SCALP

Layers of the scalp (SCALP)

Skin Connective tissue layer, dense & fibrous. It is adherent to the overlying skin and the underlying
muscle layer. It contains vessels and nerves of the scalp.

Occipitofrontalis, a musculo-fibrous sheet extending from the highest nuchal lines to the eye brows.
Consists of 2 occipital and 2 frontal bellies connected by the epicranial aponeurosis.

Loose areolar tissue Pericranium, the outer periosteum

Skin

Bl. vessels & nerves

Superficial fascia Aponeurosis Loose areolar tissue Pericranium

Bone

Occipito-frontalis muscle
Formed of 2 frontal bellies and 2 occipital bellies connected together by the epicaranial aponeurosis The frontal bellies are attached to the skin of forehead and eye brows, no bony attachment The occipital bellies are attached to the highest nuchal lines The frontal belly is supplied by the temporal branches of facial nerve The occipital belly is supplied by the posterior auricular branch of facial nerve

Frontal belly

Temporal line

Epicranial aponeurosis

Occipital belly

Arterial Supply of the Scalp

The scalp is supplied by 5 arteries on each side Three arteries lie in front of the auricle and 2 behind the auricle
Supraorbital a

Supratrochlear artery (from ophthalmic a, ICA) Supraorbital artery (from ophthalmic a, ICA)

Supratrochlear artery

Superficial temporal artery (from ECA)

Posterior auricular artery (from ECA) Occipital artery (from ECA)

Occipital a

Superficial temporal a Maxillary a

Posterior auricular a

External carotid a

Internal carotid a

Wounds of the scalp

Common carotid a

Because the superficial fascia of the scalp is dense, fibrous and adherent to the vessel walls, the arteries of the scalp do not retract or contract when they are cut, leading to profuse bleeding from scalp wounds.

Nerve Supply of the Scalp

Sensations from the scalp in front of the auricle are carried by branches of trigeminal nerve Sensations from the scalp behind the auricle are carried by branches of cervical nerves.
- The scalp is supplied by 10 nerves on each side - Five of the 10 nerves lie in front of the auricle and 5 lie behind the auricle - Four of the 5 nerves are sensory and one is motor
Posterior auricular n

Supraorbital n

Supratrochlear n Zygomaticotemporal n Auriculotemporal n Temporal branches of facial n

Greater occipital n

3rd occipital n

Lesser occipital n

Nerves in front of the auricle:

Great 1. Supratrochlear nerve (from ophthalmic n). auricular n 2. Supraorbital nerve (from ophthalmic n). 3. Zygomatico-temporal nerve (from maxillary n). 4. Auriculotemporal nerve (from mandibular n). 5. Temporal branches of facial nerve (motor), supply the frontal bellies of occipto-frontalis muscle

Nerves behind the auricle:

1. 2. 3. 4. 5. Great auricular nerve (from cervical plexus C2,3) Lesser occipital nerve (from cervical plexus C2) Greater occipital nerve (from dorsal ramus of C2) 3rd occipital nerve (from dorsal ramus of C3) Posterior auricular branch of facial nerve (motor), supplies the occipital belly of occipitofrontalis m.
Supraorbital n Posterior auricular n

Supratrochlear n Zygomaticotemporal n

Greater occipital n

3rd occipital n

Auriculotemporal n
Temporal branches of facial n

Lesser occipital n

Great auricular n

Muscles of the Face

They are called muscles of facial expression They are mainly inserted into the skin of the face They are all (except the levator palpebrae superioris) supplied by branches from the facial nerve

Classification of Muscles of the Face

Muscles of the Eyelids Orbicularis oculi Levator palpebrae suprioris Corrugator supercilli

Scalp muscles Muscles of the Mouth Occipito-frontalis Levator labii superioris alaeque nasi Levator labii superioris Levator anguli oris Zygomaticus minor Muscles of the Auricle Muscles of the Nose Zygomaticus major Auricularis anterior Procerus Risorius Auricularis superior Nasalis Depressor anguli oris Auricularis posterior Depressor septi Depressor labii inferioris Mentalis Platysma Buccinator Obribularis oris

Auricularis anterior, superior & posterior Nasalis Occipital belly of occipito-frontalis

Frontal bellies of occipito-frontalis

Procerus Corrugator supercilli Orbital part of orbicularis oculi

Palpebral part of oribicularis oculi

Levator labii superioris alaeque nasi Buccinator Levator labii superioris

Risorius

Levator anguli oris

Zygomaticus minor

Depressor anguli oris Zygomaticus major Risorius Nasalis Orbicularis oris platysma Platysma Depressor septi nasi Mentalis Depressor anguli oris Depressor labii inferioris

Dilator muscles of the lips

All the dilators of the lips take origin from bones and facia around the oral orifice They are inserted into the lips Action: They separate, elevate or depress the lips or their angles.
Frontal bellies of occipito-frontalis

Procerus Corrugator supercilli Orbital part of orbicularis oculi Palpebral part of oribicularis oculi Levator labii superioris alaeque nasi Levator labii superioris Levator anguli oris

Platysma
It takes origin from the deep facia covering pectoralis major and the clavicle and inserts into the base of the mandible and angle of the mouth.

