​ ANA: ANATOMY

[LOGO] ​ ​CA1: SCALP AND SKULL 

​ ​[Dr. Santos] [August , 2019]
Clinical applications:
→ Profuse bleeding
OUTLINE
I. Scalp ● due to laceration of the blood vessels
A. Skin ● bleeding is stopped by applying pressure directly to the
B. Connective Tissue area that is bleeding
C. Aponeurosis → Caput succedaneum
D. Loose Areolar Tissue ● edematous swelling of subcutaneous tissue during
E. Pericranium or Periosteum vaginal delivery (gives rise to cone-head appearance of
II. Skull infant)
A. Infant Skull ● due to prolonged pressure while passing through the
B. Fractures of the Skull birth canal
C. Hemorrhage ● heals on its own after 2-3 days
D. Head & Brain Injuries
E. Basilar Skull Fractures C. APONEUROSIS
III. Citation ● Attachment of the Occipitofrontalis muscle
IV. References
Clinical Application:
I. SCALP
→ Gaping wound
Layers of the Scalp: ● laceration to the scalp that injures the aponeurosis layer
● S​kin ● Due to pulling of frontal and occipital bellies of the
● C​onnective Tissue occipitofrontalis muscle
● A​poneurosis or Galea Aponeurotica ● treated by suturing layer by layer to prevent disruption of
● L​oose Areolar Tissue skin incision
● P​ericranium or​ P​eriosteum ● when suturing is not done well there is risk of subgaleal
hematoma
A. SKIN D. LOOSE AREOLAR TISSUE
● known as the dangerous layer of the scalp
● This layer of the scalp is thick and hair bearing
● Contains numerous sebaceous glands
Clinical application:
● Susceptible to ​Sebaceous Cysts → Cavernous sinus thrombosis

Clinical Applications: ● compression of the cavernous sinus

→ Sebaceous Cyst ● infection transmitted to the cranial cavity through the
● Arises from a clogged sebaceous gland emissary veins
● Treatment is by the incision and drainage of pus before ● may lead to osteomyelitis if infection reaches the bone
the cyst is excised. marrow of the skull
● An infected cyst is usually inflamed, therefore excision of
E. PERICRANIUM or PERIOSTEUM
the cyst is expected to be bloody.
● Punctum​ - head or opening of the cyst; has the least ● attaches to the outer surface of calvaria by connective tissue
resistance fibers
● If the cyst is left untreated, it may become infected and
may lead to ​cavernous sinus thrombosis Clinical Applications:
→ Alopecia → Cephalohematoma
● bleeding between pericranium and skull that can
B. CONNECTIVE TISSUE OR SUBCUTANEOUS TISSUE progress to formation of blood cysts on an infant’s skull
● due to rupture multiple minute periosteal arteries in the
● Blood vessels are present in this layer (mostly arterial) which skull
causes profuse bleeding when lacerated. → Craniosynostosis/Craniostenosis
● The vascularity of this layer of the scalp promotes ​rapid w
​ ound ● premature fusion of sutures
healing ● treated by opening the skull to allow growth
● Fibrous Inelastic Septa
→ Holds the blood vessels
→ Prevents the blood vessels from retracting or constricting
during laceration injuries

Trans # 1 Group A: Surname, Surname, Surname 1 of 3

 II. SKULL Pterion
● Junction of the frontal, temporal, sphenoid, and parietal
A. Infant Skull bones
● Weakest part of the skull; also the deepest point
● Meningeal artery is embedded.
● Where people usually shoot themselves.
● Injury may be fatal

Sutures​: are dense connective tissue membranes at fibrous joints

separating the bones of the skull.
· Coronal suture: suture connecting the frontal to the parietal
· Lambdoid suture: suture connecting the parietal to the
occipital
· Sagittal suture: along the midline, between the parietal bones
· Squamosal: temporal bone and the parietal bone
Forceps delivery​: usage of forceps to assist in delivery. Leaves
Fontanel: ​large fibrous areas where suture converges behind ​Forceps marks.
● Anterior fontane​l: Frontal and Parietal ● C7 and other terminal branches of the facial nerve may
o Closes at 18 months - 2 years be damaged. May result to cerebral palsy.
o BREGMA in adults
● Posterior fontanel
o Closes at 9 months
o LAMBDOID in adults

Clinical significance:
● In delivery
● Infancy: determinant of hydration
❏ Depressed on dehydration
❏ Bulging: Increased Intracranial pressure
● Site of CSF collection
● Determinant of growth progress

