THE SCALP

Dr. Edgar Gasco

SCALP
is the part of the head that extends from the
supercillary arches ANTERIORLY to the
EXTERNAL OCCIPITAL PROTUBERANCE &
SUPERIOR NUCHAL LINES POSTERIORLY.
LATERALLY it continues INFERIORLY TO THE
ZYGOMATIC ARCH.
consists of 5 layers, the first 3 of which are
intimately bound together and move as a unit.

S - SKIN

C - CONNECTIVE TISSUE (DENSE)

A - APONEUROTIC LAYER

L - LOOSE CONNECTIVE TISSUE

P - PERICRANIUM

laterally as far as the attachement of the

aponeurosis to the temporal fascia

OCCIPITOFRONTALIS MUSCLE -> move

the scalp; wrinkle the forehead & raise
the forehead;
ONE OF THE MUSCLE FOR
FACIAL EXPRESSION
GAPING OF WOUND -> means that the
aponeurotic layer was included with the cut.
Note: the aponeurosis must be included in
suturing to avoid DEHESENSE.
LOOSE AREOLAR TISSUE/LOOSE
CONNECTIVE TISSUE
occupies the SUBAPONEUROTIC SPACE
loosely connects the epicranial aponeurosis to
the periosteum of the skull (PERICRANIUM)
CONTAINS FEW SMALL ARTERIES -> but also
CONTAINS SOME IMPORTANT EMISSARY VEINS

EMISSARY VEINS -> are valveless &

connect/ communicatesthe superficial
veins of the scalp with the diploic veins
of the skull bones (diploe) & with the
intracranial venous sinuses

Diploe is the soft tissue of the bone.

DANGEROUS LAYER OF THE SCALP
Infection in this layer can spread to the
SUPERIOR SAGITTAL SINUS via THE DIPLOIC
VEIN.
PERICRANIUM
DEEPEST LAYER OF THE SCALP & IS THE
PERIOSTEUM ON THE OUTER SURFACE OF THE
CALVARIA

SKIN
thick; hair bearing & contains numerous
sebaceous glands, numerous sweat glands.
OUTER LAYER of the scalp; similar structurally to
skin throughout the body with the exception that
hair is present on a large amount of it.
CONNEC TIVE TISSUE (DENSE)
beneath the skin -> FIBROFATTY -> the fibrous
septa uniting the skin to the underlying
aponeurosis of the occipitofrontalis muscle
NUMEROUS ARTERIES & VEINS are found in this
layer
ARTERIES: BRANCHES OF EXTERNAL &
INTERNAL CAROTID ARTERIES -> free
anastomosis takes place between them.
BLEEDER AREA : profused bleeding if injured.
Rx: suture.
prevents BVs from contracting resulting to
continuous bleeding. (Press, release, bite).
where NEUROVASCULAR STRUCTURES are found
wound in the scalp -> suture the wound
APONEUROSIS
EPICRANIAL
FLATTENED TENDON
DEEPEST LAYER OF THE 1ST THREE LAYERS
Other term: "GALIA APONEUROTICA -> thin,
tendinous sheet that unites the OCCIPITAL &
FRONTAL BELLIES OF THE OCCIPITOFRONTALIS
MUSCLE
Has 2 muscles the frontalis muscle and the
occipitalis muscle.
lateral margins of the aponeurosis are
attached to the temporal fascia.
SUBAPONEUROTIC SPACE is the potential space
having loose areolar CT beneath the epicranial
aponeurosis; limited in front & behind by the
origins of the occipitofrontalis muscle -> extends

NERVE SUPPLY
SENSORY NERVE SUPPLY (SCALP)
main trunks of the sensory nerves lie in the
superficial fascia -> moving laterally from the
midline anteriorly

SENSORY NERVE SUPPLY OF THE

SCALP
NERVE
S

BRANC
H

Greate
r
Occipi
tal N.

