Scalp

 Soft tissue covering cranial vault

 Hair bearing area of skull
 Extent:
 Anteriorly: supra orbital margin
 Posteriorly: external occipital protuberance &
superior nuchal line
 Laterally: superior temporal line
 superior temporal line

supra
orbital
margin
External
occipital
protuberance
SCALP layers
 S-Skin
 C-connective tissue (superficial fascia)
 A-aponeurosis (galea aponeurotica)
 L-loose areolar tissue
 P-pericranium
 Skin

 Thick and hairy

 Firmly attached to the epicranial aponeurosis
through dense fascia
 Abundant sebaceous & sweat glands
Applied aspects
 Scalp is a common site for sebaceous cysts
 Connective tissue (dense)
 Fibrous and dense, contain blood vessels & nerves
 Binds skin to underlying aponeurosis
 Wounds bleed profusely as blood vessels are prevented
from retraction by fibrous tissue. Bleeding is stopped by
applying pressure against the bone
 Subcutaneous hemorrhage are not extensive since fascia
is dense
 Inflammation cause little
swelling but are much painful
Applied aspects
 Wounds of scalp bleed profusely because the
cut vessels can not contract due to adherence of
their wall with dense connective tissue

 Bleeding is stopped by applying pressure

against the bone
Galia aponeurotica (Epicranial
aponeurosis)
 Sheet of fibrous tissue
 Connects occipitalis & frontalis muscles
 Extent:
 Behind: attached to external occipital protuberance &
highest nuchal line
 Infront: blends with subcutaneous tissue at the root of
nose
 On each side: attached to zygomatic arch

 It gaps if cut transversely

Occipito-frontalis

 Consist of a pair of frontal bellies

in the front & a pair of occipital
bellies behind
 Both bellies united by intervening
galea aponeurotica
 Occipitalis or occipital bellies
 Originate from lateral 2/3rd of
superior nuchal line
 Supplied by posterior
auricular branch
of facial nerve
 Frontalis or frontal bellis
 Originate from skin
of forehead
&mingled with
orbicularis oculi
muscle
 Supplied by temporal
branch of facial
nerve
Actions:
 Alternate contraction of occipitalis &
frontalis move the entire scalp backward &
forward
 Acting from above frontal bellies rise the
eyebrows as in surprise or horror
 Acting for below frontal bellies produce
transverse wrinkles of forehead as in fright
Loose areolar tissue
 Consists of loose areolar tissue
 Contains emissary veins (devoid of valves &
communicate veins of scalp with intracranial venous
sinus)
 Bleeding cause generalized swelling of scalp
Applied aspects
 4th layer is called dangerous layer of scalp
 because scalp-emissary veins open here and
carry any infections from extracranial veins into
intracranial venous sinuses
Applied aspects
 Collection of blood in this space due to a blow
on the head, slowly gravitates into eye lids
because frontalis has no bony attachment, this
condition is called black eye
Applied aspects
 Cephalohydrocele is condition affecting
children, where a swelling under the scalp
contains CSF which has escaped through the
fracture of vault resulting from tear of meninges
of brain
Applied aspects
 Caput succedaneum in new
born is a temporary swollen
& oedematous condition of a
portion of scalp , takes place
during passage through birth
canal due to interference of
venous return
 Pericranium
 Is the periosteum of skull
 Loosely attached to surface of bone but is firmly
adherent to the sutures
 Injury deep to it take the shape of bone
(cephalhaematoma)
 Scalping injury- should be
replaced and stitched
because healing is better
 Cephalohaematoma
is a hemorrhage of
blood between the
skull and the
periosteum of a
newborn baby
secondary to rupture of
blood vessels crossing
the periosteum.
Blood supply
 Arteries
 Supratrochlear
 Supraorbital
 Superficial temporal
 Posterior auricular artery
 Occipital artery
 Veins-follows the artery
Nerve supply
 In front of auricle
 Supratrochlear n.
 Supraorbital n.
 Zygomaticotemporal n.
 Auriculotemporal n.
 Temporal branch of facial n.
 Behind auricle
 Greater auricular n
 Lesser occipital n.
 Greater occipital n.
 Third occipital n.
 Post. Auricular branch of facial
n.
Lymphatics

