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The Boundaries of the Region Are Margo Supraorbitalis, Linea Temporalis Superior, Linea Nuchae Superior Till Protuberantia Occipitalis Externa

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The Boundaries of the Region Are Margo Supraorbitalis, Linea Temporalis Superior, Linea Nuchae Superior Till Protuberantia Occipitalis Externa Topographical anatomy & operative surgery of the head. Topographical pecularities of regions of the head and its practical importance. Main principles of surgical treatments The boundaries and divisions. The border between the head and a neck carried out (conditionally) to the inferior margin of mandible, angle of mandible, posterior margin of the vertical process of the mandible; the anterior and posterior edges of the mastoid process, superior nuchal line (linea nuchae superior), external occipital protuberance (protuberantia occipitalis externa). Then it passes symmetrically to the opposite side. On the head distinguish cerebral and facial departments, according to the cerebral and facial skull. The border between these departments passes by supraorbital margin, superior margin of the zygomatic arch to the porus acusticus externus. All that is down and anterior to this border belongs to the facial department, which is upward and backward, refers to the cerebral department. The cerebral department is divided into calvaria (fornix cranii) and bases of skull (basis cranii). The boundary between the base of scull and calvaria is mainly passes by the horizontal plane which joins the nasion to the inion (an imaginary line that passes along the supraorbital margin - margo supraorbitalis, superior margin of the zygomatic arch - arcus zigomaticus, base of the mastoid process - processus mastoideus, upper nuchal line - linea nuchae superior to inion). The parts of the skull located above this plane belong to the calvaria; located below - to the base of skull. Calvaria areas. 1) fronto-parietal-occipital region - regio frontoparietooccipitalis; 2) Temporal region - regio temporalis. Fronto-parieto-occipital region (regio fronto-parieto-occipitalis) The boundaries of the region are margo supraorbitalis, linea temporalis superior, linea nuchae superior till protuberantia occipitalis externa. Scalp The scalp covers the calvaria, extending from the superior nuchal lines on the occipital bone to the supraorbital margins of the frontal bone. The scalp consists of five layers of soft tissues, the first three of which are connected intimately and move as a unit. Each letter of the word scalp serves as a memory key for its layers: skin, connective tissue, aponeurosis epicranialis, loose connective tissue, and pericranium. I The skin, thick especially in the occipital region, contains many sweat and sebaceous glands and hair follicles; it has an abundant arterial supply and good venous and lymphatic drainage. The skin is fixed to the aponeurosis by dense strands of fibrous tissue which traverse the subcutaneous tissue and split it into a number of separate pockets filled with fat. II The connective tissue is a thick, richly vascularized, subcutaneous layer which is well supplied with nerves. The connective tissue includes five neuro-vascular bunches and a separate nerve Location of the neuro-vascular bunches 1. a.v.n. supratrochlearis ( frontalis ) 2. a.v.n. supraorbitalis Arteries are terminal branches of ophthalmic artery, a branch of internal carotid artery; veins begin from the forehead and descend to unite at the medial angle of the eye to form the facial vein. Veins have connection with ophthalmic vein, which drains into sinus cavernosus. Nerves are the major cutaneous branches of the ophthalmic nerve (first branch of trigeminal nerve). 3. a.v. temporalis superficialis and n.auriculo-temporalis. Artery is smaller terminal branch of external carotid artery. The superficial temporal artery emerges on the face between the temporomandibular joint and the ear and ends in the scalp by dividing into frontal and parietal branches, the vein drains the forehead and scalp and receives tributaries from the veins of the temple and face. Near the auricle, the superficial temporal vein enters the parotid gland. The retromandibular vein, formed by the union of the superficial temporal and maxillary veins, descends within the parotid gland, superficial to the external carotid artery and deep to the facial nerve. The retromandibular vein is divided into an anterior branch that unites with the facial vein and a posterior 1 branch that joins the posterior auricular vein to form the external jugular vein. The nerve is major cutaneous branch of the mandibular nerve, which is the third branch of trigeminal nerve. 4. a.v.n. auricularis posterior. Artery is branch of external carotid artery; auricular posterior nerve is branch of facial nerve. 5. a.v. occipitalis and n.occipitalis major. Artery is a branch of external carotid artery. Vein forms external jugular vein with v. auricularis posterior. Nerve is branch of the second cervical nerve (posterior root ). 