Posterio
r ramus
of the
2nd
cervical
N.
(Cervica
l
plexus)

Lesser

Cervica

ARISE
S

ASCEN
DS
Ascends
over the
back of
the
scalp

Anteri
or

On the
posterio

SUPPLI
ES
Skin as
far
forwar
d as
the
vertex
of the
skull
- Scalp
over
the
lateral

Occipi
tal N.

l
Plexus
(C2)

ramus
of C2
spinal
N.

r border
of the
SCM M.

Auricu
lotempo
ral N.

Mandib
ular
division
of the
trigemin
al N.

Anteri
or
ramus
of C2
spinal
N.

Over
the side
of the
head
from in
front of
the
auricle

Supraorbital
N.
(Senso
ry)
Supratrochle
ar N.
(Senso
ry)
Zygom
aticotempor
al N.

Opthalmi
c division
of
trigemin
al N.

Winds
aroun
d the
superi
or
orbital
margi
n

Opthalmi
c division
of
trigemin
al N.
Maxillar
y
division
of the
trigemin
al N.

Over
the
forehea
d

part of
the
occipit
al
region;
Scalp
over
the
medial
surface
of the
auricle
Termina
l
branche
s:
Supply
skin
over the
tempora
l region

Scalp
as Far
backwa
rd as
the
vertex

Over
the
forehea
d

Scalp
over
the
temple

Trigeminal nerve: a face nerve wich supplies the

face and scalp.
Auricular nerve: branch of mandibular nerve.
ARTERIAL SUPPLY
the scalp has a rich supply of blood to
nourish the hair follicles -> if cut, even
smallest cut bleeds profusely
ARTERIES lie in the superficial fascia
MOVING LATERALLY FROM THE MIDLINE
ANTERIORLY
ARTERIAL SUPPLY OF THE SCALP
ARTERY

BRANCH

Supratrochl
ear

Supraorbital

Zygomaticotemporal

Branche
s of
Opthal
mic
Artery

ASCENDS
Over the
forehead in
company
with the
supratrochle
ar /orbital

SUPPLY

Scalp as far
posteriorly
as the vertex
of the head

nerves

Maxillar
y

Occipital
Branche
s of
External

From the
apex of the
posterior
triangle, in
company
with the
Great
Occipital N.

Behind

Skin over
the scalp &
reaches as
high as the
vertex of the
skull
Scalp above

Post.
Auricular

the
and behind
auricle
the auricle
In front
ANTERIOR &
of the
POSTERIOR
Superficial
auricle in BRANCHES:
Temporal
company Supply the
with the
skin over the
auriculofrontal &
temporal temporal
nerve
regions
Superficial temporal artery:
: has pulsation.
: smaller terminal branch of External carotid A.
Maxillary A.
: biggest branch of External carotid a.
Carotid
Artery

VENOUS DRAINAGE of the SCALP

VEINS

UNITE

To FORM

Supratrochlea
r
Supraorbital

@ medial
margin of
Facial Vein
orbit
With the
maxillary vein
Retromandib
Superficial
in the
ular vein
Temporal
substance of
the parotid
gland
With the
Post.
posterior
External
Auricular
division of the jugular vein
retromandibul
ar vein
DRAINS INTO: SUBOCCIPITAL
VENOUS PLEXUS -> w/c lies
Occipital
beneath the floor of the upper
part of the posterior triangle; ->
SUBOCCIPITAL PLEXUS drains into
the VERTEBRAL VEINS or the
INTERNAL JUGULAR VEIN
VEINS OF THE SCALP freely anastomose with one
another & are connected to the diploic veins of
the skull bones & the intracranial venous sinuses
by the VALVELESS EMISSARY VEINS.
THE FACE
SKIN of the Face

possesses numerous sweat & sebaceous glands

connected to the underlying bones by the loose

connective tissue -> embedded the MUSCLES OF
EXPRESSION

NO DEEP FASCIA IS PRESENT IN THE FACE

WRINKLE LINES OF THE FACE -> result from the

repeated folding of the skin perpendicular to the
long axis of the underlying contracting muscles,
coupled with the loss of youthful skin elasticity.

surgical scars of the face are less conspicuous if

they follow the wrinkle lines
SENSORY NERVES OF THE FACE
divisions: umbilicus
1. faciculus gracilis- lower limb
2. faciculus coneatus-upper limb
*trigeminal nerve is the largest nerve in the head and
face.
*vagus nerve is the longest nerve.
Sensory Nerves:
is supplied by branches of the THREE DIVISIONS
OF TRIGEMINAL NERVE (seen in pons) -> except
for the small area over the angle of the mandible
& the parotid gland -> SUPPLIED BY THE GREAT
AURICULAR NERVE (C2 & 3)

1.
2.