 Anterior part
 Preauricular & superficial parotid lymph nodes
 Posterior part
 Posterior
auricular, mastoid gr & occipital
lymph nodse
Face
 Face
Boundaries Hair line

 Extends superiorly
to the hair line,
inferiorly to the chin
and base of
Auricle
mandible, and on
each side to auricle
Base of mandible
 Forehead is
Chin
common to both
scalp and face
Skin
 Highly vascular
 Wounds of face bleed profusely but heal rapidly
 Results of plastic surgery are excellent on face
 Rich in sebaceous gland and sweat gland
 Sebaceous glands keep the skin oily but also
cause acne in adult
 Sweat glands regulate body temperature
 Superficial fascia contain facial muscles
 Deep fascia absent except parotid fascia
Facial muscle

 Called muscle of facial expression and lie in

superficial fascia
 Embryologically they develop from mesoderm of
2nd branchial arch, therefore supplied by facial
nerve
Muscles of eye lids
Frontalis

Corrugator supercilli Orbicularis oculi

 Orbicularis oculi
 Surrounds palpebral fissure
 3 parts:
 Orbital Palpabral part
 Palpabral Orbital part
 Lacrimal
 Orbital part
 Originate from medial palpebral ligament and form
concentric rings, return to point of origin
Action – closes the lids tightly & protects the eyes from
intense light
 Palpebral part
 Originate from medial palpebral ligament
 Insert into lateral palpebral raphe
Action- closes the lids gently as in blinking or in sleep
 Lacrimal part
 Originate from lacrimal fascia & lacrimal bone
 Insert into upper &lower tarsi
Action- dilates lacrimal sac & help in transport of
lacrimal fluid
Actions of orbicularis oris

Tight closure of eye lids Gentle closure of eye lids

(by orbital part of orbicularis oculi ) (by palpabral part )
Actions of muscles of eye lids

Corrugator supercilli – draws

eyebrows medially &
downwards
Eg: protecting the eyes from
bright sunlight
Corrugator supercilli – produces
vertical wrinkles of forehead
Eg: frowning as an expression of
annoyance
Actions of muscles of eye lids

Frontalis - Rises the eyebrows Frontalis - produce transverse

Eg: surprise or horror wrinkles of forehead
Eg: Fright
 Muscles of nose

Procerus

Nasalis

Depressor septi
Actions of muscles of nose

Procerus – Produces Nasalis & Depressor septi – dilates

transverse wrinkles across the nasal aperture Eg: anger
bridge of nose Eg: Frowning
 Muscles of lips & cheeks
Levator labii
superioris alaeque
nasi

Levator labii
superioris

Zygomaticus
minor
Zygomaticus
major
Levator
anguli Risorius
oris
Actions of muscles of lips & cheeks

Levator labii superioris alaeque Levator labii superioris,

nasi , Zygomaticus minor & Zygomaticus minor & Levator
Levator labii superioris – everts anguli oris – accentuate
& elevates upper lip nasolabial furrow Eg: sadness
Actions of muscles of lips & cheeks

Risorius – Retracts angle of mouth Zygomaticus major – Draws

Eg: Grinning angle of mouth upwards
Eg: Smiling & laughing
Actions of muscles of lips & cheeks

Depressor anguli oris – Draws Depressor labii inferioris – draws

angle of mouth downwards lower lip downwards
Eg: Grief Eg: expression of irony
Actions of muscles of lips & cheeks

Mentalis – puckers the chin,

protrudes lower lip
Eg: in drinking or in expression
of disdain
 Depressor
anguli oris
Buccinator

Depressor labii
Mentalis inferioris
 Orbicularis oris
 Origin: maxilla above incisor teeth
 Insertion: skin of lip.

