF A PARTICULAR PURPOSE OF
STUDY:
                                                Test № 1
 The victim had a combined injury of the trachea and the isthmus of the thyroid gland. At what
level of tracheal rings is the typical location of the isthmus of the thyroid gland?
A. 2.1
B. 2.3
C. 3.4
D. 5.4
E. 6.5
                                                Test № 2
  In an emergency room, conicotomy was performed on a patient with mechanical asphyxia.
What was done to the patient in this situation?
A. Dissection of the trachea
B. Application of a fistula in the trachea
C. Dissection of thyro-cricoid membrane
D. Cutting and puncturing the thyro-cricoid membrane
E. Application of a fistula to the larynx
                                                Test № 3
  The surgeon performs a lower tracheostomy. In what direction should he shift the isthmus of
the thyroid gland in this case?
A. Upward
                                               55


B. Downwards
C. Outwards
D. Inward
E. Anteriorly
Standards of response to targeted tests: № 1 - B; № 2 - C; № 3 - A.

                BRIEF NOTES TO THE STUDENTS ON PRACTICAL EXERCISES
   In earlier studies monitoring and correction of the basic level of "knowledge and skills" was
carried out. Then students do some individual study of features of topographic anatomy of the
neck on the cadaver, models and posters. Using external landmarks, students define the
projection for conichotomic sections, the upper and lower tracheotomy; carryout the execution of
surgical operations and manipulations in the respiratory tube; and also perform tracheostomy and
conicotomy. During independent work of students, they reinforce their skills in the proper use of
surgical instruments, tissue separation and connection respectively. After discussing the results
of independent work, test control and result summarization is carried out.
                                                                  56


                                                          APPENDIX:
              GRAPH LOGICAL STRUCTURES RELATED TO:
"TOPOGRAPHIC ANATOMY OF THE NECK. OPERATIONS AND MANIPULATION OF
                            SNORKEL"


                                                           Organs of the Neck


                                      Larynx                                                                      Trachea



                                Topographical Anatomy


                       Location
                                                             Fascial Covering




                                                                                                                    Venous drainage
                                                                                     Blood supply

                                                                                                    Innervation




                                                                                                                                      Lymphatic
                                Skeletopy


                                               Holotopy
       Structure




                                                                                                                                      drainage
                   Syntopy




                             Operative intervention and manipulation


  Access to the
                                                              tracheotomy (-stomy)




  organs of the
                                                              The upper and lower




  neck
                                            Chonicotomy




                                                                                                                                                  endotracheal
                                                                                                                                                  intubation
                                            (-central)
  trachea


                    To the
  To the




                    throat
                                                  57


 13. TOPOGRAPHIC ANATOMY OF THE NECK. THYROID SURGERY.
       VAGO-SYMPATHETIC BLOCKAGE BY VISHNEVSKYI.
 Relevance of the topic: The thyroid gland is often the object of surgical procedures. Vago-
sympathetic blockage, used for the prevention and relief of pleura-pulmonary shock has saved
the lives of many patients. A good knowledge of the characteristics of topographical anatomy of
the neck helps avoid several medical errors, not only during surgery, but also in solving the
complex problems of diagnosis.

LEARNING OBJECTIVES:
 The overall goal: to be able to interpret the features of topographic anatomy of the neck in order
to learn performing surgery on the thyroid gland and vago-sympathetic blockage by Wisniewski.

SPECIFIC OBJECTIVES FOR BACKGROUND KNOWLEDGE & SKILLS:
Be able to:
A. interpret the features of topographic anatomy of the neck;
B. substantiate the operational intervene in the thyroid gland;
C. base and model for Wisniewski vago-sympathetic blockage.
D. Identify structures and other entities of the neck (Department of the general anatomy).

  To determine the initial level of knowledge and skills for self-assessment and self-correction,
solving the following tests are recommended:
                                                  Test № 1
  The surgeon has shifted down the part of the thyroid gland that is located between the left and
right of its halves, at the level of the third tracheal ring. What part of the thyroid gland has been
shifted by the surgeon in this situation?
A. cheek
B. The bottom
C. Body
D. Isthmus
E. The average half
                                             Test number № 2
 During an operation on the neck, the surgeon mistakenly removed the parathyroid gland. How
many of these glands are usually present in man?
A. One
B. Two
C. Three
D. Four
E. Five
Standards of answers to tests to determine the initial level: № 1 - D; № 2 - D.

