بسم الله الرحمن الرحيم والصلاة والس م علي نبينا محمد وعلي آلة وصحبة اجمعين

Clinical Anatomy of Head and Neck By Essam Eldin Abdelhady Salama

Scalp Skin, (hairs) subcutaneous tissue and epicranial aponeurosis are adherent together, (first 3 layers). Sebaceous cyst of scalp are common due to presence of numerous sebaceous glands.

Scalp Scalp infection localized and painful because of large amount of fibrous tissue. May spread to dural venous sinuses through emissary veins causing venous thrombosis. Osteomyelitis when infection spread to the skull bones (Diploic veins)

Scalp Rich blood supply to hair follicles. Small laceration of scalp causes sever blood loss. Arteries of the scalp are unable to contract easily so ligation of scalp wound is important to stop bleeding. Necrosis of the scalp is uncommon.

Scalp Blood or pus beneath epicranial aponeurosis tends to spread over skull vault, limited by orbital margin, nuchal and temporal lines. Subperiosteal blood or pus is limited to one bone due to attachment of the periosteum to the sutural ligaments.

Fractures base of the skull The anterior cranial fossa; is manifested by epistaxis and cerebrospinal rhinorrhea. The middle cranial fossa; fracture is common due to numerous foramina, cavities and air sinuses, it is manifested by leakage of blood and CSF from the external auditory meatus. The posterior cranial fossa; fracture is manifested by escape of blood into nape of neck, later it appears in the posterior triangle.

Extradural Hemorrhage Injuries to ant. division of middle meningeal artery, artery of extradural hemorrhage, (Pterion). Hematoma will press on motor area in precentral gyrus.

Subdural Hemorrhage Results from tearing of superior cerebral veins as they inter the superior sagittal sinus. It is caused by excessive displacement of the brain, or trauma to front or back of head.

Subarachnoid Hemorrhage Results from leak of blood in the subarachnoid space. Sudden sever headache, and loss of consciousness.

Cerebral Hemorrhage Caused by cerebral artery hemorrhage. The patient losses his consciousness, muscle paralyzed is manifested later.

Arterial pulsation The superficial temporal artery can be felt as it crosses the zygomatic arch in front of the ear. The facial artery can be felt as it crosses the lower border of the mandible at the anterior border of masseter muscle.

Dangerous triangle Infection in the dangerous area of the face may spread through communication of superficial veins to dural sinuses. Cavernous sinus thrombosis may be fatal unless adequately treated by massive antibiotics.

Parotid gland Facial nerve lies between superficial and deep parts of the gland. Malignant tumors are invasive and causing facial palsy. Benign tumors rarely causes facial palsy.

Facial nerve Supplying muscles of the face. Idiopathic acute inflammation of the facial nerve in the facial canal or in the stylomastoid foramen. Tumor in the internal acoustic meatus, or parotid gland, leads to Bell ’ s palsy distortion of the face. Bell ’ s palsy is manifested by, dropping of the angle of the mouth. inability to close the eye in the affected side.

Trigeminal nerve Supplying skin of the face except angle of mandible. Trigeminal neuralgia is a common condition. The patient complains of severe pain in area of mandibular nerve distribution.

Surgical Incisions Karl Langer ’ s lines in the skin. Surgical incisions made in the direction of these lines lead to minimal scar tissue. As it runs in the direction of the dermal collagen bundles.

Developmental failure Cleft upper lip may be accompanied by cleft palate. It is usually unilateral, but it could be bilateral. It is due to failure of fusion of the maxillary process to the medial nasal process.

Developmental failure

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