Molding:​ softness of the bones and looseness of the connections

at these sutures.
● Skull undergoes changes of shape during labor to Tympanic membrane:
accommodate childbirth. ● Infant: pull pinna downwards and lateral.
● Adult: Pull Pinna upward and backwards to a 55 degree
angle

Fractures of the skull

Anencephaly:​ absence of major skull portions
Microcephaly​: Smaller than normal cranium. Indicative of mental
retardation.
Factors to consider
1. Age: young<adult<senior
2. Severity of blow:
● Inner table of the bone: more extensively
fracture than outer table
3. Area: ​Pterion​- ​known as the most fragile area of the skull
Infant’s fracture: ​POND’s fracture
● “Dent”: ​Appears on relatively more elastic skulls
● Elastic: ​prevent blows from producing fractures.
● Depression of fractured bones without splinting
Linear fractures
● Most Frequent type
● Occurs at the point of impact
● Fracture lines may radiate in numerous directions
(broken window)
● Coup versus countercoup
❏ Coup: brain injury at the same side of impact
❏ Countercoup: brain injury at the opposite side
of impact

PH 1XX Title of Lecture 2 of 3

Depressed fractures of calvaria (skullcap)
● Caused by direct violence
● Inner table​: more brittle, thinner, and less curved
● Outer table​: resilient
● Fractures: inner table fractures more dangerous
Basilar skull fractures
Anterior cranial fossa
● Involves the frontal, ethmoidal, and sphenoidal sinuses
● Cerebrospinal fluid leaks from the nose> meningeal tear>
risk of meningitis> test for glucose in nose drainage to
confirm
● Thus subarachnoid space is this put in communication
with the exterior via the nasal cavity
Damages to the :
● Cribriform plate: houses the olfactory nerve: will lead to
anosmia due to rupture of fibers on injury
● Orbital plate:will lead to exophthalmos: pushes brain
upwards
● Optic foramen: primary optic atrophy and blindness
Signs: exophthalmos, racoon eyes, bleeding in the nose
and eyes.
Middle Cranial fossa
Weakest or the thinnest part of the skull due to being thin and
presence of multiple foramina
● CSF leak or bleeding in external auditory meatus
● Facial and auditory nerve injury: facial and
vestibulocochlear nerves
● Bleeding into the mouth: possible sphenoid involvement
Results in: Diplopia, deafness, bleeding into the mouth
PH 1XX Title of Lecture
Posterior Cranial fossa
● Not commonly fractured
● Affects the jugular foramen which houses the cranial
nerves 9-11
● Hypoglossal nerve usually not affected
● Bleeding: mastoid: check the back of the neck
● Sign: battle signs(bruising of the mastoid process
● Inability to shrug shoulder, loss of taste
I. CITATION
● Book
Author, A. (Year). ​Title of work (​ 6​th ed). Place of publication:
Publisher.
Naughton, B. (2007). ​The Chinese economy: Transitions and growth.
Cambridge, MA: MIT Press.
● Online Book
Author, A. (Year). ​Title of work. ​Retrieved from URL
Toy, E. C., & Klamen, D. (2009). ​Case files: Psychiatry ​(3​rd ed.) [Kindle
version]. Retrieved from http://www.amazon.com/
● Website with an author
Author, A. (Year). Article title. Retrieved from URL
Simmons, B. (2015). The tale of two Flaccos. Retrieved from
http://grantland.com/the-triangle/the-tale-of-two-flaccos/
● Website without an author
Article title. (Year). Retrieved from URL
Teen posed as doctor at West Palm Beach hospital: police. (2015). Retrieved
from
http://www.nbcmiami.com/news/local/Teen-Posed-as-Doctor-at-West-Pal
m-Beach-Hospital-Police-288810831.html
● Journal Articles
Author, A. (Publication Year). Article title. Periodical Title,
Volume (Issue), pp.-pp.
Nevin, A. (1990). The changing of teacher education special education.
Teacher Education and Special Education: The Journal of the Teacher
Education Division of the Council for Exceptional Children, 13(3-4),
147-148.
● Pictures
Photographer, A. (Photographer). (Year). Title of photograph
[digital image]. Retrieved from http://xxxxx
Ferraro, A. (Photographer). (2014). Liberty enlightening the world [digital
image]. Retrieved from https://www.flickr.com/photos/afer92/
14278571753/in/set-72157644617030616
II. REFERENCES
● Snell, R. (2012). Clinical Anatomy by Regions​ (​ 9​th​ ed)​. L
​ ippincot Williams &
Wilkins, Two Commerce Square, 2001 Market Street, Philadelphia.
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