 Information necessary for acquiring initial knowledge and skills can be found in the following
sources:
A. Prywes M., N. Lysenkov Human Anatomy. - Moscow: Meditsina, 1985. - Pg. 138-258.
B. Sinelnikov RD Atlas of Human Anatomy. - Moscow: Gos. ed. honey.literature, 1963. -
Volume 2. - Pg. 278-305.
                                              58


C. Sapin MR Human Anatomy. - Moscow, 1993. - Pg. 270-295.
D. Tests on human anatomy. - Donetsk, 1999. - Pg. 82-87.
CONTENTS OF TRAINING:
After mastering the necessary basic knowledge and skills, you can proceed to study the
following materials:
LIST OF THEORETICAL ISSUES
A. Topographic anatomy of the neck (thyroid and parathyroid glands, larynx, trachea, pharynx,
esophagus): features of location, blood supply, innervation, venous and lymphatic drainage.
B. Operations on the thyroid gland; the provisions by Nikolayev to be followed in carrying out
these operations; possible errors and complications.
C. Technique for Wisniewski vago-sympathetic blockage; possible errors and complications.
On a graph of the logical structure to the topic can be found in the Appendix.
SOURCES OF INFORMATION:
MAIN REFERENCES
A. Operative Surgery and Topographical anatomy / pid ed. Kulchitskogo K.І. - Dublin: Vishcha
wk., 1994. - Pg. 100-105, 112-116.
B. Operative Surgery and Topographic Anatomy / ed. KI Kulchitsky, I.I.Bobrika. - K.: Vyshcha
School, 1989. - Pg. 111-116, 123, 127-129.
C. Lecture on the theme sessions.
FURTHER READING
A. Operative Surgery and Topographical anatomy; manual for Dentistry students. Faculty tіv /
MS Skripnikov, AM Bіlich, V. I. Shepіtko that іn., For Ed.MS Skripnikova. - K.: Vishcha wk.,
2000. - Pg. 223-228, 236-237, 247-248.
B. Siroid D. Technique of operational skills a doctor. - Donetsk, 2009. - S. 82-87, 90-92.

SET OF TASKS TO ENSURE ACHIEVEMENT OF A PARTICULAR PURPOSE OF
STUDY
                                             Test № 1
 In carrying out operations on the thyroid gland, the surgeon accidentally removed parathyroid
glands. From what area of the thyroid gland were these glands removed by the surgeon in this
situation?
A. Minor
B. Lower
C. Upper
D. Posterolateral
E. Posteromedial
                                             Test № 2
 A surgeon performs a subtotal subfascial resection of the thyroid gland, but was careful when
working in the "dangerous" (posteromedial) zone of the gland. What kind of formations are
located extra-capsularly that could be damaged in this situation?
A. recurrent laryngeal nerve
B. vagus nerves
C. Common carotid artery
D. The internal jugular vein
E. Parathyroid glands
Test number 3
                                                59


 A doctor performs the vago-sympathetic blockade by Wisniewski. What should be the direction
of movement of the needle when performing this manipulation?
A. Perpendicular to the skin
B. Up and inward
C. Up and out
D. Downwards and inwards
E. Down and out
Standards of response to targeted tests: № 1 - E; № 2 - E; № .

          BRIEF NOTES TO THE STUDENTS OF PRACTICAL EXERCISES
  In earlier studies, monitoring and correction of the basic level of "knowledge and skills" os
students was carried out. Then, students organize individual study of the features of topographic
anatomy of the neck on the cadaver, models and posters. Using external landmarks, students
define the projection of Kocher’s access to the thyroid gland, outline the implementation of this
technique of surgical interventions on the gland, and substantiate the model of vago-sympathetic
blockage by Wisniewski. During independent work of students, their skills in the proper usage of
surgical instruments, tissue separation and connection are reinforced. After discussing the results
of independent work, test control and summarizing of its results are carried out.
                                                                                       60


                            APPENDIX:
              GRAPH LOGIC STRUCTURES RELATED TO:
"TOPOGRAPHIC ANATOMY OF THE NECK. THYROID SURGERY. Vago-sympathetic
                    blockage by VISHNEVSKIY"

                                                                               Organs of the Neck




    Laryn                             Trac                      Phary                        Esoph                  Thyroid                           Parathyroid
                                                                                                                    gland                             glands
    x                                 hea                       nx                           agus


                                         Topographical anatomy


                                Location
                                                                                  Fascial Covering




