Competency-based Medical Bachelor

Program
“CBMBP”
 Lecture 1

Face and Scalp

Prof. Dr. Morsy Abdelfattah Morsy
Professor of Anatomy and Embryology
Tanta Faculty of Medicine

Assistant Prof. Dr. Rabab Amer

Anatomy and Embryology
Tanta Faculty of Medicine
 Semester II
Principles of anatomy
Lecture (1)
Face and Scalp

Time: 1 hour
Type of lecture: interactive online lecture.

References :
1. Kaplan step 1.
2. Snell’s clinical anatomy.
 ILOS

1- Determine the extent of the face and scalp.

2- Identify the layers of the region.

3- Recognize the nerve and blood supply.

4- Identify the different anatomical findings.

5- Interpret and analyze clinical findings in correlation with the anatomical

facts.
 Scalp and Face

Source:
-USMLE lecture notes Anatomy 2018
- Snell Clinical Anatomy by Regions 2018 pp:1518-1538
 Scalp and face
It is the soft tissue covering of the skull cap

➢The scalp extends from the

superciliary arches
anteriorly to the external
occipital protuberance and
superior nuchal lines
posteriorly and to the
temporal lines laterally.

➢It consists of 5 layers.

 ❑Layers of the scalp:
S
1. Skin. Thick, hair bearing and C
contain sebaceous glands
2. Connective tissue fascia. A
Dense fibrous tissue adherent to
overlying and underlying layers.
L
Contains vessels and nerves of the
scalp. cutting vessel in it, leads to P
profuse bleeding.
3. Aponeurotic layer. Contains the
aponeurosis of the occipitofrontalis
muscle
4. Loose areolar connective
tissue. (Dangerous layer of the scalp)
traversed by emissary veins, can
spread infection to the cranial cavity
5. Pericranium: it is the outer
periosteum of the skull
 Muscles of the scalp
• The occipitofrontalis (epicranius) is the sole skeletal
muscle in the scalp .
• The muscle consists of paired frontal and occipital
bellies connected by the expansive epicranial
aponeurosis.
• This muscle is responsible for movement of the
scalp.
• The frontal bellies of the occipitofrontalis can raise
the eyebrows in expressions of surprise or horror.
 Muscles of the scalp
Occipitofrontalis muscle:
❖It is the muscle of the scalp and consists of:
1-Occipital belly behind. From the superior nuchal line, to the epicranial
aponeurosis.
2-Frontal belly in front. From skin and superficial fascia of the eyebrows, to the
epicranial aponeurosis
3-Epicranial aponeurosis in between.
Neve supply: Facial nerve
Action: Elevates the eyebrow
Occipital
Frontal belly Epicranial belly
aponeurosis
❑Nerve supply of
it:
➢Frontal bellies by
temporal branch of facial
nerve.
➢Occipital bellies by
posterior auricular branch
of facial nerve.
Nerve supply of the scalp

3- Third occipital n.
4- Great Auricular n.
 Sensory nerve supply of the scalp

• The nerves are arranged in two

main groups:
(1) branches of the trigeminal nerve
located anterior to the ear.

(2) branches of cervical spinal nerves

located posterior to the ear.
 Arterial supply of the scalp

In front of
the ear

Behind the
the ear
 Venous Drainage of the scalp
• 1-Supraorbital vein.
• 2-Supratrochlear vein.
• 3-Superficial temporal vein.
• 4-Posterior auricular vein.
• 5-Occipital vein.
❖ Supratrochlear and supraorbital veins unite together to form
anterior facial vein.
❖ Superficial temporal and maxillary veins unite together to form
posterior facial vein.
❖ Posterior facial vein divided into anterior and posterior divisions.
❖ The anterior division unite with anterior facial vein to form
common facial vein which end in the internal jugular vein.
❖ The posterior division unite with the posterior auricular vein to
form external jugular vein which ends in the subclavian vein.
❖ The occipital vein drains into the suboccipital venous plexus in
floor of upper part of posterior triangle, which in turn drains into
the vertebral veins or the internal jugular vein.
 Lymph Drainage of the scalp

• From the forehead drain into

the submandibular lymph
nodes.

