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Anatomy of the Forehead and Periocular Region
Published in Neil S. Sadick, Illustrated Manual of Injectable Fillers, 2020
Marcelo B. Antunes, Stephen A. Goldstein
The frontalis muscle serves as the sole brow elevator. It is a paired thin muscle and rhomboidal in form. There are no true bony attachments. It is enveloped by the galea aponeurotica. Inferiorly the frontalis muscle inserts into the forehead skin blending with fibers from the orbicularis oculi, procerus, and corrugator muscles. Superiorly it continues as the galea aponeurotica transitioning posteriorly into the occipitalis. The frontalis muscle raises the eyebrow and draws the scalp forward giving the expression of surprise. This vertical lift promotes the formation of transverse rhytides in the forehead skin. These rhytides become more well-defined at rest as elongation of the forehead progresses. The corrugator is a pyramidal muscle that originates from the medial end of the superciliary arch, travels superiorly and laterally inserting into the subcutaneous tissue close to the pupillary line. The action of the corrugator is to draw the eyebrows medially and inferiorly, creating the oblique and vertical folds in the glabella known as the “elevens.” The procerus muscle lies medial to the corrugators in the midline of the forehead with an origin along the nasal bones and insertion into the skin of the glabella. The contraction of the procerus muscle draws the eyebrows inferiorly and creates horizontal wrinkles in the glabella.
Regional injuries and patterns of injury
Published in Jason Payne-James, Richard Jones, Simpson's Forensic Medicine, 2019
Jason Payne-James, Richard Jones
The scalp is vascular, hair-bearing skin; at its base is a thick fibrous membrane – the galea aponeurotica. Lying between the galea and the skull is a very thin sheet of connective tissue penetrated by blood vessels (emissary veins) emerging through the skull. Beneath this connective tissue is the periosteum of the outer table of the skull. Injury to the vascular scalp can lead to seemingly dramatic haemorrhage which can usually be stopped by local application of pressure but, in some circumstances (e.g., acute alcohol or drug intoxication), can lead to physiological shock and death. Bleeding scalp injuries can continue to ooze after death, particularly when the head is in a dependent position.
Tumescent Anesthesia
Published in Marwali Harahap, Adel R. Abadir, Anesthesia and Analgesia in Dermatologic Surgery, 2019
William B. Henghold, Brent R. Moody
TA has proved to be especially useful for surgery on the scalp (68). With conventional local anesthesia, large areas can be difficult to anesthetize without multiple needle sticks or nerve blocks. With TA, the scalp can be completely anesthetized with only a few puncture sites. Given its rich vascular supply, the scalp is ideally suited for TA. Hydraulic effects (elevation, magnification, compression) on the tissue in this area go a long way toward facilitating the subsequent surgical procedure. The large fluid volume causes hydrodissection of the galea aponeurotica from the pericranium and facilitates the wide undermining often required with scalp reductions or large flaps to cover defects after tumor removal. Hair transplant surgery, especially with the newer technique of micrografting, takes advantage of all that TA has to offer (71–73).
Operative variations in temporal lobe epilepsy surgery and seizure and memory outcome in 226 patients suffering from hippocampal sclerosis
Published in Neurological Research, 2021
Karl Roessler, Burkhard S Kasper, Julia Shawarba, Katrin Walther, Roland Coras, Sebastian Brandner, Fabian Winter, Hajo Hamer, Ingmar Blumcke, Michael Buchfelder
No mortality was observed in this consecutive series of 226 patients who underwent 231 surgeries. One patient needed surgical revision of a post-operative hygroma with a consecutive permanent shunt implantation (0.4%). Severe post-operative complications occurred in one patient with permanent hemiplegia (0.4%), 11 patients with temporary hemiparesis (4.8%), and 7 patients with temporary aphasia (3.0%), with some residual deficits that do not restrict daily life activity. Post-operative temporary double vision occurred in 13 patients (5.6%) owing to oculomotor nerve affection; it was resolved completely within 3 months. Post-operative permanent contralateral upper quadrant visual field defects occurred in 56 patients (24.2%) and permanent contralateral hemianopia occurred in three patients (1.3%). Seven patients suffered from post-operative Galea Aponeurotica flap cerebro-spinal fluid (CSF) collections, successfully treated by serial lumbar punctures. Two patients developed post-operative meningitis (0.9%), one developed deep venous thrombosis (0.9%), and 8 patients had early post-operative seizures during the hospitalization (0.4%; Table 1).
A temporofrontal fascia flap that penetrated temporal muscle for the reconstruction of an anterior skull base bone and dura: a technical case report
Published in British Journal of Neurosurgery, 2019
Makoto Katsuno, Koichi Uchida, Akira Matsuno
However, there are some disadvantages. First, there is a potential for lack of blood flow to the pedicled flap. During the preparation of vascularised flaps, it is necessary to consider the surgical anatomy of the scalp and temporal muscle. The scalp consists of skin, subcutaneous tissue, the galea aponeurotica, subgaleal loose connective tissue and periosteum and it is supplied by several arteries such as the supraorbital, supratrochlear, superficial temporal, posterior auricular and occipital arteries, with connective arteries between each of these arteries to the skin and temporal muscle.1 As demonstrated in our clinical case, the pericranial flap sacrifices blood supply from the supraorbital or supratrochlear arteries. However, the blood supply to the pericranial flap is maintained by the temporal muscle fascia because the pericranium is firmly attached to the fascia of the deep temporalis muscle by connective arteries and tissues at the temporal line.1 The temporal muscle fascia is supplied from the middle temporal artery, a branch of the superficial temporal artery. This artery usually originates 0.5–2 cm below the zygomatic arch and enters the deep temporal fascia.2 From the anatomical point of view, the blood supply for a pedicled flap from the temporofrontal fascia to the frontal pericranium is maintained from the middle temporal artery by making the base of the pedicled flap parallel to the zygomatic bone. Therefore, the surgeon has to pay attention to preserve the connective arteries surrounding the temporal line in order to maintain blood supply to the pedicled flap.
Hairpulling causing vision loss: a case report
Published in Orbit, 2019
Sidharth Puri, Sarah Madison Duff, Brett Mueller, Mark Prendes, Jeremy Clark
Subgaleal hematoma (SGH) results from bleeding within the potential space between the thin fibrous galea aponeurotica of the scalp and the periosteum covering the cranium.1 SGH usually presents in two clinical settings. Most frequently, it is observed in the neonatal population specifically following vacuum-assisted vaginal delivery. SGH is also seen in the setting of childhood trauma.2 SGH has been reported in children with minor and major head trauma.3 Damage to vessels in the subgaleal space can result in significant hemorrhage and, in rare cases, extend into the orbit.4 We report a unique case of a child who presented with an expanding SGH after hairpulling who subsequently developed orbital compartment syndrome and required urgent surgical intervention.