Anatomy clinical correlates: Skull, face and scalp

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Anatomy clinical correlates: Skull, face and scalp

Gross anatomy


Anatomy clinical correlates: Skull, face and scalp

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A 4430-g (9-lb 10-oz) male newborn is delivered at term to a 30-year-old woman. The pregnancy was unremarkable, but the second stage of labor was complicated by recurrent late decelerations and required vacuum assistance. Apgar scores are 6 and 8 at 1 and 5 minutes, respectively. The newborn is evaluated 6 hours later for scalp swelling. Temperature is 35.6°C (96.1°F), the pulse is 186/min, respirations are 40/min, and blood pressure is 40/28 mm Hg. The patient appears pale. Physical examination shows a diffuse, fluctuant swelling of the head that extends to the orbital ridges anteriorly, to the nape of the neck posteriorly, and the level of the ears laterally. Which of the following is the most likely cause of this infant’s presentation? 


The head is one of the most complex parts of our body. Besides having an abundance of muscles, nerves and blood vessels, it protects our brain and houses various facial structures. In this video, we’ll go through a variety of conditions that can affect the skull, face, and scalp. This might not be the easiest subject to learn about, but you’ll see that it’s nothing to get a headache over!

First, let’s discuss the bones of the skull that make up the cranial vault, which as a group are also called the calvaria. We’ll start from the very beginning of their development. See, the flat bones that make up the skulls of neonates have gaps between them and these gaps are covered by fibrous membranes. These membrane-covered gaps between the bones are called fontanelles. The anterior fontanelle is a large diamond-shaped area found at the junction of the sagittal suture, coronal sutures and frontal suture.

In adults, this point where the sutures eventually come together is called the bregma. The anterior fontanelle is bordered by the frontal bone anteriorly and two parietal bones posteriorly. By 18 months of age, the bones fuse together and the anterior fontanelle closes. The posterior fontanelle is a triangular shaped membrane found at the junction of the lambdoid sutures and sagittal suture. In adults, this point is called the lambda. The posterior fontanelle is bordered by the two parietal bones anteriorly and the occipital bone posteriorly. The posterior fontanelle usually closes during the first few months of life and is no longer palpable by the end of the first year.

By palpating fontanelles before they close, bone growth and development of the skull can be assessed. How fontanelles look is also important from a clinical standpoint. For example, a depressed fontanelle can indicate dehydration, while a bulging fontanelle can signal increased intracranial pressure.


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