CLINICAL ANATOMY OF THE

SCALP
MBchB/BDS/MMED/MDS
• Definition

• Anatomy and its clinical aspects

 Defn / Description
It is the soft tissue covering of the norma verticalis (vault of the
skull)

It extends:
• Posteriorly, from the superior nuchal lines of the occipital bone
• Anteriorly, from the supraorbital margin of the frontal bone
• Laterally, over the temporal fascia, to the zygomatic arches
 SCALP

S – SKIN (Layer 1)
C – CONNECTIVE TISSUE (DENSE) (L2)
A – APONEUROSIS (GALEA) (L3)
L – LOOSE CONNECTIVE TISSUE (L4)
P – PERICRANIUM (L5)
 Scalp Proper
• Encompasses layers 1,2,3.
• Considered as one unit
 Layer 1 - Skin
• It is thick, hairy with numerous sebaceous and sweat glands.
• Obstruction of the ducts of the sebaceous glands by secretions form
Sebaceous cysts.
• Dandruff - dermatology
 Layer 2 – Connective tissue
• It is a fibro-fatty layer which is adherent to the skin and to the underlying
aponeurosis by fibrous septa.
• It is richly supplied with vessels and nerves that run within it. The arteries freely
anastomose with each other. Alternative/collateral blood supply.
• Wounds of the scalp bleed profusely because of:
1. The abundant arterial anastomoses.
2. Arteries do not retract when lacerated because they are held open by the dense
connective tissue.
 Layer 3 – Connective tissue
• Galea aponeurotica
• Deep scalp wounds gape widely when the epicranial aponeurosis is divided
due to tension of the aponeurosis produced by the tone of the occipito-
frontalis muscle.
 Layer 4 – Loose connective tissue

Sub-aponeurotic space
• limited in front and behind by
the origins of the occipitofrontalis
muscle
• extends laterally as far as the
attachment of the aponeurosis to
the temporal fascia
• Has loose areolar tissue with
important emissary veins
 Importance of layer 4

Dangerous layer:
• Scalp infections can spread through the emissary veins to the intracranial
venous sinuses to cause Venous Sinus thrombosis.
(Emissary veins - valveless veins that connect the superficial veins of the scalp with the diploic veins of the skull
bones and, through them, with the intracranial venous sinuses).

• Blood or pus can spreads to the eye lids and the root of the nose because of
the attachment of the frontalis into the skin and not to the bone
• “Panda eyes”
 Surgical utility:

• Coronal flap exposure to access

facial skeleton
 Layer 5 - Pericranium
• It is the periosteum covering the outer surface of the skull bones
• At the sutures between individual skull bones, the periosteum on the outer
surface of the bones is continuous with the periosteum on the inner surface
of the skull bones
• Sub-periosteal haematomas follow outline of the cranial bone
• “Potts puffy tumour”
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