• From the lateral part of the

scalp drain into the superficial
parotid (preauricular) nodes.

• Vessels in the back of the

scalp drain into the occipital
nodes
 The area bordered from the hairline (or where it should be) superiorly, anterior border of the
auricles laterally and the inferior border of the chin inferiorly.
Layers of the face:
1- Skin: is thick, very vascular and contains numerous sweat and sebaceous glands.
2- Superficial fascia: contains variable amount of fat, nerves and vessels.
3- Deep fascia: no deep fascia in the face except the parotid fascia and buccopharyngeal fascia over
the buccinator m.
4- Muscles of the face: (muscles of facial expression). Lie in the superficial fascia and are inserted
into the skin of the face and supplied with the facial nerve.

Muscles of the mouth and cheek:

Muscles of the eyelids:
Orbicularis oculi muscle
Levator palpebrae superioris
Orbicularis oris muscle
Muscles of the nose : Levator labii superioris
Procerus Depressor labii inferioris
Nasalis Zygomaticus major
Zygomaticus minor
Buccinator
 Facial Muscles
(Muscles of Facial Expression)

• The facial muscles are the skeletal

muscles that are embedded in the
superficial fascia of the face.
• The facial muscles are integumentary
muscles. Most arise from the bones
of the skull, and all insert into the
skin or other facial muscles.
• All the facial muscles develop from
the second pharyngeal arch and are
supplied by the facial nerve.
It is a flat muscle surrounds the orbit, extends to the eyelids and lacrimal sac
Formed of three parts:
1- Orbital: part surrounds the orbital margin. Closes the eye tightly to protect it from sudden injury.
2- Palpebral part: lies in the eyelids. Its action is blinking and support the lower lid against gravity.
3- Lacrimal part: draws the eyelids medially and dilates the lacrimal sac. Direct tears to the lacrimal
sac and keeps the surface of the cornea always moist.
Nerve supply is temporal and zygomatic branches of facial nerve.
It consists of 2 parts:
1. Intrinsic part :has 3 types
of fibers, circular, radiating
and antro-posterior fibers
2. Extrinsic part formed from
the neighboring muscles.

Action: closes the mouth

and compresses the lips
against the teeth.

Nerve supply: buccal and

mandibular branches of
facial nerve.
It forms the muscle layer of the cheek
Action:
1- it is a is a significant muscle in food
processing as it compresses the lips
and cheek against the teeth, so the
food is kept under immediate action of
teeth.
2- Helpes in whistling and blowing.

Nerve supply: buccal branch of facial

nerve
1- Motor:
The facial nerve, leaves the skull through the stylomastoid foramen then enters the parotid
gland and divides into its 5 terminal branches, temporal, zygomatic, buccal, mandibular, and
cervical branches.
2- Sensory: The skin of the face is supplied by branches of the three divisions of the
trigeminal nerve, except for the small area over the angle of the mandible and the parotid
gland; which is supplied by the great auricular nerve (branch of the cervical plexus C2,C3).
I. Ophthalmic Nerve (V1) its 5 terminal branches in the face are:
▪ The supratrochlear nerve (branch of frontal nerve):
▪ The supraorbital nerve (branch of frontal nerve)
▪ The infratrochlear nerve
▪ The external nasal nerve
▪ The lacrimal nerve
2. Maxillary Nerve (V2): its three branches passing to the skin:
▪ The infraorbital nerve
▪ The zygomaticofacial nerve
▪ The zygomaticotemporal nerve
3. Mandibular Nerve (V3): Its branches:
▪ The Mental nerve
▪ Buccal nerve
▪ The Auriculotemporal nerve
 Facial nerve in the face
▪ The facial nerve divides into its five terminal branches as it runs
forward within the substance of the parotid salivary gland.
 Arterial supply of the face

• The face receives a rich

blood supply from two
main vessels, the facial
and superficial temporal
arteries, which are
supplemented by several
small arteries that
accompany the sensory
nerves of the face.
 ❑Arteries of the face:

1-Arteries of the face.