                                                                                                                                    Venous drainage
                                                                                                     Blood supply

                                                                                                                      Innervation




                                                                                                                                                             Lymphatic
                                         Skeletopy
                           Synotopy




                                                                    Holotopy
    Structure




                                                                                                                                                             drainage
                                      Operative intervention and manipulation
                                                     subfascial resection)




                                                                                                                                                      Vagosympathetic
                gland (Kocher’s)




                                                     the thyroid gland




                                                                                                                                                      blockage by
                                                     Operations on




                                                                                                                                                      Wisniewski
                the thyroid
                Access to




                                                     (subtotal
                                               61


              14. ADMISSION OF PRACTICAL SKILLS MODULE
   Relevance of the topic: Dentists should be able to use external landmarks of the head and
neck to describe the physical examination data and perform various manipulations. They should
also be able to determine the pulsation points on the head and neck, to stop bleeding, to perform
the initial surgical treatment of wounds, to provide emergency assistance in case of mechanical
asphyxia, etc. These skills should be based on the knowledge of the topographic anatomy of the
head and neck. The health and even lives of their patients depends on how doctors will learn
these practical skills well.

LEARNING OBJECTIVES:
The overall goal: to be able to simulate medical manipulations performed on the head and neck,
applying topographic-anatomical basis to the technique used.

SPECIFIC OBJECTIVES TO OBTAIN BACKGROUND KNOWLEDGE & SKILLS
To Be able to:
A. use general-surgical instruments;
B. simulate the separation of tissues, temporary and finally hemostasis, knotting, the imposition
and removal of sutures;
C. denote the boundaries of the head and neck, their external landmarks and points of pulsation;
D. to carry out the projections and cuts on the head and neck;
E. base and simulate surgical interventions and manipulations performed on the head and neck.
   Recognize the anatomical formations of head and neck (Department of the normal human
anatomy).
To determine the initial level of knowledge & skills to test one’s knowledge and make self-
correction, solving the following tests is high recommended:
Test number 1
The doctor performs a central mandibular nerve anesthesia. To which opening of the skull did
the anesthetic get through in this situation?
A. Round
B. Oval
S. stylomastoid
D. Chin
E. mandibular
Test number 2
 In a condition of mechanical asphyxia, a doctor in an emergency room punctured and performed
the cutting of thyro-cricoid membrane (lig. conicum). What anatomical structure holds this
cartilage?
A. thyroid
B. cricoid
C. The first ring of the trachea
D. Second tracheal rings
E. 3rd tracheal rings
Standards of answers to tests to determine the initial level: № 1 - B; № 2 - A.
  Information necessary for the formation of initial knowledge and skills, can be found in the
following sources:
                                                62


A. Prywes M., N. Lysenkov Human Anatomy. - Moscow: Meditsina, 1985. - Pg. 138-258.
B. Sinelnikov RD Atlas of Human Anatomy. - Moscow: Gos. ed. honey.literature, 1963. -
Volume 2. - S. 278-305.
C. Sapin MR Human Anatomy. - Moscow, 1993. - Pg. 270-295.
D. Tests on human anatomy. - Donetsk, 1999. - Pg. 82-87.
CONTENTS OF TRAINING
After mastering the necessary basic knowledge and skills, you can proceed to study the
following materials:
LIST OF THEORETICAL ISSUES
A. Classification of surgical instruments, rules for using them.
B. Technique of separation and connection of tissue, the time and definitive hemostasis, knitting
units, removal of sutures.
C. External borders and landmarks of the head and neck. The projection of the formations and
sections performed on these parts of the body. Determination of pulse points on the head and
neck.
D. Technique of surgical interventions and manipulations performed on the head and neck.
 A graph of the logical structure to the topic can be found in the Appendix.

SOURCES OF INFORMATION:
MAIN REFERENCES:
A. Operative Surgery and Topographic Anatomy / pid ed. Kulchitskogo K.І. - Dublin: Vishcha
wk., 1994. - Pg. 33-116.
B. Operative Surgery and Topographic Anatomy / ed. K.I.Kulchitskogo, I.I.Bobrika. - K.:
Vyshcha School, 1989. - Pg. 15-133.
C. Lectures on the topic of training.
FURTHER READING
A. Operative Surgery and Topographic Anatomy: Handbook for dentistry students. Faculty tіv /
MS Skripnikov, AM Bіlich, V. I. Shepіtko that іn., For Ed.MS Skripnikova. - K.: Vishcha wk.,
2000. - Pg. 8-248.
B. Siroid D. Technique of operational skills of a doctor. - Donetsk, 2009. - Pg. 9-92.