6.n. occipitalis minor is situated between the fourth and fifth bunches. It is a branch of cervical plexus. These arteries and veins of the scalp make anastomoses freely with each other and with those of the opposite side. Because of this, wounds of the scalp bleed profusely, but heal rapidly. III The aponeurosis epicranialis is a strong stringy sheet that covers the superior aspect of the calvaria; the aponeurosis is the membranous tendon of the fleshy bellies of the occipitalis and frontalis muscles (whereas the frontalis pulls the scalp anteriorly, wrinkles the forehead, and elevates the eyeblayerss, the occipitalis pulls the scalp posteriorly and wrinkles the skin on the posterior aspect of the neck). The aponeurosis consists of two layers. The deep layer attaches to the borders of the region and the superficial one continues to the neibouring regions as superficial fascia. IV The loose connective tissue is somewhat like a sponge because it has many potential spaces that may distend with fluid that results from injury or infection; this layer allows free movement of the scalp proper (first three layers, skin, connective tissue, and epicranial aponeurosis). V The pericranium, a dense layer of connective tissue, is the periosteum of the calvaria; it attaches firmly to the cranial bones, but the pericranium can be stripped fairly easily from the cranial bones of living persons, except where it is continuous with the fibrous tissue in the cranial sutures. VI The subperiostal connective tissue is situated between the pericranium and the bone. VII The bones of the head consist of three layers. The names of the external and internal layers are lamina compacta externa et interna (or vitrea) because it can be broken very easily. The name of the middle layer is lamina diploe, which contains diploic veins. VIII The cranial dura mater consists of two layers. Dural venous sinuses are situated between two layers of dura mater. Projections of the main neurovascular bundles of the fronto-parietal-occipital region. 1. A.v. n. supratrochlearis - projected on the crosspoint between vertical line drawn through the medial angle of the orbit and supraorbital line. 2. A. v. n. supraorbitalis - projected on the border between middle and medial thirds of supraorbital line. 3. A. v. temporalis superficialis, n. auriculotemporalis - projected one transverse finger in front to the tragus of the ear on the zygomatic arch. 4. A. v. n. auricularis posterior - projected by the middle of the distancesbetween the external auditory meatus and the tip of the mastoid.process 5. A. v. occipitalis, n. occipitalis major - projected on the midpoint of the distances between the tip of the mastoid process and inion. 6. N. occipitalis minor - is projected on the tip of the mastoid process The Peculiarities of Fatty Tissue in Fronto-parieto-occipital Region Blood or pus can gather in those layers, where we have loose connective tissue. In this region there are three layers of this kind and in each of them haematoma or abscess has peculiarities: a) Subcutaneous fatty tissue- Haematomae which are located in this layer are blocked, as they appear in separate pockets of subcutaneous tissue (between dense fibrous septa connecting the skin with aponeurosis). These haematomae appear just in the region of the injury by oedema of the skin as a “lump” Frontal region is an exception, where subcutaneous tissue has connection with subcutaneous tissue of the superior eyelid. Here haematoma and oedema can spread easily. b) Subaponeurotic loose connective tissue- Haematomae and abscesses of this layer can spread all over the region, but they cannot spread out of its boundaries, as the deep layer of the aponeurosis is attached to the boundaries of the region. An exception is again frontal region, where there is connection with the loose 2 connective tissue of the orbits. Consequently, a black eye can result from an injury to the scalp (a symptom of the “glasses”) c) Subperiostal connective tissue- Haematomae of this layer can spread inside the boundaries of a bone, as periosteum is attached to the bones in the region of the sutures. The Peculiarities of Blood Supply in Fronto-parieto-occipital Region Peculiarities of Arterial Supply 1. The main vessels of this region are in subcutaneous fatty tissue and extend to the bregma from every side. Because of this superficial position they can be damaged very easily. 2. The vessels are fixed by their adventitia to the dense strands of the connective tissue and so remain retracted when they are injured. 3. The vessels make anastomoses freely with each other and with those of the opposite side. That’s why bleeding is from the both sides of injured vessel. So the scalp wounds bleed profusely, but heal rapidly. 4. Here we have anastomoses between the branches of internal and external carotid arteries. Peculiarities of the Venous Supply The venous supply of this region consists of three levels: 1. Veins which are located in subcutaneous tissue. 2. Diploic veins. 3. Dural venous sinuses. They are connected through the emissary veins. Emissary veins don’t have any valves and blood can pass in two directions. The permanent emissary veins are: - Parietal (in fronto-parieto-occipital region, single) - Mastoid (in mastoid region, double) - Occipital (in fronto-parieto-occipital region, double) If the patient has an inflammation of scalp in area of emissary veins the infection may spread into the cranium and if the patient has a wound of the scalp in area of emissary veins profuse venous bleeding may occur.
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