Action –
1. Closes the mouth
2. Protrudes the lips as in pursing
3. Articulation of speech

Orbicularis oris
Actions of orbicularis oris

Closure of mouth Articulation of speech Protrusion of lips

Buccinator (Trumpeter’s muscle)
 Upper fibers
 Origin- from maxilla
opposite molar teeth
 Insertion-upper lip
 Lower fibers
 Origin-from mandible
opposite molar teeth
 Insertion-lower lip
 Middle fibers
 Origin –from
pterigomandibular raphe
 Insertion-decussate
before passing to lips
Actions of Buccinator
 Prevents accumulation of food in vestibule
of mouth
 Forcibly expels the air between lips from
inflated vestibule as in blowing a trumpet
Platysma
 Origin– upper part of pectoral
and deltoid fascia
 Insertion– base of mandible,
skin of lower face and lip Platysma

 Action– releases pressure of

skin on the subjacent veins,
depress mandible, pulls angle
of mouth downwards
Eg: Horror, terror & fright
Nerve supply of face

 Motor supply
 Facial nerve
Sensory supply
 Ophthalmic division
 Supratrochlear

 Supraorbital

 Lacrimal

 Infratrochlear

 External nasal

 Maxillary nerve
 Infraorbital

 Zygomaticofacial and
zygomaticotemporal
 Mandibular nerve
 Auriculotemporal

 Buccal nerve

 Mental

 Skin over the mandibular angle is

supplied by ant. Div. Of greater
auricular n.
Blood supply of face
 Arterial supply-
 Facial artery
 Superficial temporal
artery
 Ophthalmic artery
 Supraorbital and
 Supratrochlear
 Facial artery
 Arises from external carotid artery
 Loops around submandibular gland
 Enters face by winding round lower border of mandible
 At antero-inferior angle of masseter it pierces deep fascia
 Passes tortuously upwards in the face
 Ascends along the side of nose to medial angle of eye
 Ends by anastomosing with dorsal nasal branch of
opthalmic artery
Branches & their supply:
 Inferior labial- to lower lip
 Superior labial- to upper lip,
provides a septal & alar
branches to the septum
& ala of the nose
 Lateral nasal- to ala &
dorsum of nose
Applied aspects
 Facial wounds bleed profusely but heal quickly
due to its rich blood supply
Venous drainage
 Vein follow the arteries and
drain into common facial vein
and retromandibular vein
 Deep connections of facial
vein-
 Communication between
supraorbital &superior
ophthalmic vein
 With pterigoid plexus of vein
through deep facial vein.
 Superior ophthalmic vein &
ptergoid plexus of vein
communicate with cavernous
sinus
Lymphatic drainage
 3 territories-
 Upper territories- greater part
of forehead, lateral ½ of eye
lid, conjunctiva, lateral part of
cheek and parotid area–
preauricular lymph node
(parotid)
 Middle territories- median part
of forehead, external nose,
upper lip, lateral part of lower
lip, medial ½ of eye lid, medial
part of cheek, greater part of
lower jaw– submandibular
lymph node
 Lower territories- central part
of lower lip, chin– sub mental
lymph node
Applied aspects
 Trigeminal neuralgia
 Maxillary and mandibular nerve are involved
 Excruciating pain in the region of distribution of these nerve

 In infranuclear lesions of facial nerve (eg, bell’s palsy)-

whole face is paralyzed
 Affected side is motionless
 Loss of wrinkles
 Eye cannot be closed
 In smiling the mouth is drawn to normal side
 During mastication food accumulates in vestibule of mouth
 In supranuclear lesions of facial nerve only the lower
part of face is paralyzed. The upper part (frontalis &part
of orbicularis oculi) escapes due to its bilateral
innervation
Bell’s palsy
Applied aspects
 Dangerous area of
face- infections from
face mainly from
upper lip & nose can
go to cavernous sinus
through ophthalmic
vein and deep facial
vein
Thank you