SET OF TASKS TO ENSURE ACHIEVEMENT OF A PARTICULAR PURPOSE OF
STUDY
                                             Test № 1
 During surgery, the surgeon used a sharp-pointed scissors, curved on the edge. To which group
of instruments does this tool used by the surgeon, belong to?
A. For the separation of tissues
B. To stop bleeding
C. Auxiliary tools
D. Special tools
E. For the connection of tissue
                                             Test № 2
 The surgeon dressed the damaged tissue in the process of ligation of vessels. For this, he formed
the first preliminary round of the double, and then - single fixing. What type of knot was tied by
the surgeon in this situation?
A. "Women"
                                                 63


B. "Male"
C. Marine
D. Surgical
E. Anatomical
                                              Test № 3
 The surgeon places a seam on the skin. He has a needle holder, forceps, and suture
material. What else is needed in this situation by the surgeon?
A. cutting needle
B. Needle Stitching
C. Deschamps needle
D. Billroth clip
E. Kocher clamp
                                              Test № 4
 A surgeon applies several stitches during a surgical operation. Which of these stitches is
continuous?
A. mattress
B. A simple node
C. Donati
D. U-shaped
E. Pirogov
                                              Test № 5
 The surgeon performed a radial incision in the parotid phlegmon. What landmark should be
used as the center by the surgeon in choosing the direction of the cut in this situation?
A. The base of the ear lobe
B. The angle of the mouth
C. The angle of the mandible
D. Outer corner of eye
E. Wing of the nose
                                              Test № 6
 During a central-palatal anesthesia, the doctor moves the needle in the greater palatine canal. In
what direction should he move the needle in this situation?
A. Upward and anteriorly
B. Top and posteriorly
C. Downward and anteriorly
D. Downward and backward
E. Perpendicular to the sky
                                              Test № 7
 The doctor accessed the projection of the common carotid artery on the lateral border of the
carotid triangle. In the front of which muscle was this access to the projection carried out in this
situation?
A. digastric
B. Omohyoid
C. trapezius
D. Sternocleidomastoid
E. sternohyoid
Test № 8
                                                64


 A doctor performs the vago-sympathetic blockage by Wisniewski. On the descending edge of
which muscle should this manipulation be done?
A. digastric
B. infra-hyoid
C. trapezius
D. Sternocleidomastoid
E. sterno-hyoid
 Answers to test questions: № 1 - A; № 2 - D; № 3 - A; № 4 - A; № 5 - A; № 6 - In; № 7 - D; №
8 - D.

  BRIEF NOTES TO THE STUDENTS OF PRACTICAL EXERCISES
Receive practical skills carried out by the ticket system, using a set of surgical instruments,
cadaver materials, plaster casts and posters. Each ticket - 4 questions.
  -The first one is devoted to the ability to use general surgical instruments, tissue separation
technique, the time and definitive of hemostasis, knitting units, applying and removing sutures.
  -The second question focuses on the skills that deal with the head region (except for conduction
of anesthesia).
 - The third question focuses on the engineering performance of conduction anesthesia in the
maxilla and mandible.
  -The fourth question focuses on the skills on the neck. While a student demonstrates the
technique of execution of procedures and gives a topographo-anatomical study of their
technique, and the rest are engaged in self-study. At the end of the practical lessons the teacher
sums up the results.
                                                                                                                                       65


                                             "RECEPTION OF PRACTICAL SKILLS MODULE"
                                                                                 Practical Skills to Module number 1

                            Technique of separation, joining of tissues and stopping bleeding


Possession of                                                           Separati                                 Stoppag                    Knotting (with                                                               Suturi                                                            Removal
all tools and                                                           on of                                    e of                       fingers and                                                                  ng                                                                of simple
instruments                                                             Tissues                                  bleedin                                                                                                                                                                   nodular
                                                                                                                 g                          apodaktyl)                                                                                                                                     suture

                                                                                                                                                                     Nodes                                                                         Continuous (simple
Tempora




                                                                                                                           Surgica
                                                                                                 Marine
                                                                        Simple




                                                                                                                                                                     (simple U-                                                                    Multanovsky, mattress)
                             Final




                                                                                                                                                                     shaped,
ry




                                                                                                                           l                                         Donati)

