Chapter 1: Head Examination

I. Introduction

A head examination is a crucial component of a comprehensive patient assessment. It enables physicians to detect early signs of abnormalities in the scalp, skull, and brain tissue, paving the way for prompt and effective treatment.

II. Layers of the Scalp

The scalp comprises five distinct layers, arranged from the outermost layer to the innermost layer:

1. Skin: The outermost layer, consisting of the epidermis and dermis.
2. Subcutaneous Connective Tissue: Situated directly beneath the skin, it contains abundant adipose tissue, blood vessels, and nerves.
3. Galea Aponeurotica (Scalp Aponeurosis): This thick, tough membrane connects the frontal and occipital muscles, providing protection for the skull.
4. Loose Connective Tissue Beneath the Aponeurosis: Found between the Galea aponeurosis and the periosteum, this layer is rich in blood vessels and nerves.
5. Periosteum: A thin membrane covering and protecting the skull.

III. Scalp Lesions

1. Open Wounds:

• What layer needs to be torn for an open scalp wound?
  • Scalp wound: The Galea aponeurosis is torn, revealing underlying tissues.
  • Penetrating scalp wound: The wound penetrates the Galea aponeurosis and extends deeper, potentially reaching the skull or brain tissue.
• Types of open wounds:
  • Skin abrasion: The skin is superficially scraped, not deep.
  • Scalp laceration: The skin is torn, with or without Galea aponeurosis involvement.
  • Scalp avulsion: The skin is ripped away from the Galea aponeurosis.
  • Penetrating wound: The wound pierces the scalp, potentially contacting the skull or brain tissue.
• Open wound description:
  • Location: The precise location of the wound on the scalp.
  • Size: Length, width, and depth of the wound.
  • Shape: The wound’s shape (e.g., circular, oval, star-shaped).
  • Depth: The wound’s depth, whether it reaches the Galea aponeurosis or not.
  • Edges: Whether the wound edges are regular or irregular, and any signs of infection.
  • Subcutaneous hematoma: Presence or absence of a subcutaneous hematoma, and its location (beneath the Galea aponeurosis, beneath the periosteum).
  • Foreign objects: Presence or absence of foreign objects within the wound.
  • Skull and brain tissue involvement: Careful examination to assess the extent of potential damage.

2. Subcutaneous Hematoma:

• Hematoma beneath the Galea: Blood collection between the scalp and the Galea aponeurosis.
• Hematoma beneath the periosteum: Blood collection between the Galea aponeurosis and the skull periosteum.

3. Infections:

• Scalp abscess: A pus collection in the scalp, often caused by bacteria.
• Cellulitis: An infection of the subcutaneous tissue in the scalp.

4. Masses:

• Sebaceous cyst: A small cyst containing sebum, commonly occurring in the scalp.
• Lipoma: A benign mass composed of fat cells, often present in the scalp.
• Scalp cancer: A malignant tumor originating from scalp skin cells.
• Keratoacanthoma: A non-fluid-filled cyst, often found in the scalp.
• Neurofibroma: A benign tumor formed from nerve cells, frequently occurring in the scalp.

5. Vascular Lesions:

• Hemangioma: A benign tumor consisting of blood vessels.
• Venous malformation: Abnormal dilation of veins.
• Arteriovenous malformation: An abnormal circulatory connection between arteries and veins.

IV. Note

• During a head examination, physicians should pay close attention to any unusual signs, such as swelling, pain, warmth, redness, bleeding, or the appearance of masses.
• A thorough examination of the scalp, hair, skull, and brain tissue is essential.
• In case of any detected abnormalities, further diagnostic tests should be conducted for an accurate diagnosis.
• Careful post-treatment monitoring of the patient’s condition is vital.

V. Conclusion

Head examinations are an integral part of patient health assessments. A meticulous head examination empowers physicians to detect early abnormalities and implement appropriate treatment strategies.

Note: The information presented in this article is for informational purposes only. For accurate diagnosis and treatment, consult a qualified medical professional.