Topographical and Pathotopographical Medical Atlas of the Human Body Scrivener Publishing 100 Cummings Center, Suite 541J Beverly, MA 01915-6106 Publishers at Scrivener Martin Scrivener ([email protected]) Phillip Carmical ([email protected]) Topographical and Pathotopographical Medical Atlas of the Human Body Z. M. Seagal This edition first published 2020 by John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA and Scrivener Publishing LLC, 100 Cummings Center, Suite 541J, Beverly, MA 01915, USA © 2020 Scrivener Publishing LLC For more information about Scrivener publications please visit www.scrivenerpublishing.com. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or other- wise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions. 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Library of Congress Cataloging-in-Publication Data ISBN 978-1-119-61433-3 Cover image: 3D Illustration, Pepe Gallardo | Dreamstime.com & Abstract Background, Pokaz | Dreamstime.com Cover design by Kris Hackerott Set in size of 11pt and Minion Pro by Manila Typesetting Company, Makati, Philippines Printed in the USA 10 9 8 7 6 5 4 3 2 1 Contents Preface ix Part 1: Ultrasonic Topographical and Pathotopographical Anatomy 1 Topography and Pathotopography of the Head 3 2 Topography and Pathotopography of the Neck 25 3 Topographical and Pathotopographical Anatomy of the Chest 43 4 Topographical and Pathotopographical Anatomy of the Abdomen 61 5 Topographical and Pathotopographical Anatomy of the Retroperitoneal Space 91 6 Topography and Pathotopography of the Pelvis 103 Topographical anatomy of the pelvic organs 103 Topography of the female pelvis 104 Topography of male pelvis 107 Ultrasonic topographical anatomy of male pelvis 108 7 Topography and Pathotopography of Lower Extremity 123 8 Conclusion 153 Part 2: Topographical and Pathotopographical Medical Atlas of the Head and Neck 9 Introduction 159 10 The Head 163 Topographic Anatomy of the Head 163 Cerebral Cranium 163 Basis Cranii Interna 177 The Brain 180 Surgical Anatomy of Congenital Disorders 203 Pathotopography of the Cerebral Part of the Head 204 Facial Head Region 209 Dentes-Teeth 226 The Lymphatic System of the Head 251 Congenital Face Disorders 254 v vi Contents Pathotopography of the Facial Part of the Head 256 Attachment 1: Neurocranial Part Topography 264 Attachment 2: Facial Part Topography 265 11 The Neck 267 Topographic Anatomy of the Neck 267 Fasciae, Superficial and Deep Cellular Spaces and their Relationship with Spaces Adjacent Regions 269 Triangles of the Neck 275 Organs of the Neck 297 Pathography of the Neck 306 Attachment 3: Topography of the Neck 317 Part 3: Topographical and Pathotopographical Medical Atlas of the Chest, Abdomen, Lumbar Region, and Retroperitoneal Space 12 The Chest 321 Topographic Anatomy of the Chest 321 Chest Cavity Organs Projection and Layers of Chest 322 Surgical Anatomy of Thoracic Wall Congenital Malformation 337 Thoracic Cavity 338 Mediastinum Topography 343 13 Abdomen 371 Topographic Anatomy of Anterolateral Abdomen Wall 371 Surgical Anatomy of Congenital Malformations of Anterior Lateral Abdominal Wall 384 Abdominal Region Topography 385 Peritoneum and Abdominal Cavity Levels 385 Abdominal Cavity Organs 392 14 Lumbar Region and Retroperitoneal Space 431 Topographic Anatomy of Lumbar Region and Retroperitoneal Space 431 Topographic Anatomy of Lumbar Region 431 Topographical anatomy of retroperitoneal space 437 Organs of Retroperitoneal Space 440 Surgical Anatomy of Congenital Malformations 450 15 Pathotography of the Chest 459 Abdominal Cavity 467 Retroperitoneal Space 487 Part 4: Topographical and Pathotopographical Medical Atlas of the Pelvis, Spine, and Limbs 16 Introduction 501 17 The Pelvis 503 Topographic Anatomy of the Pelvis 503 Individual, Gender and Age Differences 503 Contents vii The Organs of the Male Pelvis 512 The Topography of the Vas Deferens 520 The Organs of the Female Pelvis 523 Defects of the Genitourinary System in Children 530 Perineum Topography 531 Pudendal Region in Men 533 Pudendal Region in Women 538 The Topography of the External Female Genitalia 538 Surgical Anatomy of Congenital Pelvic and Perineum 542 Anus. Ischiorectal Fossa. Perineal Rectum 546 Surgical Anatomy of Congenital Malformations of the External Genitalia 551 Pathotophography of the Peivis 553 18 The Spine 571 Topographic Anatomy of the Spine 571 Individual and Age Differences of the Spine 573 The Spinal Cord and Nerve Roots 573 Surgical Anatomy of the Malformations of the Spine and Spinal Cord 581 Pathotopography of the Spine 583 19 The Limbs 593 Topographic Anatomy of the Upper Limb 593 Supra Brachium – Shoulder Girdle 593 Shoulder 598 Forearm 603 Hand 612 Surgical Anatomy of Congenital Malformations of the Upper Limb 618 Pathotopography of the Upper Limbs 621 Topographic Anatomy of Lower Limbs 634 Gluteal Region 635 Femur 636 Canals of Thigh 648 Shin 652 Foot 664 Pathotopography of the Lower Limbs 671 Conclusion 687 Appendix A 701 Appendix B 709 Preface Topographical and Pathotopographical Medical Atlas of the Human Body is a fundamental and practically important book designed for doctors of all specializations and students at medical schools. The atlas contains almost everything connected with the topographic and pathotopographic human anatomy, topography of different areas in layers, pathotopogra- phy, variant, normal, computer and magnetic resonance imaging (MRI) of topographic and pathotopographic anatomy. Also presented in the atlas are new theoretical and practical sections of topographic anatomy developed by the author; these are published for the first time. They are of practical importance in mastering the technique of operative interven- tions and denying the possibility of iatrogenic complications during operations. Images of individual and age-related changes in human organs are presented accord- ing to variant topographic anatomy. Topographic anatomy describes holotopy, skeletopy, organ syntopy and