                                                                         Practical skills and procedures on the head

Determination                                                                    Carrying                                  Carrying                                                 Determination                                                                               Mode of
of external                                                                      out                                       out                                                      of the                                                                                      conduction of
landmarks,                                                                       projection                                projections                                              holding projecti                                                                            anesthetics
borders &                                                                        formations                                of cut                                                   ons of
regions.                                                                                                                                                                            pulsating points
                             Branches of the facial nerve




                                                                                                                                              In the side region of the
                                                                             (supraorbital, infra-orbital
Excretory duct of parotid




                                                                                                                                                                                                                                                                The front of the artery
                                                                                                                                                                                                                         At the occipital artery
                                                                                                                     In abscesses of the
                                                                             final branches of the




                                                                                                                                                                                                                                                                                                                         On the lower jaw
                                                                             Where they exit the




                                                                                                                                                                                                                                                                                               In the upper jaw
                                                                             and mental nerve)




                                                                                                                                                                                    In the superficial
                                                                             trigeminal nerve




                                                                                                                                                                                    temporalartery
                                                                                                                     cranial vault
gland




                                                                                                                                              face




Central (in a round                                                                                       peripheral                        Central (the foramen                                                                                                                          Peripheral
hole)                                                                                                                                       ovale)
       Inferior Pterigoid




                                                                                                                                                                                                         Sub-zygomatic
                                                                                                 Infra orbital




                                                                                                                                                                                                                                                   Mandibular




                                                                                                                                                                                                                                                                                                                  Mandibular
                                                            Palatinal




                                                                                                                           Palatinal
                                                                            Tuberal




                                                                                                                                            Tuberal




                                                                                                                                                                                                                                                                                           Mental
                                                                                                                                                                          Incisal
                                              66


Continuation

                       Practical skills are performed on the neck

                                           Determination of the
  Determination of        Carrying                                                 Modeling of




                                                                  Modeling co
                                           holding projections
  external reference      out projecti                                             vago-




                                                                  nicotomy
                                           pulsating point of
  points, and             ons of cuts      the common
                                                                                   sympathethic
  the boundaries                           carotid artery                          blockage
  of the triangles


  In                   For exposure of the             During upper             In operations
  inflammatory         arteries: common, external      and                      on the thyroid
  processes            carotid & facial                lower tracheoto          gland (Kocher’s
                                                       my (-Stomy)              access)
                                                67


                       15. FINAL TEST CONTROL MODULE
Relevance of the topic: To prevent medical errors in the implementation of medical procedures,
it is necessary to know the specifics of topographic anatomy of the head and neck and have a
good knowledge of the theoretical practice. The test control is meant to determine the level of
theoretical training of the student.
LEARNING OBJECTIVES:
 The overall goal: to be able to interpret the features of topographic anatomy of the head and
neck to support the medical skills.

SPECIFIC OBJECTIVES FOR OBTAINING BACKGROUND KNOWLEDGE AND SKILLS
To Be able to:
A. interpret the features of topographic anatomy of the head and neck;
B. To justify surgical intervention and manipulation on the head and neck; To identify properly,
the head and neck regions (Department of the normal anatomy).

To determine the basic level of knowledge and skills and to assess one’s self and make self-
correction, the following tests are recommended to be solved:
Test number 1
 An anesthesia tagged "for foramen ovale," was administered by a doctor and injected into the
foramen ovale of the skull base. What nerve leaves the cranial cavity through this hole?
A. Facial
B. Vagus
C. The first branch of the trigeminal nerve
D. Second branch of the trigeminal nerve
E. Third branch of the trigeminal nerve
Test number 2
 A doctor palpated the patient's neck and felt a muscle that runs in an oblique direction from the
head to the sternum. What neck muscle did the doctor palpate in this case?
A. Sternocleidomastoid
B. Sternohyoid
C. The belly of thyroid
D. Digastric
E. Shoulder hyoid
Standards of answers to tests to determine the initial level: № 1 - E; № 2 - A.