3.

*anterior part of the petrous bone dilatation of

the CN5.
* Trigeminal nerve has bigger root-sensory

smaller root- motor

OPTHALMIC NERVE -. in superior orbital fissure
which supplies the region developed from the
FRONTONASAL PROCESS-sensory
MAXILLARY NERVE -in foramen rotundum.
serves the region developed from the
MAXILLARY PROCESS OF THE 1ST PHARYNGEAL
ARCH-sensory
MANDIBULAR NERVE in foramen ovale with
lesser petrosal wich supplies the muscles of
mastication.
serves the region developed from the
MANDIBULAR PROCESS OF THE 1ST PHARYNGEAL
ARCH-mixed
*Ganglion- neurons seen in dilatation called
semilunar ganglion or trigeminal ganglion.

OPTHALMIC DIVISION OF TRIGEMINAL NERVE:

SENSORY; supplies the OPTHALMIC REGION: the skin
of the forehead, upper eyelid, the conjunctiva, & the
side of the nose down to & including the tip.
5 BRANCHES:
NERVE
LACRIMAL NERVE

SUPRAORBITAL
NERVE
Winds around the
upper margin of the
orbit @ the
supraorbital notch
SUPRATROCHLEAR
NERVE
Winds around the
upper margin of the
orbit medial to the
supraorbital nerve
INFRATROCHLEAR
NERVE
Leaves the orbit
below the pulley of
the superior oblique
muscle
EXTERNAL NASAL
NERVE
Leaves the nose by
emerging between
the nasal bone & the
upper nasal cartilage

SUPPLIES
Skin & conjunctiva of the
lateral part of the upper
eyelid
Skin & conjunctiva on the
central part of the upper
eyelid;
Skin of the forehead

Skin & conjunctiva on the

medial part of the upper
eyelid;
Skin over the lower part of
the forehead, close to the
median plane.
Skin & conjunctiva on the
medial part of the upper
eyelid & the adjoining part
of the side of the nose.

Skin on the side of the nose

down as far as the tip

ZYGOMATICOTEMPORAL
NERVE
Emerges in the temporal
fossa through a small
foramen on the posterior
surface of the zygomatic
bone

SUPPLY

Skin of the lower eyelid

& cheek, the side of the
nose, & the upper lip

Skin over the

prominence of the
cheek

Skin over the temple

MANDIBULAR DIVISION OF TRIGEMINAL

NERVE: SENSORY & MOTOR; supplies the skin of
the lower lip, lower part of the face, temporal region
7 part of the auricle; passes upward to the side of
the scalp.
*temporal region:
1. Anterior to the pinna of the ear.
2. Lower part of the mandible except the greater
auricular nerve.
3 BRANCHES:
NERVE
MENTAL NERVE
Emerges from the
mental foramen of the
mandible
BUCCAL NERVE
Emerges from beneath
the anterior border of
the masseter muscle
* a branch of facial
nerve- motor
* a branch of trigeminal
nerve- sensory.
AURICULOTEMPORAL
NERVE

MAXILLARY DIVISION OF TRIGEMINAL NERVE:

SENSORY; supplies the skin on the
posterior part of the nose, the lower eyelid, the
cheek, the upper lip, & the lateral side of the
orbital opening.
3 BRANCHES:
NERVES
INFRAORBITAL
NERVE
Direct continuation of
the maxillary nerve;
ENTERS THE ORBIT &
APPEARS ON THE FACE
THROUGH THE

INFRAORBITAL
FORAMEN; immediately
divides into numerous
small branches-> which
radiate out from the
foramen
* the largest nerve that
exits thru infraorbital
foramen, terminal
branch of maxillary
nerve.
ZYGOMATICOFACIAL
NERVE PASSES onto
the face through a
small foramen on the
lateral side of the
zygomatic bone

Sensory type but it

carries with it a post
ganglionic
parasymphatetic fibers
that supplies the
parotid gland.
Ascends from the
upper border of the
parotid gland between
the superficial
temporal vessels & the
auricle.