Orbicularis oris
Origin: maxilla and mandible Insertion: forms loops around the oral orifice Nasalis Action: compresses lips together

Zygomaticus minor Zygomaticus major

Risorius

Orbicularis oris Platysma Depressor septi nasi Mentalis Depressor anguli oris Depressor labii inferioris

Buccinator
Origin: Maxilla, above the 3 molar teeth Pterygomandibular raphe Mandible below the 3 molar teeth.

Pterygoid process of sphenoid

Buccinator

Insertion: Upper fibers insert into upper lip Lower fibers insert into lower lip Middle fibers decussate at the angle of the mouth Action: Compression of the cheeks and lips against the teeth to prevent food from falling into the vestibule of the mouth Blowing of air Nerve supply: buccal branch of facial N.

Superior constrictor of pharynx Pterygomandibular raphe

Decussating middle fibers of buccinator

Upper fibers of buccinator Parotid duct Lower fibers of buccinator

Orbicularis oculi
Formed of 3 parts; orbital, palpebral and lacrimal Orbital portion, Arises from the medial palpebral ligament Forms loops around the ocular orifice Palpebral portion, Arise from the medial palpebral ligament Restricted to the eyelids Laterally, the fibers form the lateral palpebral raphe
Orbital part of orbicularis oculi Palpebral part of orbicularis oculi

Lacrimal portion, Fibers which take origin from the posterior lacrimal crest (behind the lacrimal sac) and from fascia covering lacrimal sac
Action: The palpebral portion closes the eyelids during blinking The orbital portion is utilized during squeezing of eyelids The lacrimal portion pulls on the lacrimal fascia to dilate the lacrimal sac, which leads to suction of lacrimal fluid.

Medial palpebral ligament

lateral palpebral raphe

Superior tarsus
inferior tarsus

Sensory Innervation of the Face

Skin of the face is supplied by branches of the trigeminal nerve (ophthalmic, maxillary and mandibular), EXCEPT the area over the lower half of the ramus of mandible (supplied by great auricular nerve)

Supraorbital Area of the face supplied by great auricular n Area supplied by cervical plexus Supratrochlear Branches from ophthalmic n Infratrochlear

External nasal Palpebral branches of lacrimal

Branches from the ophthalmic division of trigeminal

Supraorbital n, supplies the forehead Supratrochlear n, supplies the forehead Infratrochlear n (from nasocilary n), supplies medial parts of eyelids and upper part of the nose Palpebral branches of lacrimal n, supply lateral parts of eyelids External nasal n (from anterior ethmoidal n), supplies lower part of the nose (tip of the nose)

Branches from the maxillary division of trigeminal

Zygomatico-facial, supplies skin on the cheek prominence Infraorbital, reaches the face through the infraorbital foramen and divides into: Palpebral branches to the lower eyelid Nasal branches to the ala of the nose Labial branches to the upper lip

Area of the face supplied by great auricular n Area supplied by cervical plexus Palpebral Branches of infraorbital n Nasal Labial Infraorbital

Zygomatico-facial From maxillary n

Branches from the mandibular division of trigeminal

Mental n, reaches the face by passing through the mental foramen, supplies the chin and lower lip Buccal n, supplies skin and mucous membrane of the cheek

Area of the face supplied by great auricular n Area supplied by cervical plexus

Buccal n From mandibular n Mental n

Motor Innervation of the Face

All muscles of the face, EXCEPT the levator palpebrae superioris, are supplied by the facial nerve
The facial nerve leaves the skull by passing through the stylomastoid foramen Just below the stylomastoid foramen it gives: 1.Nerve to the posterior belly of digastric and stylohyoid muscles 2.Posterior auricular nerve Then it enters the parotid gland, and breaks into its terminal branches which supply muscles of the face 1.Temporal branches Temporal branches Posterior 2.Zygomatic branches auricular nerve 3.Buccal branches 4.Marginal mandibular branch 5.Cervical branch (supplies the platysma)

