[email hidden] (Chalo) wrote in message
news:<[email hidden]>...
Quoted message said:(Carl Fogel) said:[email hidden] (Chalo) wrote:
Quoted message said:Quoted message said:If by scalp you mean skin, yes. But there are also muscle, fascia, ligaments, and fat, which
for the purposes of taking a whack to the noggin must tally up in the "scalp" column.
...
Quoted message said:Quoted message said:I think you are missng the layer between skin and bone.
Essentially, there is no layer between the skin and bone when we're talking about the scalp--the
scalp is often cited as the thickest skin on our bodies and covers almost nothing except bone.
...
Quoted message said:Press a finger into the areas covered by a helmet and you'll feel the bone immediately under the
skin--wiggle your finger back and forth and you'll feel the skin sliding around over the bone.
Surprise! It ain't bone. Mine is still dented now, a year later, though not as deeply as before
(and it has hardened up again). If the scalp were as thin as you say, this dent would constitute a
displaced skull fracture. But as I've said, there wasn't a fracture. The skin still slides over
this area as you describe, but it's sliding over a dented portion of something other than bone.
The subcutaneous layer feels hard 'cause it's bound up with tough connective tissue, but it's
still a fleshy layer.
anatomy-resources.comsh202 ca.jpgOpen ↗
Quoted message said:It's about like the skin covering the bump of bone on the outside of your wrist, just thicker.
There are no muscles there. But there are muscles on your head, all the way over. Plus the
ligaments that tie to them and the fascia that wrap them up.
Quoted message said:Scalp wounds bleed profusely and swell alarmingly, producing a much thicker, swollen area in a
surprisingly short time--the "knot" or "bump" with which we're all familiar. This often gives us
a mistaken impression of scalp thickness.
Well, the mushy spot in my noggin was far and away deepest before the swelling began. And if it
had not seemed plenty deep enough to indicate a hole in my skull, I'd not have bothered going to
the hospital to get a professional opinion.
Quoted message said:If you have a wound requiring stitching, the swelling will be local and will give a distressing
impression of depth, like the dent that you suffered that seemed so deep by the time that you
got to the ER.
There was never any bleeding. The skin was not broken. What _was _ broken was the seemingly hard
layer of tissue that lay between my scalp and my skull.
By the time there was swelling, the hole in my head had gotten a bit shallower, but there was also
a huge hematoma directly behind the dent, causing a dramatic sinusoidal wave atop my head. The
hematoma subsided over the next month or so, but the dent remains, still gradually filling in.
Quoted message said:Your ears actually offer more padding than your scalp.
Consider this: With my head tilted down, I hit my head against an unpadded steel tube about 2" in
diameter, hard enough to pop joints all the way down my neck and back. Hard enough to bend the
28.6mm chromoly steel seatpost upon which I was sitting. Yet my skull was not broken and neither
was my scalp. _Something_ absorbed that blow and went all mushy. What do you propose it was?
Chalo Colina
Dear Chalo,
Sorry, but average thickness is about 6mm scalp, 7mm skull. It's easy to be deceived, but your
fingertips will confirm what real x-rays and MRI's and corpses reveal. Feel the bony area on the
back of your wrist and then feel your scalp.
The picture at:
anatomy-resources.comsh202 ca.jpgOpen ↗
is just a plastic demo model. If you take another look, you'll see that this model shows no scalp
layer above the skull. It's more an idealized model intended to show where major structures lie than
an accurate copy.
Here's the real thing, an x-ray showing a similar cross-section of a normal skull--nothing gory,
just black and white:
liv.ac.ukstk1.htmlOpen ↗
As the text and numbered markers explain, the skull shows up as three thin layers, two inner
and outer white lines of solid bone that sandwich a very narrow grayish area of cancellous bone
(swiss-cheese) that pretty much vanishes from sight on the top of the skull because it's so
thin there.
Very faintly, you can just make out a thin gray halo next to the outer bone layer--the scalp. It's
cut off at the top, but fairly clear on the forehead and the area around the markers. For judging
thickness, compare this thin gray shadow to the the noticeably thicker exposed parts of the teeth
above the deep dental roots.
If you want something closer to the stylized plastic demo, the same site shows an MRI:
liv.ac.ukmri2.htmlOpen ↗
Unfortunately, an MRI is much messier and trickier to interpret. That black area marked "1", for
example, is an empty frontal sinus. The whole MRI is deceptive concerning the thickness of the skull
because it's not a clean slice down the center, but is instead offset enough to slice through the
corner of the mouth and not even touch most of the nose. This offset exaggerages the thickness of
the skull--we're looking sideways into a pot lying on one side, so the walls of the pot look thicker
than they really are:
____________________
/ \
/ _______________ \
/ / ___________ \ \
/ / / \::\ \
| / / \::\ || / / \::\ || offset slice \ \ /::/ || || <--true thickness \ \ /::/ || /::/
| <--apparent thickness \ \___________/::/ || \_______________/ /
\ /
\ /
\_____________________/
On the principle that it never hurts to check when I think I'm right, I badgered a few clients
today. Folks who graduated from medical school and have been in practice 20-30 years all volunteered
immediately that the scalp is some of the thickest skin on our bodies--about a quarter of an inch
thick, about 6mm. Nothing else worth noting stands between our skulls and the barber.
The 6mm scalp thickness figure includes what fat, muscle, tendon, and ligament exists on our upper
domes. (Your hat size doesn't change when you gain or lose weight, just as no amount of strenuous
ear-wiggling or brow-furrowing will give you bulging body-builder scalp muscles--there just isn't
much there beyond the unusually thick hide. Grit your teeth with your hands on the sides of your
head but nothing on top.)
As for your accident, it sounds like typical blunt trauma to the top of the head--a broad impact
(even though it felt painfully narrow) on top of an exceptionally strong, almost spherical structure
that makes the most of thin bone plates, with much of the force dissipated down the series of
rubbery spinal disks--thank heavens!
What's left, even a year later, may be the remains of the haematoma, some calcifying scar tissue, or
even a healing fracture. (If there's no sign of intra-cranial bleeding, treatment for many small
skull fractures consists of telling the patient not to do that again.) In our private email, I
mentioned the gorgeous skull photo in "Bones." Elsewhere in R. McNeill Alexander's book, you can see
a healed rib fracture that shows just how much bone can be deposited at the site of an injury.
Keep in mind that even at your impressive weight, your neck will break before the top of your skull
if you stand on your head. If the force of your accident had been concentrated in a point or even
just a narrower edged line, we probably wouldn't be discussing anatomy.
Sadly, it helps to have dealt with human skulls in various stages of injury and decomposition.
X-rays and MRI scans are a much nicer way to get at this sort of thing, but once you handle a real
smashed skull or dangling scalp, you get an idea of how thin things are.
Carl Fogel
P.S. Here's a marvelous phrase that I stumbled across while looking for a nice MRI link: "Thirty
healthy controls [for scalp thickness EEG testing] were examined using an auditory evoked P300
elicited by a standard oddball paradigm."
I now long to know what a "standard oddball paradigm" is. Perhaps I've been using them for years.
C.F.