THE SCALP AND CRANIAL MENINGES Arteries in the face: There are two main arteries: Facial artery:

it has many branches like superior and inferior labial arteries One termination: nasal artery 2. The superficial temporal artery: providing main blood supply to all of the lateral aspect of the skull on the zygomatic arch. It gives the transverse fascial artery it comes to facial and supply it There are many small arteries: -Infraorbital artery: comes from maxillary artery -mental artery: comes from inferior alveolar artery -supraorbital and supratrochlear artery
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Veins in the face: **facial vein: drains in the internal jugular vein **superficial temporal vein: it is joined to the maxillary vein behind neck of mandible to form retromandibular vein and divide to anterior and posterior branches Scalp: The layers that cover the cranial cavity or the skull, its the skin, subcutaneous tissue fatty layer what ever that covers the cranial vault. It has 3 extensions: *superior nuchal line (posteriorly) *supraorbital margin (anteriorly) *zygomatic arches (laterally)
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Scalp has 5 layers indicated by its letters

**SCALP: S: SKIN C: CONNECTIVE TISSUE A: APONEUROSIS (FLAT TENDON) L: LOOSE CONNECTIVE TISSUE P: PERIOSTUM (CONNECTIVE TISSUE FIBERS THAT COVER THE BONE) **skin: is very thin area except in the occipital region with many hair follicles, sebaceous glands ,sweat glands and its rich in blood supply The skin is composed of 2 layers (epidermis and dermis) **connective tissue: its a layer beneath the skin ,its a thick layer of dense irregular connective tissue made up of septa (separate lines of connective tissue).Between two septa, theres a layer of fat called fat lobules. -connective tissue layers made up of: dens irregular connective tissue and adipose (fat kind of connective tissue). So there two types of connective tissue: -Fat layer -connective tissue with septa. These two layers have a very rich of blood supply because the blood supply (arteries and veins to the scalp run within second layer (connective tissue))

**aponeurosis: epicranial aponeurosis, because it covers the cranial or galea apeneurosis galea means helmet. () Ofcourse its strong tendinous sheet. Providing attachment for occipitofrontalis muscle of facial expression, laterally providing attachment for auricularis muscle. Those are the three layers (skin, connective tissue, and aponeurosis) Attached to each other and move as one unit over your head this unit is called scalp proper. **loose connective tissue: loose area of connective tissue with many potential spaces (empty spaces). Three layers (scalp proper) move as one unit over the bone and periosteum so we need a layer that contains many spaces in its nature, such as loose connective tissue layer. Clinically these spaces are very important because any injury, bleeding or infection in the scalp occurs in this layer between the scalp proper and the bone, periosteum Where blood hemorrhage, pus or other stuff start to accumulate here, once accumulated there, you have to now look to the aponeurosis.The occipitalis muscle attached to superior nuchal line (boney attachment) and frontalis goes to the skin to the superficial fascia of the (sorry).Thats why .(same word) it can by function of occipitofrontalis that open anteriorly but it close postero laterally scalp proper it attaches to zygomatic arch.
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So any bleeding or pus it can go posteriorly or laterally. Most bleeding occurs anteriorly beneath or underlining eyebrows and eyelids leading to bulging eyeballs which is called black eye (edema in that region ). *thats why the loose connective tissue with many potential spaces is dangerous because any bleeding or pus accumulated here (I tried to write what the doctor Said exactly) **periosteum: outer connective tissue layer that surrounds the bone of calvaria.If there is a layer surrounding the bone from inside we called it endosteum. Periosteum is firmly attached to the bone. *the scalp is the 2nd richest area with blood supply after the nasal cavity. The arteries and veins pass to scalp through the second layer (dense connective tissue) between the skin and aponeurosis. *arteries of the scalp: the main five arteries that supply the scalp are: Anteriorly- supratrochlear and supraorbital arteries. Those arteries are branches from the internal carotid artery.Tt gets in the middle cranial fossa, it gives a branch to supply structures of orbit, this branch is ophthalmic artery. It passes through the superior orbital fissure. It provides blood supply there and terminals to supratrochlear and supraorbital artery.