main anatomic formations, fascial compartments, cellular spaces, neurovascular bundles, collateral circulation, sensor and motor parts of nerve trunks. Pathotopographical anatomy is shown on typical pathology examples in various fields. It is important to visualize topographical anatomy structures not only on a corpse, but also on patients who have undergone surgical interventions. These data were obtained using computerized MRI topography, transillumination of organs and tissues, pathotopography and ultrasound topography. Currently, there are no modern atlases in the world for clinical topographic and patho- topographic anatomy. There are several reasons for this. Firstly, this subject has been stud- ied only in Russia and Hungary. In other countries, it is either absent or present in related disciplines, such as anatomy or surgery. A number of sections, such as pathotopographic, variant, normal topographic anatomy, transillumination, and vital topographic and patho- topographic anatomy on sick and healthy people were developed by the author of this atlas for the first time. This atlas can serve as reference in the daily work of theoretical and practical physio- logists and pathophysiologists, anatomists and typographic anatomists, pathologists, ther- apists, surgeons, obstetricians and gynecologists, neurologists and dermatovenerologists, radiation diagnostitions, anesthesiologists, otolaryngologists, trauma surgeons, ortho- pedologists, pediatricians, and dentists, as well as those in narrow specialties, such as car- diovascular surgeons, urologists, plastic surgeons, neurosurgeons, etc. The topographic and pathotopographic anatomy presented can be subdivided into sur- gical, anatomy, therapy, dental and pediatric. Specific and non-specific features of patho- topography and normal variants have already been found and are presented in the atlas; normal anatomy, divided into pathological, ultrasound topographic and pathotopographic anatomy, is established in the book. ix x Preface Topographic clinical anatomy changes with the disease and recovery during iatrogenic manipulations, surgical and therapeutic treatment. That is why some of these points are described in the atlas. Our atlas of topographic and pathotopographic anatomy is a full-colored handbook for students and doctors in almost all specialties. It covers all the organs and tissues of the human body. Its fundamental and practical importance is that topography and patho- topograpy are presented for the first time in vivo. These sections (ultrasound topography and pathotopography, transillumination topography and pathotopography) are of great practical importance both for early diagnosis and for providing the right treatment, includ- ing proper surgical tactics. They are important for surgeons in planning and performing numerous surgical operations. The author of the atlas has a unique museum of operative surgery at the Academy, which is visited by doctors and students from all over the world. Some exhibits from this museum are presented in our atlas. They are normal and patho- topographical surgical anatomy, electrified stands and steps of surgical intervention on the complex of formalin preparations. This three-track museum is dedicated to typical and atypical surgical interventions, as well as the author´s operations with use of the author´s original tools and techniques. Nothing like this currently exists in the world. It is reflected in the atlas and has great educational and practical importance both in surgery and med- icine. There are more than a hundred complexes in the museum which were developed and collected on the operations on various organs and tissues in surgery, dentistry, pediat- ric surgery, thoracic surgery, urology, and other areas and organs. Thus, surgical anatomy became particular for practical doctors of various specialties. In modern medicine, major problems are late diagnosis, false positive and false negative diagnostic results, and stage and size of acute pathology, which can lead to wrong treatment, mortality and disability of patients, and also to recurrence of the disease, ineffective treatment, wrong prognosis and incorrect prevention of post-operative complications in the short term and the long term. A gold standard of diagnostic and treatment, unfortunately, does not include appropriate and effective control of the diagnosis and treatment, which needs to be developed. Comparative analysis of СT scan, MRI and pathotogram, including vital transillumi- natory and ultrasound ones, revealed benefits of our vital monitoring method, which is reflected in the atlas. It provides more information and specifics on malignant and benign tumor, on degenerative, dystrophic, inflammatory processes, traumas and its complications. In the atlas there are clinical data reversible and irreversible of regional blood circulation disorder with focal pathology (adenoma, cyst, breast and thyroid cancer, vessel stenosis, intestinal paresis, etc.). Methods like PET, MRI and X-ray are highly sensitive but they cannot guide a doctor live during an operation in tumor topography. Maintenance of the surgery with these methods is not possible, which leads to iatrogenic complications: bleed, damage of lactiferous duct, and false results, and also causes an increase in the extent of the operation, recurrence and other complications. Pathotopograms mentioned in the atlas are important to determine surgical access, to visualize normal and changed lymph nodes, and to know the required extent of the operation. Ultrasound pathotopograms of focal arthritis and rheumatoid arthritis mentioned in the atlas revealed new specific differential signs of pathology, which is of practical importance in the treatment and prevention of iatrogenic rheumatic complications and in screening studies. Our work is devoted to the memory of patients who have died from the lack of scien- tific achievements, lifetime pathotopograms and a new diagnostic technology. One might