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IntegumentFasciaGlands.pptxChapter 3 – Restorative Art – J. Sheridan Mayer
Subcutaneous Tissues and Integument, Fascia, and Glands
The Best Cheat sheet
As you go through these slides and the text, use your fingers and feel each of the following locations/features on your face and cranium with your fingers while you read the description.
This will help you better understand what the text is speaking of regarding contour and tissue depth (thickness/thinness)
Doing this will help you on your exams—because YOU ARE YOUR BEST CHEAT SHEET!!! Commit these to memory as you study, using yourself as a guide. YOU are the one thing you can have with you when taking your exams/comps, so let your own body be study material to help absorb this information.
Skin Layers
Epidermis
Dermis
Subcutaneous layer (aka, Hypodermis—hypo = under, dermis = skin)
If you’ve ever taken your dog to the vet: they may have given a “Sub-Q IV” for fluids because of dehydration. This allow fluids to enter the system via diffusion and perfusion of the tissues.
Sub-Q = subcutaneous
Is also used when attempting to give an IV to someone and the veins are difficult to find
Introduction: What makes up Our skin?
Fascia and Glands
Cover bones and muscles of the head
Influence surface contour
Swollen glands distort surface form
Subcutaneous tissues
So thin over some bones that thickness can be estimated just by pressing against the skin
Think of pressing on your calf or bicep as opposed to pressing on the skin at your cheek, or elbow
Helpful during reconstruction
Some areas contain a large amount of adipose (fatty) tissue
Excessive (or diminished) quantities of adipose tissue also affect surface contours
Obesity versus Emaciation
Things to Remember:
Connective tissues:
Vary in thickness, density, accumulation of fat, amount of collagenous and elastic fibers, and the amount of tissue fluid
Deep fascia:
Surrounds and penetrates between muscles
Often identified as a gray, fibrous membrane
Word to remember:
Aponeurosis:
A broad, flat sheet of dense, fibrous, collagenous, tendon-like connective tissue
Is sheet-like in appearance
Is pearly-white colored
Attaches sheet-like muscles that need a wide area of attachment
In RA, the Epicranial aponeurosis, is an important covering on the upper part of the cranium and meets the occipitofrontalis muscle
Remember: Do not be intimidated by large words, break them down
Epi = on, over
Cranial = you know this one
Scalp and Forehead
Relatively thin tissue
Follows the convolutions of the bony framework (Contour of the bones)
Tissue is thicker than any other part of the body, BUT only a small amount of fat is embedded in the subcutaneous layer
Fibrous bands secure the skin to the deep layers of superficial fascia
Is very thick and tough in the scalp
On forehead, skin is closely attached to the underlying Frontalis Muscle
Superficial fascia is much thinner than on the scalp
Temples
Temporal Fascia forms a strong, fibrous sheet
Aponeurotic in appearance
Covers the temporalis muscle and marks the upper determination of the deep fascia
Upper portion is thin, single sheet
Lower portion near the Zygomatic Arch and divided into two layers
One continuing behind
One continuing externally to the Zygomatic Arch
Small quantity of fat lies between the two layers – superior to the Zygomatic Arch
Zygomatic Arch
Tissues covering are closely adherent
External layer of the temporal fascia is strongly adherent to the periosteum which covers the bone
Nose
Only a slight amount of fat embedded in the subcutaneous tissues covering the nasal bones
Superficial fascia is reduced over the superficial cartilages
Skin is closely bound to the underlying perichondrium
Wings of the nose are composed of fatty and fibrous tissue covered by skin
Integument of both the dorsum and sides of the nose is thin and loosely connected with the underlying parts
Over protruding lobe and wings it’s thicker and more firmly adherent
The skin is furnished with a large number of sebaceous follicles
Eye
Superficial layers of fascia covering the eyelids have no fat
Fascia is composed of loose areolar tissue which is easily distended and infiltrated with tissue fluid in edema or by blood in ecchymosis or hemorrhage
Eyelids are formed by integument, areolar tissue, fibers of the Orbicularis Oculi Muscle, tarsus and tarsal glands, and conjunctiva
Integument is extremely thin on the eyelids
Attached more tightly nearer the free margin where it overlies the firm, fibrous plate called the tarsus
Tissues overlying the bony margins of the eye-socket are very thin
Entire surface of the lateral rim is closely adherent
Medial wall repeats the smoothness of the bony structure
Eyeball occupies the front half of the orbital cavity and supports the eyelids
Embedded in fat and connective tissue
Ear
Superficial fascia is greatly reduced over the cartilages of the external ear
Skin is thin and closely bound to the underlying perichondrium
Covered with fine hairs and is furnished with sebaceous glands which are most numerous in the concha and scapha
The lobe is composed of tough areolar and adipose tissues
Skin in this area is also closely adherent
Mouth
Between the external and internal surfaces of the lips
Considerable amount of fat and tough fibrous tissue