  Information necessary for obtaining necessary basic knowledge and skills, can be found in the
following sources:
1. Prywes M., N. Lysenkov Human Anatomy. - Moscow: Meditsina, 1985. - Pg. 138-258.
2. Sinelnikov RD Atlas of Human Anatomy. - Moscow: Gos. ed. honey.literature, 1963. -
Volume 2. - Pg. 278-305.
3. Sapin MR Human Anatomy. - Moscow, 1993. - Pg. 270-295.
4. Tests on human anatomy. - Donetsk, 1999. - Pg. 82-87.
CONTENTS OF TRAINING
After mastering the necessary basic knowledge and skills, you can proceed to study the
following materials:
                                                68


LIST OF THEORETICAL ISSUES
A. Topographic anatomy of the head and neck.
B. Technique of surgical interventions and manipulations performed on the head and neck.
A graph of the logical structure to the topic can be found in the Appendix.

SOURCES OF INFORMATION:
MAIN REFERENCES:
1. Operative surgery and topographic anatomy / pid ed. Kulchitskogo K.І. - Dublin: Vishcha wk.,
1994. - pg. 33-116.
2. Operative Surgery and Topographic Anatomy / ed. K.I.Kulchitskogo, I.I.Bobrika. - K.:
Vyshcha School, 1989. - Pg. 15-133.
3. Lectures on the topic of training.
FURTHER READING:
A. Operative surgery and topographic anatomy; Pіdruchnik for dental students. Faculty tіv / MS
Skripnikov, AM Bіlich, V. I. Shepіtko that іn., For Ed.MS Skripnikova. - K.: Vishcha wk.,
2000. - P. 8-248.
B. Siroid D. Technique of operational skills of a doctor. - Donetsk, 2009. - Pg. 9-92.

SET OF TASKS TO ENSURE ACHIEVEMENT OF A PARTICULAR PURPOSE OF
STUDY
                                             Test № 1
 A patient had a wound on the left lateral part of the fronto-parieto-occipital region and had this
wound incised. On what line is the lateral boundary of this region?
A. Upper nuchal
B. Lower nuchal
C. The upper temporal
D. Lower temporal
E. The tempero-parietal suture
                                             Test № 2
A patient has been having the spread of an inflammatory process through temporal appendage of
the body fat and in cheeks. In which layer of the temporal region will such process spread?
A. subcutaneous
B. thick skin
C. Intra-aponeurotic fiber
D. Subgleal tissue
E. Sub-periosteal tissue
                                             Test № 3
 A surgeon performs primary debridement in the anterior neck. What are the features of the skin
in this region of the neck compared to the posterior division?
A. More subtle and moveable
B. More subtle, less mobile
C. Thick and mobile
D. Thicker, less mobile
E. Less fatty and less mobile
                                             Test № 4
                                                 69


 A patient had an abscess in the left parietal region. The surgeon conducts an autopsy on the
abscess. What kind of cut will be the most anatomically sound and least traumatic in this case?
A. Cross
B. Longitudinal
C. Radial from crown
D. Groove of the ear tragus
E. Arc
                                               Test № 5
 The surgeon performs extra-infraorbital anesthesia. In what direction should he move the
needle in this situation?
A. Upward and outward
B. Upward and medially
C. Downward and medially
D. Downward and outward
E. Perpendicular to the skin
                                               Test № 6
 A surgeon accesses phlegmon in the fascial sheath of the main neurovascular trunk of the neck.
What kind of cut/incision should he make?
A Longitudinal
B. Cross
C. Oblique (in front of the sternocleidomastoid muscle)
D. Oblique (at the rear edge of the sternocleidomastoid muscle)
E. Arc
Standards of response to targeted tests: № 1 - C; № 2 - D; № 3 - A; № 4 - C; № 5 - A; № 6 - C.

          BRIEF NOTES TO THE STUDENTS ABOUT PRACTICAL EXERCISES
  By the final module control, only students that have attended all training lessons as stated in the
curriculum for the module, and have received at least a minimum score overall in the current
study will be allowed to take the final module control test. Students who for some reasons did
not fulfill all or some parts of work on the curriculum (lectures, practical exercises) will need to
work out the academic deficit during a given period of time and date and obtain the minimum
score required for qualification to the final module control (in accordance with the PWS and the
Ministry of Health). At the final session, each student must answer 30 questions of situational
problems. Assessment of theoretical knowledge is determined by the percentage of correct
answers:
90% or more (0-3 errors) "5"
75-89% (4-7 errors) "4"
60-74% (8-12 errors) "3"
less than 60% (13 errors or more) "2"
If a student received a "2" for test control, he must retake the exam.
                                                             70


                                                     APPENDIX:
                          GRAPH LOGIC STRUCTURES RELATED TO:
                             "FINAL TEST CONTROL MODULE"

