Regional injuries and patterns of injury
Jason Payne-James, Richard Jones in Simpson's Forensic Medicine, 2019
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.
The Bladder (BL)
Narda G. Robinson in Interactive Medical Acupuncture Anatomy, 2016
Clinical Relevance: The occipitofrontalis muscle comprises two physiologically and anatomically distinct muscles.2 The rostral limit of the galea aponeurotica in the vicinity of BL 3 and BL 4 creates a unique layering system that raises the possibility of nerve entrapment. That is, the superficial fascia over the occipital belly turns into the temporoparietal fascia that attaches to the superior, or upper, border of the frontalis muscle. This superficial musculoaponeurotic complex lifts the eyebrow and pulls the scalp rostrad. In contrast, the occipital belly of the occipitofrontalis muscle joins with the galea aponeurotica and inserts on the deeper aspect, or underside, of the frontalis muscle, forming the deep musculoaponeurotic system. The occipital muscle attachment gives this layer the capacity to pull the scalp, including the superficial musculoaponeurotic system, caudad. Clinically, this layering system poses opportunities for nerve entrapment as branches travel between layers. Compression or traction of the cranial and upper cervical spinal nerves that supply the scalp, muscle, fascia, and aponeurotica leads to headache and, potentially, visual disturbances. After giving off branches that supply the upper eyelid and mucosal lining of the frontal sinus, the supraorbital nerve pierces the frontalis muscle at variable levels from the orbital rim to the mid-forehead. It also courses through the galea aponeurotica to supply sensation to the skin, subcutaneous tissue, and periosteum of the scalp as far as the vertex of the skull.3 The superficial branch of the supraorbital nerve travels along the BL channel and covers BL 3 and BL 4. Palpate the rostral cranium and forehead to determine the loci of tender sites and trigger points. Deactivate accordingly.
Head
Harold Ellis, Adrian Kendal Dixon, Bari M. Logan, David J. Bowden in Human Sectional Anatomy, 2017
Note the five layers of the scalp – skin, underlying dense connective tissue (3), dense epicranial aponeurosis, or galea aponeurotica (4), which is separated by a film of loose areolar connective tissue from the outer periosteum of the skull, the pericranium (5). The pericranium is densely adherent to the surface of the skull and passes through the various foramina, where it becomes continuous with the outer endosteal layer of the dura (8) and is also continuous with the sutural ligaments that occupy the cranial sutures.
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.
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).
Related Knowledge Centers
- External Occipital Protuberance
- Frontalis Muscle
- Nuchal Lines
- Occipital Bone
- Occipitofrontalis Muscle
- Skull
- Connective Tissue
- Aponeurosis
- Anterior Auricular Muscle
- Superior Auricular Muscle