SUPPLIES
Skin of the lower lip &
chin

Skin over the small area

of the cheek

Skin of the auricle, the

external auditory meatus,
the outer surface of the
tympanic membrane &
skin of the scalp above
the auricle

FACIAL SKIN receives its SENSORY NERVE SUPPLY from

the 3 divisions of TRIGEMINAL NERVE; a small area of
skin over the angle of the jaw is supplied by the GREAT
AURICULAR NERVE (C2 & 3)

Great auricular nerve: seen at the angle of the

mandible which
Not supplied by trigeminal nerve.
TRIGEMINAL NEURALGIA condition in which patient
experiences excruciating pain in the distribution of the
mandibular or maxillary division. with the ophthalmic
division usually escaping
TRIGEMINAL GANGLION/gasserian/trigeminal
ganglion sensory in origin , sensory fibers in
trigem n.
flattened area
where the cell bodies are found
semilunar ganglion
gasserian ganglion

ARTERIAL SUPPLY OF THE FACE

THE FACE receives a rich blood supply from two
main vessels:
1. FACIAL ARTERY: palpable at the angle of the
mandible anterior to the anterior border of the
maseter.
* presence of tortuous artery which are movable
due to different facial expression.
2. SUPERFICIAL TEMPORAL ARTERIES
both of which are supplemented by
several small arteries that accompany
the sensory nerves of the face.
3. BRANCHES
ARTERY
ARISES/
SUPPLY
FACIAL ARTERY
Skin of the
SUBMENTAL
@ lower border
chin & lower
of mandible
lip
Near the angle
of the mouth;
INFERIOR
runs medially in
LABIAL
the lower lip &
anastomoses
with its fellow of
the opposite
side
Near angle of
the mouth; runs
medially in the
SUPERIOR
upper lip &
LABIAL
gives branches
to the septum &
ala of the nose

SUPERFICIAL
TEMPORAL

SUPRORBITAL
SUPRATROCHL
EAR

FACIAL ARTERY
alongside the
nose
Smaller terminal
branch of ECA,
commences in
the parotid
gland; ascends
in front of the
auricle
Branches of
ophthalmic
artery

FV descends behind the FA to the lower margin of the

body of the mandible

crosses superficial to the submandibular gland -> joined

by the ANTERIOR DIVISION OF THE RETROMANDIBULAR
VEIN

*DRAINS INTO THE Internal jugular

vein
VENOUS DRAINAGE:
1. INTERNAL JUGULAR VEIN
2. SUPERFICIAL TEMPORAL VEIN
3. FACIAL VEIN

ANGULAR VEIN

formed by the union of

SUPRATROCHLEAR & SUPRAORBITAL
VEIN @ THE ORBIT

DANGEROUS TRIANGLE OF THE FACE ->

2 orbits & 1 upper lip

communicates with cavernous sinus via

the veins of superior opthalmic vein.

INFECTION IN DANGEROUS TRIANGLE

can spread to CAVERNOUS SINUS
causing swelling arising to CAVERNOUS
SINUS THROMBOSIS (*lethal.)

Skin on the
side & dorsum
of the nose

Scalp

Skin of the
forehead

VENOUS DRAINAGE OF THE FACE

FAC IAL VEIN (FV)/angular vein is formed @ the medial
angle of the nose by two tributaries (the union of the)
A. supraorbital &
B. supratrochlear veins.

by means of SOV -> FV is connected to the CAVERNOUS

SINUS
(this connection is of great clinical importance because it
provides pathway for the spread of infection FROM THE
FACE TO THE CAVERNOUS SINUS)

BLOOD VESSELS OF THE FACE

LATERAL
NASAL

connected to the SUPERIOR OPHTALMIC VEIN (SOV)

directly
(THROUGH SUPRAORBITAL VEIN)

read clinical corr of snell.

