FACTS & HINTS

High-Yield Facts

Clinical Points

Scalp lacerations

Scalp has rich blood supply

Bleeding from scalp lacerations often profuse, because blood enters peripheryof scalp and vessels anastomose Because of dense connective tissue in second layer of scalp, bleeding vessels do not retract into wound but stayopen Patient can exsanguinate if bleeding is not controlled

Bleeding controlled initiallybydirect pressure initiallyfollowed bysuturing in layers rather than tying individual vessels

Clinical Points

Blood or infections in the scalp

Blood or pus from an infection collects in loose connective tissue Can spread easily

Prevented from passing into the neck or subtemporal regions, because of attachments of the epicranial aponeurosis Fluid can descend into orbits because orbitalis muscle attaches to skin in this region

Orbital hematomas commonlyoccur following injuryto the scalp

Clinical Points

Facial palsy(Bell's palsy)

Facial nerve palsywithout a known cause

Can follow exposure to cold, dental work, Lyme disease, or otitis media Results in inflammation, compression, or edema of the nerve

Facial nerve supplies muscles of facial expression

Thus result is loss of facial muscle tone on the affected side Symptoms generallyseen:

Paralysis orbicularis oris causes drooping of mouth on affected side and dribbling of saliva

Paralysis of orbicularis oculi causes eyelid to droop and evert, leaving cornea inadequatelylubricated and eye constantlytearing Paralysis of buccinator together with orbicularis oris leads to accumulation of food between cheek and teeth when chewing

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Clinical Points

Table I00-2. Sites of lesions of the facial nerve and resulting symptoms

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