                   "FINAL TEST – MODULE CONTROL"

                                                      Head and Neck

                                Topographical anatomy


       The                      Layer               Features of the             Syntopy,                    Possible path
       boundaries               structu             blood                       skeletopy,                  ways of
       and                                          supply, innervati
                                re                                              holotopy of                 pathological
       external lan                                 on, venous and
       dmarks                                       lymphatic draina            organs and                  processes
                                                    ge                          their
                                                                                entities



                       Operative intervention and manipulation
                                                                          Determination
Primary surgical




                                    on organs and
                                    Interventions




                                                                                          nerve blockage
                                                                                          anesthetics and
                                                                                          Conduction of
                                                           Arresting of
treatment of




                    Operative




                                                           bleeding


                                                                          of pulse
                                    entities
wounds




                    access




                                                                          points
                                               71


REFERENCES:
1. Antipov, N., D. Siroid, Zhuk IV The role of skills in the teaching of operative surgery and
topographic anatomy, and the formation of skills of doctors / / Actual problems of operative
surgery and topographic anatomy: Materials of All-Russian Scientists. conference. with
int. participation. - Moscow, 2009. - Pg. 141-143.
2. O. Bolshakov, GM Semyonov Lectures on the Operative Surgery and Clinical Anatomy. - St.
Petersburg: Izd. "Peter", 2000. - 480.
3. Kulchitsky, KI Lectures on the operative surgery and topographic anatomy. - Kiev, Poltava,
1992. - 245.
4. Operative Surgery / Ed. Ed. I.Littmanna. - 2nd ed. in Russian. lang. - Budapest, Ed. Hungarian
Academy of Sciences, 1982. - 1175.
5. Operative Surgery and Topographic Anatomy / ed. Cova new VV - 3rd ed.with rev. -
Moscow: Meditsina, 1995. - 400.
6. Operative Surgery and Topographic Anatomy: Pіdruchnik / Kulchitsky K.І., Kovalsky, MP,
AP Dіtkovsky she іn.; for Ed. Kulchitskogo K.І. - Dublin: Vishcha wk., 1994. - 464.
7. Operative Surgery and Topographic Anatomy: A Textbook / Ostroverkhov GE, Bomash YM,
Lubotsky DN - 4th ed. additional. - Rostov-on-Don: Phoenix, 1998. - 720.
8. Operative Surgery and Topographic Anatomy: Pіdruchnik / For Ed.Skripnіkova MS - Dublin:
Vishcha wk., 2000. - 504.
9. Operative Surgery and Topographic Anatomy: Method. vkazіvki to Pract.to take studentіv 3.4
kursіv honey. Faculty tіv / Semenova TV, І.V. Zhuk, DV Siroїdshe іn.; for
Ed. Professor. T.V.Semenovoї. - Donetsk, 2003. - 226.
10. Operational hіrurgіya: hіrurgіchnі operatsії that manіpulyatsії: Pіdruchnik / Svistonyuk І.U.,
Pіshak VP, Buttercup MD, Ahtemіychuk YT, for Ed.І.U.Svistonyuka. - K.: Health Protection,
2001. - 367.
11. Workshop on Operative Surgery with Topographic Anatomy / ed.prof.T.V.Semenovoy and
prof.N.S.Skripnikova. - Donetsk, 1999. - 232.
12. Semenova TV, Bombushkar IS How the characterization and application of sutures in
surgery. - Donetsk, 1999. - 17 p.
13. Siroid D., Semenova TV, Zhuk IV, Voitenko S., Gilles R. Problems of teaching of operative
surgery and topographic anatomy in the light of the Bologna process and ways to overcome them
/ / Tauride Medical Biology. Bulletin. - 2006. - V. 9. - № 3. - Part II. - S. 166-169.
14. Siroid D. Technique of operational skills a doctor. - Donetsk, 2009. - 223 p.
15. Surgical sutures. - Grintsov AG, Semenov, TV, Obornev LE, Miroshnichenko, E.,
Bombushkar IS. - Kiev, 2002. - 45.
                                             72


Educational publishing

Nikolai Antipov, Dmitry V. Syroyid,
Zhilyaev Ruslan A., Zaritsky, Alexander B., Sergei Voitenko


GUIDELINES
to workshops on "Operative Surgery and
Topographic anatomy of head and neck "
for students of dental faculty.




                              Translated by: Ben Ayobami Omodara {Student of DonNMU}

				
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