MUSCLES OF THE FACE

2 SETS OF MUSCLES:
1. Muscles of Facial Expression
2. Muscles of Matication
* no deep facia
MUSCLES OF FACIAL EXPRESSION

O: FROM EITHER FACIAL BONE

I: SKIN OF THE FACE
N: FACIAL NERVE
ORIFICES OF THE FACE: ORBIT, NOSE & MOUTH
-> guarded by the EYELIDS, NOSTRILS & LIPS
FUNCTION: to serve as sphincters or dilators of
these structures
2 function: modify the expression of the face
all muscles are developed from the 2nd
pharyngeal arch & supplied by the facial nerve
Muscle of facial expression
1. zygomaticum- major muscle for laughing and
smiling.
I: angle of the mandible.

MUSCLE OF THE SCALP

2. OCCIPITOFRONTALIS M.
Frontal belly
Occipital belly
muscle for surprise/ horror
together with platysma muscle.
(when it contracts it opens the
mouth)
MUSCLE OF THE EYELIDS
3. ORBICULARIS OCULI constrictor/sphincter
muscle of the eyelids/orbit
has PALPEBRAE parts and
ORBITAL parts.
Both are dilator muscles of the eyelids
(shut the eye tightly and force to open)
MUSCLE OF THE NOSTRILS
COMPRESSOR NARIS sphincter muscle which
compresses the nasal opening.
DILATOR NARIS dilator muscle which dilates
the nasal opening.
PROCERUS MUSCLE- Region of the nosefrowning @ forhead.

MUSCLE OF THE LIP & CHEEK

ORBICULARIS ORIS sphincter muscle
NERVE SUPPLY: FACIAL NERVE
(BUCCAL & MANDIBULAR BRANCHES)
ACTION: Compresses the lips together
DILATOR MUSCLES OF THE LIPS:
UPPER PART OF THE FACE

Levator labii superioris alaeque nasi

most medial
longest term

Levator labii superioris

Zygomatic Minor

Zygomatic Major

Levator Anguli Oris

Risorius- sardonic smile

LOWET PART OF THE FACE

Depressor Anguli Oris -> muscle of

sadness

Depressor Labii Inferiosus -> muscle of

irony

Mentalis- despair
NERVE SUPPLY: FACIAL NERVE
(BUCCAL & MANDIBULAR BRANCHES)
*orbicularis oris- constrictor of the mouth.

MUSCLE OF THE CHEEK

BUCCINATOR BLOWING/trumpeter
muscle
-compresses cheeks toward the teeth,
important in mastication, bolus of food
compresses in the center so that it will be
masticated.

MUSCLE
Occipitofrontalis

EXPRESSION / ACTION
Shock/ Surprise/ Horror

Corrugator
Zygomaticus
Risorius
Depressor Labii Inferioris
Depressor Anguli Oris
Mentalis
Platysma

Frowns
Laugh / Smile
Grins
Irony
Grief
Doubt
Lowers the lip, Shock/
Horror

NERVE SUPPY
Facial Nerve (pons): mixed nerve which contains
1. sensory fibers
2.somatic motor fibers and
3 parasymphatetic fibers
MUSCLES SUPPLIED BY MOTOR COMPONENT (motor
root):