Zygomatic branches Main trunk of facial nerve Parotid duct Buccal branches

Nerve to posterior belly of digastric and stylohyoid muscles Parotid gland

Marginal mandibular branch Cervical branch

Facial artery

Arterial supply of the face

The main source of blood supply to the face It arises from ECA in the neck Reaches the face by piercing the deep fascia at the antero-inferior angle of masseter m. Runs upward & forward to the angle of mouth Ascends vertically and ends at the medial angle of the eye by anastomosing with the dorsal nasal a. It gives the following branches in the face: 1.Inferior labial a, to the lower lip 2.Superior labial a, to the upper lip. 3.Lateral nasal a, to the side of the nose

Lateral nasal a Superior labial a

Inferior labial a

Facial artery ECA CCA ICA

Other arteries that supply the face

Supartrochlear a (from ophthalmic a, ICA), supplies the forehead Supraorbital a (from ophthalmic a, ICA), supplies the forehead Dorsal nasal a (from ophthalmic a, ICA), supplies dorsum of the nose Medial & lateral palpebral a (from ophthalmic a, ICA), supply the medial & lateral parts of eyelids Zygomatico-facial a (from lacrimal a, ICA), comes out of the zygomaticofacial foramen

Infraorbital a (from maxillary a, ECA), comes out of the infraorbital foramen Transverse facial a (from superficial temporal a, ECA)
Supraorbital

Buccal a (from maxillary a, ECA), on the outer surface of buccinator m. Mental a (from inferior alveolar a, ECA), comes out of the mental foramen
Superficial temporal a

Supartrochlear

Dorsal nasal

Infraorbital

Transverse facial

Buccal Facial a

SUMMARY
The face receives its arterial supply via branches of the ECA and ICA

Branches from ECA Facial a (from ECA)

Transverse facial a (from superficial temporal, from ECA) Mental a (from inferior alveolar a, from 1st part of maxillary, from ECA) Buccal a (from 2nd part of maxillary, from ECA) Infraorbital a (from 3rd part of maxillary, from ECA)

Branches from ICA

Supratrochlear a (from ophthalmic a, from ICA) Supraorbital a (from ophthalmic a, from ICA) Dorsal nasal a (from ophthalmic a, from ICA) Medial palpebral a (from ophthalmic a, from ICA) Lateral palpebral a (from lacrimal a, from ophthalmic a, from ICA) Zygomatico-facial a (from lacrimal a, from ophthalmic a, from ICA)

Venous Drainage of the Scalp and Face Anterior facial vein

Formed at the medial angle of the eye by union of supraorbital and supratrochlear veins. It runs behind the facial artery. Crosses the anterior-inferior angle of the masseter and pierces the deep facia to reach the neck It receives tributaries corresponding to branches of the facial artery. Supraorbital v
Supratrochlear v

Retromandibular vein
Formed inside the parotid gland by union of superficial temporal and maxillary veins It divides into anterior and posterior divisions which emerge from the lower end of the parotid gland
Occipital v

Superficial temporal v
Communication with sup ophthalmic v

Ant facial v

Posterior auricular v Post branch of retromandibular v

Maxillary v Retromandibular v Ant branch of retromandibular v

External jugular v Common facial v Subclavian v Internal jugular v

Brachiocephalic v

Common facial vein

Formed by the union of the anterior facial vein and the anterior division of retromandibular vein It ends in the internal jugular vein.

External jugular vein

Formed by the union of the posterior division of retromandibular vein and the posterior auricular vein It ends in the subclavian vein
Supraorbital v

Occipital vein
Drains into the suboccipital plexus of veins

Supratrochlear v Superficial temporal v

Communication with sup ophthalmic v

Occipital v

Ant facial v Maxillary v

Posterior auricular v Post branch of retromandibular v

Retromandibular v
Ant branch of retromandibular v

External jugular v

Common facial v
Subclavian v Internal jugular v

Brachiocephalic v

Dangerous area of the face

Includes the area of the upper lip and lower nose, extending up to the median region of forehead and scalp
This region is drained by tributaries of facial vein at its beginning

The facial vein and the supraorbital vein are connected to the superior ophthalmic vein, which drains into the cavernous sinus
Thus, infection in the dangerous area of the face can be carried to the cavernous sinus leading to cavernous sinus thrombosis and intracranial infection

Lymphatic drainage of the scalp and face

SCALP
The anterior part of the scalp drains into the submandibular LN The temporal region drains into the preauricular LN The posterior part of the scalp drains into the occipital and mastoid LN

FACE
Lateral parts of eyelids drains into preauricular LN Medial parts of eyelids drain into submandibular LN The nose, cheek, upper lip and lateral parts of lower lip drain into the submandibular LN The central part of lower lip drains into submental LN

Occipital LN Mastoid LN

Submandibular LN Preauricular LN

Submental LN