After having taken you on a journey through the cranial nerves, I am going to take you on a ride around the brain, doing a deep dive into the substance of it, and after that, weâll run down the entire spine. Just like there are 12 cranial nerves, there are 33 vertebrae â so hold on tight.
Letâs start with the scalp, an underrated piece of real estate. Five neat layers â Skin, Connective tissue, Aponeurosis, Loose areolar tissue, and Pericranium â work silently to protect the skull and all the important meetings happening inside. Most people ignore it until something grows on it that shouldnât. My greatest regret is that whatâs supposed to grow on it, doesnât: hair!
Rani, a sprightly 62-year-old with the energy of a woman half her age and the hairstyle of someone who had been too busy living to care much for grooming, came to see me on a rainy afternoon. She was wearing a bright floral kurta, carrying a cloth bag, and smiling conspiratorially. She leaned forward across my desk, lowering her voice. âDoctor, Iâve brought you a samosa.â I raised an eyebrow: food bribes are not standard medical practice, and come to think of it, you canât seduce a Parsi with vegetarian food! She tapped the top of her head. âItâs here.â Parting her hair with two fingers, she revealed a smooth, dome-shaped swelling about the size of a small gulab jamun.
It sat smugly on her scalp, just off-centre, like a badly placed cherry on a cake. âItâs been growing for years, but now itâs become painful,â she said. âMy husband calls it my second head. I took one look at it and explained that it was a sebaceous cyst â a harmless sac filled with keratin and sebum, the skinâs natural oils. She looked relieved.âSo, youâll just squeeze it out like toothpaste?â she asked. Not quite. I told her weâd have to remove it surgically, because squeezing it would be messy, partial, and likely to return.
âCan we do it now?â she sprung at me. âWe can do anything,â I told her.
In the next hour, in the minor OT, she lay comfortably prone while I infiltrated the area with local anaesthetic. She chatted about her neighbourâs sonâs wedding while the numbing took effect. The cyst was just beneath the skin, but the scalp is a notorious bleeder, richly supplied with vessels. The trick is to plan the incision so that you donât nick a major one and turn the table into a Holi celebration.
I parted her hair with the precision of a hairstylist, then made a neat elliptical incision over the swelling. The skin opened like the crust of a well-baked pie, revealing the pearly white dome of its wall. Sebaceous cysts have their own personality. Some are shy and slip out whole; others are stubborn, tearing as you coax them, releasing their contents in an olfactory event you donât soon forget. This one was somewhere in between â firm, but not hostile. I slid my scalpel gently around its capsule, freeing it from the surrounding connective tissue. Each sweep was deliberate, avoiding rupture. Beneath my fingertips, the cyst felt like a hard-boiled egg still in its shell. Once Iâd freed its base, I lifted it out in one satisfying, intact piece. I dropped it into a metal tray with a soft plink.
We irrigated the wound, checked for bleeding, and closed it with fine stitches. A small dressing covered the site. When she sat up, Rani reached up to touch her head. âItâs flat!â she exclaimed. Her son, whoâd been waiting outside, walked in and asked, âWhereâs the samosa?â I showed him the cyst in the tray. He made the universal Indian face for I wish I hadnât asked.
Before leaving, she said, âDoctor, for the first time in years, I can lie on my pillow without feeling like Iâm crushing a ladoo.â
The scalp may seem like a trivial starting point in our journey through the brainâs layers, but it has its own dramas. From simple cysts to serious lacerations, it is the first and most visible line of defence. And like many things in medicine, the humble can be deceptively important.
Sometimes, the best surgical victories are not in the deepest recesses of the brain, but in removing a small, stubborn lump thatâs been part of someoneâs daily life â and haircare routine â for years.
16 thoughts on “The scalp”
Dearest Dr Mazda sir âŠâŠ..
As a regular Reader & fan I am extremely happy that after cranial Nerves you are taking us to SPINE journeyâŠâŠ..
In between you chose Rani & her small cyst removal so pretty well in minor painless procedure in consultation time onlyâŠâŠ.
If not samosa what non vegetarian food bribe a Parsee is comfortable with ???? đ„°
We are waiting for your series on spine eagerly sir âŠ.đč
God bless you always with umpteen nos of Surgeries & Articles dear DrâŠâ€ïž
Hi nanda your today’s piece was so readable as always.Vividky describigthe surgery which obviously wasn’t as easy as u made it to be. Your magical hands are truly a gift from God. Carry on my friend.
Dear Doc,
It is such a pleasure to read all your postsâŠ.your pen & knife both work with your straight from heart approach & heal ! Stay blessedđ€
GOD bless you in whatever you do, Dr. MAZDA!
I am speachless!
“Estou sem palavras perante Ă s maravilhas que essas abençoadas mĂŁos tĂȘm feito em benefĂcio dos seus pacientes!
As minhas sinceras felicitaçÔes com votos de boa sorte no exercĂcio das suas funçÔes, Dr. Mazda!
Que Deus o abençoe a si e Ă sua famĂlia đ
Another wonderful start to a Sunday thanks to my visit to Mazdaâs operation room. Youâve been praised, applauded and congratulated numerous times over your successes with the knife and pen!
This time let me send you hugs for the win human being that you are!
đ€đ€
Hi Doc
Trust you and family are well.
Another delightful, entertaining and informative article.
You have an amazing writing talent.
Take care and see you when we are next in Mumbai. Let’s do dinner ~ your cuisine choice.
Imtiaz Jagot
South Africa
Reminds me of my wife’s cyst removal done by your crafty magical hands. GOD bless you dear.
Always a pleasure to read your article, so vividly described that the scene actually unfolds in front of one’s eyes keep it up Dr mazda.
A simple sebaceous cyst can be so complicated sometimes.Your writeups are hilarious and so thought fully penned .I admire the way it is made simple and interesting đ Superb.
Rani is one lucky lady to have gone to u. So simply u removed years of irritable growth from her scalp,and immediatel
God bless u.
Sir
Your posts are informative and method of narration is nice as if you are talking with us.
Look forward to more posts in future.
Dear Doc…
Another wonderful piece of work and writing as well…How magically you work with scalpel in OT n with pen on paper..
Simply outstanding you are…
Great mind with great skill…
Trust you to make a sebaceous cyst sound tastier than a samosa (albeit a Veg one) đ
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