muscles of the facial expression

Stylohyoid muscle

posterior belli of digastric muscle

muscles of pinna

stapedius muscle
*SENSORY fibers supplies the : special
sensory fibers/ taste fibers of the anterior
2/3 of the tongue
*parasympathetic fibers supply the ff:
1. lacrimal gland,
2. mucus gland of the nose
3. submandibular salivary gland &
4. sublingual salivary gland
FACIAL NERVE exits into the
A. internal acoustic meatus
B. stylomastoid foramen
- it gives off the posterior auricular nerve to
the styloid, nerve to posterior belli to the
parotid gland
it will divide into S terminal branches:
1. temporal branch
2. zygomatic branch
3. bucal branch: upper and lower
4. mandibular branch
5. cervical branch- supplies the platysma
PES ANSIRINUS- Arrangement of the terminal
facial nerve like a foot of the goose.
GENECULATE GANGLION: seen in the
union of sensory and motor
a sensory ganglion with sensory neurons
wich will give rise to the taste fibers.
1st branch
1. greater petrosal nerve- has para syphatetic
fibers for the lacrimal gland.
2. the biggest part of the facial nerve passes the
facial canal which gives 2 branches:
a. stapedius m.
I: in the ossicles/stapes
b. carda tympani
b.1 taste fibers
b.2 parasymphatetic fibers
b.2.a sublingual
b.2.b submandibular
REVIEW:
Injury: A.internal accoustic meatus
1. sensory deficit taste in anterior
2/3 of
the tongue
*Trigeminal- prick in the 2/3 of the tongue
2. Blowing
3. diminish salivation-lacrimation,
nasal
discharge.
4. closing and opening of the eye
5. bells palsy- paralysis of the
muscles of
facial
expression.
the opposite side is the flaccid= damage of
contracting.

Bells palsy is the most common disorder in facial

expression.

PAROTID REGION
PAROTID GLAND

largest salivary gland

mixed but composed mostly of serous acini

lies in a deep hollow below the external auditory

meatus, behind the ramus of the mandible & in front of
the SCM muscle

ANTERIOR TO THE PINNA, EXTENDING DOWNWARD TO

THE SUBMANDIBULAR REGION

with capsule which comes from investing facia of the

neck which restricts enlargement of the parotid
glands= mumps (viral infxn)

a capsule limits the swelling causing pain

divides the gland into 2 lobes:

SUPERFICIAL LOBE
DEEP LOBE
both are divided by facial nerve

- inside the
parynchema of
parotid gland
- after exit from the
stylomastoid
foramen, it
goes directly to the
parotid
region

1.
2.
3.

forming

STRUCTURES THAT ENTER & PASS THROUGH/ PASS

JUST DEEP TO THE PAROTID GLAND:
FACIAL NERVE
EXTERNAL CAROTID ARTERY & ITS BRANCHES
RETROMANDIBULAR VEIN & ITS TRIBUTARIES - formed
by the union of 2 veins
a. maxillary veins
b. superficial temporal vein
Divisions of Retromandibular vein
a.anterior= unites with the facial vein
b.posterior=unites with the posterior auricular vein
external jugular vein.
DIVISIONS OF EXTERNAL CAROTID ARTERY
ECA enters into or passes deep to the inferior
border of parotid gland.
as it continues in a superior direction it gives
off the POSTERIOR AURICULAR ARTERY before
dividing into its 2 TERMINAL BRANCHES near
the lower border of the ear:
1. MAXILLARY ARTERY passes horizontally
deep to the mandible
2. SUPERFICIAL TEMPORAL ARTERY
continues in a SUPERIOR DIRECTION &
emerges from the upper border of the
gland after giving off the TRANSVERSE
FACIAL ARTERY

INSIDE THE PAROTID

RETROMANDIBULAR VEIN is formed in
the substance of the parotid gland when
the SUPERFICIAL TEMPORAL & MAXILLARY
VEINS JOIN TOGETHER
SECRETIONS parasympathetic secretomotor supply
-> arises from the glossopharyngeal nerve. -> nerve,
reaches the gland via the tympanic branch, the lesser
petrosal nerve, otic ganglion, & the auricotemporal
nerve.
PAROTID DUCT STENSSEN DUCT
( duct secretions is conveyed by the parotid
duct called)

-will pierce the buccinator M. to enter the oral

cavity & prevents backflow of saliva.
-drains the oral cavity opposite the 2nd upper
molar tooth
PREGANGLIONIC NERVE SUPPLY:
1. Supplied by GLOSSOPHYRTNGEAL NERVEcarries the preganglionic parasymphatetic
fibers.
2. tympanic branch
3. tympanic plexus
4. lesser petrosal N- pass thru foramen ovale,
unites with otic ganglion.
* postganglionic parasyphatetic fibers found
in auricotemporal nerve from otic ganglion.
auricotemporal nerve: branch of mandibular
division.