The Scalp
- 1. TheScalp Dr. Hadi Munib Oral and Maxillofacial Surgery Resident
- 2. TREYresearch Structure • Consists of five layers, the first three of which are intimately bound together and move as a unit • To assist one in memorizing the names of the five layers of the scalp, use each letter of the word SCALP to denote the layer of the scalp. • Skin, which is thick and hair bearing and contains numerous sebaceous glands • Connective tissue beneath the skin, which is fibro-fatty, the fibrous septa uniting the skin to the underlying aponeurosis of the occipitofrontalis muscle. • Numerous arteries and veins are found in this layer. • The arteries are branches of the external and internal carotid arteries, and a free anastomosis takes place between them. • Aponeurosis (epicranial), which is a thin, tendinous sheet that unites the occipital and frontal bellies of the occipitofrontalis muscle. 2
- 3. TREYresearch Structure • The lateral margins of the aponeurosis are attached to the temporal fascia. • The subaponeurotic space is the potential space beneath the epicranial aponeurosis. • It is limited in front and behind by the origins of the occipitofrontalis muscle, and it extends laterally as far as the attachment of the aponeurosis to the temporal fascia. • Loose areolar tissue, which occupies the subaponeurotic space and loosely connects the epicranial aponeurosis to the periosteum of the skull (the pericranium). • The areolar tissue contains a few small arteries, but it also contains some important emissary veins. • The emissary veins are valveless and connect the superficial veins of the scalp with the diploic veins of the skull bones and with the intracranial venous sinuses 3
- 4. TREYresearch Structure • Pericranium, which 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 becomes continuous with the periosteum on the inner surface of the skull bones. • When the Occipitofrontalis muscle contracts, the first three layers of the scalp move forward or backward, the loose areolar tissue of the fourth layer of the scalp allowing the aponeurosis to move on the pericranium. • The frontal bellies of the occipitofrontalis can raise the eyebrows in expressions of surprise or horror. 4
- 5. TREYresearch SensoryNerveSupplyoftheScalp • The main trunks of the sensory nerves lie in the superficial fascia. • Moving laterally from the midline anteriorly, the following nerves are present: • The supratrochlear 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. • The supraorbital 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. • The zygomaticotemporal nerve, a branch of the maxillary division of the trigeminal nerve, supplies the scalp over the temple. • The Auriculotemporal 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 5
- 6. TREYresearch SensoryNerveSupplyoftheScalp • 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. • The greater occipital nerve, a branch of the posterior ramus of the 2nd cervical nerve, ascends over the back of the scalp and supplies the skin as far forward as the vertex of the skull 6
- 7. TREYresearch ArterialSupplyoftheScalp • The scalp has a rich supply of blood to nourish the hair follicles, and the smallest cut bleeds profusely. • The arteries lie in the superficial fascia. • Moving laterally from the midline anteriorly, the following arteries are present: • The supratrochlear and the supraorbital arteries, branches of the ophthalmic artery, ascend over the forehead in company with the supratrochlear and supraorbital nerves • The superficial temporal artery, the smaller terminal branch of the external carotid artery, ascends in front of the auricle in company with the Auriculotemporal nerve; It divides into anterior and posterior branches, which supply the skin over the frontal and temporal regions. • The posterior auricular artery, a branch of the external carotid artery, ascends behind the auricle to supply the scalp above and behind the auricle • 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. 7
- 8. TREYresearch VenousDrainageoftheScalp • The supratrochlear and supraorbital veins unite at the medial margin of the orbit to form the facial vein. • The superficial temporal vein unites with the maxillary vein in the substance of the parotid gland to form the retromandibular vein. • The posterior auricular vein unites with the posterior division of the retromandibular vein, just below the parotid gland, to form the external jugular vein. • The occipital vein drains into the suboccipital venous plexus, which lies beneath the floor of the upper part of the posterior triangle; the plexus in turn drains into the vertebral veins or the internal jugular vein. • The veins of the scalp freely anastomose with one another and are connected to the diploic veins of the skull bones and the intracranial venous sinuses by the valveless emissary veins 8
- 9. TREYresearch LymphDrainageoftheScalp • Lymph vessels in the anterior part of the scalp and forehead drain into the submandibular lymph nodes • 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. • Vessels in the back of the scalp drain into the occipital nodes 9
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- 20. TREYresearch References • Chapter 11: The Head and Neck (572 – 579) 20
- 21. THANKYOU! 21