01-Scسسسسسسسسسسسسسسسسسسسسسسسسسسسسسسalp.ppt
- 1. SCALP
- 2. prof. Makarem 2 DEFINITION The scalp consists of: • Skin (normally hair-bearing) and • Subcutaneous tissue • it covers the calvaria 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
- 3. prof. Makarem 3 STRUCTURE The SCALP consists of five layers: • Skin • Connective tissue • Aponeurosis • Loose areolar tissue • Pericranium
- 4. prof. Makarem 4 CONNECTIVE TISSUE • the arteries are branches of the external and internal carotid arteries, and a free anastomosis takes place between them. • fibro-fatty • fibrous septa connect the skin to the underlying aponeurosis of the occipitofrontalis muscle. • numerous arteries and veins (the superficial veins of the scalp)
- 5. prof. Makarem 5 APONEUROSIS • name: epicranial aponeurosis, galea aponeurotica • thin, tendinous sheet • unites the occipital and frontal bellies of the occipito- frontalis muscle
- 6. prof. Makarem 6 • The lateral margins of the epicranial aponeurosis are attached to the temporal fascia • the skin, the subcutaneous connective tissue and the epicranial aponeurosis (layers 1, 2, 3) are adherent to each other and move as a one unit
- 7. prof. Makarem 7 SUBAPONEUROTIC SPACE • potential space beneath the epicranial aponeurosis • 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 • occupied by loose areolar tissue
- 8. prof. Makarem 8 LOOSE AREOLAR TISSUE • Occupies the subapo- neurotic space • loosely connects the epicranial aponeurosis to the periosteum of the skull (the pericranium) • contains a few small arteries • contains some important emissary veins
- 9. prof. Makarem 9 EMISSARY VEINS • Emissary veins: are valveless veins • They connect the superficial veins of the scalp with the diploic veins of the skull bones and, through them, with the intracranial venous sinuses
- 10. prof. Makarem 10 PERICRANIUM • 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 • It is the periosteum covering the outer surface of the skull bones
- 11. prof. Makarem 11 MUSCLES OF THE SCALP Occipitofrontalis (epicranius) • Origin: It consists of four bellies, two occipital and two frontal, connected by an aponeurosis. • The occipital bellies are smaller and arise from the highest nuchal line on the occipital bone and pass forward to be attached to the aponeurosis. • The frontal bellies are larger and closer to each other in the middle line • The arise from the skin and superficial fascia of the eyebrow and pass backward to be attached to the aponeurosis.
- 12. prof. Makarem 12 Nerve supply: • The occipital belly is supplied by the posterior auricular branch of the facial nerve; • the frontal belly is supplied by the temporal branch of the facial nerve.
- 13. prof. Makarem 13 Action The first three layers of the scalp can be moved forward or backward, the loose areolar tissue of the fourth layer of the scalp allowing the aponeurosis to move on the pericranium. (e.g. layers 1, 2, 3 will slide together as ONE LAYER)
- 14. prof. Makarem 14 The frontal bellies of the occipitofrontalis can raise the eyebrows in expressions of surprise or horror. Which nerve is responsible for this action? - The temporal branch of the facial nerve.
- 15. prof. Makarem 15 SENSORY NERVE SUPPLY OF THE SCALP The main trunks of the sensory nerves lie in the superficial fascia.
- 16. prof. Makarem 16 • The supra- trochlear nerve, a branch of the ophthalmic division of the trigeminal nerve, winds around the superior orbital margin and supplies the scalp. • It passes backward close to the median plane and reaches nearly as far as the vertex of the skull.
- 17. prof. Makarem 17 • The supra- orbital nerve, a branch of the ophthalmic division of the trigeminal nerve, winds around the superior orbital margin and ascends over the forehead. • It supplies the scalp as far backward as the vertex.
- 18. prof. Makarem 18 • The auricu- lotemporal nerve, a branch of the mandibular division of the trigeminal nerve, ascends over the side of the head from in front of the auricle. • Its terminal branches supply the skin over the temporal region.
- 19. prof. Makarem 19 The zygoma- ticotemporal nerve, a branch of the maxillary division of the trigeminal nerve, supplies the scalp over the temple.
- 20. prof. Makarem 20 The lesser occipital nerve, a branch of the cervical plexus (C2), supplies the scalp over the lateral part of the occipital region and the skin over the medial surface of the auricle.
- 21. prof. Makarem 21 The greater occipital nerve, a branch of the posterior ramus of the second cervical nerve, ascends over the back of the scalp and supplies the skin as far forward as the vertex of the skull.
- 22. prof. Makarem 22 SENSORY NERVE SUPPLY (in brief)
- 23. prof. Makarem 23 ARTERIAL SUPPLY OF THE SCALP • The scalp has a rich supply of blood to nourish the hair follicles, and, for this reason, the smallest cut bleeds profusely. • The arteries lie in the superficial fascia.
- 24. prof. Makarem 24 The supratrochlear and the supraorbital arteries, branches of the ophthalmic artery, ascend over the forehead in company with the supratrochlear and supraorbital nerves.
- 25. prof. Makarem 25 • The superficial temporal artery, the smaller terminal branch of the external carotid artery, ascends in front of the auricle in company with the auriculo- temporal nerve. • It divides into anterior and posterior branches, which supply the skin over the frontal and temporal regions.
- 26. prof. Makarem 26 The posterior auricular artery, a branch of the external carotid artery, ascends behind the auricle to supply the scalp above and behind the auricle.
- 27. prof. Makarem 27 • The occipital artery, a branch of the external carotid artery, ascends from the apex of the posterior triangle, in company with the greater occipital nerve. • It supplies the skin over the back of the scalp and reaches as high as the vertex of the skull.
- 28. prof. Makarem 28 ARTERIAL SUPPLY OF THE SCALP (in brief)
- 29. prof. Makarem 29 VENOUS DRAINAGE OF THE SCALP The veins of the scalp freely anastomose with one another.
- 30. prof. Makarem 30 The veins of the scalp are connected to the diploic veins of the skull bones and the intracranial venous sinuses by the valveless emissary veins.
- 31. prof. Makarem 31 The supra- trochlear and supraorbital veins unite at the medial margin of the orbit to form the facial vein.
- 32. prof. Makarem 32 The superficial temporal vein unites with the maxillary vein in the substance of the parotid gland to form the retroman- dibular vein.
- 33. prof. Makarem 33 The posterior auricular vein unites with the posterior divi- sion of the ret- romandibular vein, just below the parotid gland, to form the external jugular vein.
- 34. prof. Makarem 34 The occipital vein drains into the suboccipital venous plexus, which lies beneath the floor of the upper part of the posterior triangle.
- 35. prof. Makarem 35 The suboccipital venous plexus in turn drains into the vertebral veins or the internal jugular vein.
- 36. prof. Makarem 36 LYMPH DRAINAGE OF THE SCALP Lymph vessels in the anterior part of the scalp and forehead drain into the submandibular lymph nodes.
- 37. prof. Makarem 37 • Drainage from the lateral part of the scalp above the ear is into the superficial parotid (preauricular) nodes; • lymph vessels in the part of the scalp above and behind the ear drain into the mastoid nodes.
- 38. prof. Makarem 38 • Vessels in the back of the scalp drain into the occipital nodes. • All these groups of lymph nodes are drained into the deep cervical group of lymph nodes.