Head and Neck

Duramater pars endosteal

a. Meningea mediana EDH
Bridging vein
sinus sagitalis superior
Falx cerebri
Tentorium cerebelli
08.04 falx cerebelli
09.30 duramater pembungkus spinal cord
Arachnoid spinal cord
 The pia mater of the spinal cord has a pair of denticulate ligaments
(one on each side of the spinal cord) with 21 attachments per side
which attach it to the arachnoid and dura mater.
Named for their tooth-like appearance, the denticulate ligaments are
traditionally believed to provide stability for the spinal cord against
motion within the vertebral column.
SCALP
S: The skin on the head from which head hair grows. It contains numerous sebaeceous glands and hair follicles.
C: Connective tissue. A dense subcutaneous layer of fat and fibrous tissue that lies beneath the skin, containing the nerves and
vessels of the scalp.
A: The aponeurosis called epicranial aponeurosis (or galea aponeurotica) is the next layer. It is a tough layer of dense fibrous tissue
which runs from the frontalis muscle anteriorly to the occipitalis posteriorly.
L: The loose areolar connective tissue layer provides an easy plane of separation between the upper three layers and the
pericranium. In scalping the scalp is torn off through this layer. It also provides a plane of access in craniofacial surgery and
neurosurgery. This layer is sometimes referred to as the "danger zone" because of the ease by which infectious agents can spread
through it to emissary veins which then drain into the cranium. The loose areolar tissue in this layer is made up of random collagen
I bundles, collagen III. It will also be rich in glycosaminoglycans (GAGs) and will be constituted of more matrix than fibers. This layer
allows the more superficial layers of the scalp to shift about in relation to the pericranium.
P: The pericranium is the periosteum of the skull bones and provides nutrition to the bone and the capacity for repair. It may be
lifted from the bone to allow removal of bone windows (craniotomy).
The clinically important layer is the aponeurosis. Scalp lacerations through this layer mean that the "anchoring" of the superficial
layers is lost and gaping of the wound occurs; this requires suturing. This can be achieved with simple or vertical mattress sutures
using a non-absorbable material, which are subsequently removed at around days 7-10.
Blood supply of scalp
The blood supply of the scalp is via five pairs of arteries, three from the external carotid
and two from the internal carotid:
internal carotid
the supratrochlear artery to the midline forehead. The supratrochlear artery is a branch of the
ophthalmic branch of the internal carotid artery.
the supraorbital artery to the lateral forehead and scalp as far up as the vertex. The supraorbital
artery is a branch of the ophthalmic branch of the internal carotid artery.
external carotid
the superficial temporal artery gives off frontal and parietal branches to supply much of the scalp
the occipital artery which runs posteriorly to supply much of the posterior aspect of the scalp
the posterior auricular artery, a branch of the external carotid artery, ascends behind the auricle to
supply the scalp above and behind the auricle.
Because the walls of the blood vessels are firmly attached to the fibrous tissue of the
superficial fascial layer, cut ends of vessels here do not readily retract; even a small scalp
wound may bleed profusely.
Innervation is the connection of nerves to the scalp: the sensory and motor nerves innervating the scalp.
The scalp is innervated by the following:[2]
Supratrochlear nerve and the supraorbital nerve from the ophthalmic division of the trigeminal nerve
Greater occipital nerve (C2) posteriorly up to the vertex
Lesser occipital nerve (C2) behind the ear
Zygomaticotemporal nerve from the maxillary division of the trigeminal nerve supplying the hairless
temple
Auriculotemporal nerve from the mandibular division of the trigeminal nerve
The innervation of scalp can be remembered using the mnemonic, "Z-GLASS" for, Zygomaticotemporal
nerve, Greater occipital nerve, Lesser occipital nerve, Auriculotemporal nerve, Supratrochlear nerve and
Supraorbital nerve.[2]
Duramater
Duramater dibentuk dari jaringan ikat fibrous (terdiri dari serabut kolagen) yang tebal dan kuat.
Pada duramater terdapat serabut elastis, fibrosit, saraf, pembuluh darah, dan limfe. Di bagian
tertentu terdapat rongga yang disebut sinus longitudinal superior yang berisi darah vena dari
otak.
Duramater terdiri dari dua lapis yaitu lapisan endosteal (menyatu dengan tengkorak sebagai
endostium) dan lapisan meningeal (duramater yang sesungguhnya yang mudah dilepaskan dari
tulang kepala). Kedua lapisan ini dipisahkan oleh sinus vena dural. Sinus ini mengalirkan darah
dan cairan serebrospinal dari otak dan bermuara di vena jugularis interna. Di antara tulang kepala
dengan duramater terdapat rongga epidural.
Lapisan meningeal membentuk empat septum yang berfungsi untuk menahan pergeseran otak
dan membagi rongga kranium menjadi ruang-ruang yang saling berhubungan.
Lapisan duramater merupakan lapisan yang memiliki banyak ujung-ujung saraf sensorik yang peka
terhadap rangsangan. Jika ada rangsangan pada bagian ini dapat menimbulkan sakit kepala yang
hebat. Saraf inilah yang bertanggung jawab terhadap beberapa jenis sakit kepala.