➢Superficial temporal artery from Ex. carotid artery.
➢Transverse facial artery from superficial temporal
artery .
➢Facial artery from Ex. carotid artery.
➢Infraorbital artery from maxillary artery.
➢Mental artery from inferior alveolar artery of
maxillary.
➢Supraorbital artery from ophthalmic artery.
➢Supratrochlear artery from ophthalmic
artery.
➢Dorsal nasal artery from ophthalmic artery.
 ❑Facial artery in the face:

➢It is a branch of the external carotid

artery.
➢It runs close to the Antero -inferior
angle of the masseter then angle of the
mouth, then ends at the medial angle of
the eye.
❖Branches of the facial artery in the
face:
1. Inferior labial.
2. Superior labial.
3. Lateral nasal.
4. Angular.
5. Submental.
 Venous drainage of the face

❑Veins of the face:

➢The face is drained by 2 main
veins:
1-Facial vein anteriorly.
2-Retromandibular vein
posteriorly.
❑Facial vein:
➢It is formed by union of
supratrochlear and supra orbital
veins.
➢It runs downwards and
backwards just behind the facial
artery.
➢It ends by joining the anterior
division of retromandibular vein
to form the common facial vein
which ends in internal jugular
vein.
❑Retromandibular vein:
➢It is lies within the parotid gland.
➢It is formed by union of maxillary and
superficial temporal veins.
➢It ends by dividing into anterior and
posterior divisions.
➢Its posterior division unite with
posterior auricular vein to form
external jugular vein which ends in
subclavian vein.
 ❑Communications of the facial vein with the cavernous sinus:

❖The facial vein communicates with

the cavernous sinus through two
routes:
1-Ophthalmic veins.
2-Deep facial vein. This vein
connects the facial vein with
pterygoid plexus of vein and this
plexus connects with the cavernous
sinus by an emissary vein through
foramen oval.
❑Dangerous triangle of
the face:
➢It is area around the nose and
upper lip.
➢It is dangerous because of the
connection of the facial vein with
the cavernous sinus and
possibility of spread of infection
from the face to the cavernous
sinus.
 Lymphatic drainage of the face:

▪ Lymph from the forehead and the

anterior part of the face drains into
the submandibular lymph nodes.
▪ A few buccal lymph nodes may be
present along the course of these
lymph vessels.
▪ Lymph vessels that end in the
parotid lymph nodes drain the
lateral part of the face, including the
lateral parts of the eyelids.
▪ The central part of the lower lip and
the skin of the chin drain into the
submental lymph nodes.
 Clinical notes

• Trigeminal Neuralgia.
• Facial Infections and Cavernous Sinus Thrombosis.
• Facial Muscle Paralysis (Bell’s palsy).
• Scalp Infections.
• Scalp Lacerations.
 Multiple-Choice Questions

1- A 40-year-old male patient visited the clinic complaining of inability to

tight close his right eyelids, which of the following nerves may be affected?
A- Maxillary
B- Facial
C- Mandibular
D- Mental

2-A 51-year-old female patient admitted to the hospital with sever pain in the
right side of here face, on examination it reveals no local obvious lesion or
injury, which of the following nerves may be irritated causing such pain?
A- Facial
B- Great auricular
C- posterior auricular
D- Trigeminal
 Multiple-Choice Questions

3- The common facial vein ends in which of the following veins?

A-Subclavian.
B-Internal jugular
C-Retromandibular
D-External jugular

4-which of the following layers is the 3rd layer of the scalp?

A- Pericranium
B- Loose areolar tissue
C- Aponeurosis (epicranial)
D- Connective tissue
5-Which of the following veins does NOT drain the scalp?
A- Supraorbital vein.
B-Supratrochlear vein.
C-Superficial temporal vein.
D-Transverse facial.

6- Which of the following nerves receives sensory innervation

from the face?
A. Infraorbital.
B. Third occipital.
C. Lesser occipital.
D. Greater occipital.