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SCALP:

[Keith L Moore]

The scalp consists of skin [hair bearing] and sub-cutaneous tissue, which
covers the calvaria from the superior nuchal lines on the occipital bone to
the supra-orbital margins of the frontal bone. Laterally, the scalp extends
over the temporal fascia to the zygomatic arches
LAYERS OF THE SCALP:
o The scalp consists of 5 layers of tissue.
o The first 3 layers of which are connected intimately and more as a
unit [eg: when wrinkling the forehead and thus moving the scalp.]
o The layers are:
SKIN:
It is thin except in the occipital region. It contains
many sweat, sebaceous glands and hair follicles. It has
an abundant arterial supply and good venous and
lymphatic drainage.
CONNECTIVE TISSUE:
It forms the thick, dense, richly vascularized subcutaneous layer that is well supplied with cutaneous
nerves.
APONEUROSIS:
It is a epicranial aponeurosis, a strong tendinous sheet
that covers the calvaria between the occipitalis
superior auricular and frontal muscles [collectively,
these structures constitute the epicranius muscles].
The frontalis pulls the scalp anteriorly, wrinkling the
forehead, and elevates the eye brows, the occipitalis

pulls the scalp posteriorly and wrinkles the skin at the


back of the neck.
LOOSE CONNECTIVE TISSUE:
It is somewhat like a sponge because of its many
potential spaces that may distend with fluid resulting
from injury or infections. This layer allows free
movement of the scalp proper [the first 3 layers] over
the underlying calvaria.
PERICRANIUM:
It is a dense layer of connective tissue that forms the
external periosteum of the calvaria. It is firmly
attached but can be stripped easily from the calvaria of
living persons, except where the pericranium is
continuous with the fibrous tissue in the cranial
sutures.
NERVES OF SCALP:
o Innervation of the scalp anterior to the auricles is through branches
of all 3 divisions of cranial nerve [5th] the trigeminal nerve.
o Posterior to the auricle, the nerve supply of the scalp is from spinal
cutaneous nerves. [C2 and C3]
VASCULATURE OF THE SCALP:
o The blood vessels run in 2nd layer of the scalp iethe dense subcutaneous layer between the skin and the epicranial aponeurosis.
They are held by the dense connective tissue in such a way that
they tend to remain open when cut. Consequently, bleeding form
scalp wounds is profuse.

o ARTERIES OF SCALP:
External carotid arteries through the occipital, posterior
auricular and superficial temporal arteries and from the
internal carotid arteries through the supra-trochlear and
supra-orbital arteries.
The scalp has rich blood supply and the arteries anastomise
freely with one another in layer two of the scalp, ie..dense
sub-cutaneous connective tissue layer.
o VEINS OF THE SCALP:
The venous drainage of superficial parts of the scalp is
through the accompanying veins of the scalp arteriesthe
supra-orbital and supra-trochlear veins, which begin in the
forehead and descend to unite at the median angle of the eye
to form the angular vein that becomes the facial vein at the
inferior margin of the orbit. The superficial temporal veins
and the posterior auricular veins drain the scalp anterior and
posterior to the auricles, respectively. The posterior auricular
vein often receives a mastoid emissary vein from the
sigmoid sinus, a dural venous sinus. The occipital vein drain
the occipital region of the scalp. Venous drainage of the deep
parts of the scalp in the temporal region is through deep
temporal veins that are the tributaries of the pterygoid plexus
of the veins.
o LYMPHATIC DRAINAGE:

There are no lymph nodes in the scalp.


Lymph from this region drains into the superficial ring [pericervical collor] of lymph nodessubmental, submandibular,
parotid, mastoid or retroauricular and occipital-that is
located at the junction of head and neck. Lymph from these
nodes drain into the deep cervical lymph nodes along the
internal jugular vein.
CLINICAL ASPECTS:
o CEPHALOHEMATOMA:
Sometimes during a difficult birth, bleeding occurs between
the babys pericranium and calvaria usually over one parietal
bone. The bleeding results form multiple minute periosteal
arteries that nourish the bones of the calvaria. The resulting
collection of blood developing several hours after birth is a
CEPHALOHEMATOMA.
o SEBACEOUS CYSTS:

DANGEROUS AREA OF THE FACE:


The region of upper lip and lower part of the nose is known as dangerous
area of the face.

Infections from the face can spread in a retrograde direction and cause
thrombosis of the cavernous sinus. This is specially likely to occur in
upper lip and in the lower part of the nose.
Deep connections of the facial vein which communicates with cavernous
sinus through which the thrombosis occurs are [i] communication
between the supra-orbital and superior ophthalmic veins and [ii] another
with the pterygoid plexus through the deep facial vein which passes
backwards over the buccinator.

DANGEROUS AREA OF THE SCALP:


The layer of loose areolar tissue in the scalp is known as dangerous area

of the scalp.
It is so because the emissary veins which open here, may transmit
infections from the scalp to the cranial venous sinuses.