Laterally- Suprafacialtemporal artery comes from the external carotid artery, it divides into anterior and posterior branches to cover all the lateral area, there is another small artery to help it. Its zygomatictemporal artery a branch of maxillary artery Goes from zygomatictemporal foramen Posteriorly-posterior auricular artery and occipital artery come from external carotid artery. The scalp is an area of anastomosis between branches of external and internal carotid artery *Injuries to the scalp: any injury will result in severe and prolonged bleeding why severe bleeding? Because the scalp is rich in blood supply ,the bleeding takes long time and does not stop by itself because separation of vessels end. Suture is stitching ( )to prevent bleeding this is because separation of the vessel end when injury occur connective tissue septa and aponeurosis beneath it contract then frontalis take aponeurosis anteriorly and occipitalis take it posteriorly, so to treatment any injury we have directly to do stitching, do not leave it (that what the doctor said exactly). *Innervations to the scalp(sensory): Anteriorly-supratrochlear and supraorbital nerves come from V1 (ophthalmic n) Laterally- zygomatictemporal nerve comes from maxillary nerve and auriculotemporal nerve comes from v3 (mandibular nerve)

Auriculotemporal nerve is sensory innervation to the lateral aspect of the skull; does any one remember an important structure that is innervated by auriculotemporal nerve? Tempromandibular joint, tympanic membrane Posteriorly- lesser occipital nerve comes from the anterior ramus of c2 and greater occipital nerve comes from the posterior ramus of c2 **meninges: its fibrous connective tissue of three layer inside the bone: 1-dura mater 2-archnoid mater 3-pia mater These three layers contribute to: -protect the brain -provides supporting framework for arteries and veins -shock absorber because it contains fluid called cerebra spinal fluid **dura mater: the most important layer and its the strongest layer. Its made up of 2 layers the endosteal layer that connects it to the bone in addition to it meningeal layer. The meningeal artery and vein pass within the dura mater between the periosteal and meningeal layer. **The arachnoid layer sends septa that attach to the pia mater through web like archnoid trabeculae which it tightly attached to brain tissue, this fluidish one.

Brain is folded into grooves or sulci (depressions), and gyri (elevations) overlapping region very small area with large number of neurons. Increase the surface area of the brain increase number of neurons *Pia mater and arachnoid mater are continuous by a space called sabrachnoid space it contains cerebrospinal fluid and arachnoid trabeculae. -Arachnoid layer avascular layer in nature *dural mater folding of internal meningeal layer between brain compartment: 1-falx cerebri: between left and right cerebrums 2-falx cerebelli: between left and right cerebellums 3-tentorium cerebelli: its a horizontal reflection between cerebral and cerebellum. 4- Sellar diaphragm: it covers the sella tucica in the middle cranial fossa to protect pituitary gland. Its attached to the corner of clinoid process. **pia mater: is a very thin membrane that is highly vascularized, adheres to brain surface and follows its contours. Meningeal spaces: 1-epidural space: between dura and bone its not present normally. It is present if hemorrhage occurs in the meningeal artery 2- Subdural space: between dural and arachnoid mater and is not present normally 3-subarachnoid space: is real space contain CSF *Arteries that supply meninges:

1-middle meningeal artery is the largest and the main artery that supplies the meninges, it comes from the maxillary artery and passes through spinosum foramen (between meningeal and endosteal layer of dura) then it divides to an anterior branch (go ant. sup) and a posterior branch (Go post.sup) 2-accessory meningeal artery is a small branch comes from maxillary artery passes through foramen ovale to help middle meningeal artery 3- Posterior meningeal artery comes from ascending pharyngeal artery and passes through jugular foramen to the skull 4- Anterior meningeal artery is a small branch comes from ethmoidal artery comes from ophthalmic artery of internal carotid artery **epidural hemorrhage: Due to meningeal artery the blood collects between bone of clavaria and periosteam or between periosteum and meningeal layer. The complication Of this hemorrhage: increased blood mass compresses the brain loss of consciousness and coma *venous drainage of the meninges: Through several venous sinuses that are located within dura mater between periosteal and meningeal layer. (Dont have to know more details) *sup sagittal sinus *inf sagittal sinus *straight sinus *sigmoid sinus
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*cavernous sinus Sorry for any mistakes in the lecture Special Thanks to my sister dr.mysoon to help me DONE BY: MANAL OTOOM Editor: As editors, we are not responsible for the contents of the lecture. It is the responsibility of the person who writes the lecture to try to make it understandable and clear, and avoid any confusing mistakes which might change the meanings of the sentences.We,as editors, only check for any spelling and grammar mistakes, and correct them, but avoid altering the structure of the sentences as much as possible. Please guys try to revise the lecture before submitting it, ya3ni the red and green lines were everywhere in this lecture, kalemat mlaz2een be ba3ad, shaghlat mish mafhoome, no commas or fullstops, and this might affect the meanings of many phrases. Writing a lecture is a responsibility. Its everybodys responsibility to submit a lecture which everyone can depend on, and go back to when needed. Thank you