Each lip also contains fibers of the Orbicularis Oris, labial vessels, nerves, areolar tissue, and numerous small labial glands
Inner surface of each lip is connected to the corresponding gum by a fold of mucous membrane called the Frenulum
The upper Frenulum is usually larger than the lower
Cheek (Buccal area)
Contains a considerable amount of fat
Superficial fascia is tougher and more fibrous than at other parts
Between the external and internal surfaces:
Muscles, fat, areolar tissue, blood vessels, nerves, and glands are found
Fascia covering the cheekbone has minimum fat
A greater amount of fat is found on the part of the maxilla lying below the orbital cavity
Masseter Muscle
Contributes to the fullness of the posterior part of the cheek between the angle of the jaw and the Zygomatic Arch
Posterior border of the muscle is covered by part of the Parotid Gland which extends to the ear
Fullness of the anterior cheek is produced by facial muscles and remnants of the “Buccal Fat Pad”
Encapsulated mass of fat lying superficial to the Masseter Muscle but anterior to its front border
Chin (mandibular/Mental area)
Bony prominence of the chin is covered by tissues which are somewhat dense
Composed of muscles and a moderately large amount of fat
Only at the inferior-posterior margin of the bone is the tissue close to the body structure
Submandibular Area
Superficial fascia of the region immediately below the jawline is thinner and less dense than the fascia of the facial area
May contain very little or develop a moderately large amount of adipose tissue
Fascia splits to enclose the Submaxillary Gland
Two layers come together again for a short distance near the angle of the jaw and then separate again to ensheath (cover) the Parotid Gland
Integument (aka: Skin)
Face is covered by skin that is thin, highly vascular, and supplied with many sebaceous and sweat glands
Consists chiefly of a layer of dense connective tissue (Derma, aka Dermis) and an external covering of epithelium (Epidermis)
Skin protects the deeper tissues from drying and injury
Waterproof but also an agent of water output
Has absorbing powers; it will absorb oily materials placed in contact with it
Thickness of skin varies between one-thirtysecond (1/32) to a little more than one-sixteenth (1/16th) of an inch
Slightly less on the eyelids
Ability of the skin to be stretched varies with its thickness
Density of the Derma (Dermis) and the firmness of fixation by the superficial fascia are directly related to its mobility
Limit to how much the skin can be stretched
Texture varies among individuals and at various ages
Starts soft and as time passes, many things affect the texture of the skin
Derma (AKA DERMIS or corium)
The deeper layer of the skin
Tough, flexible, and elastic
Thickness varies in different parts of the body
Consists of felted connective tissue
Contains a small amount of fat, rich plexuses of blood vessels and lymphatics, nerve twigs, and numerous sensory nerve endings
Moving down the Derma from the Epidermis are hair follicles, sebaceous glands, the ducts of sweat glands, and bundles of smooth muscle fibers
Deeper layer of Derma is a mass of interlacing bundles of both white and elastic connective tissue fibers
This layer is mostly responsible for the toughness and strength of the skin
Sebaceous glands are oil glands found in most parts of the skin
Are especially abundant in the scalp and face
Epidermis
Remember: “Epi” = over, above, on
So, over, or on, the dermis
Outermost layer of the skin
Has no lymph or blood vessels
Composed of four strata (layers) of cells
Three outer layers are practically dead and constantly shed to be replaced by new ones from the fourth layer
External layer of the Epidermis
Protoplasm of cells has become chemically changed into a protein substance which acts as a waterproof covering and provides the protective coating for the living cells of the Derma
Color of the Skin
Partly dependent upon
The presence of the skin pigments
The blood of the superficial capillaries
ARCHAIC DESCRIPTION FROM THE MAYER TEXT (not Klicker) BUT YOU SHOULD BE FAMILIAR WITH THE TERMINOLOGY UNTIL THE TEXT IS CHANGED OR UPDATED:
‘Deep brown or blackishness of the skin of the Negro, and the “tanned” color of some of the white race’ (page 74)
Color is due to the presence of pigment in the cells of the Epidermis
PIGMENT (MELANIN)
Consists of dark brown or black granules of very small size which are packed closely together within the cells of the Epidermis
Deposited in the cells of the deepest stratum (layer)
Greatest deposits of melanin are found in hair
Exposure to sunlight involves increase of pigmentation as a protection for the deeper structures
Melanin may be totally lacking in some persons
A condition known as albinism
Partial albinism may also occur
Some may have patches of skin that are pigment-free
Moles are localized spots of intense pigmentation
Freckles are common in many
Elderly get small areas of pigmentation spots (think “age spots”)
SECOND PIGMENT (CAROTENE)
In the stratum corneum layer and fat of the Derma and superficial fascia
Pigment varies in quantity from time to time in each individual
In old age, this yellow pigment contributes greatly to the sallowness of the skin coloring
Remember to merge this information with what you are learning in Anatomy and Embalming. This is all reiteration!!!!
The end!
