Anatomy of scalp

PhD. Mohammed Simawy

 Scalp
Definition :
it is the soft tissue‫نسيييالرخو ييي ر‬
which covers the vault of skull .
Extension :
• Antero-posteriorly : from the
supraorbital margin (eye
brows) (anteriorly) to the
external occipital protuberance
and superior nuchal line
(posteriorly).
• On either side : it extend
between the superior temporal
line , it continuous with the
hairy area of temple of both
side , also reaching to the level
of zygomatic arch .
Layer of the scalp : they are 5 layers can be
memorized by the word scalp
1. Skin : most superficial layer , thick , more
hairy and rich in sebaceous glands ‫غده دهنيه‬.
2. Connective tissue : it is a dense layer ‫كثافي ر‬
that connects the skin (1st layer) to the
epicranial aponeurosis (3rd layer) , it contain
blood vessels and nerve of scalp.
3. Aponeurotic layer ( epicranial aponeurosis) :
fibrous ‫ ليفيهه‬tissue sheet attached to it occipito-
frontalls muscle.
(first three layer connected to each other and
move as awhole on the skull)
4. Loose ‫ مضهمل‬connective tissue : it separated
the previous 3 layer (the scalp proper) from the
pericranium of the skull and facilitating their
movement over the skull . It is continues with
loose tissue of upper eyelids .
5. Pericranium : it is the periosteum of the
outer surface of the skull , it is attached to the
bone of skull , but is removable except in the
area of suture .
Occipito-frontalis muscle:
It has a two frontal bellies anteriorly and
two occipital bellies (epicranial
aponeurosis connecting them) .
• Frontal bellies : are large , wide and
meet in the middle line. (origin) skin
of the eyebrows . They passes upward
, across forehead to become
continuous with aponeurotic tendon
(insertion).
• Occipital bellies : are shorter ,
narrower and separated by the
posterior extension of the epicranial
aponeurosis . Each belly arise (origin)
superior nuchal line of occipital bone
and mastoid process of temporal
bone . They passes superiorly to
attached to the aponeurotic tendon
(insertion).
Action and nerve supply :
• The occipito-frontalis muscle move the scalp , raise the eyebrows and
transverse wrinkle of forehead .
• Frontal belly is innervated by temporal branches of facial nerve and
occipital belly by the posterior auricular branch of facial nerve .
Nerve supply of the scalp :
Motor nerve supply by facial nerve to occipito-frontalis
muscle while sensory nerve from two major source
cranial nerve and cervical nerve.
 Anterior to the ear and vertex of head : (branches
from trigeminal nerve)
 Supratrochlear nerve supply the front of forehead .
 Supraorbital nerve supply the front of the
forehead reach to the vertex of head .
 zygomatico-temporal nerve supply the non hairy
area of temple .
 Auriculo-temporal nerve supply the hairy area of
temple.
• Posterior to the ear and vertex of head : (branches
from cervical nerve specially C2-C3 segment of
spinal cord )
 Great auricular nerve (C2-C3 ventral rami): supply
skin of mastoid process and reach to angle of
mandible .
 Lesser occipital nerve (C2 ventral rami): supply
scalp behind the auricle .
 Greater occipital nerve (C2 dorsal rami): supply
skin over occipital bone (back of scalp) up to the
vertex .
 Third occipital nerve (C3 dorsal rami): supply skin
Blood supply of the scalp :
 Arterial supply by 5 arteries (3
anterior and 2 posterior)
 Supratrochlear artery (supply front
of forehead) from ophthalmic
branch of internal carotid artery .
 Supraorbital artery (supply front of
forehead reach to vertex) from
ophthalmic branch of internal
carotid artery .
 Superficial temporal artery (supply
side of scalp) one of the terminal
branches of external carotid artery .
 Posterior auricular artery (supply
mastoid process and area behind
the ear ) from external carotid
artery .
 Occipital artery (supply back of
scalp) from external carotid artery .
Blood supply of the scalp :
 Venous drainage (it accompanies
the venous derange of the face)
 Supratrochlear vein and supraorbital
vein form the anterior facial vein.
 Superficial temporal vein and
maxillary vein form the
retromandibular vein .
 retromandibular vein divided into 2
division (anterior and posterior
division ).
 Anterior division unite with anterior
facial vein to form common facial
vein which drain into internal jugular
vein .
 Posterior division unites with
posterior auricular vein to form
external jugular vein , which join the
subclavian vein .
 Occipital vein ends suboccipital
venous plexuses .
Lymphatic derange of scalp 
• Anterior to the ear drains into parotid and pre-
auricular lymph node .
• Posterior to the ear drains into occipital and
mastoid lymph node then to deep cervical lymph
node .
Applied anatomy :
 The skin (1st layer) of the
scalp is rich in the sebaceous
gland, so it is common site of
sebaceous cyst seborrhea .

 The connective tissue (2nd

layer) of the scalp is fibrous
and dense, so when the scalp
is cut , the dense connective
tissue surrounding the
vessels tends to hold cut
vessels open . This result in
profuse bleeding .
Applied anatomy :
 The loose connective tissue (4th
layer) of the scalp is the plane of the
scalping at which the fused 3 layer
(scalp proper) is torn away during
serious scalping injury, and because
it continuity with loose tissue of
upper eyelids, hemorrhage reaching
this layer gravitates down to the
upper eyelid causing black eye.
 The loose connective tissue (4th
layer) is the dangerous layer of the
scalp at which infection can spread
to the bone of the skull or to the
intracranial venous sinuses( through
parietal emissary vein : to superior
sagittal sinus, and through mastoid
emissary vein : to sigmoid sinus).
Thanks